The health service should increase the size of its graduate scheme tenfold, the Rose review into NHS leadership has concluded.

  • “Woefully small” graduate scheme should be extended tenfold
  • Senior managers should be required to attend “accredited courses” to show “consistent levels of experience and training”
  • Recommendations to ensure data requests “necessary and proportionate” to stop NHS “drowning in bureaucracy”
  • Criticism of abolition of strategic health authorities and other changes following Health Act 2012

The long awaited review of NHS management by former Marks & Spencer chief executive Lord Rose was published today as part of a wider package of reforms outlined by Jeremy Hunt.

It made 19 recommendations all of which have been accepted “in principle” by the health secretary. While a DH spokeswoman told HSJ they would work with partner organisations to take forward the recommendations, she confirmed that funding had not been identified for the expansion of the graduate scheme.

The review recommends responsibility for the NHS Leadership Academy should be transferred to Health Education England and that the NHS graduate scheme should be “reviewed, refreshed and extended tenfold”.

The report describes the current scheme as “woefully small and underpowered”.

Hunt’s 25 year vision

It also recommends that senior managers should be required to attend accredited courses to show “consistent levels of experience and training have been reached”.

On completion of this course, individuals would then “enter a senior management talent pool open to all trusts”.

The review says NHS performance management is “haphazard and weak”, and that a “simple, rational appraisal” should be developed involving a “balanced scorecard” for individuals and standardised appraisals for senior managers across the health service.

According to the report, the NHS is “drowning in bureaucracy” with “too many organisations asking for similar returns of data”.

It notes that many of the requests “are driven directly by NHS England and the Department of Health”.

Greater independence should be given to clinical commissioning groups through the creation of an officer to ensure requests are “necessary and proportionate”, with NHS England and the DH required to produce a “burden impact assessment” prior to requesting information.

Health Act slammed

The Rose review is critical of a number of changes brought about by Health Act 2012, such as the abolition of strategic health authorities.

“The disappearance of the [strategic health authorities] means there is no one to lead any region in a collaborative reconfiguration over the longer term,” it notes.

It adds: “Many continue to mourn the loss of SHAs.”

The review claims the health service is “drowning in bureaucracy” because of a proliferation in oversight bodies as “the NHS has become more fragmented and more distant from government”.

Multiple responsibilities for monitoring and compliance had “spawned an industry of data collecting”.

“All recent reforms have been about devolving the system. Now there is no one system leader; so all are vying for territory,” it notes.

The review also heard that “the system is creaking and that competition is causing harm, even that there has been too much competition”.

There had been “enormous change in the NHS in the last two years”, but people had not been equipped “personally or professionally to manage change and to make themselves properly able to do what is asked of them”.

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