Ministers and national leaders are failing to model compassionate treatment of staff, say experts

Health ministers and national NHS leaders are still failing to model the compassionate treatment of staff the health and care system needs at all times, experts have said.

Richard Murray, chief executive of the health think tank the King’s Fund, said the government’s recent plan to make GPs deliver more appointments face to face harked back to old style, dogmatic leadership approaches.1 “It was almost a voice from the past, a slightly shouty or aggressive system of leadership which we know from the evidence doesn’t work,” he said.

Murray was chairing a debate on leadership, hosted online by the King’s Fund on 25 November, that discussed the government’s recently launched review of leadership in health and social care.23

Suzie Bailey, director of leadership and organisational development at the King’s Fund, said that, despite some encouraging signs of progress towards emphasising kinder leadership behaviours, England was still lagged somewhat behind Wales, Scotland, and Northern Ireland. “We continue to hear stories of national performance management and regulation that is anything but kind and compassionate,” she said.

She added, “An ‘off with their heads’ approach to performance management doesn’t improve performance and doesn’t deal with the systemic causes of underperformance. It also risks creating a toxic leadership culture, and fear doesn’t incentivise anyone or improve anything.”

Panellists representing leadership bodies in the NHS and social care said that staff and leaders were under extreme pressure in trying to steer a covid recovery and to gear up for structural reforms. They faced endemic workforce shortages along with high levels of stress, burnout, bullying, discrimination, and under-representation of ethnic minority groups in leadership roles.

The experts said that the government’s leadership review, being led the by former vice chief of the defence staff Gordon Messenger, was an opportunity to improve things but warned that past leadership reviews had not always been acted on. They said the latest review should seek to foster compassion and develop and support frontline staff and teams to take up “collective leadership,” and not focus only on the most senior executives.

Panellists described how local health and care leaders often struggled to cope with overlapping and disjointed priorities set by national or external bodies.

Matthew Taylor, chief executive of the NHS Confederation, said that staff at the local level lacked autonomy and felt they were working under “multiple layers of control and multiple systems of accountability.”

“The NHS is just far too centralised, it’s as simple as that,” he said.

“It’s very difficult to exercise compassion when you’re under an enormous amount of pressure and those pressures are pulling you in different directions. We’ve got to create a shift that enables power and autonomy to flow down the system at all levels,” Taylor said.

Bailey said, “There is so much emphasis on integrated care at the moment and the focus on the recruitment to those roles, that we’re forgetting the day to day lived experience of people coming to work in the health and care service. I’d like to see this review place much more emphasis on these different levels.”

Murray said that when the topic was clinical care it often came round to how many nurses and GPs the NHS needed but that discussion of managers and leaders tended to be about culture and skills. “We might have focused a bit too much on their capabilities and not whether there are enough to go around,” he said.