The document discusses several issues relating to leadership and management skills development in the UK health sector. It argues that greater emphasis needs to be placed on improving leadership and management skills for all NHS staff, both clinical and non-clinical. It also calls for the establishment of a voluntary system of leadership and management accreditation to ensure consistent, high-quality training across the country. Finally, it seeks clarification on the roles and responsibilities of new government bodies related to health education and training, such as Health Education England and local education and training boards.

1. Health Select Committee Inquiry into Education, Training and
Workforce Planning
December 2011
Contact:
Petra Wilton Philippa Tucker
Director, Policy & Research Public Affairs Manager
petra.wilton@managers.org.uk philippa.tucker@managers.org.uk
Tel: 0207 421 2708 Tel: 0207 421 2723

2. Executive Summary
The Chartered Management Institute (CMI) welcomes the Committee’s timely inquiry into
education, training and workforce development in the health sector. CMI has consistently called
for a much greater emphasis on leadership and management skills development in the NHS,
and is encouraged that this important subject is now gaining more attention.
However, we believe that much work is still to be done if the Government is serious about
achieving its Quality, Improvement, Productivity and Prevention (QIPP) efficiency targets and
introducing a completely new structure of commissioning, education, training and workforce
development at the same time.
We very much welcome the creation of the National Leadership Academy, the successor body
to the National Leadership Council, but urge Government to pick up the pace in its
implementation so that the achievements of the National Leadership Council are not lost. We
are also keen to learn more about the new arrangements for education and training, and how
the new structure will deliver much-needed improvements in leadership and management skills,
both for clinical and non-clinical managers, particularly in terms of demonstrating what good
management and leadership looks like.
With the crucial recommendations of the Mid-Staffordshire inquiry keenly anticipated in the first
half of next year, the pressure is on Government, NHS employers and staff to raise the bar in
terms of leadership and management skills, so as to deliver improved patient care and to ally
the public’s perception of alarming variations in care standard levels, particularly at the acute
hospital trust level.1
We look forward to working with Government and its agents towards better leadership and
management skills at all levels, and in all professions, throughout the NHS.
About the Chartered Management Institute
The Chartered Management Institute is the only chartered professional body in the UK
dedicated to promoting the highest standards of management and leadership excellence. CMI
sets the standard that others follow.
As a membership organisation, CMI has been providing forward-thinking advice and support to
individuals and businesses for more than 50 years, and continues to give managers and
leaders, and the organisations they work in, the tools they need to improve their performance
and make an impact. As well as equipping individuals with the skills, knowledge and experience
to be excellent managers and leaders, CMI’s products and services support the development of
management and leadership excellence across both public and private sector organisations.
Through in-depth research and policy surveys of its 90,000 individual members CMI maintains
its position as the premier authority on key management and leadership issues.
CMI has an extensive network of approved centres around the UK, which are authorised to
deliver our qualifications. To date there are 680 centres, many of which are FE or HE
institutions, including Oxford University, Edinburgh Napier University and London South Bank
University. Many leading employers are also registered CMI Approved Centres, such as Virgin
Atlantic Airways, National Express UK and PriceWaterhouseCoopers. We also work closely with
1
See, for example, the recent media coverage of problems at Barts and the London NHS Trust
(http://www.bbc.co.uk/news/uk-england-london-15983985)
2

3. leading business schools to develop our research and knowledge of the management and
leadership profession, including Cass, Warwick, Henley, Cranfield and Ashridge Business
Schools.
We offer our qualifications to a wide range of learners through a flexible system of credit based
learning units, which allows learners to study at their own pace, and in manageable chunks. We
also develop new qualifications in response to the needs of employers, such as the CMI Level 3
in Neighbourhood Management and the CMI Level 5 Diploma in Leadership for Health and
Social Care and Children and Young People’s Services.
CMI conducts a wide range of activities in the health sector. We have around 3,000 members in
the sector, and work with a range of NHS employers to deliver skills training, eg. qualifications,
coaching and mentoring and accreditation services. Some examples of our clients include
Nottingham University Hospitals NHS Trust, the General Medical Council, the Royal College of
Physicians and the Heart of England NHS Trust, Birmingham.
1. Workforce development: prioritising leadership and management skills
Improving leadership and management skills ultimately saves the NHS money, as problems and
mistakes are avoided and efficiencies gained. For example, the NHS Institute for Innovation and
Improvement estimates that its work has potentially saved the NHS £6bn over the last few
years. Therefore all NHS managers, whether clinical or non-clinical, should have the opportunity
to develop and professionalise their leadership and management skills. By doing so, they will be
better equipped to deliver the ambitious reforms being introduced by the Government.
We therefore urge Government and NHS employers to place a much greater emphasis on
improving the leadership and management skills of staff, both clinical and non-clinical. Much of
the Government’s reform programme (including integrated care pathways, clinical
commissioning groups, any qualified provider and the QIPP efficiency programme) will depend
on these skills for success. We therefore continue to encourage Government to place a greater
emphasis on leadership and management skills as part of the education and training agenda for
the NHS.
While we understand that the Government is limited in its powers to compel employers to
prioritise these skills, we believe much more could be done by Government to encourage
employers and individuals to improve their leadership and management skills. We are
encouraged that others are now beginning to join our call for leadership and management skills
to be put on a professional par with clinical skills (for example, the King’s Fund2, and various
witnesses to the Mid-Staffs Inquiry3).
However, the slow progress in establishing the new Leadership Academy (see page 5) and the
lack of detail regarding Health Education England’s (HEE’s) responsibilities in this area are
2
The King’s Fund are working on a Review of Leadership in the NHS, which will be launched in May 2012. Several of
their senior executives, including CEO Chris Ham, have recently highlighted the need for Government to support
leadership and management skills more, for example see Chris Ham’s blog, Is good NHS management a waste of
money? dated 29.11.11
3
For example, see HSJ article from 27.10.11 (Mid Staffs inquiry hears calls for regulation of managers) or the
Guardian article, “Doctors are the best hospital managers, study reveals”, dated 19/07/11
3

