Have NHS managers got the right skills?: With three CCGs recently warned, healthcare leaders must be able to engage staff and patients if they are to deliver change
Managers in both acute trusts and clinical commissioning groups have been scrutinised by the NHS leadership in the last few days and found wanting.
The NHS Commissioning Board is tightening its grip on clinical commissioning groups. On Wednesday, the announcement of the second wave of CCGs to be authorised revealed that three of the 67 – Herts Valleys, Medway and Nene in Northamptonshire – have been formally warned they could have members imposed on their board if they do not improve their performance.
On the CCG authorisation Richter scale these are ranked as "level 4" conditions. Levels 5, 6, and 7 consist respectively of firing the accountable officer, stripping the organisation of specific functions and closing the CCG down. Those at highest risk of suffering these sanctions are still going through the authorisation mill.
In the latest wave a further 45 had conditions attached to their authorisation; only 19 came through the process unscathed.
Although everyone talks about "the commissioning board", the board itself has virtually no profile. Its chair, Prof Malcolm Grant, has had almost no visibility over the last two crucial months of development of the new system.
But there is no lack of profile for chief executive Sir David Nicholson, who has begun 2013 with two interviews – including one in the Health Service Journal that was clearly a pre-emptive strike against those who would like to see his head on a pole outside the Mid-Staffordshire inquiry – and a Commons public accounts committee appearance.
It was his evidence to the Commons committee that had the most troubling news for managers – and for patients and taxpayers. He said the NHS is struggling to appoint "top drawer" trust chief executives to the many vacancies, and most of the top managers have the wrong skills.
Both admissions are an indictment of current NHS culture. Nicholson admitted that the "vast majority" of the top 1,000 managers had a pacesetter leadership style – highly directional, great for hitting targets but much weaker at collaboration, engaging staff and working in partnership.
The solution being pursued is heavy investment in leadership development, notably through the NHS Leadership Academy. That is certainly welcome and over time it will make a difference. But Nicholson's evidence emphasises that there is now serious instability right across the management of the NHS, from GPs being thrust into a strategic planning and commissioning role for which they have limited experience, to acute trusts been forced to find savings and often reconfigure services – as well as adapting to the new commissioning regime – with a shortage of appropriately skilled managers.
This highlights the central importance of the commissioning board delivering on its oft-repeated promises that the new world will be less directional and more empowering. If they do not change, the NHS will never secure the engagement with staff and patients which has to underpin reforms to the structure and culture of care that are required.
GPs need to force the pace on this. They can be great allies to acute trust managers, many of whom would be only too pleased to use the full range of their management skills rather than having to depend on the Napoleonic style which the relentless pursuit of targets perpetuates. The new commissioners can do much to encourage a focus on local care rather than national targets, and their pivotal position in the system could provide managers with some cover from the pressures exerted on them from elsewhere.
Managers also need to be courageous, rattling the bars on the cage rather than passively waiting for the door to be opened. In the past such behaviour has led to good managers being fired or forced out, so it is certainly risky, but if ever there was a moment to exert pressure it is now.
GPs leading clinical commissioning groups have one very powerful lever when it comes to influencing the commissioning board, the like of which PCTs never had. If the top-down culture doesn't change they can simply walk. Guardian Professional.
Managers in both acute trusts and clinical commissioning groups have been scrutinised by the NHS leadership in the last few days and found wanting.
The NHS Commissioning Board is tightening its grip on clinical commissioning groups. On Wednesday, the announcement of the second wave of CCGs to be authorised revealed that three of the 67 – Herts Valleys, Medway and Nene in Northamptonshire – have been formally warned they could have members imposed on their board if they do not improve their performance.
On the CCG authorisation Richter scale these are ranked as "level 4" conditions. Levels 5, 6, and 7 consist respectively of firing the accountable officer, stripping the organisation of specific functions and closing the CCG down. Those at highest risk of suffering these sanctions are still going through the authorisation mill.
In the latest wave a further 45 had conditions attached to their authorisation; only 19 came through the process unscathed.
Although everyone talks about "the commissioning board", the board itself has virtually no profile. Its chair, Prof Malcolm Grant, has had almost no visibility over the last two crucial months of development of the new system.
But there is no lack of profile for chief executive Sir David Nicholson, who has begun 2013 with two interviews – including one in the Health Service Journal that was clearly a pre-emptive strike against those who would like to see his head on a pole outside the Mid-Staffordshire inquiry – and a Commons public accounts committee appearance.
It was his evidence to the Commons committee that had the most troubling news for managers – and for patients and taxpayers. He said the NHS is struggling to appoint "top drawer" trust chief executives to the many vacancies, and most of the top managers have the wrong skills.
Both admissions are an indictment of current NHS culture. Nicholson admitted that the "vast majority" of the top 1,000 managers had a pacesetter leadership style – highly directional, great for hitting targets but much weaker at collaboration, engaging staff and working in partnership.
The solution being pursued is heavy investment in leadership development, notably through the NHS Leadership Academy. That is certainly welcome and over time it will make a difference. But Nicholson's evidence emphasises that there is now serious instability right across the management of the NHS, from GPs being thrust into a strategic planning and commissioning role for which they have limited experience, to acute trusts been forced to find savings and often reconfigure services – as well as adapting to the new commissioning regime – with a shortage of appropriately skilled managers.
This highlights the central importance of the commissioning board delivering on its oft-repeated promises that the new world will be less directional and more empowering. If they do not change, the NHS will never secure the engagement with staff and patients which has to underpin reforms to the structure and culture of care that are required.
GPs need to force the pace on this. They can be great allies to acute trust managers, many of whom would be only too pleased to use the full range of their management skills rather than having to depend on the Napoleonic style which the relentless pursuit of targets perpetuates. The new commissioners can do much to encourage a focus on local care rather than national targets, and their pivotal position in the system could provide managers with some cover from the pressures exerted on them from elsewhere.
Managers also need to be courageous, rattling the bars on the cage rather than passively waiting for the door to be opened. In the past such behaviour has led to good managers being fired or forced out, so it is certainly risky, but if ever there was a moment to exert pressure it is now.
GPs leading clinical commissioning groups have one very powerful lever when it comes to influencing the commissioning board, the like of which PCTs never had. If the top-down culture doesn't change they can simply walk. Guardian Professional.
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