As the NHS recovers from the pandemic, there is a dire need for sound health and social care leadership. The alliances responsible for developing sustainability and transformation plans (STPs) have been replaced by legal entities in the form of integrated care systems. The executive teams of these systems are responsible for making difficult decisions pertaining to resource allocation against compelling and competing demands within a constrained system (Brown, 2022). Integrated care systems are expected to make collaboration and system-level working the norm, and drive interorganisational working to deliver the desired service and client outcomes across the local health and social care economy. Delivery upon this ambition will require good communication across all contributing organisations if staff and clients are to feel fully engaged in the integrated care endeavour.
Over the years, various failures in communication and NHS leadership have emerged. The Francis Report (House of Commons, 2013) was highly critical of the leadership and resulting culture at Mid Staffordshire NHS Foundation Trust. Sir Bill Kirkup (2015) described the dysfunctional maternity provision at Furness General Hospital, part of the University Hospitals of Morecambe Bay NHS Foundation Trust, where he found ‘failures at almost every level’. More recently, the Ockenden (House of Commons, 2022) inquiry has laid bare the inadequacy of maternity services at the Shrewsbury and Telford Hospital NHS Trust, which failed parents and their infants. Donna Ockenden is now undertaking a review of maternity services at Nottingham University Hospital NHS Trust in light of concerns raised by the Care Quality Commission regarding 19 serious incidents reported between March 2021 and February 2022, in addition to five Healthcare Safety Investigation Branch investigations. However, leadership failings are not unique to maternity services, nor individual NHS Trusts, which is why Sajid Javid, the former Secretary of State for Health and Social Care, asked General Sir Gordon Messenger in October 2021 to examine leadership and management in health and social care.
The Messenger (2022) report referred to the NHS's ‘institutional inadequacy in the way that leadership and management is trained, developed and valued…it is…a federated ecosystem where complex tribal and status dynamics continue to exist.’
The recent Messenger (NHS England, 2022) report referred to: ‘an institutional inadequacy in the way that leadership and management is trained, developed and valued’. It is noteworthy that he described: ‘The NHS is itself far from a homogenous unified organisation, but rather a federated ecosystem where complex tribal and status dynamics continue to exist’. Due to the diverse nature of the NHS with its primary and secondary care services, he concluded that it was not possible to identify sensible interventions which would have universal relevance and impact. However, he was clear that: ‘a well-led, motivated, valued, collaborative, inclusive, resilient workforce is “the” key to better patient and health and care outcomes, and that investment in people must sit alongside other operational and political priorities’. Messenger received: ‘reports of poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance’ which should not be tolerated as such behaviour affects care delivery as well as staff. Messenger was particularly critical of the evidence of inequity in experience and opportunity for those with protected characteristics, especially those that concerning race and disability. He recommended that every leader and staff member have a personal responsibility for their actions regarding equality, diversity and inclusion.
The report made seven recommendations to bring about a cultural change across the whole of health and social care, from senior management to front-line staff, with clear behavioural and cultural expectations at the point of entry. The recommendations included: interventions to foster collaborative leadership and organisational values; positive equality, diversity and inclusion action; assuring consistent management standards; a simplified, standard NHS appraisal system; a new career and management function to oversee NHS management careers; more effective recruitment of non-executive NHS directors to widen the pool; and support and incentives to encourage the top talent to take roles in the most challenging parts of health and social care. Time will tell whether Messenger's report helps the NHS deliver excellent leadership across its constituent parts.