There should be fewer NHS organisations to avoid management talent being spread too thin, a high profile report on the leadership challenge has recommended, plus the rest of today’s news and comment

5.40pm BBC health editor Hugh Pym has blogged about HSJ’s Future of NHS Leadership inquiry report, and whether the health service needs a leadership shake-up.

“The Health Service Journal panel has certainly raised the profile of the issue and set out the case for reform,” he writes.

5.20pm The campaign group Cure the NHS, which campaigned for the Mid Staffordshire public inquiry, has criticised the decision by NICE to suspend work on nurse staffing levels – exclusively revealed by HSJ earlier this month – as a “bitter blow… to the relatives of Mid Staffs”.

“[Cure the NHS] battled to get the Mid Staffs Public Inquiry and to now have to battle for key recommendations to be implemented is a step too far, for us,” the group said in a statement issued today.

“Our loved ones and many other vulnerable patient suffered unnecessarily on understaffed wards at Mid Staffs. Mid Staffs board’s priority was to “balance the books” and this came at a very high price for our loved ones,” the statement continued.

“It is our worry that [NHS England] will have one eye on the finances when drawing up this guidance, instead of patient & staff safety. We believe that is why Sir Robert Francis recommended NICE and not [NHS England] to do this work.

Cure the NHS intends to march from Downing Street to Richmond House this Thursday, to hand a letter to health secretary Jeremy Hunt asking him to immediately reverse the decision.

The group’s founder Julie Bailey said: “It is critical that this work is done independently. We cannot allow this important work to be sabotaged we have all waited too long for this already.

“Our fear is that the guidance will be based on cost and not evidence, anymore. Removing NICE from this critical work in our opinion is a step backwards for patient and staff safety.”

On Thursday we will unite, march together with a shared message that safe staffing means safer patients and it is critical that NICE should be allowed to continue with this work”.

3.06pm There are only five days left to enter the HSJ Awards 2015.

Entries close on Friday 19 June.

There are 22 categories to enter this year, including a new category to showcase the organisation that best improves outcomes through learning and development.

The last year has been a crucial period in the development of the NHS. The need to improve efficiency, while maintaining or improving quality, has been combined with the challenge of introducing new care models and navigating increasing levels of government and regulatory scrutiny.

The winners will be announced at an event at Grosvenor House Hotel in London on 18 November.

Should you need any help with your entry, please call Flavio Rispo on 020 3033 2350 or email

2.10pm Through intelligent procurement and making use of available analytical tools, NHS trusts could save millions, says Edi Truell, chief executive of Tungsten Network.

1.46pm Commenting on the recommendations from HSJ’s Future of NHS Leadership inquiry, NHS Providers chair and inquiry panel member Gill Morgan said: “The results of the report offer a clear leadership message that will sustain the future of the NHS and act in its best interests.

“The most important influence on behaviours in NHS organisations is the culture - it was the key problem identified by both Robert Francis and Don Berwick in their reports resulting from the failures at Mid Staffordshire NHS Trust.

“Boards must develop a clear and powerful leadership strategy to nurture the NHS cultures we will need for the future. This includes making sure that leadership reflects the diversity of the staff and local community, and specifying the skills leaders require to achieve the organisational vision, for example,  improving compassion, staff engagement and openness.

“It will also involve identifying collective leadership capabilities so that clinical and non clinical leaders work together to implement organisational strategies.

“It is a leadership in which all take responsibility for ensuring high quality patient care otherwise we cannot move forward.

“The Dalton Review explored the different organisational models trusts could adopt to secure clinical and financial sustainability for NHS care in the future - different models bring different benefits, but the advantages of effective leadership will be common to all.

“In this renewed effort to maximise the NHS leadership talent pool, it is important that we maintain the principles of the Foundation Trust model, ensuring that NHS providers have access to appropriate freedoms.

“Future leadership in the NHS, across health and social care, requires not only enough capacity but also the right capacity to make the radical changes required in the coming years.

“Organisations need to bring together different leadership perspectives so that their activities and efforts deliver integrated, consistent and coherent care for all patients and service users.”

1.43pm Barts Health Trust has appointed a new interim finance director, to replace a departing interim.

Ian Miller has left the trust after five months in his temporary post.

1.35pm In response to HSJ’s Future of NHS Leadership inquiry, Health Foundation chief executive Jennifer Dixon said: “The inquiry led by the Health Service Journal highlights important issues that need to be addressed to strengthen leadership within the NHS, with the goal of making rapid improvements in the quality of care in England.

“We identified a number of ingredients for successful change in our report ‘Constructive Comfort’ earlier this year. People leading change in the NHS spoke to us about an unrelenting set of pressures – including pressure on performance, feeling unsupported by the system they work in, and media attention on where the service is failing.

“Today’s report rightly identifies the need to make leadership roles more attractive and manageable. But leadership is only one issue which needs addressing. We need a better balance in the  national approach to improving quality moving on from ‘prodding and performance managing’ organisations to ‘support’ , greater investment in skilling up front line clinicians to make changes across services, and a rethink about the capacity in the NHS to improve operational processes on which clinical care rests. Without this needed change to improve care for patients will be delayed.”

1.05pm Nearly half of Bolton’s stroke patients are still being admitted to their local hospital despite a service reconfiguration.

Changes implemented in March mean all new stroke cases in Greater Manchester should receive their initial treatment at one of three specialist “hyperacute centres” at Salford Royal Foundation Trust, Pennine Acute Hospitals Trust or Stockport FT. It is hoped the centralisation of services could save 50 lives a year.