4. frustrating for those wishing to raise leadership and management skills in the NHS. Much more
time and resources need to be invested in this area if Government are to succeed in
transforming the NHS structure, introducing clinical led commissioning and achieving the QIPP
efficiencies at the same time.
2. High and consistent standards of leadership and management education and
training
Alongside the lack of policy emphasis on leadership and management skills, CMI is also
concerned that there are no national development programmes or professional standards for all
managers and leaders in the NHS, despite the fact that the Department has recently launched a
leadership competency framework. The code of conduct for NHS managers is widely criticised
as insufficiently robust in terms of professional standards, ethics and accountability, as the
findings from the first Mid-Staffs inquiry revealed.
We would therefore strongly recommend that a voluntary system of leadership and
management accreditation be introduced, so that managers who have undertaken accredited
management and leadership development, whether it be a full-scale diploma or bite-sized units
of on-the-job learning, are recognised and rewarded for their skills by employers.
We have recently contributed to a pilot programme to accredit training programmes in the NHS,
which was carried out by the National Leadership Council, and which was very successful. We
are also planning a research project in the New Year to help further demonstrate the value of
accredited learning to employers and individuals, the findings of which will hopefully facilitate the
wider introduction of accredited learning in the NHS.
We are also concerned that under the current system, much of the leadership and management
education and training which is carried out is not accredited, meaning that no national standards
are maintained from Trust to Trust, profession to profession and around the UK. In a clinical
profession this would be unacceptable – but management and leadership development is often
neglected by employers, and staff are left to become “accidental” managers when they are
promoted.
Unaccredited learning is not necessarily inferior, but given the current pressures on budgets it
would surely be better for the training which does take place to be recognised and benchmarked
as meeting national professional standards, ensuring better value for money for the employer
and greater commitment to study from the learner.
From our own research and employer feedback, we have identified the following benefits of
providing accredited learning:
For all types of management qualifications, a clear majority of employers agreed that
productivity gains, staff attraction rates and professional reputation are improved4
4
“The Value of Management Qualifications, - The perspective of UK employers and managers”. Chartered
Management Institute, 2007
4

5. 81% of managers disagreed that offering qualifications causes a high turnover among
qualified staff5
Learning is made more attractive to employees and thus encourages uptake and
commitment to the development programme
The employer’s reputation is improved, thereby supporting recruitment and retention of
staff
Minimum standards of competence are established, against which managers and
leaders can be measured
High-flyers are identified, thus supporting talent management programmes
A more strategic approach to leadership and management development can be taken,
enabling integration with career frameworks
Accredited leadership and management learning also promotes social mobility, so that those
wishing to take a professional qualification can do so without facing significant barriers to entry
which exist in some professions. Through providing higher external recognition of the
development programme, accredited learning can improve the confidence and engagement of
the learner.
Contrary to some perceptions, accredited learning does not have to involve a significant
commitment to study, or time away from the workplace. With the introduction of Qualifications
and Curriculum Framework, many leadership and management courses can be taken in units,
delivered via distance learning or “blended learning” (ie. a mixture of face-to-face and distance
learning). This makes them more attractive to learners and employers alike.
Accredited learning could play a significant role in helping to restore trust in the quality of
leadership and management in the NHS. Whilst no patient would wish to be operated on by a
surgeon who did not hold full medical qualifications, surely no taxpayer would wish to hand over
significant public funding and management decisions (which could affect peoples’ lives) to an
unqualified manager.
3. Infrastructure for professionalising leadership and management skills
As mentioned above, the transition from the National Leadership Council to the National
Leadership Academy is slow and complex. There are many workstreams which the NLC has
embarked on which must be completed. In addition, there appears to be a significant shift in
staff, with NLC staff returning to their “day jobs” and new staff being recruited to the nascent
Leadership Academy. Although we accept that the establishment of the Academy is likely to
take time, we are frustrated by the slow rate of progress and the lack of information about its
structure, remit and responsibilities, although we very much welcome its overarching objectives.
Once in place, we would like the new Academy to have a greater role in endorsing and
promoting standards for clinical and non clinical leaders and managers, rather than fully
devolving responsibility for development to employers, which may lead to uneven skills
development. We believe that the Leadership Academy’s role should be to establish best
5
Ibid
5

