In the face of the long NHS waiting lists, lack of hospital beds, failure to address social care, lack of NHS medics, incompetent management and falling standards of care, on June 8th the Government NHS website proclaimed the publication of its report as the “Biggest shake-up in health and social care leadership in a generation to improve patient care”. This so-called ‘landmark’ review into health and social care leadership led by General Sir Gordon Messenger and Dame Linda Pollard was announced in a press release on the website.
The website statements are full of rhetoric but without clear meaning: “The review team met over a thousand passionate front-line staff, managers and leaders across health and social care.” And I thought: What is a passionate staff member? How did they define or measure “passion”? Were some more “passionate” than others? And isn’t “passion” a bit of a danger? Do I really want a passionate doctor or nurse looking after me? No, I want a competent and kind professional, not someone who is “passionate”.
Then I read in the press release that the review found what they called “an ‘institutional inadequacy’ in the way that leadership and management is trained, developed and valued”. What does this mean? What is training for management that is not adequate? And what does the report mean about leadership and management that is “valued”? Here again is wishy-washy rhetoric. What are the ‘values’ that should be valued? And how should one show a leader or manager he or she is valued? A pay rise? Biscuits with a cup of tea? Champagne nights out? Holidays in the sun?
And again, the press report states that the review team “found evidence of poor behaviours and attitudes such as discrimination, bullying and blame culture”. This sounds rather threatening to me. How do they define “poor behaviours”, or “poor attitudes” or “discrimination’” or “bullying” or “blame”? Especially when everyone they met, “over a thousand people”, were “passionate”?
Does the full report give more data and detail for these vague statements given to the press? What is the detailed evidence behind the press release?
The full report does not give data or evidence for its statements. There is no appendix of evidence. There are no supporting data attached. There are no records of meetings. Instead it expands the rhetoric – interviewees were not just “passionate” they were also “devoted” and “hardworking”. How did the review team know this, I wondered.
The full report seems to me to include at least five contradictions.
It begins with a message from Sir Gordon: “I have encountered nothing but friendliness, candour, self-reflection, pragmatism and support from the impressive array of experts, front-line staff, academics, service users and leaders who willingly gave us their time to share their views.” The report seems to indicate that he and his review colleagues have based this review on the opinions of the people they met. But is this this an adequate basis for a formal review?
Here is contradiction number one: Subjective opinions (however friendly and reflective) are not evidence. Sir Gordon and Dame Linda may have met some truly impressive and “passionate” people, but that is not an objective assessment or measure of the care given to actual patients in the U.K. health care system. After all, words are cheap.
The second contradiction follows from this: Sir Gordon states that he and Dame Linda (now his “good friend”) bought together an “excellent”, “inclusive and diverse team” which “included representatives from the Department of Health and Social Care (DHSC), NHS England, Health Education England, NHSX and social care leaders, as well as clinicians, managers and academics – all bringing their own lived experience and personal knowledge of the health and care system”. If this was such an excellent, inclusive and diverse team, why are there any problems that need changing? Surely it’s not possible to better excellence? And what is meant by their “lived experience”. How can this be measured or assessed? Is this just how interviewees felt about their “lived experience” on this particular day?
The third contradiction is this: The review team had a “listen and learn” phase. They engaged with “more than 1,000 stakeholders on over 400 different occasions, plus welcoming contribution from all via an open email address”. They did not appear to have gone out into hospitals or community health and social care to look for themselves and to gain their own objective “lived experience”. The methods do not seem to have included visits out of the office (or maybe even away from zoom at home). They do not seem to have gone into wards where patients are being looked after.
The fourth contradiction follows: The review comments on the “excellent” progress made since the Francis Report (2013). But as with the rest of the report, no data or evidence are given to support this wildly generalising and very vague statement. Staff are passionate, devoted and committed but, as the review concludes, there is a culture of discrimination and bullying and blame. This is contradiction number four. Some of these interviewees must have been blaming colleagues to the review team. Otherwise how would they reach this conclusion? The ‘no-blame’ culture desired for the NHS was obviously not being practised by the interviewees giving their critical opinions to the review team.
The fifth contradiction is the apparent lack of understanding of everyday patient care by the review team. This is no better illustrated than in the deeply cynical statement in the review: “Senior nurses talked about ‘going to the dark side’ as a comment often made when they moved into senior management roles.” Senior nurses in management, by moving away from the coal face, don’t seem to understand the everyday realities of practice. They are disconnected from frontline patient care. No amount of postgraduate seminar training (that the review calls for) will remedy this.
So what is the Government intention and objective behind this very vague ‘landmark’ report? Is it to improve health and social care for the population? No, as the press release concludes, the intention is to “ensure the Government and the NHS can continue to tackle disparities across the country”. Ah, the levelling up agenda!
