Health CommitteeWritten evidence from the Chartered Management Institute (ETWP 105)

Executive Summary

The Chartered Management Institute (CMI) welcomes the Committee’s timely inquiry into education, training and workforce development in the health sector. CMI has consistently called for a much greater emphasis on leadership and management skills development in the NHS, and is encouraged that this important subject is now gaining more attention.

However, we believe that much work is still to be done if the Government is serious about achieving its Quality, Improvement, Productivity and Prevention (QIPP) efficiency targets and introducing a completely new structure of commissioning, education, training and workforce development at the same time.

We very much welcome the creation of the National Leadership Academy, the successor body to the National Leadership Council, but urge Government to pick up the pace in its implementation so that the achievements of the National Leadership Council are not lost. We are also keen to learn more about the new arrangements for education and training, and how the new structure will deliver much-needed improvements in leadership and management skills, both for clinical and non-clinical managers, particularly in terms of demonstrating what good management and leadership looks like.

With the crucial recommendations of the Mid-Staffordshire inquiry keenly anticipated in the first half of next year, the pressure is on Government, NHS employers and staff to raise the bar in terms of leadership and management skills, so as to deliver improved patient care and to ally the public’s perception of alarming variations in care standard levels, particularly at the acute hospital trust level.1

We look forward to working with Government and its agents towards better leadership and management skills at all levels, and in all professions, throughout the NHS.

About the Chartered Management Institute

The Chartered Management Institute is the only chartered professional body in the UK dedicated to promoting the highest standards of management and leadership excellence. CMI sets the standard that others follow.

As a membership organisation, CMI has been providing forward-thinking advice and support to individuals and businesses for more than 50 years, and continues to give managers and leaders, and the organisations they work in, the tools they need to improve their performance and make an impact. As well as equipping individuals with the skills, knowledge and experience to be excellent managers and leaders, CMI’s products and services support the development of management and leadership excellence across both public and private sector organisations.

Through in-depth research and policy surveys of its 90,000 individual members CMI maintains its position as the premier authority on key management and leadership issues.

CMI has an extensive network of approved centres around the UK, which are authorised to deliver our qualifications. To date there are 680 centres, many of which are FE or HE institutions, including Oxford University, Edinburgh Napier University and London South Bank University. Many leading employers are also registered CMI Approved Centres, such as Virgin Atlantic Airways, National Express UK and PriceWaterhouseCoopers. We also work closely with leading business schools to develop our research and knowledge of the management and leadership profession, including Cass, Warwick, Henley, Cranfield and Ashridge Business Schools.

We offer our qualifications to a wide range of learners through a flexible system of credit based learning units, which allows learners to study at their own pace, and in manageable chunks. We also develop new qualifications in response to the needs of employers, such as the CMI Level 3 in Neighbourhood Management and the CMI Level 5 Diploma in Leadership for Health and Social Care and Children and Young People’s Services.

CMI conducts a wide range of activities in the health sector. We have around 3,000 members in the sector, and work with a range of NHS employers to deliver skills training, eg. qualifications, coaching and mentoring and accreditation services. Some examples of our clients include Nottingham University Hospitals NHS Trust, the General Medical Council, the Royal College of Physicians and the Heart of England NHS Trust, Birmingham.

1. Workforce development: prioritising leadership and management skills

Improving leadership and management skills ultimately saves the NHS money, as problems and mistakes are avoided and efficiencies gained. For example, the NHS Institute for Innovation and Improvement estimates that its work has potentially saved the NHS £6 billion over the last few years. Therefore all NHS managers, whether clinical or non-clinical, should have the opportunity to develop and professionalise their leadership and management skills. By doing so, they will be better equipped to deliver the ambitious reforms being introduced by the Government.

We therefore urge Government and NHS employers to place a much greater emphasis on improving the leadership and management skills of staff, both clinical and non-clinical. Much of the Government’s reform programme (including integrated care pathways, clinical commissioning groups, any qualified provider and the QIPP efficiency programme) will depend on these skills for success. We therefore continue to encourage Government to place a greater emphasis on leadership and management skills as part of the education and training agenda for the NHS.

While we understand that the Government is limited in its powers to compel employers to prioritise these skills, we believe much more could be done by Government to encourage employers and individuals to improve their leadership and management skills. We are encouraged that others are now beginning to join our call for leadership and management skills to be put on a professional par with clinical skills (for example, the King’s Fund,2 and various witnesses to the Mid-Staffs Inquiry3).

