• NHS leaders do not feel speaking out about bullying and discrimination would make a difference, report says.
  • Sir Ron Kerr calls on regulators to deal with “bad behaviours”. 
  • Says troubled organisations need to be more “desirable” place to work.
  • Asks for “new deal” between centre and problem trust chiefs.

“Bullying and discrimination” are “prevalent and accepted” in NHS leadership, according to an official review by a former top hospital boss. 

Sir Ron Kerr was commissioned to review some of the biggest problems for NHS leadership by the Department of Health and Social Care, under the previous health secretary Jeremy Hunt. It is due to be published today and makes a series of recommendations. 

The former Guy’s and St Thomas’ Foundation Trust chief executive, who is now a non-executive director of the department, found: ”The conditions in which leaders operate are stressful and difficult, with great responsibility and the highest stakes. Over time, this has led to a negative working culture in which both bullying and discrimination are prevalent and accepted.

“This must change and should be led from the top, with NHS leaders ensuring they model the highest standards of behaviour. The review recommends a number of actions to build a modern working culture in which all staff feel supported, valued and respected for what they do and can challenge without fear.” They are some of the strongest official findings about bullying in NHS leadership from someone who has been a very senior insider in the service for many years.

The review – which included evidence from NHS Providers and NHS Clinical Commissioners – also found “negative behaviours” stemmed from the ”conflicting messages [which] can be sent to the rest of the system from within” NHS England and NHS Improvement. It said they should address this in their new joint working and via the chief people officer they are due to appoint.

Sir Ron stressed that some leaders “do not feel confident that speaking out would make a difference”.

One of the major recommendations of the review, called Empowering NHS leaders to lead, is for the NHS long-term plan to make troubled NHS organisations more “desirable” places to work. It is thought the NHS long-term plan is likely to discuss how to address long-term underperforming NHS organisations, indicating an approach and options for turnaround.

Matt Hancock, the current health and social care secretary, is due to comment on the report in a speech today.

Analysis found that trusts rated “outstanding” by the Care Quality Commission had only 3 per cent of executive posts with vacancies where “inadequate” trusts had a 14 per cent vacancy rate.

The review, therefore, called for the introduction of a “new deal”, or “starting package”, between national bodies, the incoming chief executive, chair and other stakeholders.

This would include realistic expectations of “what success looks like”, a support package including capital to address estates and technology issues and “the right balance of space” to achieve these objectives.

The review has also recommended:

  • Regional directors be given responsibility for developing “local leadership pipelines” through “regional talent boards”.
  • A recruitment strategy in partnership with NHS leaders to attract individuals from other sectors.
  • The burden of bureaucracy would be reduced via leaner performance management.
  • NHS management be further “professionalised” and include career planning and appraisals for NHS managers, linked to expected behaviours.

Responses to “Empowering NHS Leaders to Lead”

“There have been too many instances where excessive controlling style, bordering on outright bullying or coercive control has been exhibited. As a chair, I am not as exposed as officers to that sort of behaviour and I am very cognisant of challenging too hard when officers then bear the brunt of any challenge back. The original meetings of appropriate two-way challenge between NHSE and the CCG did not last very long”  - CCG leader 

“It’s aligned in that they’re asking for the same thing. It’s not aligned in that they’re all asking for the same thing separately” – Trust chief executive 

“The culture of seeing CEOs as wholly dispensable is damaging to individuals, to organisations and the reputation of the wider NHS” – NHS Providers survey 

Ex-NHS chief finds 'bullying and discrimination prevalent' in official review