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Sir Gordon Messenger and Dame Linda Pollard’s review of health and social care leadership is nearing publication. The review comes at a pivotal moment as the NHS battles to recover from the pandemic, while working to improve the quality and efficiency of services – particularly in light of learnings from the Ockenden Maternity Review. The strength of government’s response to the Messenger review will play an important role in shaping the NHS’s ability to rise to these challenges.

Our recent long read set out how NHS leadership and management can be strengthened. These insights were gathered through interviews the Health Foundation conducted with NHS managers – highlighting the challenges they face, what works well and what could be done differently. The strength of NHS leadership can ultimately determine the quality of care patients receive, while also ensuring the efficient use of public funds.

Based on our research we suggest five recommendations for strengthening NHS management and leadership.

Management practice and culture varies considerably across the health and care landscape, including within individual providers. Such variation is unlikely to be resolved through a one-size-fits-all intervention. Instead, local leaders need to be encouraged and supported to develop strategies tailored to local needs and context to ensure good practice is replicated across organisations and systems.

Training and development opportunities are currently patchy and hard to access for many current and prospective managers and leaders. Significant resources need to be earmarked to strengthen the infrastructure for training, development and talent management.

It could make sense to develop new accredited training offers and programmes on a regional basis, while ensuring these complement existing local programmes and are tailored to local needs.

Training must include the knowledge and skills managers and leaders need to flourish in today’s landscape, which is networked, place-based, data-driven and improvement focused.

This includes more emphasis on collaborative leadership skills, so that managers and leaders can work effectively with their peers across the local health care system, as well as on performance measurement, quality improvement and technology appraisal and implementation skills.

Employers and regional and national bodies have a responsibility to help ensure management workloads are feasible and that management time is spent where it can add most value.

They should reflect on how they can reduce the upward reporting burden, tackle priority thickets and avoid unnecessary reorganisations – all of which can consume management capacity and make it harder to manage effectively.

Employers, regional and national bodies should work collaboratively to shift perceptions of NHS managers and leaders and to challenge negative stereotypes, as well as ensuring that remuneration supports effective recruitment and retention.

This will be particularly important to help employers recruit and retain good managers, particularly in those parts of the country facing recruitment challenges.

Strengthening management and leadership in the NHS won’t be easy – and will require action from central government, as well as local bodies and leaders. But it is the right thing to do to enable services to recover from the pandemic.

Bryan Jones is an improvement fellow in the improvement team at the Health Foundation.

Tim Horton is an assistant director in the improvement team at the Health Foundation. 

Joe Home is a clinical fellow in the improvement team at the Health Foundation. 

Caitlin Law is an external affairs officer at the Health Foundation.

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