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Messenger review could ‘set NHS leaders up to fail’, Javid warned

Published on: 15 Nov 2021

A government-commissioned review of NHS management could turn into a ‘blame game” with leaders ‘set up to fail [against] unrealistic expectations’, NHS Providers chief Chris Hopson has warned.

Mr Hopson said “the implication of some of the stuff around the review [led by General Sir Gordon Messenger]” was that the best way to deal with some of the NHS’ most challenged trusts was to “kick out the NHS people and bring in somebody from outside the NHS”.

Speaking exclusively to HSJ ahead of the NHS Providers’ annual conference this week, Mr Hopson also said parts of government were “resistant” to efforts by the NHS to produce a robust long-term workforce plan because ministers were scared by the “financial consequences”.

Mr Hopson said the leadership review presented “risks and opportunities for the sector”. The review team, he said, provided a good mix of external experience from Sir Gordon, Department of Health and Social Care input, and sector input, with Leeds Teaching Hospitals chair Dame Linda Pollard playing a central role. The review has also pledged to “work closely” with NHS England chief executive Amanda Pritchard.

The review appears to be facing substantial delays — Mr Javid promised its terms of reference within a week in early October, but they have still not been published.

Mr Hopson warned: “Here is the risk; given the scale of pressure and expectation at the moment on the NHS around the delivery for that extra funding [from the spending review], we are really worried that the NHS is being set up to fail.

“Basically, we won’t be able to meet those expectations and therefore what the review could turn into is effectively a blame game where fingers are pointed at NHS leaders for not being able to meet these unrealistic expectations.”

“I think people are quite worried that, particularly given the fact expectations are high and the pressure is great… it’ll turn into ‘oh well, we all know why the NHS is not delivering as it should be, it’s because the quality of the leaders’. I just don’t think that’s true.”

He added: “So, we would say, isn’t it finding the answers to the structural solutions and finding ways to incentivise and support our best leaders to go into those trusts which is the right answer, rather than… saying the best thing to do is to kick out the NHS people and bring in somebody from outside the NHS, which is the implication of some of the stuff around the Messenger review.”

The NHS faces rising demand and is understaffed while being underfunded compared to the health systems of other wealthy nations.

He said while it was fair that health secretary Sajid Javid had identified there was a group of trusts which have been struggling for years, he was concerned the review could jump to the wrong conclusions about the reasons why.

It was structural issues – they are often multisite, with smaller dispersed populations, so they do not get the volume required to benefit from the tariff, and they are often geographically isolated and very difficult to recruit to – rather than leadership deficiencies which underpinned the challenges faced by these trusts, he said.

There were some trusts where you could have a chief executive who was a combination of “Marianne Griffiths, David Dalton and Robert Naylor [but] if you don’t address the structural issues, it’s very difficult to achieve what needs to be achieved”.

Where the review could be valuable to the sector would be if it focused on “how we create the right incentives to attract the best leaders for what are often the most difficult jobs” Mr Hopson said.

The NHS could learn from the education system on how top head teachers had been attracted to turnaround the most challenged schools.

Pay was of course a lever, but was far from the only issue, with Mr Hopson suggesting how regulators supported leaders at troubled organisations, and how they benchmarked success, was also something which needed looking at.

Parts of government “avoiding having a clear NHS workforce plan”

Mr Hopson also said “parts of government [were] resistant” to having well-worked through workforce requirement estimates “because they know full well… inevitably it has financial consequences”.

“Therefore [some people] want to avoid seeing those financial consequences really clearly by avoiding having a clear workforce plan in the first place.”

He said the health bill needed to be strengthened to beef up Health Education England’s powers so it could hold government to account on the issue.

The act will require government to set out requirements “in a top line way” he said, but “we are saying they need to go much further than that and say they will commit to the production of, with appropriate independence, a clear plan for the number of workforce needed in each particular category and then government needs to respond once that regular plan is produced and set out formally how they are going to respond to it”.

Commons health and social care committee chair Jeremy Hunt is also pushing for the move. Amendments to the bill are expected to be tabled as early as this week.

Mr Javid told the Commons’ health committee earlier this month that ministers would publish “a 15 year-plan to set up a strategic framework for the long-term workforce needed across health and social care” in the spring.

The plan will be underpinned by analysis of workforce requirements HEE was tasked with doing by ministers in July. However, there is widespread frustration in the sector about the lack of solid workforce projects, not least because it is four year since HEE’s draft workforce plan was published in 2017.

“Anger” over attacks on NHS attempts to tackle diversity challenges

Mr Hopson also highlighted concerns he said were shared by many senior NHS leaders about the services’ efforts to address its diversity and equality challenges. 

He said: “There have been noises from stage right saying ‘we’re about to have all the extra money being raised by the health and social care levy being spent on things [like on diversity] that it shouldn’t be spent on’.

“[But] we think it is absolutely vital that we spend money time and effort ensuring that leaders and managers of trusts are appropriately supported, educated and trained to enable them to get maximum contribution from every single member of their staff.”

He continued: “There is a clear correlation between the treatment of staff [from different ethnic and racial backgrounds] and the quality of care that is delivered to patients. “It is not ‘woke’ and it is not inappropriate to spend public money and public ensuring that we get the best contribution from staff. That’s the way you get great care and best outcomes.”

Mr Hopson declined to specify exactly which factions he meant by “noises from stage right” as he did not want to provoke an already sensitive area.

However, HSJ understands a glut of recent hostile articles and social media attacks on NHS diversity initiatives, including in the Daily Mail and The Daily Telegraph have angered some senior managers who are looking to push forward the equalities agenda.