Tackling NHS leadership challenges with talent management

The NHS has always been concerned with managing talent: the Management Training Scheme itself dates back to the 1950s.

However, the literature on talent management is far from clear - for example, there is no single definition of talent management, but a common working definition refers to “the systematic attraction, identification, development, engagement/retention and deployment of those individuals with high potential who are of particular value to an organisation.” 

While, at least until recently, many may not recognise the term, its most frequent practices - including development programmes; coaching; mentoring; secondments; assignment centres; action learning sets; appraisals - may be more familiar.

A systematic talent management policy may contribute to addressing three of the main leadership problems of the NHS:

• Reducing challenges experienced in recruiting and retaining able chief executives
• Contributing towards a more diverse or inclusive leadership or an “NHS of all the talents”
• Producing benefits in terms of organisational performance by achieving competitive advantage through people

The research explored in this article was conducted in six separate stages in the period 2009-11:

• Literature review
• Two focus groups of 24 managers in total (FG)
• 22 interviews with those responsible for talent management at national (N) and SHA levels
• 42 interviews with four cohorts of managers (C)
• Questionnaire Survey of 556 managers (survey free text comments: SFT)
• Interviews with managers in three high performing organisations (HPT).

The source of quotations used in this article is referenced by the code above. For example, FG means a quote from the focus group.

Just over a third (36 per cent) of survey respondents were aware of the current talent management initiative in the NHS, and it is interesting to note that some who said they were “not aware” had attended SHA courses such as aspiring directors.

Our respondents broadly agreed that the current national TM system was “long overdue” and was an improvement on the more informal, variable and ad hoc “managing talent” system that it replaced, where the picture was “very mixed”, ranging from ‘excellent’ to ‘pretty woeful’, and patronage was potentially a major problem.  

There was much support in principle for a talent management system, and Inspiring Leaders was regarded as more “joined up” and “systematic”:

New talent management is broadly seen as an improvement:

“New imperative around systematising it more on a national level” (N)

“I’ve been in the NHS 25, 30 years and that’s the first time its [support] been that structured and objective” (FG)

“First time NHS has taken a proactive and systematic approach to development” (SFT)

There was also a large degree of support for many of the individual elements in the talent management system such as development courses (Management Training Scheme; Gateway; Breaking Through; Aspiring Directors; Aspiring Chief Executives; Clinical Leadership), coaching and mentoring, secondments, and action learning sets.

However, there was no clear agreement on the appropriate system architecture as some respondents regarded the NHS as a collection of competing organisations rather than a collaborative system.

In other words, there was a clear conflict of views over whether “talent” was the property of the system (to be shared) or the organisation (to be hoarded).  

Most respondents considered that the NHS should adopt a more “inclusive” approach to talent (where development should be cascaded throughout the workforce) rather than the “exclusive” approach in some private sector organisations where talent management is restricted to “high flyers”, “A-players” and succession planning.

Some struggled to see how different pieces fitted together. For example, it was pointed out that a large temporal gap exists between MTS and aspiring directors, and aspiring chief executives courses, and the top leaders scheme.

Issues concerning the TM system:

“Chief executives sometimes jump up and down and say how dare you ‘poach’ this person, but I regard them as the property of the system and not the property of your organisation” (SHA)

“Hoarding your best staff is absolutely what you should do as leader of an NHS organisation” (N)

“To some extent TM requires an element of altruism, working for the greater good of the system, not simply for your own good” (N)

Respondents expressed a number of additional concerns over the talent management system, with fairness and transparency being regarded as major issues. It was felt that the experience of talent management was variable between and within SHAs, and it was difficult to speak of a system where SHAs had no authority over FTs.

Moreover, some respondents considered that the previous system cast a long shadow in that the new system could perpetuate, and even legitimate, the “old boys’ network”. Similarly, some considered that it had the potential to be ageist, sexist and racist. It was felt that the “top down” and “exclusive” focus (Top Leaders, Aspiring Directors, Aspiring Chief Executives) could discourage those perceived as  “untalented”, blight careers of the “un-chosen” and might increase expectations of those who “passed” Aspiring chief executives courses (“all revved up, but no place to go”).

The identification of talent remained problematic. With no common and transferable definition, and no common database, talent spotting still depends largely on the line manager.

Finally, the quantity and quality of appraisals, and their link with personal development plans, remained a concern.

Concerns over the TM system:

“Identification of talent is subjective rather than objective at the moment” (SHA)

“Need more rigorous and transparent process” (SHA)

“If your face doesn’t fit often you’re not spotted” (FG)                              

“We are talking about patronage. If your face fits you get everything and if your face doesn’t you get nothing” (N)

“Could be exclusive … if not handled right” (SFT)

“The important thing for me about TM is not just managing the high powered talent, it’s the every-day talent” (N)

“Looking at the whole not just a bit of it. Need to embed it across the organisation; cascaded through organisation” (HPT)

“I see TM in terms of managing the whole of the workforce rather than the higher levels that the SHA seems to be concentrating on” (HPT)

“Concept of “Top Leaders” causes a lot of anxiety. Real dangers of it becoming around patronage.” (N)

“It is totally subjective and likely to lead to greater ageism, sexism, racism and favouritism in the NHS” (Cohort)

“I think you’ll find the further away you get from London the whiter and more male it becomes” (Cohort)

“I do not think TM will come to much…tokenism, patronage and cliques are the dominant cultural decisions” (Cohort)

The main facilitators that enabled staff to pursue development opportunities were motivation (63 per cent), support from line manager and senior managers (44 per cent), opportunistic availability (24 per cent), support of family (13 per cent), support of peers (10 per cent) and PDPs arising from appraisals (4 per cent). 

About 95 per cent of those who had been on programmes/activities stated that they were of value. The findings on barriers from the different data sources were less consistent. There was little discussion of them in the qualitative interviews, but over a third reported them in the quantitative survey (although these may not have been severe).

However, there was some consistency in the nature of the barriers, with 37 per cent reported problems either obtaining development or while involved in development. The main problems were respectively seen as lack of organisational support and lack of funding and once on the course, lack of dedicated study time, leading to people trying to juggle work, study and home commitments.

There was also some consistency in that more female and black and minority ethnic (BME) staff tended to report barriers, which were perceived as very severe in a few cases.

Finally, given the financial climate, reorganisation, and threats of redundancy for some, there were great concerns over the future of managerial careers in the NHS.  Given previous failures and false starts, there were concerns over sustainability, and it was not clear who would be responsible for carrying forward the talent management initiative.

Future/sustainability of the TM system:

“Littered with a track record of failure around this” (N)

“In difficult economic times, a really coherent TM becomes absolutely, utterly crucial. But easier to cut than to close a ward” (N)

“Economic downturn will ‘profoundly’ affect the NHS- significant cut in development and training; it always happens in any industry. You can cut in the short term, it’s painless, but in the long term it is very damaging” (N)

“Hope it is here to say this time, not another false start; need sustainability.” (N)

“All the benefits of TM in terms of organisational memory … will be lost as SHAs and PCTs are disbanded. We all have to start again” (SFT)

“Given the recent White Paper and the spate of manager bashing I am very pessimistic as to the future of general management in the NHS” (SFT)

“I’m not saying TM strategies are dead in the water, but we are going to lose a hell of a lot of talent” (Cohort)

This project was funded by the National Institute for Health Research Service Delivery and Organisation (NIHR SDO) programme (project number 08/1808/247). Visit the SDO programme website for more information.

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the SDO programme, NIHR, NHS or the Department of Health.

To read the full report visit http://www.netscc.ac.uk/hsdr/projdetails.php?ref=08-1808-247