Shake-up in NHS leadership looms as Sajid Javid accepts review recommendations


The Health and Social Care Secretary Sajid Javid has welcomed the publication of an independent review of health and adult social care leadership, and, in what is being described as the biggest shake-up in health and social care leadership in a generation, is accepting all seven transformative recommendations they have put forward.

The landmark review, led by General Sir Gordon Messenger and Dame Linda Pollard, Chair of Leeds Teaching Hospitals NHS Trust, will be published today.

The review team met over a thousand passionate front-line staff, managers and leaders across health and social care to hear their views, which informed their recommendations for improving the skills of all leaders and managers and putting the right culture, training and incentives in place.

While it recognised the current pressures faced by the workforce and identified many examples of inspirational leadership, it found overall there was a lack of consistency and coordination – in particular that there has developed over time an “institutional inadequacy” in the way that leadership and management is trained, developed and valued.

The report also sets out new plans to attract great leaders to the most challenged areas in the NHS, with a package of support and incentives to recruit the top talent into these positions. Through support networks, peer mentoring, training and development, this will ensure the government and the NHS can continue to tackle disparities across the country.

It also found evidence of poor behaviours and attitudes such as discrimination, bullying and blame cultures in certain parts of the health and social care system, with some staff in the NHS in particular not feeling comfortable to speak up. It identified a lack of equal opportunity for managers to access training and colleagues to progress in their careers, with those who have existing networks or contacts more likely to access these opportunities.

Sajid Javid says: “The findings in this report are stark; it shows examples of great leadership but also where we need to urgently improve. We must only accept the highest standards in health and care - culture and leadership can be the difference between life and death.

“I fully support these recommendations for the biggest shake-up of leadership in decades. We must now urgently take them forward, to ensure we have the kind of leadership patients and staff deserve, right across the country.”

The seven recommendations are:

1. Targeted interventions on collaborative leadership and a unified set of values across health and social care, including a new, national entry-level induction for all who join health and social care and a new, national mid-career programme for managers across health and social care.

2. Action to improve equality, diversity and inclusion (EDI), including embedding inclusive leadership practice as the responsibility of all leaders, committing to promoting equal opportunity and fairness standards, more stringently enforcing existing measures to improve equal opportunities and fairness, and enhancing CQC’s role in ensuring improvement in EDI outcomes.

3. Consistent management standards delivered through accredited training, including a single set of unified, core leadership and management standards for NHS managers, and a curriculum of training and development to meet these standards, with completion of this training made a prerequisite to advance to more senior roles.

4. A simplified, standard appraisal system for the NHS, including a more effective and consistent appraisal system, to reduce variation in how performance is managed and focus on how people have behaved not just what they have achieved.

5. A new career and talent management function for managers, including the creation of a new function at regional level to address a lack of clarity and structure in NHS management careers, providing clear routes to progression and promotion, and ensuring a strong pipeline of future talent.

6. More effective recruitment and development of Non-Executive Directors (NEDs) - NEDs play a vital role in providing scrutiny and assurance, and an expanded, specialist Non-Executive Talent and Appointments team will encourage a diverse pipeline of talent.

7. Encouraging top talent into challenged parts of the system, including a better package of support and incentives in place to enable the best leaders and managers to take on some of the most difficult roles, whereby roles in challenged areas are seen as the best jobs rather than the most feared jobs.

The review acknowledges the hard work of NHS staff and leaders, recognises the often challenging environment in which world-class services are delivered and the good leadership that already exists. It also recognises that leaders, at all levels, need support. The review has been welcomed as a constructive document that highlights the critical importance of good leadership and its impact on patient care whilst setting out where more needs to be done.

General Sir Gordon Messenger says: “The best organisations are those which invest in their people to unlock their potential, foster leadership and accountability at every level, with good leadership running through the entire workforce. This must be the goal and I believe our recommendations have the potential to transform health and social care leadership and management to that end.”

Dame Linda Pollard adds: “Today’s report is about empowering you to be the best version of yourselves – to work to the best of your abilities, have the tools to develop your careers and support each other and to create an equal opportunities workplace of which we can all be proud.”

Publication of the report will be followed by a delivery plan with clear timelines on implementing agreed recommendations.


About this review:

The review of health and social care leadership in England was announced in October 2021 and is the most far-reaching review of health and social care leadership in 40 years.

The review team was made up of representatives from the Department of Health and Social Care, NHS England, Health Education England, NHSX and social care leaders, as well as clinicians, managers and academics.

The review engaged with more than 1000 stakeholders on over 400 different occasions including: patients and users of social care services, GPs, Allied Health Professionals, clinicians, managers, care workers, researchers, clinical fellows, chairs of previous reviews, NEDs, CEOs, Chairs and MPs.

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