Mind the gap: the urgent need for better NHS leadership

Philippa Brice

22 July 2015

A new review of the British National Health Service (NHS) leadership has called for urgent actions to help stop management short-termism, and instead show strategic leadership and oversight.

Lord Rose was asked to undertake the review by the Secretary of State for Health, in order to examine how to improve leadership to help with NHS transformation and to equip clinical commissioning groups to deliver the Five Year Forward View. It is believed that the resulting report, Better leadership for tomorrow: NHS leadership review , was completed in December 2014, but not released to the public until this month.

The need for review

The NHS is under pressure from the rising demands placed by an ageing (and expanding) population combined with increasing needs for fiscal restraint. The review notes that the 2012 Health and Social Care Act ‘changed the landscape of the NHS fundamentally’ and observes that changing structures requires equipping people to run them. Whilst the NHS is praised as delivering great results overall, the review nevertheless concludes that there are ‘significant shortcomings’ in staff management and a lack of strategic oversight.

The recommendations made by Lord Rose fall into three broad categories: vision, people and performance. There is an obvious call for improved internal communications, to ensure that a single vision and ethos for the NHS is shared throughout the service, including NHS trusts and Clinical Commissioning Groups (CCGs).

Helping people, improving performance

Training and support of NHS staff for leadership and management roles is the second major theme of the report; it accurately observes that within the NHS is a deep-rooted perception that management is “the dark side”, ranged against front-line staff. Existing management is criticised for being too focused on short-term tactics at the expense of long-term, strategic thinking and planning for the future. This ‘short-termism of NHS management thinking’ is attributed to the need for constant regulatory data, and the fear of not being able to change fast enough.

In response, the review recommends various measures to bolster all forms of management training and support coordinated by Health Education England, including recruitment from and secondment to other sectors.

The final area for action is performance. Better performance management and ‘rationalised and harmonised’ requirements from regulatory and oversight bodies to simplify reporting systems are also recommended, along with suitable recognition and reward for good leadership.

The dangers of a leadership deficit

These findings and proposals are consistent with recent PHG Foundation policy recommendations on infectious disease genomics. The Pathogen Genomics Into Practice report found that the individual and public health benefits of advances in genomics for diagnosis, management and control of infectious diseases in the NHS were being hampered by a lack of strategic coordination and leadership.

Project leader Dr Sobia Raza commented that using genomics effectively as a frontline tool in national services to manage infectious diseases requires “the direction, investment and support of health service leaders”.

Wasting science, failing health?

This is a worrying reality. The importance of genomics for health has been recognised by the current Government to the tune of £300 million investment in the 100,000 Genomes Project. Similarly, infectious disease control is currently recognised as a major health policy priority in the light of efforts to tackle the sharply increasing danger of antimicrobial resistance and global challenges typified by the 2014 Ebola outbreak.

If, then, the use of even such a promising combination of scientific tools available to address urgent health needs is being seriously hampered by a lack of strategic thinking and leadership in the NHS, how many more opportunities to use science to boost health are being missed? And can we really afford to miss out on the potential to deliver some of those desperately needed transformations and efficiencies, for want of some leadership?

The government has reportedly said that it accepts all of Lord Rose’s recommendations ‘in principle’. Let’s hope it is in practice, too – and the sooner, the better.