‘Learned helplessness and crisis mentality’ prevalent in former ‘success regime’

A review of the leadership in Devon – based on private interviews with the county’s NHS chiefs – sets out the challenges they face when trying to work together.

It found a culture of “learned helplessness and crisis mentality” pervading the system leadership, and said key challenges were not tackled to avoid conflict.

Devon was one of three troubled health economies selected to be placed into a success regime by NHS England in 2015, due to its financial and performance issues.

This meant it received additional management capacity to help leaders “work together” to address deep-rooted problems that previous interventions had not solved. This ended in 2018.

The review, obtained by HSJ under freedom of information laws, was commissioned jointly by national and local NHS leaders. It was largely based on private interviews with more than 40 top-level NHS and local authority chiefs in Devon.

The review document included the following comments from interviewees:

• An unnamed provider CEO told the reviewers: “Conflict is not dealt with, people just get cross and withdraw”;
• Senior chiefs in the county complained about “packs and packs of paper” issued for meetings, making it difficult to “find the key issues hidden in the volume”. They said different people would sit in different meetings discussing the same issues; and
• Another leader told reviewers: “We love a vision and a plan. When it gets to a difficult decision we go back to developing a vision and a plan.”

The sustainability and transformation partnership, which has long been plagued by financial problems, has had three executive leadership changes since 2016 – the highest number of changes of all STPs.

The £100,000 review, carried out between April and May this year by PA Consulting, found that, while good progress was made during the success regime, this “was not enduring”. Both clinical commissioning group and provider chiefs agreed “as financial pressures have increased, individuals have retrenched back into their organisations”.

An example of leaders failing to work as a system was providers investing in different IT systems, thereby ignoring a joined-up approach.

Observing meetings, the reviewers noted: “Most comments tended to be in recognition of how hard the challenge was and how difficult it would be to address, making it harder for those who were keen to address the challenge, as they were isolated in their stance.”

However, the review concluded the health economy has the potential to turn around and become an integrated care system by 2021, as required in the NHS long-term plan. It added there was a potential for the transfer of CCG capabilities and resources to help providers.

It also praised strong relationships between the CCG and councils in Plymouth and Torbay.

 A Devon STP spokeswoman told HSJ local leaders fully accepted the report’s findings and 12 recommendations (see report attached below).

She said the leadership instability and financial and performance challenges had meant a temporary slowdown of progress was “inevitable”.

Earlier this summer, the STP appointed Philippa Slinger as its senior responsible officer, who is expected to remain in the post for between 12 and 18 months until a substantive appointment is made.

The STP has also appointed Bob Deans as director of transformation for up to four months while it “considers longer term options”. Filling both roles were among the review’s recommendations.

The spokeswoman said other changes made since the review included: improved governance and management; a development programme for system leaders to help maintain relationships through “more challenging decisions”; and a workstream focused on developing the ICS.