Hopson: Winter will test regulators on ‘aggressive command and control’

In an interview with HSJ, Chris Hopson said, although members thought some of the organisations’ leaders were “committed” to changing their approach, “leopards don’t change their spots overnight”.

Mr Hopson said: “It is relatively common in my job to hear people complain about the fact they are on the end of really quite aggressive top-down command and control.

“If it’s going to take a long time for that culture change, it means there is an uncomfortable dissonance in the meantime.”

NHS Improvement chair Baroness Dido Harding, who joined in 2017, has repeatedly advocated a change to a supportive improvement approach, both by the national organisations and elsewhere in the NHS. Mr Hopson said members believed she was committed to the change.

But he added that the coming winter, and the operational and political pressure it normally brings, would be a test for NHSE/I. He stressed the newly joined-up leadership needed to “think carefully” about how they manage it.

“Will it be [an] increasing grip and command and control in the old way?” he said. “You can’t abandon performance management and accountability but everyone in the system is looking for more support and improvement and not top down oversight.”

His comments come as NHS Providers begins its annual conference in Manchester today. And in a report published today, The State of the NHS Provider Sector, it reports that only 29 per cent of the 131 NHS trust leaders it surveyed were confident their trust had the right numbers, quality, and mix of staff to deliver high quality healthcare to patients.

To counter this, the report recommended focusing on modelling positive, inclusive leadership but also called for a “significant increase” in national funding to train more people and a flexible immigration system.

“There are no silver bullets or quick fixes,” Mr Hopson said. “It has taken us five years to get into this mess and will probably take five years to get out of it.”

Frontline leaders must step up

Mr Hopson also addressed the increasing demand on the workforce, adding this was currently being met by working staff “harder and harder”.

“Everywhere you look you get the sense that if we try and carry on squeezing our staff, it isn’t going to work,” he said. “That is the bit the NHS needs to wake up to.”

He addressed criticism the interim People Plan, published earlier this year, was “underwhelming”, instead pointing out it contained key points on making the NHS the best place to work and stopping staff from burning out. 

“You are missing the point if that’s what you are saying about the People Plan, that it was underwhelming,” he said. “We have to help frontline leaders step up to the plate and stop waiting for Health Education England and the government.”

Resolving the pensions crisis

In his speech to the conference, Mr Hopson will say the government has a crucial part to play in rapidly solving the current pensions crisis.

“The focus has been on consultants but there are other sets of people we must not forget,” Mr Hopson said.

He said these people included senior staff including managers, who were also affected by the annual allowance taper, and those at the bottom of the payscale who were struggling to have a decent quality of life.

“It is difficult to say we are going to provide high paid consultants flexibility but do nothing for the people who are asking for a different kind of flexibility at the bottom of the scheme,” he said. “It smacks of one rule for the rich and one rule for the poor.”

“We are in discussions with the Treasury and NHSE/I, and we are making these points strongly,” he added.