The comprehensive independent report – authored by General Sir Gordon Messenger and Dame Linda Pollard – has been welcomed by the Health and Social Care Secretary Sajid Javid who has pledged to accept all seven of their recommendations.

The report team met with thousands of NHS workers from across the country from a variety of different roles to understand how to improve the culture and the leadership landscape in the NHS. Not only will this improve harmony and efficiency across the health service, but it will ensure that value for money is achieved through joined-up working.

The team’s investigation found mixed results – ranging from countless examples of inspirational leadership to a lack of consistency and coordination across the board. The latter was damningly described as ‘institutional’ as leadership and management has failed to be trained and cultivated adequately for many years.

Worryingly, there was widespread evidence of bullying and discrimination – with many staff fearful of speaking up – as well as a lack of equal access to training and career progression due to preferential treatment for those with existing networks and contacts.

In a positive development, the report has unveiled its plans to attract talented individuals into leadership roles in the most challenged parts of the NHS – achieved through incentives and continued support. This marriage will ensure that the best people are in place to fully deliver plans developed by the Government and the NHS to equalise disparities.

All seven recommendations from the report are outlined here:

1. Targeted interventions on collaborative leadership and a unified set of values across health and social care, including a new, national entry-level induction for all who join health and social care and a new, national mid-career programme for managers across health and social care.
2. Action to improve equality, diversity and inclusion (EDI), including embedding inclusive leadership practice as the responsibility of all leaders, committing to promoting equal opportunity and fairness standards, more stringently enforcing existing measures to improve equal opportunities and fairness, and enhancing CQC’s role in ensuring improvement in EDI outcomes.
3. Consistent management standards delivered through accredited training, including a single set of unified, core leadership and management standards for NHS managers, and a curriculum of training and development to meet these standards, with completion of this training made a prerequisite to advance to more senior roles.
4. A simplified, standard appraisal system for the NHS, including a more effective and consistent appraisal system, to reduce variation in how performance is managed and focus on how people have behaved not just what they have achieved.
5. A new career and talent management function for managers, including the creation of a new function at regional level to address a lack of clarity and structure in NHS management careers, providing clear routes to progression and promotion, and ensuring a strong pipeline of future talent.
6. More effective recruitment and development of Non-Executive Directors (NEDs) – NEDs play a vital role in providing scrutiny and assurance, and an expanded, specialist Non-Executive Talent and Appointments team will encourage a diverse pipeline of talent.
7. Encouraging top talent into challenged parts of the system, including a better package of support and incentives in place to enable the best leaders and managers to take on some of the most difficult roles, whereby roles in challenged areas are seen as the best jobs rather than the most feared jobs.

In response to the report, the Health and Social Care Secretary Sajid Javid said, “The findings in this report are stark, it shows examples of great leadership but also where we need to urgently improve. We must only accept the highest standards in health and care – culture and leadership can be the difference between life and death.

“I fully support these recommendations for the biggest shake-up of leadership in decades. We must now urgently take them forward, to ensure we have the kind of leadership patients and staff deserve, right across the country”.