Health and Social Care Leadership Review

Baroness Fookes Excerpts

Thursday 9th June 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I thank everyone who works in the NHS for their continued dedication and skill. We owe them our gratitude. I also put on record my thanks to General Sir Gordon Messenger and Dame Linda Pollard for leading this very important review.

We know that we are at the foothills of a huge programme of NHS reform and reorganisation, which your Lordships’ House carefully scrutinised during the passage of the Health and Care Act. It came through loud and clear that the healthcare system requires proper leadership and a workforce that has enough staff to do the job, something that we know is not the case at present nor is suitably in the pipeline.

I confirm that these Benches support the review’s seven recommendations and welcome that the Secretary of State has already agreed to implement them. However, the critical thing will be to see whether, when and how the proposals are implemented and we will keep a close eye on this. Regrettably, we have too often seen the commissioning of a review by Ministers only to see those same Ministers drag their feet on implementing the recommendations or shelve them completely. Will the Minister give us today a firm date for when he intends to publish the plan to implement the seven recommendations?

The social care survey from the Association of Directors of Adult Social Services shows that more than 500,000 people are waiting for a social care assessment in England, and we need swift action to alleviate this. Will the Minister explain why the review has not covered leadership in social care or primary care in sufficient detail? Is not this a missed opportunity?

Of course, this review is just one part of dealing with the crisis that the NHS faces. New staff getting an induction when they first join the NHS is sensible, but that is just a basic requirement of any organisation worth its salt. We all know that there are bigger, real mountains to climb. Waiting lists are at a record high: 6.4 million in the queue for treatment—nearly one in 10 people—patient satisfaction is at its lowest since 1997, and there have been longer waiting times for cancer treatment in every year since 2010. So it goes on.

There are currently 106,000 vacancies in the NHS, and staff are leaving in droves. In many specialities, they are leaving faster than they can be recruited to those vacancies. It remains to be seen how a shake-up for management will help our health outcomes and alleviate pain and suffering when there are not enough front-line staff. This has to be the Government’s focus.

Yesterday, the Secretary of State talked about the 15-year workforce strategy that he has commissioned. When can we expect it? It would be much appreciated if the Minister could put more flesh on the bones of this brief reference yesterday. Who will be leading this and what will be its terms of reference?

It would be negligent not to mention the role that managers played in the North East Ambulance Service cover-up. The Government are still considering whether to launch a review. Will the Minister provide an update? Surely, if management is to be improved, there is a need to learn from the times when it fails. The incidents at the North East Ambulance Service are a clear case in point.

Finally, it is regrettable that NHS senior leadership still does not represent the diversity of the population that it serves. How will the Government drastically improve equality, diversity and inclusion? And how will the best leaders—whether or not they have a so-called good network—be encouraged, prepared and brought into the most challenging roles where we need to see them?

These Benches welcome the review and its recommendations, but there are many outstanding questions while the NHS is in dire need of support and a workforce able to meet the demands and serve the people who need it.

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely and I now invite her to speak.

[Baroness Brinton (LD) [V]]

My Lords, from these Benches we also thank all the staff in the NHS and social care sectors, and specific thanks go to General Sir Gordon Messenger and Dame Linda Pollard for this excellent report. We too support the recommendations in the report.

The Liberal Democrats believe our NHS is in desperate need of support. We need to remember that there are well over 100,000 NHS staff vacancies—and an equally worrying number in the social care sector—and we are concerned about the impact of these vacancies on patient safety.

With millions now waiting for treatment and waiting times increasing, it is more important than ever that the Government address the workforce crisis facing health and social care. We have just come this afternoon from debating two key issues in Grand Committee that the NHS faces: managing RSV and other respiratory infections, and managing neurological conditions.

The two sectors have serious staff shortages in clinical health and that is replicated right across the NHS. After a gruelling couple of years, many staff are considering leaving or retiring early. The Government need to get a grip on this workforce crisis and seriously start planning for the long term, giving the crisis the attention it deserves. I too echo the question from the noble Baroness, Lady Merron, about when the workforce planning draft will first be presented to Parliament. It is urgently needed.

