The Operating Framework set out an ambitious agenda, including a new emphasis on improving dignity and patient experience as well as reducing unplanned admissions from conditions such as asthma and diabetes.
Delivering this agenda while managing the transition to the new system envisaged in Liberating the NHS will test the skills and resilience of managers to the limits. All the more puzzling therefore that the Secretary of State for Health chose the day of the chief executives' conference to write an article for the Daily Telegraph in which he argued that Labour had increased spending on the NHS 'but wasted much of it on managers'. It was hardly surprising that he received a lukewarm reception from an audience that quite reasonably expected to be praised rather than criticised for its efforts in maintaining performance in challenging circumstances.
The revival of manager-bashing reminded me of the report the Fund published this year – The future of management and leadership in the NHS. Drawing on new research and expert contributions, the report argued that there was no evidence that too much is spent on management in the NHS. If anything, the evidence suggests that the NHS is over-administered and under-managed, with the demands of regulators and performance managers requiring the employment of large numbers of staff to ensure compliance with standards and targets.
The commission that produced this report went on to argue that the time has come to value managers rather than to denigrate their contribution. An organisation as large and complex as the NHS, employing more than one million people and spending around £100 billion each year, needs to recruit and retain the very best if it is to successfully navigate the most challenging period in its history. These leaders must include clinicians who move into leadership as well as experienced managers. Great leaders are needed at all levels – from the board to the ward – with the emphasis on leadership teams rather than heroic individuals.
In recognising the importance of leadership and management, the commission acknowledged that management costs should not be exempt from the pursuit of efficiency savings. At a time when £20 billion has to be released from existing budgets to fund new developments and improvements in care, there can be no 'no go' areas. Equally, the NHS cannot rise to the challenges with which it is faced unless its leaders feel supported in the work they do, and are recognised for their contribution.
It is for this reason that The King's Fund will continue to make the case for effective leadership and management. Our new Leadership Review is focusing on the role of leaders in engaging staff, patients and other partners in improving performance and tackling the areas in which the OECD has identified room for improvement. We will be publishing the results of the review at our second annual leadership summit on 23 May 2012.