Throwing money at the NHS won’t solve its problems, says military chief turned troubleshooter
Throwing money at the NHS will not address its fundamental weaknesses, the author of a review into the leadership of the health service has warned.
General Sir Gordon Messenger said that the health service is in urgent need of reform, without which extra funding will be wasted.
He suggested that supermarkets and banks are better at ensuring the right people are in senior management roles than the health service.
His intervention comes as the NHS faces the biggest strikes in its history on Monday, with nurses and ambulance workers walking out over pay.
Unions are demanding pay rises of up to 19 per cent, despite warnings that such salary increases would eat into budgets that were expanded to fund reform and improve patient outcomes.
Grant Shapps, Business Secretary, warned that the industrial action could cost lives.
In his first major interview since leading the review of health and social care leadership, which was ordered by Boris Johnson, Sir Gordon said: “The two big things you want from the health service are productivity – ie effective use of public money – and good patient care.
“I would argue that a really important component of that is a well-led, well-motivated, valued, resilient workforce, which comes from the culture, and the right attitude to leadership.
“I found an inadequate focus on that… and I would argue that unless you get the right culture, which means better leadership, it’s almost like painting the bedrooms without fixing the roof, in terms of throwing money at A&E waiting times.”
His comments come a week after the Prime Minister published an Urgent and Emergency Care Recovery plan, backed by £14 billion of extra spending over two years, to tackle record accident and emergency and ambulance waiting times.
The boost in last year’s budget followed a £36 billion, three-year spending plan agreed the previous year. Increases in funding to clear waiting-list backlogs have remained in place, even after the rise in National Insurance intended to pay for them was axed.
The former general, who led the Royal Marines’ invasion of Iraq, was clear that he was not suggesting funds are not needed. However, he warned that money will continue to be wasted without efforts to improve the quality of management and motivate staff.
“Unless you have that well-led, well-motivated, valued, resilient workforce, the sand is slipping through your fingers, however much you keep topping it up,” he said.
Sir Gordon warned that a “sense of constant crisis” in the NHS too often means other matters are neglected.
The former vice-chief of the defence staff said all NHS managers should now be asked to achieve competence standards at key points in their career, in order to develop the best leaders – and avoid over-promotion of those without core skills.
As the biggest employer in the country, the NHS should be able to do far more to “talent spot” good people and develop them, he said
Sir Gordon, who spent 38 years in the military, also told The Telegraph that he was surprised by the extent of the “blame culture” and “responsibility avoidance” in the NHS.
The former military chief said the NHS appeared to lack a “collective instinct” and enough sense that people should “rally round” and tackle problems they encounter.
‘Finger-pointing in the NHS came as a shock to me’
General Sir Gordon Messenger has served in Kosovo, Lebanon and Afghanistan.
Twenty years ago, he led the Royal Marines’ invasion of Iraq.
Yet he suggests Britain’s health and social care system, and how best to manage it, is in some ways a more fiendish challenge.
The military man was asked by Downing Street to launch the most far-reaching review of health and social care leadership in 40 years.
“I think there is an assumption, wrongly held, in certain quarters that if you want to get something done, you get a general in,” said Sir Gordon. “It misses the point that generals can get things done because they’ve got lots of people who do things for them, because they have a system in place.”
The former general had already been brought in by ministers to assist in the pandemic, introducing community testing and hotel quarantines.
Repeatedly, he found himself “pulling levers” only to find “there was nothing at the end of them”.
“I have learned more about leadership in the three years since I left the military than in the 38 years I served in it,” said Sir Gordon, 60.
“Essentially, military leadership has got a lot going for it. It’s got a good hand of cards because you’ve got a culture of leaders and being led, well-understood structures, relationships and very clear hierarchies.
“The reason why the military can ‘do’ crises is because they’ve got a doctrine established in peacetime to fall back on – a set of handrails if you like. I don’t think that’s necessarily true of other organisations, such as the NHS.”
Since his review of leadership in health and social care reported last summer, the Government’s own leadership has been on its own rollercoaster, including three changes of health secretary.
