NHS management - the retailer's view

There has certainly been a blizzard of announcements from the Health Secretary Jeremy Hunt - including reform of consultants' contracts, a new single hospital trust regulator and a buddying scheme linking a leading US hospital to five NHS trusts.

He spelled out in some detail his vision of a patient-centred, transparent NHS providing a full seven-day-a-week service.

With rather less fanfare, a report on the leadership of the NHS in England was made available to MPs and put up on the Department of Health website.

This is the work of a leading figure in the business world, Stuart (now Lord) Rose who once ran Marks & Spencer.

Early last year he was given the task of reporting on how to develop potential top managers in the health service and how strong leadership might help deliver reform where required in hospitals.

The Rose report was delivered at the end of last year. He was then asked by Jeremy Hunt to update it to take account of the Five Year View produced by Simon Stevens and other NHS leaders in England.

A new version was duly delivered in the spring. But nothing more has been heard of it till now.

Labour claimed the report was too sensitive to be published during the election campaign and tried to put pressure on ministers to get it out.

Government sources argued that it wasn't deliberately shelved and that time ran out before parliament was dissolved.

Beefed up

Cynics might wonder why it has taken till the last week before the summer recess and on the day of a series of other health announcements for it to see the light of day.

Lord Rose is not directly critical of government policy. But implicit in his analysis is the view that successive NHS reforms, including the controversial Health and Social Care Act changes implemented in 2013, have not exactly helped managers go about their work.

He says the level and pace of change in the NHS remains "unsustainably high" and that the bureaucratic and regulatory burden is "fast becoming insupportable".

In effect he says the NHS does not have enough experienced managers to deal with the major changes which have been launched.

Some of the problems, argues Lord Rose, are "chronic" and have not been addressed by different governments in recent years .

Lord Rose has come up with a series of recommendations aimed at improving training and mentoring of managers and future leaders.

He wants the current NHS Leadership Academy to be beefed up, and more effort made to encourage recruitment from outside the health sector.

The former M&S boss says there are great opportunities for the NHS during a period of "extraordinary and rapid change".

But he adds that there are "shortcomings in the management of staff and …..a lack of local strategic oversight".

'Space to lead'

He talks of "change fatigue" and "constant fire-fighting" and concern over "many and varied messages sent from the centre of government".

Managers are distracted, he argues by demands for data and targets monitored by regulators and inspectors.

Lord Rose takes the view that NHS has what's needed to be "an extraordinary organisation", but says it requires the right leaders with the "space to lead".

His analysis of the pressures on NHS management is a reminder of the scale of the challenge facing the service in delivering unprecedented efficiency savings by 2020 as well as the seven-day-a-week working demanded by ministers.