This leadership report is blunt. It highlights the current absence of accepted standards and structures for the managerial cohort within the NHS and says that it has

“long been a profession that compares unfavourably to the clinical careers in the way it is trained, structured and perceived”.

And that is not just inside the NHS. Far too many people—even Ministers—slam managers as unseen, expensive bureaucrats. This report calls that out, as well as recognising that consistent standards and improvement are needed. That is welcome.

The recommendation for a new national entry-level induction for all who join health and social care, as well as national career programmes for managers right across the sector, is very welcome, but what plans do the Government have now for the interim? The crisis is with us—we see it every night on the television news—and the benefits of training and culture change will take some time to bear fruit.

The executive summary advocates a step change in the way the principles of equality, diversity and inclusion are embedded as the personal responsibility of every leader and every member of staff. It goes on to say that good practice is by no means rare but it is not consistent throughout the NHS, and it raises particular concerns about the experience of those with disabilities or race-protected characteristics. We agree with the report’s proposals that EDI should become a universal indicator of how the system is working.

The fourth recommendation in the report on the simplified standard appraisal system is also welcomed, alongside consistent management standards and consistent accredited training. The talent management recommendations are also excellent.

We welcome any measures that seek to improve the way the NHS works, such as the Government’s pledge to build more hospitals, but many of our senior NHS managers struggle with failing buildings that, rather like our Parliamentary Estate, need urgent repair or replacement—but until then they have to try to make them safe. My own local hospital, Watford General, is a case in point. With that in mind, will the Minister please tell us how he proposes to unblock the delays to meet his Government’s pledge of 40 new hospitals by 2030?

Yesterday, the Secretary of State likened the NHS to the now-defunct video store Blockbuster, saying that the country has a

“Blockbuster healthcare system in the age of Netflix”

and that things would change by 2030. To date, only six projects that predate the Prime Minister’s premiership have started construction, despite the Government’s 2019 election pledge that 40 would be built by 2030.

A core theme of the report is collaboration. It reports pockets of excellent practice but also pockets of stuck and poor practice. The report is clear that a real culture change is needed now. In some parts of the NHS there is still an “ignore if not invented here” approach that must be challenged and changed.

Leadership is indeed key to a well-functioning health service, but having enough staff to care for patients is critical to reducing waiting times and improving patient outcomes. Ministers seem keen only on tinkering with leadership programmes. They seem to be ignoring the huge number of vacancies in the NHS and recently refused to write workforce planning and projections into law. So what additional steps will they take to increase the number of doctors and GPs working in our health service in the next nine months? Workforce shortages across the health and social care sector are leading to long wait times and poor outcomes.

Our NHS leaders have done a sterling job steering the NHS through the pandemic and now they are trying to tackle record-breaking waiting times. Leadership is pivotal to the success of any organisation, and the example set by the head of the organisation plays a huge part in that success.

It is a shame that the report focuses only on the NHS and not on the department, because it is important that we remember that two areas over which the Secretary of State’s predecessor, Matt Hancock, had power were PPE and test and trace, both of which were extremely badly handled in leadership terms. Does the Minister agree that leadership starts with Ministers? In an exchange between the Secretary of State and General Sir Gordon Messenger published yesterday, the Secretary of State said, “Leadership is critical”.

Finally, the most welcome chapter of the report is the final one, chapter 4, on implementation. The authors set out a clear route map for making this happen through the establishment of the review implementation office. I note that, yesterday, the Secretary of State said that he accepted all the recommendations. From these Benches, we will hold him to account for the resources necessary for the review implementation office to deliver them.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I thank the noble Baronesses for their questions and for their general welcome for the tone of the Messenger report. I also pay tribute, as did the noble Baronesses, to Sir Gordon Messenger and Dame Linda Pollard for their combination of leadership skills as well as clinical and medical knowledge. I pay tribute too to the number of people who were consulted across the system who fed into the report.

