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Reduce compliance to get the best out of NHS leadership, MPs told

Reduce compliance to get the best out of NHS leadership, MPs told
By Beth Gault
16 April 2024

The burden of compliance for NHS leaders needs to reduce to allow leaders to be more ‘dynamic’ the health and social care committee (HSCC) has heard today.

In the first session into an inquiry on leadership, performance and patient safety, chief executive of NHS Confederation, Matthew Taylor, said  ‘It’s vital to take responsibility for the overall ask and expectations that we have of leaders in the health service. We can pour evermore recommendations and targets and incentives in. But it feels to be very rare for anyone to stand back and say what does this all actually amount to.

‘And the danger is that as we require more, what we develop is a culture of compliance, that all the boards do is try to make sure that they’re ticking every single box that is put in front of them. And that in the end is not leadership, mere compliance in a context that feels very difficult.’

He added: ‘If nearly all the boards do is worry about compliance, you’re going to get compliance not leadership. And that is one of the reasons why I think ultimately, the NHS is not as responsive and dynamic as it needs to be.’

Mr Taylor also said leaders need to be given the ability to communicate more directly with their population, particularly on conversations around balancing risk, as the avoidance of risk does not always improve patient outcomes.

‘We need to give leaders the scope to be able to get that balance right, and to talk explicitly and openly about it,’ he said.

‘At the moment, it is quite difficult to do that. Because we have a culture in which if you are on the board of a system or a trust, and you have things you have to comply with, you don’t have the scope to say, well, I’m going to comply with 80 of them. But I’m not going to comply with the other 30, I just can’t do that. You have no accountability mechanism that would allow you to say, well, on behalf of local people we aren’t doing that.

‘One of the things I’ve encouraged the committee to do is to explore how we can give leaders more permission to lead in opening up some of those debates and engaging the public and their staff and others in those kinds of conversations.’

He added that integrated care partnerships may give scope for systems to learn from local government in the area of communicating with populations.

‘I don’t want to reduce accountability,’ he said. ‘I want more accountability, however, downwards and outwards and less compliance upwards.’

Also today, the Department of Health and Social Care (DHSC) called for evidence on creating a more open healthcare system.

The review will look at the duty of candour system, which requires health and care providers to be open when things go wrong. It will explore how this is honoured, monitored and enforced in healthcare settings.

ICB workforce

In an earlier conversation on ICBs and how to ensure their culture is right the committee heard that there needs to be a more ‘fluid’ workforce across the systems to build awareness of what happens beyond an individual’s role.

General Sir Gordon Messenger, leader of the review of leadership for a collaborative and inclusive future, said: ‘There is remarkably little, or I would argue insufficient, fluidity of workforce, which allows those that come to ICBs to feel part of a community.

‘If you want good patient outcomes, then you need to be able to work and understand the realities of others.’

Leadership development was also covered, with Professor Rich Withnall, chief executive of the Faculty of Medical Management and Leadership, saying this needs to start from ‘day one’ of vocational training for clinical people and non-medical managers, with training ringfenced to inspire, nurture and grow leadership talent.

He added that there was often a ‘manager bashing’ culture within the NHS, which needs to be challenged as a narrative.

‘There have been attacks on NHS leaders and there’s been a bit of a culture of manager bashing,’ he said. ‘I don’t actually think we are over managed in the NHS. We don’t actually know the number of people operating in roles that feature leadership, and I would suggest we need to do research understand that better.

‘But what we do know is that managers make up only two percent of the NHS workforce. If we look in other sectors, it’s about nine and a half percent.

‘We need to challenge the narrative that we have too many managers in the NHS and stop  manager bashing.’

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