A commentary on Leadership for a collaborative and inclusive future
By Mr Peter Lees, Dr Paul Evans, Kirsten Armit, Dr Daljit Hothi and Yasmin Ali
FMLM Senior Management Team
The NHS is to be praised for acknowledging the importance of leadership and management to good, effective and efficient healthcare. General Sir Gordon Messenger and Dame Linda Pollard’s independent report, Leadership for a collaborative and inclusive future is a positive step demonstrating a willingness to explore – and where necessary expose – areas for improvement.
As outlined in our response to the report, published on Wednesday 8 June, FMLM sees a number of caveats to the recommendations and their future implementation.
FMLM is unique in its charitable aim of improving the quality of patient care through better medical and dental leadership. FMLM’s five-year strategy published at the beginning of the year, addresses the seven ‘Messenger’ recommendations and we see a strong endorsement of many FMLM initiatives which have been delivered in the past decade.
The FMLM Leadership and Management Standards for Medical Professionals were first published in 2015 and are concordant with both the Nolan Principles and the GMC’s Good Medical Practice. More than 200 UK doctors and dentists have benchmarked themselves through peer review as worthy of the award of FMLM Fellowship. Moreover, an increasing number of organisations are also capitalising on the value of these Standards as a prerequisite to becoming affiliated to FMLM, and thereby committing to strong medical leadership.
The report calls for “a single set of unified, core leadership and management standards for managers”. We ask ourselves if this would replace the pioneering work of FMLM and devalue the effort of so many fellows?
The report recommends “training and development bundles to meet these standards”. We await clarification of that statement and its fit with adult learning methods. It is disappointing in the light of the research evidence which FMLM frequently publicises that the report’s answer to leadership and management development in several areas is simply a programme. Research suggests that most leadership skills are learned through direct experience, not the classroom. As well as ignoring the evidence of what works, there is no mention of how that might be achieved in such a massive and diverse workforce. The seemingly interchangeable use of management and leadership is confusing.
Equality, diversity and inclusion remain a challenge, and are a major focus for FMLM. We will not take our eye off the ball, but we must also acknowledge the exceptional performance of the eight clinical fellow schemes which FMLM manages on behalf of NHS England’s chief officers and the Leadership Academy. The clinical fellow alumni now number over 400, and the current 2022/23 appointments, totalling 133 clinical fellows, are 72 per cent women and 37 per cent from a BME background.
Impressive though those statistics are, FMLM needs continued recognition and support to ensure the clinical fellow alumni are actively supported as they return to the NHS. Current support from the NHS England People Directorate must be translated into a long-term commitment and novel, enabling job planning to ensure these progressive outcomes are not reversed over time and the potential to offer a diverse senior clinical leadership in the future is lost. More broadly, the report’s use of EDI performance as a barometer of organisation culture is well worded. Yet there is a contradiction in eloquently describing three unwelcome outcomes then positing the solution to EDI is more stringent enforcement through targets and the CQC.
There is implied criticism in the statement: “We encourage the medical profession to examine honestly their role in setting cultures, given their unique influence in the workplace dynamic.” This would seem to be at odds with a separate statement encouraging equality in leadership behaviours across all professional groups. The unreferenced FMLM Standards are, of course, all about the exemplary values and behaviours required of doctors; these Standards are proving equally valid to other healthcare professionals, their organisations and ultimately their patients.
It is not clear why the established, pertinent efforts of other organisations are not referenced, but that may be wise. It is, however, frustrating that yet another commissioned NHS report makes no mention of the extensive work of FMLM in so many areas, but particularly in standards, accreditation of programmes, the diversity of future leaders such as the national clinical fellows, and research into effective leadership development methods.
There are some further contradictions, not least around appraisal. The medical profession obviously has a clear statutory system around appraisal and revalidation. On the face of it a single standard appraisal system may make sense, but does that mean legislative change for medical appraisal and revalidation? Or will doctors have to face two annual appraisals?
All said, FMLM welcomes an in-depth examination of healthcare leadership and management, and the report makes a number of powerful statements and observations. Helpfully, it does not hold back in some crucial areas such as the behavioural distortions of zealous regulation and what is often referred to as the ‘target culture'. FMLM offers its support and collective experience - through its diverse membership and exemplary fellowship - to help guide implementation.
On a final note, the report opens with the observation of "the very real difference that first-rate leadership can make in health and social care”, with that, we fully concur and would add that there is research evidence which demonstrates that good leadership benefits patients and staff alike.