However, the slow progress in establishing the new Leadership Academy (see page 5) and the lack of detail regarding Health Education England’s (HEE’s) responsibilities in this area are frustrating for those wishing to raise leadership and management skills in the NHS. Much more time and resources need to be invested in this area if Government are to succeed in transforming the NHS structure, introducing clinical led commissioning and achieving the QIPP efficiencies at the same time.

2. High and consistent standards of leadership and management education and training

Alongside the lack of policy emphasis on leadership and management skills, CMI is also concerned that there are no professionally accredited standards for leadership and management development in the NHS, although we welcome the Department of Health’s recent launch of a Leadership Competency Framework. The code of conduct for NHS managers is widely criticised as insufficiently robust in terms of professional standards, ethics and accountability, as the findings from the first Mid-Staffs inquiry revealed.

We would therefore strongly recommend that a voluntary system of leadership and management accreditation be introduced, so that managers who have undertaken accredited management and leadership development, whether it be a full-scale diploma or bite-sized units of on-the-job learning, are recognised and rewarded for their skills by employers. The Leadership Framework also needs to be much more embedded in managers’ work, eg via induction programmes, appraisals and reward programmes.

We have recently contributed to a pilot programme to accredit training programmes in the NHS, which was carried out by the National Leadership Council, and which was very successful. We are also planning a research project in the New Year to help further demonstrate the value of accredited learning to employers and individuals, the findings of which will hopefully facilitate the wider introduction of accredited learning in the NHS.

We are also concerned that under the current system, much of the leadership and management education and training which is carried out is not accredited, meaning that no national standards are maintained from Trust to Trust, profession to profession and around the UK. In a clinical profession this would be unacceptable—but management and leadership development is often neglected by employers, and staff are left to become “accidental” managers when they are promoted.

Unaccredited learning is not necessarily inferior, but given the current pressures on budgets it would surely be better for the training which does take place to be recognised and benchmarked as meeting national professional standards, ensuring better value for money for the employer and greater commitment to study from the learner.

From our own research and employer feedback, we have identified the following benefits of providing accredited learning:

For all types of management qualifications, a clear majority of employers agreed that productivity gains, staff attraction rates and professional reputation are improved;4

81% of managers disagreed that offering qualifications causes a high turnover among qualified staff;5

Learning is made more attractive to employees and thus encourages uptake and commitment to the development programme;

The employer’s reputation is improved, thereby supporting recruitment and retention of staff;

Minimum standards of competence are established, against which managers and leaders can be measured;

High-flyers are identified, thus supporting talent management programmes; and

A more strategic approach to leadership and management development can be taken, enabling integration with career frameworks.

Accredited leadership and management learning also promotes social mobility, so that those wishing to take a professional qualification can do so without facing significant barriers to entry which exist in some professions. Through providing higher external recognition of the development programme, accredited learning can improve the confidence and engagement of the learner.

Contrary to some perceptions, accredited learning does not have to involve a significant commitment to study, or time away from the workplace. With the introduction of Qualifications and Curriculum Framework, many leadership and management courses can be taken in units, delivered via distance learning or “blended learning” (ie a mixture of face-to-face and distance learning). This makes them more attractive to learners and employers alike.

Accredited learning could play a significant role in helping to restore trust in the quality of leadership and management in the NHS. Whilst no patient would wish to be operated on by a surgeon who did not hold full medical qualifications, surely no taxpayer would wish to hand over significant public funding and management decisions (which could affect peoples’ lives) to an unqualified manager.

3. Infrastructure for professionalising leadership and management skills

As mentioned above, the transition from the National Leadership Council to the National Leadership Academy is slow and complex. There are many workstreams which the NLC has embarked on which must be completed. In addition, there appears to be a significant shift in staff, with NLC staff returning to their “day jobs” and new staff being recruited to the nascent Leadership Academy. Although we accept that the establishment of the Academy is likely to take time, we are frustrated by the slow rate of progress and the lack of information about its structure, remit and responsibilities, although we very much welcome its overarching objectives.

Once in place, we would like the new Academy to have a greater role in endorsing and promoting standards for clinical and non clinical leaders and managers, rather than fully devolving responsibility for development to employers, which may lead to uneven skills development. We believe that the Leadership Academy’s role should be to establish best practice standards of leadership and management, and to promote the uptake of these to employers, who remain responsible for staff development.

