'Zero confidence'

Unite has broadly welcomed a new review into health and social care leadership, but has warned that the government will fail to bring about any meaningful change if it doesn’t address more central problems such as chronic NHS underfunding and huge staff shortages.

The review, led by retired general Sir Gordon Messenger and Dame Linda Pollard, chair of Leeds Teaching Hospitals Trust, found evidence of “discrimination, bullying and blame cultures in certain parts of the health and social care system”.

The report also found that some NHS staff did not feel comfortable enough to speak up about such issues. The review went on to identify “a lack of equal opportunity for managers to access training and colleagues to progress in their careers, with those who have existing networks or contacts more likely to access these opportunities”.

The recommendations outlined in the report included stronger action on equality and diversity to ensure inclusive leadership at all levels; clear leadership and management standards for NHS managers with a standardised appraisal system; and an induction for new joiners to instil core values across health and social care, among other recommendations.

The review into NHS leadership comes at a time when the health service is under continued strain as both waiting lists and staff vacancies soar. The latest figures show that the number of people in England waiting to start routine hospital treatment has skyrocketed to a record-breaking 6.4m.

A separate analysis found that in March, the latest month for which data is available, one in five patients left A&E before completing treatment, with many leaving without being assessed at all. This is the highest level of patients leaving A&E before being treated since records began in 2011 – and triple the number since 2019.

Meanwhile, data for health service vacancies published by NHS Digital found that by the end of 2021, there were more than 110,000 unfilled posts in the NHS in England – equating to one in every 12 jobs across NHS England.

The pressures facing the health service were brought into sharp relief at Prime Minister’s Questions this week, when Labour leader Keir Starmer told the story of a Manchester resident he spoke to recently whose mother died while waiting for an ambulance — after he called 999 six times.

Commenting on the review into NHS leadership, Unite national officer for health Colenzo Jarrett-Thorpe highlighted that the government must focus on both NHS funding and staff well-being in order to alleviate the unprecedented pressures facing the health service.

“As we at Unite have long said, the culture of bullying and harassment in the NHS is endemic and the report rightly points out that action must be taken,” he said. “There needs to be an emphasis on quality leadership, a focus on supportive and inclusive management and a genuine right for staff and patients to speak out without fear of persecution when things go wrong.

“It is a disgrace that Black and Asian ethnic minority (BAEM) staff are still more likely to be disciplined and harassed in the NHS – and we believe this is a direct consequence of an institutionalised culture in some NHS trusts where protecting individual management figures’ reputation is often prioritised over staff well-being,” Jarrett-Thorpe added.

“Above all, the government must understand that many of the problems highlighted in the report are a symptom of decades of privatisation within the NHS which has forced trusts and NHS organisations to compete with each other rather than to collaborate for the benefit of patients,” he went on to say. “More leadership training is all well and good but it will do nothing if the NHS continues to be starved of the resources and staffing it so desperately needs.”

Jarrett-Thorpe highlighted a survey of Unite in Health members in England earlier this year where 75 per cent of respondents said they had frequently experienced staff shortages over the last year.

Reported staff shortages were significantly higher among respondents working in the ambulance service, with 93 per cent noting shortages. Shortages were also high among health visitors, with 90 per cent highlighting a lack of staff, as well as 85 per cent of biomedical scientists reporting the same.

A strong majority – 66 per cent of our survey respondents – said they had specifically raised concerns regarding staffing levels in their workplace over the last year. This figure rose to 86 per cent among health visitors, 78 per cent for mental health nurses, 75 per cent for health care assistants, 73 per cent for biomedical scientists and 69 per cent for pharmacists.

Turning back to the review of health leadership, Jarrett-Thorpe noted that Unite had ‘zero confidence’ that the government will take on board the report’s recommendations and make the reforms needed.

“After all, how can we trust this government when only this week the health secretary made a vacuous comment on how the NHS needs to become more like – of all things – Netflix?” he said. “That they think a paid subscription model for streaming entertainment is the best analogy for our national health service’s future tells you everything you need to know about this government’s intentions.”

Rallying call

In response to the review on leadership, Unite is now issuing a rallying call to all its health reps and activists to ask senior management the following five questions. Unite believes this can be starting point to assess and improve culture and leadership in their workplace.

1.     Does your NHS employer implement just culture principles in its disciplinary procedures?

2.     Does your NHS employer have an action plan to deal with its workforce race equality standard results?

3.     Does your NHS employer have an action plan to deal with its workforce disability equality standard results?

4.     Do you know what the vacancy rate is with your NHS employer and what initiatives does your NHS employer implement to close the vacancy rate, if there is one?

5.     What does your NHS employers’ CQC rating on being well led say and what the plans to improve or sustain this rating?

By Hajera Blagg