Truss move to cut management would ‘get in way’ of progress, says top CEO

In an interview with HSJ, Rob Webster, chief executive of the West Yorkshire integrated care system, said NHS managers have been a “fundamental” part of the response to the pandemic and that they have a “good record of delivering” when backed by coherent plans.

His comments come after Ms Truss, who was confirmed as the new prime minister today, said during the Conservative Party leadership contest she was planning “fewer levels of management” in the NHS.

When asked about the comments made by Mrs Truss, as well as similar statements from health secretary Steve Barclay, Mr Webster said: “This is part of the reality of the NHS being a political issue, that you will get this sort of debate.

“And I think if you want to enter debate about the NHS being over-managed, you can look at any one of a number of independent publications that demonstrate that it’s not, from the Kings Fund, the Nuffield trust, and various others….

“I’ve got very thick skin when it comes to this stuff, it’s politics. [But] I do think it gets in the way of the appropriate conversations about what the operating model needs to be now.

“If we’ve got a system which tries to get people to collaborate at place level, to bring together all of their resources to support improvement outcomes for local people, what resources do we need at what level?

“But the debate just turns into one about managers and cuts, when really it should be about operating models which are going to deliver success. [NHS managers] have got a very good record of delivering when we have a coherent plan, which is backed by regulation, with policy which is coherent, and process discipline and resources.

“If you look at recent experience of the pandemic, NHS leaders and managers have ensured with all of our clinical staff, administrators, volunteers and others that we’ve delivered a huge amount of additional work in a different way, rolled out the vaccination programme and so on. So managers have been a fundamental part of the covid response.”

Mr Webster said many patients in the NHS are still receiving good, safe and timely care, but at the same time many people are waiting too long to access services while staff have faced “incredible pressure” for an extended period.

“What we need to do is to work our way out of this,” he said. “And we can only do that with a coherent plan which is politically led nationally, politically owned locally, and led by people in the system collectively.”

There has also been increasing concern during the leadership contest around Ms Truss’s commitment to the ”levelling up” policies, particularly after she floated the idea of lowering civil service wages outside of London. Ministers have also been criticised recently for launching “culture wars” against the NHS, around issues such as diversity and inclusion.

Mr Webster said health inequalities are “not woke, [but] fact” and that his system’s efforts to tackle these are built upon evidence rather than “nonsense and rhetoric”.

Mr Webster, a former chief executive of NHS Confederation who has also served in national leadership roles in the Department of Health, added that tackling health inequalities is a key responsibility as an ICS leader.

He said: “If you’ve got a learning disability, if you’re black Caribbean, black African, Bangladeshi, Pakistani heritage, you’ve got worse outcomes. If you look at experiences of care, people with learning disability are more likely to die from a preventable illness, people with mental illness dying sooner, and people again from those black Caribbean, black African, Pakistani Bangladeshi communities having a worse experience of care. That’s not woke, that’s fact.

“My job is to sort that out… But we’re dealing with evidence here, not nonsense and rhetoric.”

Mr Webster added that the ICS structure has allowed best practice to be shared across West Yorkshire. For example, last year the ICS agreed to move £14m from the NHS to the council budgets to help ensure social carers are paid the national living wage.