We keenly await the findings of the current Mid-Staffs inquiry, and hope that they will include some specific recommendations around how Government can encourage employers to ensure that their staff have the necessary leadership and management skills that meet agreed national standards. This will protect patients from another tragic example of the results of poor leadership.

4. Role of Health Education England and Local Education and Training Boards

We would welcome more information from Government on the role and remit of Health Education England in terms of its responsibility for leadership and management skills development, and how it will avoid duplication of this responsibility with other bodies, such as the National Leadership Academy and the Faculty of Medical Leadership and Management.

We are also unsure as to how the new NHS local education and training boards will relate to HEE; whether HEE will have the power to make recommendations about professional standards and training; and how both bodies will relate to local employers (acute hospital trusts, private providers, voluntary sector organisations, GPs and public health workers), the education sector, the deaneries and the Royal Colleges.

Where possible, we would also encourage these new Government bodies to work with existing professional bodies to ensure the appropriate promotion of learning across all sectors and to prevent costly duplication.

There is much valuable work going on at the various Royal Colleges, and at the new Faculty of Clinical Leadership and Management, to develop leadership and management capabilities for both clinical and non-clinical managers. Other health sector bodies such as the General Medical Council have also issued advice on management skills for doctors.6 We would expect the National Leadership Academy to have a role in co-ordinating this work and working with appropriate professional bodies so as to avoid duplication and confusion for learners.

5. Formulation and development of curricula for clinicians

We would like to see a greater emphasis on leadership and management skills in medical curricula. We welcome the recent establishment of the Faculty of Medical Leadership and Management, and we are hoping that the Faculty will work with the Royal Colleges to embed management and leadership skills earlier on in a clinician’s career.

We also hope that as part of the revalidation process, leadership and management skills development will be one of the core competences evaluated and monitored—particularly with the introduction of clinical commissioning groups, which means that GPs will need much greater leadership and management skills.

6. Whole systems approach to enable multi-disciplinary leadership

An important objective of the Government’s overarching public sector education and training strategy should be to share learning and best practice across different parts of the public service network. As a professional body working across all sectors, we believe there is an essential role for the transfer of best practice and case studies in terms of improving leadership and management, especially in times of severe financial constraints. For example, we work with organisations in the health, education, local authority, police, and defence sectors and can highlight some excellent examples of innovation and best practice.

A shared approach to leadership and management is also important in terms of integrating service delivery, which is a particularly important challenge in the NHS. The need to have clear integrated care pathways, which may involve a commissioning care group (CCG), an acute hospital trust, social services, voluntary sector care providers and the patient’s relatives, will be an increasing challenge in the NHS over the next decade. By providing open management and leadership programmes to managers from all these sectors, they are able to develop a shared understanding and approach to management challenges. This in itself helps to break down unnecessary boundaries across different service providers and can promote the effective partnership working that underpins many complex care pathways.

A whole systems approach7 to leadership and management development would also reduce duplication and improve value for money. We have heard anecdotally from learners in the NHS that they receive unaccredited leadership and management training from one employer, only to find that when they change jobs they have to undergo very similar training from their new employer. This is not only a waste of valuable development budgets, but also wastes valuable staff time which could be better spent dealing with patients.

7. Conclusion

During this Inquiry the Committee has a good opportunity to raise the importance of leadership and management skills of NHS staff with Government and key stakeholder representatives. We hope its members will stress the importance of raising leadership and management skills in the NHS to Government witnesses and will probe them for answers to the queries we have raised in this paper.

December 2011

1 See, for example, the recent media coverage of problems at Barts and the London NHS Trust (http://www.bbc.co.uk/news/uk-england-london-15983985)

2 The King’s Fund are working on a Review of Leadership in the NHS, which will be launched in May 2012. Several of their senior executives, including CEO Chris Ham, have recently highlighted the need for Government to support leadership and management skills more, for example see Chris Ham’s blog, Is good NHS management a waste of money? dated 29.11.11

3 For example, see HSJ article from 27.10.11 (Mid Staffs inquiry hears calls for regulation of managers) or the Guardian article, “Doctors are the best hospital managers, study reveals”, dated 19/07/11

4 The Value of Management Qualifications - The perspective of UK employers and managers. Chartered Management Institute, 2007

5 Ibid

6 http://www.gmc-uk.org/guidance/ethical_guidance/management_for_doctors.asp

7 http://www.nationalschool.gov.uk/downloads/wholesystemsgopaper.pdf

Prepared 22nd May 2012