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Drawing on new survey data, existing research and case studies the report seeks to better understand existing deficits - and the potential - of effective management. According to the research, over one in four NHS managers and leaders (27%) said senior leadership in their healthcare organisations was “ineffective” at ensuring their organisation was successful. Most of the NHS staff surveyed also reported that management-related issues are blocking them from doing their job effectively, including staff recruitment and retention, poor organisational culture, and ineffective internal processes.
The latest data from Care Quality Commission (CQC) inspections of NHS acute care services providers shows that in 2022 a quarter of inspected organisations ranked as “require improvement” or “inadequate” and very few ranked as “outstanding”. Good and outstanding managers in the NHS make a critical difference to our health. Examples in the report, including the Teaching Hospitals Trust in Leeds and Tameside and Glossop Integrated Care NHS Foundation Trust in Greater Manchester, demonstrate how investing in good management translated into better care for patients.
The NHS will need to focus on improving the quality of management if it is to meet the acute demands and deep stresses it is facing. We hope this work with the Social Market Foundation galvanises the critical reform needed to support NHS leaders, frontline staff, and patients who rely so heavily on this treasured service.
Key Research Findings
In 2022, 25% of inspected organisations were rated as “require improvement” or “inadequate”. This may equate to more than four million Consultant Finished Episodes (CFE) having been conducted and completed in poor performing trusts in 2022.
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27% of leaders and managers reported that senior leadership in their healthcare organisations was “ineffective” at ensuring the organisation succeeded. Amongst those in junior management roles this proportion rose to 36%.
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32% of respondents agreed that the leaders in their healthcare organisations were “poor” at motivating staff, 25% said that their senior leaders were not easily available to colleagues.
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62% of leaders and managers said that they face obstacles which hindered their ability to do their job effectively. Of those, 46% cited human resourcing problems (e.g. recruitment and retention), 46% highlighted organisational challenges and 20% reported process issues (e.g. red tape) as barriers.
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Proposed Improvements
Broaden the CQC’s “well-led” category for inspections
Include a fuller range in the CQC analysis of whether an organisation is “well-led”. Attention should also be paid to the amount and quality of management and leadership training and CQC should actively support institutions to help them improve their quality of care.
Mandate minimum in-work training requirements
Accredited management training should be compulsory for newly appointed managers at each stage. The training would not have to be in the form of academic qualifications, however, to ensure quality and consistent standards across the board, a new excellence framework should be developed and implemented.
Mandate NHS England to establish a compulsory national excellence framework
This framework should be developed in partnership and should focus on setting out the minimum competence requirements at each level and, in order to ensure quality and consistency, providers should be accredited themselves by NHS England.
Encourage the piloting of NHS workplace democracy in underperforming trusts
Staff motivation and morale are important parts of a successful healthcare organisation. Having an overall strategy or a vision for the organisation can go some way to motivating staff, but the vision has to be something that staff can believe in and get behind.
Case Studies and Resources
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Browse our policy work
Autumn Budget 2024; CMI Submission
CMI’s representation to the UK Government’s 2024 Autumn Budget.
Mission Possible – A plan for a stronger managed UK
Read CMI’s policy paper setting out key areas of challenge for a new government.
Spring Budget 2024; CMI Submission
CMI’s representation to the UK Government’s 2024 Spring Budget.
Spring Budget 2023; CMI Submission
Read CMI’s representation to the UK Government’s 2023 Spring Budget, outlining the need to tackle the UK’s management skills