Government launches biggest review of NHS leadership since 1980s

The government is launching what it claims is the ‘most far-reaching review’ of NHS leadership since the seminal Griffiths report of the early 1980s.

The review will be led by the retired vice chief of the defence staff, General Sir Gordon Messenger. The review will be supported by a team from Department of Health and Social Care and the NHS, led by Leeds Teaching Hospitals chair Dame Linda Pollard. The review “will work closely” with NHS England chief executive Amanda Pritchard.

Sir Gordon is due to deliver his findings to health and social care secretary Sajid Javid “in early 2022” according to the government statement announcing the plan. Recommendations will be “considered carefully and followed by a delivery plan with clear timelines.”

The review has three stated aims:

• Establishing how to more “rapidly foster and replicate the best examples of leadership” in health and social care, and determining how they might be used to “reduce regional variation in efficiency and health outcomes”.
• Deciding how best to develop the necessary “leadership skills across both health and social care” by reviewing how leaders are trained and developed.
• Working out how to “bring in fresh ideas and talented leadership” to the sector, “to ensure every pound is spent well.”

The review will encompass clinical leadership as well as general management.

Mr Javid said: “I am determined to make sure the NHS and social care deliver for the people of this country for years to come and leadership is so important to that mission. We are committed to providing the resources health and social care needs but that must come with change for the better. This review will shine a light on the outstanding leaders in health and social care to drive efficiency and innovation.”

Sir Gordon Messenger is one of the UK’s most distinguished soldiers, serving in Kosovo, Afghanistan and Iraq. He was appointed head of operations for government’s community covid testing programme during the autumn of 2020.

Dame Linda, a successful marketing executive, was the pro-vice chancellor of Leeds University between 2007 and 2013, before taking up the chairs role at LTH eight years ago. She also chaired Leeds primary care trust.

NHS Providers chief executive Chris Hopson said of the announcement: “International evidence shows that the NHS is one of the most efficient health services in the world. And the last 18 months have shown how NHS frontline leaders, working with staff, can deliver truly world class care… Those leaders are also deeply committed to improving care, reducing variation and cutting waste - they know they need to think like a patient and act like a taxpayer.

“They will therefore want to work closely with this new review to identify ways to improve and deliver full value for the extra new taxpayer investment in the NHS.”

Sally Warren, director of policy at the King’s Fund, said: “As the health and care system moves away from a period defined by competition to one where collaboration is much more important, it is useful to think about the leadership skills required. We know that compassionate and inclusive leadership is key to successfully delivering good quality care. It is critical the review does not focus on efficiency at the expense of the leadership qualities needed to ensure that staff feel valued and able to deliver the best possible care.

“The history of the NHS is dotted with reviews of management and leadership by leading figures from outside the NHS that have failed to have significant impact, so the government will need to be clear what will be different this time.”

NHS Confederation chief executive Matthew Taylor said: “If we are going to look at leadership and its qualities, then we also need to review the context in which our leaders are operating. The environment is among the most fraught that NHS leaders have experienced and this review will need to support, not hinder, their progress. That means the government will need to do what it can to ensure we have the right regulatory environment in place that allows local leaders, including those across primary care, to lead effectively, with less bureaucracy and interference holding them back.”

The 1983 Griffiths report ended the era of consensus management in the NHS and, in time, led to general managers being appointed to most of the service’s leadership positions.

The most recent external review of NHS leadership was led by former Marks & Spencer chief executive Lord Rose. It reported in 2015 and the government accepted its 19 recommendations, but very few have been enacted. A leadership review for the DHSC by Sir Ron Kerr, former chair of Guy’s and St Thomas’, was published in 2018. The NHS People Plan, whose development was led by Baroness Dido Harding and NHS chief people officer Prerana Issar, was published last year, and also examined leadership and management along with other staffing issues.