I shall try to address some of the questions that were asked. The Messenger report looked at both health and social care. It was interesting that reference was made to reports being published but nothing being acted on. I think we can be proud that, for the first time, we are now aiming, as is set in law following the passing of the Health and Care Act, for a properly integrated health and care system. We can now work to that properly across the system.

In December 2021, the Government published their strategy for the adult social care workforce in the People at the Heart of Care: Adult Social Care Reform White Paper. Our strategy aims to create a well-trained and developed workforce, a healthy and supported workforce, and a sustainable and recognised workforce. Work that has already started includes the review of the existing workforce and the voluntary register to look at the workforce landscape and the various qualifications. We also want to look at how we make sure that the workforce is professionalised and that people feel attracted to it as a career. The strategy is backed up by an historic investment of at least £500 million for new measures over three years—noble Lords will be aware of that.

Both noble Baronesses raised workforce planning. During the debates on the Health and Care Bill, I made it quite clear that where we disagreed with some of the amendments was on the frequency of the reports that was called for. Let me be quite clear about what we are doing in terms of workforce. First, we have the Health Education England strategic framework to support long-term planning. The department commissioned HEE to review and renew the long-term strategic framework for the health and regulated social care workforce—the right skills and the right values and behaviours to deliver world-leading services. The work is nearing its final stages and will be published before the Summer Recess.

Building on this, we have also commissioned NHS England and NHS Improvement to develop a long-term plan for the workforce for the next 15 years, including long-term supply projections. We will share the key conclusions of this work as soon as it is ready. Section 41 of the Health and Care Act 2022 gives the Secretary of State a duty to publish a report at a minimum of every five years describing the NHS workforce planning and supply system. The report provided for in that section will increase the transparency and accountability of the workforce planning process. On top of this, rather than everything simply being top down—the person in Whitehall or Westminster telling local services what to do—there is also the bottom-up planning, at trust level and ICS level, looking at the right workforce and skills mixes required on the boards and in the services to deliver the right services to patients.

The noble Baroness referred to the North East Ambulance Service. This highlights why this report was so badly needed. My right honourable friend the Secretary of State for Health and Social Care said yesterday in the other place that he was very concerned by what he has heard about the ambulance service and that he is not satisfied with the review that has already been done. He said that we need a much broader and more powerful review; he will have more to say about this very shortly.

We welcome the report. We have rightly said, as both noble Baronesses have said, that we welcome all the recommendations. To ensure that these are delivered as quickly as possible and with the right impact, an implementation plan co-created across the whole health and social sector is required. This report will therefore be followed by a plan with clear timelines and deadlines for delivery.

I am grateful to both noble Baronesses for raising the issue of discrimination and lack of diversity. It is interesting that our public services post war were rescued by immigrants from Commonwealth countries—from Africa, Asia and the Caribbean—yet, amazingly, we do not see them at the top of these organisations. Why is that? Frankly, we must move away from this position of white people stopping black and Asian people from being promoted and fobbing them off as “diversity officers”. They do not want to be diversity officers. We are good enough to be leaders and we must ensure that this is instilled right through our health and social care system, not just at the bottom level but all the way up. That will be the test of true diversity and true openness to equality.

There has been some positive movement towards tackling discrimination. The NHS people plan established a set of robust and comprehensive initiatives thought to imbed equality, diversity and inclusion. The recruitment and promotion practices have been overhauled and there will be named equality champions, but we must ensure that this is not just fobbing off. We need to see more diversity right at the top of our health and care system.

If I have not answered the noble Baronesses, I will write to them.

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, the noble Baroness, Lady Masham of Ilton, wishes to take part remotely, and this seems a convenient moment to call her.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I congratulate the Government for instigating this—

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, we appear to have had a break in service, but I think we now have the noble Baroness.

[Baroness Masham of Ilton (CB)]

It is tragic that so many babies and mothers have died when they should have been safe in hospital. What happened to the standards of care which were required? Fresh young enthusiastic people joining the NHS and those in care should be safe from bullying, harassment and discrimination. If something goes wrong with patients’ treatment and care, should there not be a duty of candour, with openness and honesty? Surely this should be incorporated in leadership education. I hope that it will be.