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Wednesday 29 May 2019

NHS managers must not only be fit and proper, but also well supported

By Jon Restell

Too often, debates on NHS management focus on picking out the 'bad apples'. Instead, we should improve the health of the whole orchard.

Jon Restellsmall

Leadership development and talent management in the NHS are back on the radar screen. I was delighted to be asked to join NHS Leadership Academy Chair Peter Homa’s workstream looking at the issue as part of the wider programme to create the workforce implementation plan. This plan is intended to support the ‘people’ element of the Long Term Plan for the NHS in England over the next five to ten years.

At the time of writing the workforce plan remains unpublished. But many of the key themes –the supply of medical and nursing staff, workplace culture, leadership and new ways of working – have been widely discussed and trailed by NHS Improvement’s Dido Harding and Julian Hartley, who between them have given an impressive masterclass in engagement and co-creation.

There’s no doubt that a national focus on workforce is long overdue – most local NHS leaders say the workforce is their number one challenge. What any emerging plan needs is hard cash in the next Spending Review; new system architecture, especially at regional level, to support workforce planning and development; and a long-term funding settlement for social care with substantial investment in the pay, training and valuing of social care staff.

Intelligent accountability

It’s great to see leadership firmly embedded in an emerging workforce strategy, rather than hived off to a separate plan. This new approach finally recognises the importance of management to workforce experience and behaviour. Who doesn’t believe now that most people leave their managers, not their jobs? What research into any workforce problem does not place leadership – especially the role of line managers – at the heart of solutions? And particularly welcome in this fresh approach is the determination of Homa and others to avoid focusing solely on how to strike off the ‘bad apples’ in management.

Don’t get me wrong. I believe in robust accountability for NHS managers, as does every MiP member I’ve ever spoken to on the topic. But regulation through instruments such as the Fit and Proper Person Regulations will always be a limited intervention – and in the case of those particular regulations, as MiP argued strongly during their recent review by Tom Kark QC, an ineffective and unfair one. Fair regulation must rest on more than a vague belief that we all know a bad manager when we see one.

Improving the standards of standards

When I hear this hue and cry about bad apples, I always ask: who are you talking about, and how do you know that they should be denied the chance to earn their living? What is your proof, and under what process was the evidence tested? Nine times out of ten, there is no sensible answer to these questions. As a union of public sector professionals, we would welcome a wide-ranging consultation and debate about professional standards. The debate should encompass the updating of the NHS code of conduct for managers and issues of regulation, but more importantly it should lead to a much richer, broader and more positive vision and strategy for NHS managers.

There is an opportunity here – in this hoped-for broader vision – to advance the professionalisation of NHS management: a cause long championed by, among others, MiP’s national committee. Professionalisation goes well beyond last-resort regulation and looks at the standards and competences of health and care management, the design and evaluation of management jobs, recruitment, reward, the training and systems that support and develop managers and, above all, the day-to-day culture in which managers work.

There is also an opportunity to break leadership development and talent management in the NHS out of its narrow pre-occupation with board-level and system leaders. Both are important, but the focus on them has traditionally left leaders with day-to-day responsibilities for most NHS staff out in the cold. Three quarters of all NHS staff are managed by a Band 7. If leadership plans do not speak directly to these managers, then it’s highly unlikely that the NHS workforce will notice the difference.  

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