12.31pm In England the NHS carried on treating long waiters in April as if the ‘managed breach’ had never come to an end, scoring a significant improvement in waiting times, writes waiting times expert Rob Findlay.

12.20pm NHS England non-executive director and former Macmillan chief executive Ciaran Devane has been knighted as part of the Queen’s birthday honours.  He is currently chief executive of the British Council.

 The Department of Health’s permanent secretary Una O’Brien was appointed DCB for public service, particularly to healthcare.

 Other health professionals who received honours include Chaand Nagpaul, Chair of the BMA’s GP committee, who was awarded a CBE for his services to primary care.

Mr Nagpaul said he was “truly touched and humbled to receive this award”.

“It is a tribute to the hard work and dedication of [more than] 40,000 GPs across the UK, who I am immensely proud and privileged to represent,” he added.

Salford Royal Foundation Trust’s executive nursing director and deputy chief executive Elain Inglesby-Burke was also awarded a CBE for her services to nursing.

Alzheimer’s Society chief executive Jeremy Hughes was awarded a CBE for services to older people.

CBEs were also given to Imperial College Healthcare Trust remuneration committee chair Jeremy Isaacs, and Independent Reconfiguration Panel chief executive Richard Jeavons, who also NHS director of commissioning for specialised services, for their services to the NHS.

Sandwell and West Birmingham Clinical Commissioning Group chair Nicholas Harding, who was a founding partner of the ‘super practice’ Vitality Partnership, was awarded an OBE for services to primary care.

NHS Confederation director of policy Johnny Marshall, also a practicing GP in Buckinghamshire, was appointed OBE for services to general practice.

11.35am Take a look at our interactive maps of local NHS waits around England in April, showing the pressures and one year waits, with links to all the detail by organisation and specialty.

10.50am Barts Health Trust has revealed it will take 18 months to sort out problems with its waiting times data.

The trust stopped reporting its referral to treatment waiting list to NHS England in September after uncovering problems with its patient administration system.

10.09am You can download the full HSJ Future of Leadership inquiry report here.

Leadership in the NHS is an endlessly debated topic – but discussions rarely go beyond the expression of bland platitudes and well-worn truisms. Only very occasionally do these debates produce actionable conclusions with lasting impact on the management of the NHS. 

This report is an attempt to go beyond that uninspiring conversation, to provide real insight into the challenges faced by current and future NHS leaders, and to make some concrete recommendations on how they may be overcome.

Thirty years ago Roy Griffiths produced his landmark report containing the defining phrase that “if Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge”.

It was, precisely, the right diagnosis for the time. It led to the introduction of general management in the NHS – a form of leadership which replaced the “consensus management” that had arrived with the 1974 reorganisation of
the NHS. 

Consensus had failed because it effectively gave a veto to any member of the team and too often produced, in Sir Roy’s words, “lowest common denominator decisions”, if any decision at all.

Today’s debate on healthcare leadership, nationally and internationally, is all about integration and system leadership – perhaps
a reinvention of consensus management, but this time between organisations rather than within them.

9.53am The NHS has ‘failed’ to encourage clinicians to take up leadership positions, the chair of HSJ’s inquiry into NHS leadership has said.

Sir Robert Naylor, chief executive of University College London Hospital Foundation Trust and chair of the Future of NHS Leadership inquiry, said clinicians had not been incentivised, partly because professional bodies “have not supported clinicians going into leadership as much as they should have done”.

He added that the rewards for clinicians to go into leadership were not “sufficiently great” and the “downsides of failure are greater than the upsides of success”.

9.38am: The HSJ leadership inquiry report has also been covered in the Guardian, which leads on the recommendation that the NHS Trust Development Authority publish its list indicating which trusts it does not believe will achieve foundation status as they are not sustainable.

9.29am Chair of the HSJ Future of NHS Leadership Inquiry, Sir Robert Naylor, spoke about the report on BBC Radio 4’s Today programme this morning.

He said: “We have a very fragmented system and a large number of organisations requiring leadership…Because of that fragmentation it’s very difficult to find the talent to be able to fill all of these posts.”
Sir Robert, chief executive of University College London Hospitals Foundation Trust, was also asked about clinical leadership.

He said: “Our clinicians are some of the brightest people in our society and yet they’ve not been encouraged to become involved in leadership positions in the past.

“In most healthcare systems around the world clinical leadership is cherished as looking after communities and groups of patients as opposed to looking after individuals. For example in America many clinicians aspire to take on high level leadership positions and eventually become chief executives.”

He said: “There are a number of reasons why [clinicians don’t take on leadership roles]. They’re not incentivised to do so…

“There are too many organisations, we counted up over 800 different posts in the NHS where we require people at a chief executive level. That’s far too many. We should significantly reduce that number to reward clinicians adequately.”

7.00am Good morning and welcome to HSJ Live.

There should be fewer NHS organisations to avoid management talent being spread too thin, a high profile report on the leadership challenge has recommended.

The HSJ Future of NHS Leadership inquiry calls for the publication of a list of acute trusts that are not sustainable as standalone organisations that has been drawn up by the NHS Trust Development Authority but kept confidential. This should be published by the end of July.

These organisations should then be taken over by successful trusts, incorporated into hospital chains or run as franchise operations, the review suggests.

HSJ understands that senior government policymakers are concerned about the political opposition the list might provoke among rival parties.

The inquiry, chaired by University College London Hospital Foundation Trust chief executive Sir Robert Naylor, has returned to the issue of NHS leadership 30 years after Roy Griffiths’ report prompted the introduction of general management to the NHS, because “NHS leadership is in many respects in crisis”.