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Hold NHS England’s leaders to account for delivering their plan

Last updated: 12:50pm 6 June 2019

We will hold NHS England’s leaders to account for delivering their plan to improve patient care.

Conservative Party Manifesto 2017, p.67

Our verdict

Each year, the government issues a mandate to NHS England which sets out objectives and requirements, and details the allocated budget. The mandate also outlines the criteria by which NHS England’s performance will be assessed.

NHS England then provides an annual report which contains an assessment of how it has achieved against the government’s mandate.

So on the face of it, this policy to hold NHS England leaders to account is ‘done’ annually through this process.

However, an alternative interpretation of the status of this policy is contained in the NHS Long Term Plan, published in January 2019:

“We…do not currently have a sufficient pipeline of highly skilled and readily deployable senior leaders…”

In fact, a survey of NHS trusts by the King’s Fund, published in July 2018, found:

  • 8% of executive director posts were filled on a non-permanent basis
  • 37% of all trusts have at least one vacant post for a board-level executive

The first step towards holding leaders accountable must be to ensure that those leaders are actually in place. According to the NHS Long Term Plan and in the judgement of a leading independent think tank, the government has failed thus far to achieve that.

The Long Term Plan states the intention to form a “new compact” with senior leaders, offering better support and clearly laying out expectations. But that compact, the “NHS leadership code” is yet to materialise. The Plan also outlines initiatives to “nurture the next generation of leaders” and “develop and embed cultures of compassion, inclusion, and collaboration across the NHS”.

Those strategies may eventually plug the holes in NHS leadership but until that time, the promise to hold leaders to account cannot be effectively fulfilled, so we’re marking this as ‘in progress’. Follow this policy to see how things develop.

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