A picture of health?

Think tank: Social Market Foundation

Author(s): Richard Hyde; Niamh O Regan

July 3, 2023

This report from UK think the Social Market Foundation examines the state of leadership and management in healthcare.

The UK’s healthcare system lags behind those of many comparable countries, despite signs of slow improvement in some areas in the years before the pandemic. In this report, we examine the role that better leadership and management can play in both lifting up the tail of under-performing healthcare providers and fostering more “outstanding” healthcare providers, so that healthcare outcomes in this country are much closer those of the best systems in the world. UK healthcare provision lags behind many other comparable countries on key indicators such as cancer and heart attack survival. The aftermath of the pandemic has made the situation worse. Getting to the international frontier on healthcare will require action by politicians, policymakers and the NHS, to support improvements among the tail of under-performers, especially among acute care providers, and to increase significantly the proportion of healthcare providers rated “outstanding” in CQC inspections. Central to tackling both these problems is improving leadership and management in healthcare providers. Mounting evidence shows these factors make an important difference to healthcare delivery.

Our survey findings suggest that, while two-thirds (65%) believe leadership across the NHS is effective, there is a significant minority that do not (27%), indicating room for improvement. Performance benchmarks linked to an organisation’s overall ambitions are an example of management best practice. Yet the results from the survey found that 19% of managers did not have performance targets relevant to their role in place. Even among those who did, less than two-thirds (62%) had targets that aligned with the goals of the healthcare organisation they worked in. Even when leaders and managers already employ best practice approaches, their impact is maximised when the environment is conducive. 62% of leaders and managers surveyed said that they faced obstacles that hindered their ability to do their job as effectively as they might otherwise be able to. Obstacles cited by respondents included human resource challenges, organisational problems and internal red tape.

In order to help improve leadership and management and, in turn, boost the quality of healthcare delivery across the entire country, we propose a number of reforms, including expanding the degree of oversight of and support for leaders and managers by the CQC; offering more training in leadership and management skills to those working in healthcare; and pushing for the take-up of best practice measures in underperforming hospitals, to help improve workplace culture. The government should broaden the CQC’s “well-led” category for inspections so that it includes a detailed review of the management practices, training and leadership pipelines of the organisations it inspects; establish a set of benchmarks for judging good leadership and management that the CQC can use in its assessment of whether or not an organisation is “well‑led”; mandate in‑work leadership and management training requirements across the NHS, including primary care, for managers and leaders; mandate NHS England to establish a compulsory national excellence framework for the minimum in‑work leadership and management training requirements; and pilot workplace democracy in the NHS in under‑performing trusts.