NHS Leadership Review

Better leadership for tomorrow: NHS leadership review

Lord Rose,  June 2015

• This review, initiated by the Secretary of State, examines what might be done to attract and develop talent from inside and outside the health sector into leading positions in the NHS. It also asked how strong leadership in hospital trusts might help transform the way things get done and how best to equip CCGs to deliver the NHS five year forward view. 
• Lord Rose concludes that "the NHS, as a whole, lacks a clear, consistent, view of what ‘good’ or ‘best’ leadership look like" (p20). He found "that there was no consistant clear picture for CCGs of what ‘good’ commissioning performance looks like." (p22)

Highlights for CCGs:

• When considering the importance of leadership to support large scale change within CCGs Lord Rose says: 
•  "The current level of support given to CCG Chairs and other senior individuals such as Accountable Officers and Chief Clinical Officers is woefully inadequate. There is no ‘step up’ for these individuals: either they have the necessary leadership skills or they don’t. A systematic way to identify and develop this group is needed."
• The review also considers the place of cross-functional training of CCG Chairs to support their relationships with other CCGs and local providers.
• When considering the training which is available, Rose concludes that more can be done to encourage those working in CCGs to take part in courses offered by the NHSLA and the NHS Staff College, and that this provision needs to be supplemented by a new training programme for the specific needs of those working in commissioning.
• The review acknowledges the concerns of CCG Chairs around balancing their role as Chair and their responsibilities as practicing GPs. 
• Greater collaboration and integration of working between CCGs and providers to reduce the fragmented nature of commissioning would reduce tensions between the different organisations.
• The lack of performance management and talent management is discussed, in particular the inadequate support for CCG lay members and NEDs.
• " the NHS is drowning in bureaucracy" (p40)

The review makes 19 recommendations:

• R1: Form a single service-wide communication strategy within the NHS to cascade and broadcast good (and sometimes less good) news and information as well as best practice to NHS staff, Trusts and CCGs.
• R2: Create a short NHS handbook/ passport/ map summarising in short and/ or visual form the NHS core values to be published, broadcast and implemented throughout the NHS.
• Training (R3-R8)
• R3: Charge HEE to coordinate the content, progress and quality of all NHS training including responsibility for the coordination and measurement of all management training in the NHS. At the core of this is a 90-day action cycle. HEE must promote cross-functional training in all disciplines and at all levels, coordinating the teaching of management basics such as appraisal, motivation, negotiation and leadership.
• R4: Move sponsorship of the NHS Leadership Academy from NHS England into HEE.
• R5: Include accredited/ nominated training establishments as part of a diverse training effort.
• R6: Review, refresh and extend (x10) the NHS graduate scheme; establish career pathways, a greater variety of placements and a guaranteed job after three years’ training (quality and assessment permitting).
• R7: Refresh middle management by training and a more porous approach both from within the NHS and externally (recruitment from, and secondment to, other sectors).
• R8: Require senior managers to attend accredited courses for a qualification to show consistent levels of experience and training have been reached across the NHS. On completion of this course they enter a senior management talent pool open to all Trusts. 
• Performance Management (R9-R11), 
• R9: Set, teach and embed core management competencies and associated expected behaviours at each management level.
• R10: Establish a mechanism for providing on-going career support for all those in a management role allowing individuals to increasingly take charge and identify their own developmental needs. 
• R11: Establish and embed an NHS system of simple, rational appraisal (a balanced scorecard for individuals) supported by a regular course in giving and receiving appraisals as part of the core provision of the single training body. At a senior level, these appraisals should be standardised across the NHS.
• Bureaucracy (R12-R16)
• R12: Review the data demands of regulators and oversight bodies; these can then be rationalised and harmonised in order to produce consistent, clear and simple reporting that does not distract staff from patient care. 
• R13: Merge oversight bodies, the NHS Trust Development Authority and Monitor.
• R14: Spend time on a regular basis at all levels of the NHS to review the need for each data return being requested and to feed any findings to the Executive and Non-Executive Teams to review. 
• R15: Establish and maintain a clearer system of simple rational appraisal (balanced scorecard for the organisation). 
• R16: Health and Social Care Information Centre (HSCIC) to develop an easily accessible Burden Impact Assessment template and protocol.
• Management Support (R17-R19)
• R17: Create NHS wide comment boards. Websites and supporting technology to be designed and implemented to share best practice. 
• R18: Set minimum term centrally held contracts for some very senior managers subject to assessment and appraisal.
• R19: Formally review NED and CCG lay member activity (including, competence and remuneration) in line with the CQC Well Led initiative; and establish a system of volunteer NEDs from other sectors.