The Rose review is as remarkable for what it doesn’t say as what it does. Any convincing recommendations for future leaders should address issues of diversity and bullying and yet these crucial issues were not touched on

Lord Rose’s NHS leadership review on attracting and developing talent and creating strong leadership contains significant (and often sensible) recommendations and a few home truths.

However, the review is as remarkable for what it doesn’t say as what it does.

Lord Rose was asked to consider “what more could be done to attract top talent from within and outside the health sector into leading positions in NHS hospital trusts; and how strong leadership can be used as a force for good to transform organisational culture”.

‘Lord Rose’s review is as remarkable for what it doesn’t say as what it does’

Since commencing his report, the NHS has seen Sir Robert Francis’ Freedom to Speak Up review highlight the scale of bullying in the NHS and the victimisation of too many of those who raise concerns.

The last 18 months have also seen a growing recognition of the scale of bullying in the NHS and its damaging impact not only on staff, but on patient care.

After all, in last year’s national staff survey, 22 per cent of staff reported “experiencing harassment, bullying or abuse from staff in last 12 months”. There is nothing in Lord Rose’s recommendations that touches on these issues.

Club culture

The last 18 months have seen the publication of The Snowy White Peaks of the NHS and the acknowledgement by the NHS of the disproportionately poor treatment of black and minority ethnic staff and the waste of their talent.

In the same period there has been a growing acceptance that women who make up the large majority of NHS staff are seriously underrepresented in senior positions within the NHS and that discrimination against disabled staff is a serious issue.

‘It is much more likely that white staff will be appointed from shortlisting than BME staff’

There is an increasing understanding across the NHS of the importance of cultures of “blame”, and of the “club culture” which excludes much talent from ever reaching senior positions in the NHS.

The data is unequivocal. It is much more likely that white staff will be appointed from shortlisting than BME staff. BME staff, women and disabled staff are seriously underrepresented on trust boards and in other senior NHS positions.

Across the three national regulators (Monitor, the Care Quality Commission and the NHS Trust Development Authority) and NHS England 32 of the 51 board positions are held by men and 49 by white people.

You would never guess any of this was the case from reading Lord Rose’s report which includes half a sentence on equality stating “it is crucial for the future of the NHS that it… increases its level of cultural diversity to better reflect its staff”, and one paragraph referring to the fear “some people” have of raising concerns.

Missed opportunity

How is this possible?

One clue might be that all 29 of the individual interviews were with white leaders and just five of the 29 were women.

No whistleblower appears to have been interviewed, while there were no obvious witnesses with significant knowledge of bullying apart from the late Aidan Halligan and Sir Robert. The leading expert of NHS organisational culture, Michael West, is not listed as a witness, and nor is any other academic expert on healthcare culture, bullying or equality.

Diverse representation would not, of course, guarantee a balanced outcome. But the more diverse representation and expertise might surely have prevented such serious shortcomings in its recommendations.

‘No whistleblower appears to have been interviewed’

Any convincing set of recommendations about “better leadership for tomorrow” might reasonably be expected to address issues of diversity and bullying as central issues holding back talent, skewing leadership focus and affecting patient care.

There is, for example, little point in talking about a ten-fold expansion of the NHS Graduate Management Scheme unless such expansion addresses the ethnicity, gender and disability composition of those who enter such courses.

If we are really serious about putting people at the centre of NHS leadership and change that surely means all people. If Lord Rose was serious about values based leadership, as his report repeatedly states, it was surely crucial that its narrative and recommendations said something substantial about equality and bullying.

The opportunity was missed.

Roger Kline is research fellow in Middlesex University Business School

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