The must-read stories and debate in health policy and leadership.

Toxic stuff

Rivalries and competition between leaders can be healthy, but, in the NHS, it can also have terrible consequences.

In Lancashire, a wide-ranging review of the urgent mental healthcare pathways has heavily criticised the poor relationships between key organisations, which deteriorated so much that some health and care leaders were said to “take pleasure” from problems experienced by their peers.

The reviewers found these poor relationships and a wider blame culture had “a direct impact on front line service delivery” and may have contributed to service users attempting suicide.

They said: “Significant cultural challenges exist at a senior level in the system, between providers, and between them and commissioners, which creates a direct impact on front line service delivery.

“The authors note that some senior leaders appear to take pleasure in each other’s challenge… Staff on the front line are acutely aware of all of this, and share these challenges with service users and carers.”

This is toxic stuff which has been allowed to go on for too long.

The county’s integrated care system, led by Amanda Doyle, and the new leadership at Lancashire Care Foundation Trust have now done the right thing in publishing the review findings and fronting up to the system’s deep-rooted problems.

This had to happen before serious plans could be put in place to drive improvements.

Mind the gap

According to Department of Health and Social Care analysis seen by HSJ, even with the very best efforts to boost international recruitment, the NHS will still be short of nearly 19,000 nurses by 2023-24.

And that 19,000 estimate is if “optimal delivery” of international recruitment efforts is pulled off. As Health Education England’s director of global engagement Ged Byrne has told HSJ in an exclusive interview, there are financial barriers getting in the way of some trusts investing in international recruitment.

The nature of annualised NHS finances mean some hard-pressed trusts are unwilling to invest upfront in expensive “earn, learn and return” schemes.

HEE has been meeting regularly with colleagues in NHS England, NHS Improvement and the DHSC to raise these issues and come up with possible solutions.

Professor Byrne also addressed the process of international recruitment. He stressed HEE is trying to create greater transparency in the process to improve the “conversion rates” of interested potential recruits who actually end up working in the NHS.

The HEE director explained: “We don’t have any governance arrangements around how people are recruited. This is very often mandated by a whole raft of people [such as overseas recruitment agencies] who we don’t have a relationship with.”

In response to HSJ’s stories, Dany Bell, specialist advisor at charity Macmillan Cancer Support, reiterated just how much hinges on the final workforce plans and what staff shortages mean for patients. 

“It’s critical that the government ensures there is a fully-funded plan in place to ensure that the nursing workforce can meet current and projected demand,” Ms Bell said.