Meanwhile, the NHS has careered into the worst winter crisis in its history, with record accident and emergency delays and ambulance waits, along with seven million on waiting lists.
On Monday, Rishi Sunak, the Prime Minister, launched an urgent and emergency care plan, promising “the largest and fastest ever improvement in emergency waiting times in the NHS’s history”.
But Sir Gordon suggested that it is a mistake for the NHS to keep bouncing from one crisis to the next, without making fundamental changes to bolster the service for the long-term.
An “inadequate” focus on such matters is letting staff – and the public – down.
“I would argue that unless you get the right culture, which means better leadership, it’s almost like painting the bedrooms without fixing the roof, in terms of throwing money at A&E waiting times,” he said.
“Unless you have that well led, well-motivated, valued, resilient workforce, the sand is slipping through your fingers, however much you keep topping it up.”
In particular, he was perturbed by the lack of team spirit he encountered in many parts of the health and social-care system, with wrongdoing unchecked for fear of “putting the head above the parapet”.
“The things that I found most surprising were the blame culture, the finger-pointing and the responsibility avoidance,” he said.
“If you feel alone, you don’t feel brave enough. If you see something that's going wrong, what should happen is a collective response, a team response – let’s rally around, let’s get this sorted.”
Instead, too often he encountered staff who feared that raising issues meant “putting my head above the parapet, to be criticised or shut down or accused”.
Sir Gordon said he encountered such a response at all levels, including senior medicine and management.
“The idea that you have a collective instinct – that ‘we’re in it together’ doesn’t seem to exist and I think at the heart of it, that is a leadership issue,” he said.
‘Talent management is almost non-existent’
Among his recommendations are competence standards for NHS managers at key points in their career and consistent systems of appraisals, training and development.
The absence of such systems means that despite being Britain’s largest employer, the NHS does little to attract or develop the best leaders, he suggested. Instead, it swaps around the most senior figures, he said, giving far too little help to those coming up the ranks.
“Talent management is almost non-existent,” he said, suggesting that boards with good senior executives “hoard” them, while those in a comfortable job have no incentive to move.
Meanwhile, it is hard to persuade senior managers to take on the toughest and most high-risk jobs turning around organisations with the worst performance.
“I would describe the senior leadership in the health sector as a transfer market,” he said.
“It’s just headhunters that are paid ridiculous amounts of money phoning up the names that are already known and asking if they want to do jobs as the head of trusts. It’s unbelievable.”
While the findings were welcomed by the Government and the NHS, there has been little outward sign of changes – although Sir Gordon believes plans to roll out such changes are still “alive” within the health service.
Before his report was issued last June, newspapers – including this one – were briefed by the Government that it was part of a war on “waste and wokery”, with the NHS ordered to cut “diversity and inclusion jobs”.
Sir Gordon describes those messages as “a total distortion of the findings”.
The report itself was rather more nuanced, suggesting that in time the numbers in such posts should naturally reduce if the health service makes progress on tackling inequality.
“It was a single issue plucked and magnified it to turn it into a whole ‘woke thing’ which I have no time for at all,” he said. “There is inequality in the way that people are dealt with in all systems and you need to recognise the experience and understand it.”
Sir Gordon has now moved on to a task which may prove yet more thankless – as a non-executive director of the UK Health Security Agency (UKHSA), the body that replaced Public Health England.
Auditors have just refused to sign off its first set of accounts, accusing the organisation of having “no clear oversight structure in place” for its first six months in operation, until belatedly appointing a non-executive team.
A fitting challenge for a military man, perhaps, who has also taken on a more celebrated role as Constable of the Tower of London, taking possession of the fortress keys in a role once filled by Thomas Becket.
Asked what lessons he believes the NHS can learn from the military, Sir Gordon said one stands out – the need for a clear vision, rather than a blizzard of dictats.
“Mission command – giving a clear direction, rather than setting out all the detail of how you want it done. I think there is a lot to be said for that,” he said.