On 8 June 2022, the government published the long awaited landmark review into the health and social care leadership (NHS England, 2022) carried out by Sir Gordon Messenger and Dame Linda Pollard. The review was ordered as a result of poor management and leadership decisions in healthcare in general, and in the NHS in particular, that culminated in numerous negative outcomes towards patient care and staff wellbeing. This review was instigated by the Secretary of Health, perhaps as part of a rude awakening that good leadership at every level of healthcare, particularly at the heart of the government, plays a critical role in boosting morale, trust and commitment of the workforce to continue providing care. In the last 2 years, the COVID-19 pandemic has led to care being delivered under unprecedented conditions, which has further highlighted the importance of good leadership.
The review, which is fully supported by the Secretary of Health, and presumably by the government, makes seven key recommendations. Sir Messenger and Dame Pollard emphasise:
‘For a report like this to have the impact intended, it needs to speak to the community it affects.’
However, the real test is in seeing whether the recommendations will be implemented in full.
It is important to establish that there are several examples of good leadership across the health and social care sector, but we must also recognise the widespread inequity of experience and opportunity for those with protected characteristics (race and disability), who are also often at the receiving end of discrimination (Messenger and Pollard, 2022). It is essential that managers and leaders acknowledge this, as such negative experiences tend to affect confidence and self-esteem to the extent of impacting performance, competence and creativity. A s a result, the patient always suffers. The review argues that equality, diversity and inclusion should be a noticeable thread throughout organisational systems to ensure they uphold respect and value the entire workforce. Palliative care settings can claim they are already doing some of these, but it is not enough. The review clearly sets out some of the contexts for current leaders when it reports that pressures from above can inevitably have an impact on behaviours in the workplace:
‘…we have encountered too many reports to ignore poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance.’
Key recommendations for palliative care
Although the seven recommendations are directed at health and social care sections, it is important that palliative care embraces some of them. Some of the key recommendations that may further improve the good work already being undertaken in palliative care settings are as follows:
- Positive equality, diversity and inclusion (EDI) action. Central here is a commitment to promote equal opportunity and fairness
- A simplified, standard appraisal system for the NHS. The central message here is that behaviour-based appraisal is fundamental, as focusing solely on leaders' performance may miss bullying and victimisation of staff who speak up
- More effective recruitment and development of non-executive directors. Central to this is diversity on the profile of recruits to leadership roles.
While palliative care settings generally enjoy good leadership, it is important that EDI are also evident. Therefore, these recommendations should also be considered and implemented across palliative and end of life care settings across the UK. It is equally important that everyone in the workforce, regardless of gender, ethnicity or skin colour get the same opportunities to develop and progress their careers within palliative care. We should continue to point out that people in leadership and management positions need to reflect the community and society they serve. This would be one way to ensure effective leadership, embrace the needs of all, and make them feel that they too belong to the organisation. When staff feel like they belong, it can be argued that they become motivated, committed and proud to provide high quality care which can only benefit patients and their families and friends.