A further contradiction relating to who really wrote and influenced the report appears in the YouTube interview of Sir Gordon Messenger by Sajid Javid.
Sir Gordon Messenger is clear that in his view:
The best way that people learn leadership is not in the classroom. It’s through watching others they respect and admire and how they do it. And so there’s definitely something contagious about good leadership. I think that can have a top down approach so if you’ve got a good leader at the top it’s incredible how quickly one can set the tone for the entire organisation.
Thus spoke the soldier, General Messenger.
So leadership cannot be taught, he says, it must be caught. And this is very similar to how health care leadership and management developed in this country and in particular how the nursing profession developed. It was Florence Nightingale’s view. It was the basis for hospital leadership through the working together of doctors and nurses, matrons, medical superintendents, consultants, ward sisters, staff nurses and student nurses, together with the hospital administrator. The Francis report (2013) also held this view.
Oddly, Sir Gordon’s view on leadership does not seem to be given room in either the press release or the full report, despite Sir Gordon’s position as a leader of the review. This makes me wonder how much influence he really had in writing this report. Leadership being caught in practice rather than taught in the classroom is wholly missing from the report and its recommendations. Instead, the recommendation of the review is yet more vague wording. According to the press release, recommendations include “an induction for new joiners to instil core values across health and social care, a mid-career programme for managers, stronger action on equality and diversity to ensure inclusive leadership at all levels, clear leadership and management standards for NHS managers with a standardised appraisal system, and greater incentives for top talent to move into leadership roles in areas facing the greatest challenges, to help combat disparities across the country”.
And in particular the third of the seven recommendations in the press release completely contradicts Sir Gordon’s view that leadership is caught not taught: “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.”
This review is yet another costly (by how much we are not told) white elephant that, to mix metaphors, does not address several elephants in the room. It is yet more grandiloquent bombast full of words signifying nothing. It reiterates concepts such “inclusion and diversity” without explaining what they mean, and more importantly, how this will benefit patient care.
The King’s Fund has responded about one of said pachyderms. Suzie Bailey comments: “However, the elephant in the room is really the deep workforce crisis that predates the pandemic and that the Government has been quite reluctant to face up to. There is a huge number of vacancies, staff are exhausted, they were exhausted before the pandemic.” She added: “This review is welcome but my concerns is will it actually address the size of the workforce crisis?”
In fact, the NHS depends now on taking health care workers from other countries. One of these countries is Nigeria, which maintains the nurse training model of apprenticeship in a school of nursing, rejected several decades ago by the U.K. nursing elite, which is arguably a major contributing factor to the current U.K. nursing shortage.
This report fails to tackle another very big elephant in the room: the scathing reports on the NHS such as Francis (2013), Kirkup (2015), CQC (2018) and Ockenden (2022). “These are major markers in our lack of sustained patient safety system culture,” according to John Tingle, a lecturer in law.
These elephants – staff shortages and poor standards of care – could also be addressed by reforming nurse training to bring back student nurses into the paid workforce, away from the university seminar rooms, so that they can learn nursing leadership, management and values from their colleagues in practice. The Francis report (2013) was also concerned about current methods of nurse training. Perhaps Sir Gordon, with his stress on leadership being caught not taught, might agree?
This report of a whitewash review is deeply depressing. It does not focus on the practicalities of improving the care of patients and simply reinforces the public impression that nothing can change and that the NHS is still a captive of the elite managerial cadre which successfully resists all and any calls for a genuine ‘shake up’ of an institution chronically sick from top to bottom. Care for patients is not the NHS priority. Don’t get ill in the UK!
Dr. Ann Bradshaw is a retired lecturer in Adult Health Care.
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There is another dimension to this problem. When we have torn out the excessive management, the padded non-jobs, and the sloth and inefficiency, what the hell do we do with, what, 250,000 people who have been on good salaries who now need to find a job in the private sector.? Can you imagine them on ‘Day 1’ in a business that actually has to deliver a high quality and profitable service or product for its existence.? The overwhelming majority of NHS-er’s wouldn’t understand what you were talking about. I think we have to face facts here that the NHS is probably Europe’s biggest job scheme for the completely useless (present company excepted, of course). We should not be trying to improve them. We should be trying to isolate them.
Perhaps they should self isolate?
…’immolate’… is the word you are looking for.
And the amounts paid for unemployment benefit would increase dramatically. Better that though than letting them run the country’s health care sysstem further into the ground
Cheaper than the salaries & pension contributions though.
Plenty of other job vacancies in the UK apparently….
Unemployment benefits would be less than they get being ‘employed’ so it would be a plus.