6. practice standards of leadership and management, and to promote the uptake of these to
employers, who remain responsible for staff development.
We keenly await the findings of the current Mid-Staffs inquiry, and hope that they will include
some specific recommendations around how Government can encourage employers to ensure
that their staff have the necessary leadership and management skills that meet agreed national
standards. This will protect patients from another tragic example of the results of poor
leadership.
4. Role of Health Education England and Local Education and Training Boards
We would welcome more information from Government on the role and remit of Health
Education England in terms of its responsibility for leadership and management skills
development, and how it will avoid duplication of this responsibility with other bodies, such as
the National Leadership Academy and the Faculty of Medical Leadership and Management.
We are also unsure as to how the new NHS local education and training boards will relate to
HEE; whether HEE will have the power to make recommendations about professional standards
and training; and how both bodies will relate to local employers (acute hospital trusts, private
providers, voluntary sector organisations, GPs and public health workers), the education sector,
the deaneries and the Royal Colleges.
Where possible, we would also encourage these new Government bodies to work with existing
professional bodies to ensure the appropriate promotion of learning across all sectors and to
prevent costly duplication.
There is much valuable work going on at the various Royal Colleges, and at the new Faculty of
Clinical Leadership and Management, to develop leadership and management capabilities for
both clinical and non-clinical managers. Other health sector bodies such as the General Medical
Council have also issued advice on management skills for doctors6. We would expect the
National Leadership Academy to have a role in co-ordinating this work and working with
appropriate professional bodies so as to avoid duplication and confusion for learners.
5. Formulation and development of curricula for clinicians
We would like to see a greater emphasis on leadership and management skills in medical
curricula. We welcome the recent establishment of the Faculty of Medical Leadership and
Management, and we are hoping that the Faculty will work with the Royal Colleges to embed
management and leadership skills earlier on in a clinician’s career.
We also hope that as part of the revalidation process, leadership and management skills
development will be one of the core competences evaluated and monitored – particularly with
the introduction of clinical commissioning groups, which means that GPs will need much greater
leadership and management skills.
6
http://www.gmc-uk.org/guidance/ethical_guidance/management_for_doctors.asp
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7. 6. Whole systems approach to enable multi-disciplinary leadership
An important objective of the Government’s overarching public sector education and training
strategy should be to share learning and best practice across different parts of the public service
network. As a professional body working across all sectors, we believe there is an essential role
for the transfer of best practice and case studies in terms of improving leadership and
management, especially in times of severe financial constraints. For example, we work with
organisations in the health, education, local authority, police, and defence sectors and can
highlight some excellent examples of innovation and best practice.
A shared approach to leadership and management is also important in terms of integrating
service delivery, which is a particularly important challenge in the NHS. The need to have clear
integrated care pathways, which may involve a commissioning care group (CCG), an acute
hospital trust, social services, voluntary sector care providers and the patient’s relatives, will be
an increasing challenge in the NHS over the next decade. By providing open management and
leadership programmes to managers from all these sectors, they are able to develop a shared
understanding and approach to management challenges. This in itself helps to break down
unnecessary boundaries across different service providers and can promote the effective
partnership working that underpins many complex care pathways.
A whole systems approach7 to leadership and management development would also reduce
duplication and improve value for money. We have heard anecdotally from learners in the NHS
that they receive unaccredited leadership and management training from one employer, only to
find that when they change jobs they have to undergo very similar training from their new
employer. This is not only a waste of valuable development budgets, but also wastes valuable
staff time which could be better spent dealing with patients.
7. Conclusion
During this Inquiry the Committee has a good opportunity to raise the importance of leadership
and management skills of NHS staff with Government and key stakeholder representatives. We
hope its members will stress the importance of raising leadership and management skills in the
NHS to Government witnesses and will probe them for answers to the queries we have raised in
this paper.
7
http://www.nationalschool.gov.uk/downloads/wholesystemsgopaper.pdf
7