News / NHS leadership needs to be more than ‘culture of compliance’

16 April 2024 Steve Brown

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NHS managers need to be given more freedom to make local decisions and avoid a simple culture of compliance, the Commons Health and Social Care Committee was told this week.

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Matthew Taylor (pictured), chief executive of the NHS Confederation told the committee’s inquiry into NHS leadership, performance and patient safety that lots of research showed the service was undermanaged and that leaders were operating in a very difficult environment. 

‘The context is material,’ he said. ‘Leaders are working in the context of a gap between demand and capacity. There is an £11.5bn maintenance backlog, so many leaders are asking workers to work in circumstances that are far from satisfactory – indeed in some cases almost dangerous.’ 

He also pointed to the late planning guidance – issued one day before the new financial year – and a financial settlement that most people expect will need to be topped up mid-year as contributing to a complex environment to manage within.

He said that the centre needed to model the leadership that it wants to see in the rest of the system. And it should avoid simply layering more recommendations, targets and incentives onto systems and providers. ‘The danger is that, as we require more, we develop a culture of compliance – that all boards do is try to tick every box that is put in front of them. That is not leadership.’

Mr Taylor said it was important that the inquiry was looking at patient safety. But he added that patient safety needed to be seen in the context of broader risk. He said patient safety was a top priority for leaders, but they also had to weigh up different risks, which were endemic in a system where there are seven million people on waiting lists, tens of thousands of people waiting too long in accident and emergency departments and hundreds of thousands of young people not getting the mental health intervention they need. 

He called for greater clarity and openness in talking to the public about risk. As an example from last year, he said that, as part of an open conversation about risk, acute leaders had recognised that the biggest risk lay in ambulance response times. This meant more people in emergency departments on trolleys and more people going into wards.

‘In the end, conscientious hospital managers, with clear leadership from NHS England, understood that, even though that involved risks, the risk of having too many people in a ward and too many people in the emergency department was lower than ambulances taking too long to reach people,’ he said. ‘We need to have more conversations of that kind about how we weigh up risk and we need to be more honest with the public about how we manage risk. And that has to be the context for the conversation about how we get patient safety right.’

In an earlier session, Rich Withnall, chief executive of the Faculty of Medical Management and Leadership, also argued that leaders needed more capacity to be able to meet current demands. And there needed to be a greater focus on leadership development. Drawing on his own military background, he said that ‘leadership didn’t happen by mistake in the military’. ‘We need to start on day one of vocational training for clinical people and for non-medical managers.’ And he added that this should be supported by ringfenced central funding.

General Sir Gordon Messenger, whose review of NHS leadership reported two years ago, told the committee that greater fluidity of staff moving between sectors and organisations would help to develop the collaborative culture that the service needed.

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