Two reviews of NHS leadership, both initiated under the previous government, have been published since the election.
A number of changes will be initiated as a result with the aim of implementing a more coherent and strategic approach to leadership development. This will see the Leadership Academy move from NHS England to Health Education England and many of the responsibilities previously held by NHS Improving Quality absorbed into NHS Improvement, the new body that brings together Monitor and the NHS Trust Development Authority. Other functions will go to NHS England.
The Secretary of State has continued to emphasise the importance of leadership in developing the right culture in NHS organisations. The ambition is for the NHS to become ‘the world’s largest learning organisation’, drawing on the experience of high-performing organisations here and abroad. This may signal a move away from using external pressures such as targets to drive change towards supporting leaders and staff to improve quality of care. How this will be squared with increasing central controls over spending remains to be seen.
- Review of leadership development and improvement
The government has accepted the majority of recommendations from a review of centrally funded NHS improvement and leadership development, initiated under the previous government. The review, led by NHS England’s Deputy Chair Ed Smith, concluded that the current system for improvement and leadership development is fragmented, and cannot meet the current and future needs of the NHS. Its final report was completed in March 2015, although not published until July.
The review put forward 16 recommendations, a number of which are already being implemented (others have been superseded, will be implemented in part, or are being left for further consideration). Recommendations that will be implemented in full include:
- the development of national strategies for improvement and leadership development, and a requirement for organisations to develop their own strategies, aligned to the national ones
- that the new arrangements for improvement and leadership development should be governed by two national governing boards, made up of representatives from NHS England, NHS Trust Development Authority, Monitor, Health Education England, Public Health England and the Care Quality Commission
- clarification of the roles of clinical senates, strategic clinical networks (SCNs) and academic health science networks (AHSNs). In particular, this involves clarifying senates’ role in supporting local health economies with clinical advice and by bringing together stakeholders; the role of SCNs (which the report argues should be renamed clinical networks) in connecting stakeholders across a care pathway to share best practice and measure outcomes; and the role of AHSNs in enabling change through collaboration between stakeholders and spread of innovation. In addition, AHSNs and SCNs should be aligned to operate as a single support entity for commissioners, providers and professionals.
Other changes include ceasing the operations of NHS IQ as a national organisation and sharing its functions and expertise between the new NHS Improvement and NHS England. The review also recommended closer alignment between NHS Leadership Academy and Health Education England programmes, which has been taken one stage further with the government’s decision to transfer responsibility for the NHS Leadership Academy from NHS England to Health Education England, a recommendation set out in Lord Rose’s leadership review.
Arrangements for improvement following the review will also be aligned with plans for a jointly-led Monitor and NHS Trust Development Authority – NHS Improvement – announced in the months after the review.
- Lord Rose NHS leadership review
In mid-July the government published the findings of Lord Stuart Rose’s review of NHS leadership. The review, commissioned in February 2014, covered acute care and commissioning (but not primary care), with a focus on talent management, the role of leadership in NHS transformation, and equipping clinical commissioning groups (CCGs) to deliver the NHS five year forward view.
The review identified three main areas of concern: the lack of a single NHS vision; insufficient management and leadership capability to address these challenges; and the need for a clear overall direction for NHS management careers. It offers 19 recommendations under the headings of training, performance management, bureaucracy and management support. Key recommendations include:
- the transfer of the NHS Leadership Academy to Health Education England as the body responsible for training and talent development across the NHS
- refreshing the NHS graduate scheme
- merging Monitor and the NHS Trust Development Authority
- introducing a minimum term on some senior management contracts.
The review also highlighted two pre-conditions: an NHS-wide communication strategy for sharing information across the service; and development of a handbook or other format summarising the NHS’s core values to be implemented throughout the system.
The government has already accepted the report’s 19 recommendations ‘in principle’, with the Secretary of State emphasising his intention to transfer responsibility for the NHS Leadership Academy from NHS England to Health Education England. It has also indicated that talent management will become a formal responsibility of the new jointly-led Monitor and NHS Trust Development Authority.
Our commentary and analysis
- Read Vijaya Nath’s blog: A return to values-driven leadership or more of the same?
- Watch Jeremy Hunt speak at our fifth annual leadership and management summit
- Read our report: Reforming the NHS from within
- See our leadership development work
Next area: The NHS five year forward view