• Regional teams will use four new metrics from staff survey data to assess culture
  • Six new metrics have been added for CCGs, including overall waiting list size and 52-week waits
  • Nuffield Trust chief executive says regional teams’ behaviours will be important

Cultural issues within NHS trusts will be monitored by NHS England’s regional teams under its new single oversight framework.

The framework, which covers commissioners and providers, was published by NHS England this week and includes four new metrics drawn from the staff survey to examine bullying and harassment, teamwork and inclusivity within providers.

It makes clear the new regional teams will lead on performance management of NHS organisations.

The document said there was a strong link between compassionate and inclusive leadership cultures and good organisational performance, including on finances, patient experience and staff engagement.

It said: “Four metrics have been added to the set used to identify issues at providers. These are based on the annual NHS Staff Survey and cover bullying and harassment, teamwork and inclusivity, to highlight their importance as indicators of overall organisational performance and assist regional teams in identifying organisations where an enhanced support offer in these areas is appropriate.”

NHSE will also look at measures beyond the staff survey but said focusing on those metrics now meant “those organisations that most need it can begin to receive our culture and leadership programme, which will enable them to deliver a strategic and organisation-wide approach to improving their culture”.

Regional teams will use composites of staff survey questions on bullying harassment, teamwork and inclusion to assess the views of staff on organisational performance in these areas.

Six new metrics for CCGs

NHSE has also added six new clinical commissioning group metrics to the single oversight framework for 2019-20, including measures focused on the overall waiting list sizes and patients waiting longer than 52 weeks for treatment.

Metrics have also been added to monitor the percentage of learning disability mortality reviews being completed within six months and a separate metric measuring the investment in child eating disorder services as a percentage of total mental health spending.

In addition, the national body has included metrics on evidence-based interventions and reducing the rate of low priority prescribing by GPs.

All six metrics reflect priorities for NHSE. Regional teams will use the measures to monitor local performance and take increasing action against CCGs and trusts which lag behind.

Not ‘parent and child’

Nigel Edwards, chief executive of the Nuffield Trust, told HSJ what mattered more than the framework was the way regional team staff interpreted how to behave towards organisations they were managing.

He said: “The issue with these regimes is never the formal way it is written, which is pretty unobjectionable. It is more about how it is enacted and how the people who are tasked with the individual relationships choose to do their business. There is a long history of those people going beyond their powers and not conforming to the culture the system says it wants.

“These regions are the size of an EU27 country. They are big. It’s likely there are going to be people with responsibility for patches within them and that is where it tends to go wrong. People behave in a way that might not reflect the intentions of the regional director.”

He said regional managers needed the right blend of prioritisation, proper performance management and helping organisations get support for improvement, acting in an “adult way rather than a parent and child… you can’t write that in a framework”. 

Mr Edwards added the metrics from the staff survey were welcome “and not a bad sense check on the culture of an organisation”.

The single oversight framework reflects the coming together of NHS England and NHS Improvement and the increasing integration at a regional level with new integrated care systems across large localities.

Miriam Deakin, director of policy and strategy at NHS Providers, said: “It is important the framework continues to recognise the statutory responsibilities and accountabilities of trust boards and that sustainability and transformation partnerships and integrated care systems derive their authority from the individual organisations that comprise them.

“It will be vital that the next phase of work to further develop the framework for 2020-21 is done with the full involvement of providers and commissioners.”