‘… hat, 250,000 people who have been on good salaries who now need to find a job in the private sector.?’
Plenty of jobs loading baggage going begging at airports.
I have an idea for improving the health care system.
The state can give the population health insurance and people can chose where to get their treatment and health care.
The hospitals and clinics then receive payments from the state medical insurance scheme in the same way that private medical insurance companies do.
The hospitals and clinics that do the best job get more patients and more funds. The bad ones suffer.
In short, let the public decide what constitutes good treatment and service by voting with their feet, not a couple of random appointees armed with a political agenda.
I have said this before regarding GP surgeries that are allowed geographical monopolies.
Why involve the State? Just let people buy their own insurance and stop charging NIC.
“Greater incentives for top talent to move into leadership roles in areas”.
Ah, so that’s what’s wrong with the NHS – the managers aren’t paid enough. Well blow me down!
“Deep workforce crisis that predates the ‘pandemic’ ”
So they thought it appropriate to force out experienced staff over their refusal to take a useless, dangerous experimental medication? Still, they can always take nurses from Nigeria, I’m sure they have more than enough.
Change your NHS, change your NHS!
Well said Dr. Bradshaw, thank you.
It is a damning comment on the Government that this patronising and pointless report will be believed by any sentient person.
Messenger and Pollard are shameless placeholders with neither the wit nor the energy to produce a report that identifies the shortcomings and problems in the NHS and solicits solutions for how to solve the problems that inhibit patient care in a timely fashion.
Everyone involved in this report should be named and shamed for having taken taxpayer funds to produce this dross.
I had high hopes for this report and am deeply saddened by the outcome.
Patients deserve better than this.
What is the point in being passionate if it is about the wrong thing?
Sounds like there are plenty of passionate bullies and jobsworths.
I quote Stephen Covey:
“Efficient managers are sharpening machetes for their teams, holding machete training classes, bringing in automated equipment to haul out the brush that is cleared. Very effective at doing the task at hand and cutting through the jungle.
“The leader is the one who climbs the tallest tree, surveys the entire situation, and yells, “Wrong Jungle!”
“Effective managers will yell back, “Shut up, we are making progress.” Because they do not realize they are in the wrong jungle.” They are so busy cutting through the brush they fail to see where it is they are heading.”
I hear horror stories everyday from the families of elderly, frail loved ones who are in contact with NHS and Adult Social Care.
They come from a variety of backgrounds and social strata.
The neglect and (in my opinion) abuse is endemic.
The front line staff aren’t passionate they are indifferent.
Sir Humphry Appleby on steroids!
All that waffle describes the NHS when I started in it 1971 to 1975 when I left to work in the medical supply industry. Lots of wonderful, saintly, dedicated™️, selfless people working tirelessly, understaffed, underpaid, etc, etc.
The NHS exists – always has – to meet socialist, political aims: its aim is not to provide medical care, that’s just incidental.
The truth is the NHS cannot go bankrupt like an ordinary business, therefore nobody can lose their job if the organisation performs poorly, nobody gets fired for incompetence or laziness, nobody gets rewarded on merit or being hardworking – it’s grade and length of service – there is no profit motive to drive productivity and efficiency (which cannot be measured in any case), there is no access to World finance and thus private investment to expand.
The NHS is purely a cost centre, so it cannot recover its costs from revenue and accrue a surplus to invest in expansion to meet increased demand. The more work it does the more it spends, and being on a fixed budget there is therefore a perverse incentive to do less not more and inevitably absent a price mechanism since it does not sell its output, demand must be rationed by waiting list.
Over the years there have been hundreds of reviews, dozens of ‘reforms’ and it gets no better because it is a flawed model.
Treatment of ailments does not exist in a separate magical universe of economics, and real World economics apply, medical care can only work effectively if carried out in a competitive free market capitalist process.
Until the British understand and accept that, the NHS Socialist State collective will bumble along consuming more and more and delivering less and less.
Without food, 100% of the population will die within 6 weeks. Without medical care a tiny fraction will die within 6 years.
If State provided medical care is so terrific – and boo hoo the poor, etc – then why don’t we have a National Food Service?
Brilliantly said JXB
So leadership “can’t be taught”. Well, what on earth are all the forces training establishments like Dartmouth, Cranfield and Sandhurst doing then? And how about all those individuals, like me, who have made a living training people in leadership skill?!!
The NHS has never had patients as a key concern, since the day when the organisation was handed over to bureaucrats to run around pursuing idiotic targets.
I would have said that the clinicians were above reproach but since March 2020 their supine posture and slavish adherence to the NHS Covid narrative has shown them to be as bad as the ‘management”. A plague on all their houses.