More money won’t solve NHS crisis, says head of review

‘Unless you get the right culture, it’s almost like painting the bedrooms without fixing the roof ’

THROWING money at the NHS will not address its fundamental weaknesses, the author of a review into the leadership of the health service warns.

General Sir Gordon Messenger says that the health service is in urgent need of reform, without which extra funding will be wasted.

He suggests supermarkets and banks are better at ensuring the right people are in senior management roles than the health service.

He made the intervention as the NHS faces the biggest strikes in its history today, with nurses and ambulance workers walking out over pay. Unions are demanding pay rises of up to 19 per cent, despite warnings such salary increases would eat into budgets that were expanded to fund reform and improve patient outcomes.

In his first major interview since leading the review of health and social care leadership, which was ordered by Boris Johnson, Sir Gordon says: “The two big things you want from the health service are productivity – ie effective use of public money – and good patient care.

“I would argue that a really important component of that is a well-led, well motivated, valued, resilient workforce, which comes from the culture, and the right attitude to leadership. I found an inadequate focus on that … and I would argue that unless you get the right culture, which means better leadership, it’s almost like painting the bedrooms without fixing the roof, in terms of throwing money at A&E waiting times.”

He made the comments a week after Rishi Sunak, the Prime Minister, published an Urgent & Emergency Care Recovery plan, backed by £14billion extra spending over two years, to tackle record A&E and ambulance waiting times.

The boost in last year’s budget followed a £36billion three-year spending plan agreed the previous year.

Increases in funding to clear waiting list backlogs have remained in place even after the hike in National Insurance intended to pay for them was axed.

The former general, who led the Royal Marines’ invasion of Iraq, is clear that he is not suggesting funds are not needed but warns money will continue to be wasted without efforts to improve the quality of management and motivate staff.

“Unless you have that well-led, well motivated, valued, resilient workforce, the sand is slipping through your fingers, however much you keep topping it up,” he says.

Thousands of ambulance workers and nurses are to take part in simultaneous walkouts in the latest day of industrial action to affect the health service. Steve Barclay, the Health Secretary, said the strikes would “inevitably cause

further delays for patients who already face longer waits due to the Covid backlogs.” He emphasised that high pay rises would fuel inflation.

Grant Shapps, the Business Secretary, said that the action could cost lives.

Sir Gordon said that a “sense of constant crisis” in the NHS too often meant other matters are neglected.

“They have too much ignored looking after the team and the individuals and I would argue if that skewing continues – which it has – it quickly leads to a reduction in the quality of the output.”

Sir Gordon, a former vice chief of the Defence Staff, says all NHS managers should now be asked to achieve competence standards, at key points in their career, in order to develop the best leaders – and avoid over-promotion of those without core skills.

“You need to have a known bar, a known competence at entry point, at mid-career, and as you approach seniority,” he says.

“Sainsbury’s do this, Barclays do this, This is not a ground-breaking proposal, but in the NHS talent management is almost non-existent.”

As a result training and development was “accidental” with too much promotion based on familiar faces, he suggests. “I would describe the senior leadership in the health sector as a transfer market,” he says.

“It’s just headhunters that are paid ridiculous amounts of money phoning up the names that are already known and asking if they want to do jobs as the head of trusts; it’s unbelievable.”

As the biggest employer in the

‘There’s just diktats fired down from on high without any understanding of the impact they have’

country, the NHS should be able to do far more to “talent spot” good people and develop them, he says.

Sir Gordon, who spent 38 years in the military, says he was surprised by the extent of the “blame culture” and “responsibility avoidance” in the NHS.

He says: “There is definitely a sense that there’s just diktats fired down from on high without understanding of their impact and the relationship between centre and the coalface is not great.”