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28.11.18

NHS leadership pressures creating ‘negative working culture’ where bullying is prevalent, says official review

A review into NHS leadership has said it found a “a negative working culture” where “bullying and discrimination are prevalent and accepted.”

Sir Ron Kerr was commissioned by the Department of Health and Social Care to conduct the review in executive leadership within the NHS, and has today published a series of recommendations.

The former chief executive of Guy’s and Thomas’ NHS FT said in his report that NHS leaders were “exposed to a range of unique pressures” and were operating in conditions that are “stressful and difficult, with great responsibility and the highest stakes.”

The ‘Empowering NHS Leaders to Lead’ report said: “The difference these leaders make is not just between success and failure, it’s the difference between life and death.

“Over time, this has led to a negative working culture in which both bullying and discrimination are prevalent and accepted.

“This must change and should be led from the top, with NHS leaders ensuring they model the highest standards of behaviour.”

The review, which included evidence from NHS Providers and NHS Clinical Commissioners, recommended a number of actions which were needed to “build a modern working culture in which all staff feel supported, valued and respected for what they do and can challenge without fear.”

The report focused on three issues: the expectations and support available to leaders, options for reducing administrative burdens on leaders, and the scope for further aligning management expectations at an organisational and system level.

It said that the “NHS struggles to recruit to leadership positions” and said that, over time, the trusts and CCGs need to implement “a range of levers and incentives” to drive improvement.

Analysis from the King’s Fund found that trusts rated as ‘outstanding’ by the CQC had only 3% of executive posts with vacancies, compared to a 14% vacancy rate at trusts rated ‘inadequate.’

Around half of trust leaders who responded to the NHS Providers survey felt that messages from the national bodies aligned with the wider expectations of them as a leader.

They said that they felt a lack of alignment from national bodies about individual trust performances, and some cited examples of “conflicting messages.”

One of the review’s major recommendations was to use the NHS long-term plan to ensure challenged NHS organisations become “desirable” places to work, and called for a “new deal” between national bodies.

The director of policy at NHS Providers, Miriam Deakin, commented on the review: “This report rightly recognises the need to invest in a sustainable pipeline of future leaders in the NHS, to ensure the performance requirements any trust chief executive signs up to are realistic, and to ensure talented leaders have the support they need to succeed in challenging times.”

She said the long-term plan is an opportunity to translate actions into words and “ensure we are supporting and nurturing talented local leadership teams from a diverse mix of backgrounds.”

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