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NHS management overly ‘task focused’, government review finds

Published on: 26 Apr 2022

General Sir Gordon Messenger has nearly completed the work, which had been due to be published shortly before Easter but was delayed by the government, and has briefed several senior leaders on several of his main observations.

According to several senior figures, he has said NHS management and leadership are heavily “task focused” — a management term referring to an approach devoted to completing certain tasks or meeting certain short-term objectives; in contrast to an approach which focuses on people, relationships or skills.

General Sir Gordon was commissioned to undertake the review in October, when Sajid Javid said the work would take place quickly and be the “most far-reaching review” of NHS leadership since the seminal Griffiths report of the early 1980s.

The report is now unlikely to be published for several weeks at least, so his final conclusions – and any additions which Mr Javid might make to the final announcement – are not yet certain.

However, HSJ has spoken to several senior sources who have been briefed on Sir Gordon’s findings so far.

One said the former military figure had observed that “NHS leadership is… very focused on getting things done, and not focused enough on how things get done – which I think is very fair if you think particularly what the last 10, 15 years have been like”.

Another finding, according to those briefed, is the need for better support for NHS leaders running the most difficult local organisations, including providing what has been described as “support packages”.

Sources also told HSJ he had accepted that some managers were put off by going into challenged trusts due to unrealistic expectations, a lack of patience from the centre in meeting targets, and potential damage to leaders’ reputation and long-term career prospects.

It is understood Sir Gordon was “very struck” by a perceived lack of recognition for leaders at challenged trusts and wanted to incentivise the best to work at underperforming providers, believing this was an area that required “real focus”.

A source said: “I got the sense that a lot of it for him was about the kind of support you wrap around someone and the expectations that you set.

“It can take years and years to turn around a [challenged trust]… so there’s something about being realistic about what it is a chief executive, going in, can achieve in the first two to three years.

“There’s something about the support you offer them, there’s something about the acknowledgement you give them for the job they are doing.”

Other proposals General Sir Gordon and the review team have shared with senior figures include:

  • Developing more early and mid-career entry points into the NHS with “very clear” competencies;
  • NHS England regions having a bigger role in managing pipelines of potential directors for local NHS organisations; 
  • Going “further and faster” on equality, diversity and inclusion; and  
  • Building more system working skills, and investment in developing individuals with those attributes.

Previous press reports have linked the review to moves to introduce “academy style” NHS trusts, or “reform trusts”, involving more takeovers of struggling organisations by successful leaders, while others claimed the government was planning for “hospital managers who fail to clear mounting NHS backlogs [to] be sacked”, and that Mr Javid was “said to be preparing new powers to seize control of poorly performing hospitals”.

These kinds of messages did not feature in the observations General Sir Gordon has set out so far to HSJ’s  sources. 

There may be scope for the final review to link his findings about supporting leaders in struggling trusts, to fresh efforts to encourage stronger organisations to take them over, however.

Those who had been briefed described the Messenger review findings positively and said General Sir Gordon and Dame Linda Pollard, who is supporting it with a team from the NHS and the Department of Health and Social Care, had engaged well.

One described it as a “really good piece of work,” and an “impressive evolution rather than a dramatic revolution”.

That source said: “It’s confronting issues that have needed confronting for some time, it’s confronting things that [Baroness] Dido Harding when she was chair of NHS Improvement [was focusing on].

“It’s highlighting a set of tasks that Prerana [Issar, NHSE’s chief people officer] would have got into had it not been for the pandemic, for example.

“I think he’s been a perfect choice to do it because of the way he’s gone about it, in a genuinely inclusive kind of way.”

However, there were warnings against it coming across as too “top-down,” with one adding: “[The review has] got to be something that leaders own locally, not something that is kind of done to them.”

The publication of the report, which has not been fixed but may take place next month, is expected to be followed by an implementation programme, though it is unclear if General Sir Gordon will remain involved.

In October, the government said its recommendations would be “considered carefully and followed by a delivery plan with clear timelines”.

NHS Providers chief executive Chris Hopson said: “Given the initial background newspaper briefing on the review, which was somewhat negative about current arrangements, there’s a residual worry that, given the pressures in the NHS, the report could be used as a means of bashing NHS leaders.

“But we fervently hope that ministers and NHS colleagues will use the report to genuinely improve NHS leadership, and to treat the report in the spirit in which it’s been created. A thoughtful, evidence-based analysis that identifies what’s good about NHS leadership but also where we can systematically get better.”

HSJ has approached the DHSC and NHSE for comment.