By Carl Packman on 20 Jul 2015
The Rose Report and wisdom within the workforce
With no prior warning, the long-awaited Rose Report was eventually published last week. The review, commissioned by Health Secretary Jeremy Hunt and led by former Marks and Spencer chief Sir Stuart Rose, set out to look at complex management structures within the NHS. It was reported that Sir Stuart had completed the work in December last year before the election but the publication date was heavily delayed.
Amid a national conversation about Jeremy Hunt’s seven-day service proposals, what should have been a landmark report has received little coverage. Indeed, the Health Secretary only afforded the “excellent” report only a fleeting mention in his speech to the King’s Fund on Friday, as he outlined his 25-year vision for the NHS.
Much has been made of the delay to the report’s publication. Hunt faced criticism as it became clear it would embarrass the government for its record of training leaders and managers just before an election that focused squarely on the NHS.
The Department of Health put together a vague statement, justifying why there would be no pre-Election release: “The remit of the Rose review has been expanded so that it takes into account the NHS’s own Five Year Forward View, which was published after Lord Rose’s work had begun. This means that further work is required before the final report is published”.
This didn’t stop criticism from the Labour opposition. Andy Burnham, the shadow health secretary and now a candidate for the Labour leadership, publishing an open letter addressed to Hunt which slammed the delay as “puzzling and implausible”.
Over six months later, we now have the finished report. So what can we learn from it? As anticipated, it is critical of the Government’s handling of health policy. Rose writes, “A lack of stability is felt across the NHS, with a deep-rooted concern over the many and varied messages sent from the centre of Government”. He also points out the detrimental effects of the Health and Social Care Act 2012, implemented in 2013. The Act “changed the landscape of the NHS fundamentally”; as such, “the administrative, bureaucratic and regulatory burden is fast becoming insupportable.”
In contrast, the workforce itself is what impressed Lord Rose the most. He praises the commitment of staff at all levels and in all parts of the NHS. However, much more could be done to value “its main asset”.
This closely reflects the views of one of our clients: Dr Peter Thomond, the chief executive of Clever Together. He and his organisation have been working closely with NHS England and a number of NHS Trusts around the country developing working environments that harness staff engagement through crowdsourcing to reach consensus, rather than top-down managerialism.
Recently Dr Thomond wrote for the Guardian about valuing the NHS workforce. As a warning to NHS leaders, under whose jurisdiction many significant changes are occuring, he said:
“We run the risk of forgetting what’s most important: that the very people bringing about these changes need to be listened to.
“What would be unhelpful is top-down diktats. This is reflected in reports pointing to rising staff dissatisfaction, increasing amounts of industrial action and the falling morale of doctors, nurses and support staff.
“Counterposed to top-down change, a growing number NHS organisations are using online tools to bring about participatory change with positive results. These aren’t new models, they are tested ways of gathering workforce intelligence.
“Unless we formally involve staff in changes to the NHS, we run the risk of finding ourselves at the bottom of the snake once again, especially now that the dice have been rolled. This is a risk that cannot be ignored.”
The Rose report says we should aim to develop, recognise, and reward appropriately leadership qualities across the whole workforce. Absolutely correct. But as Dr Thomond reminds us good leadership comes from recognising the wisdom within the workforce and not simply seeing leadership as the preserve of a select few individuals at the top.