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The Future Of Healthcare Leadership – Analysis Of The Messenger Review

In October 2021 the government announced a review into leadership across health and social care in England. The Messenger Review, led by Dame Linda Pollard and Sir Gordon Messenger, has now been published along with a set of seven recommendations focusing on the best ways to strengthen leadership and management across the healthcare sector.

It highlights examples of outstanding leadership practice and recommendations for finding ways to drive up innovation to improve productivity, efficiency and deliver better public health outcomes.

Below we highlight the key ways in which the Healthcare Leadership Academy (HLA) is working to meet those recommendations to inspire and nurture the next generation of healthcare leaders.

Key observations

The Messenger Review is an important report that demonstrates the impact that good leadership at every level can make in a workforce that has faced particularly intense pressures in the last few years.

The review demonstrates the critical role that NHS leaders and managers play in delivering high quality and efficient care – and acknowledges that the NHS still has a long way to create more diverse leadership, while advocating for concrete steps to be taken to address this.

Of the many observations made, there are two that are cited in the review as almost universal:

“Firstly, the very real difference that first-rate leadership can make in health and social care, with many outstanding examples contributing directly to better service, yet; secondly, that the development of quality leadership and management is not adequately embedded or institutionalised in our health and care communities.”

Leadership & quality of care

Effective leadership within the healthcare sector is no doubt among the critical components for delivering successful and effective outcomes – and it is decisive in influencing quality of care. Importantly, it requires organisations to invest in their people to best unlock their potential – the end goal always being the pursuit of the best possible outcomes for patients and public health.

But too often in healthcare, leadership is confused with management. The Messenger Review rightly demonstrates the incredibly important role that leaders play in delivering high quality care across the NHS. More crucially, it places focus on the need to instil ‘leadership’ as “an instinctive characteristic in everyone, not just those with the word in their job title”.

As the review states, in order to help build the leadership of the future, investment in people needs to be prioritised with other operational and political priorities. Most critically, the review calls for a step-change in the way the principles of equality, diversity and inclusion (EDI) are embedded as the personal responsibility of every leader and member of staff in the NHS.

But creating a diverse leadership can only be achieved “through determined cultural change from the top of the system to the front-line.” In other words, change has to come from the top.

Another key recommendation is the need for greater collaborative action from the centre – along with greater alignment of leadership training and development (including digital and transformation) across the health and social care sectors.

This is particularly important as the NHS focuses on delivering more integrated care for patients with the recent establishment of ICSs – making it even more crucial for leaders to work more collaboratively.

Tackling the challenges

At the HLA – formed in 2016 as a direct response to young clinicians and medical students wanting to learn about leadership – we aim to lead on making inclusion and diversity a reality in the NHS, helping to empower and support the next generation of clinical leaders through a variety of programmes and projects.

We were founded on the principles of promoting greater inclusivity and accessibility within a workforce that has become almost notorious for its diversity gap – particularly in senior positions. While positive steps have been taken to help tackle this in recent years, the latest research shows that BME staff, for example, continue to remain underrepresented in these roles.

Our values have long been centred on the fact that leadership should not be the arena of a chosen few but of all those with innovative visions, ideas and solutions. We know that diversity and inclusion is hugely important to improved health outcomes, particularly as the NHS is responsible for providing care for a highly diverse array of patients.

Today, as we continue our work to prepare early-stage clinicians to lead in healthcare – and support the future of the NHS – here are some of the keys ways we are helping to address the interventions listed in the Messenger Review to help tackle underrepresentation and further the aim to build a workforce that is well-led, collaborative, inclusive and resilient, now and into the future.

1. Targeted interventions on collaborative leadership and organisational values.

At the HLA we believe in starting earlier than midcareer. We focus on teaching leadership skills and giving leadership opportunities to people before or at the very early stages of their career.

True collaboration means learning from everyone – not just in the UK. That’s why we deliberately offer our HLA scholars programme internationally, allowing NHS clinicians to learn with and from other clinicians so they can understand and take the very best of experience and understanding from healthcare systems around the world. The HLA also hosts fully virtual cohorts to support healthcare professionals from around the world to attend our scholarship programme together.

Our Mentoring scheme additionally offers scholars the opportunity to develop relationships with healthcare professionals, giving them the chance to learn from faculty members who have a plethora of leadership experience and skills.

2. Positive equality, diversity and inclusion (EDI) action

The HLA was created on the principle that EDI is vital to developing the best leaders. Our programme is open to ALL healthcare professionals, no matter what background and encourages diversity of thought, opinion and action.

One of our key programmes is the HLA Women in Healthcare Leadership (WIHL) project – set up in 2019 to address the issue that women continue to remain under-represented in leadership roles within healthcare. The programme has delivered a number of successful projects to date, including the WIHL 100 Word (Women) Project and WIHL Art Series.

We are also supporting greater diversity through HLA IDEAS, an exciting incubator programme giving healthcare professionals and students the opportunity to set up their own non-for-profit organisation. One of our participants was recently awarded The Diana Award having founded Melanin Medics as a charity to support African and Caribbean aspiring medics, medical students and doctors in the UK.

Our alumni also include The Aspiring Medic’s Support (TAMS), which was set up by a group of former medical students to support students from less advantaged socioeconomic backgrounds in gaining access to medical school.

Our scholars and faculty have consistently come from an incredibly diverse background. Many cite the HLA programme as role modelling individuals in leadership that they do not traditionally see. This is cited consistently as the reason many apply to the HLA. Scholars often go on from their time in the HLA to other leadership roles and opportunities across their health systems.

The HLA has often given non-traditional candidates for leadership roles, the confidence, the platform and then the credentials to apply for programmes and opportunities within their health system or organisation. We see our role as actively facilitating talented people, wherever they are from, being given the confidence and often the permission structure to say that they should take on leadership roles throughout any health system or organisation.

3. Consistent management standards delivered through accredited training

Our Scholars programme is consistent with the concept of a spiral curriculum and has been deliberately developed with a strong practical focus. It encourages all scholars to complete a project over the course of their year. In our approach, we use a combination of mentoring, Socratic discussion, and philosophical exploration with the aim to inspire our scholars to change the world of healthcare, one small step at a time.

HLA provides Accreditation and renewal based on these key standards:

● The Leader as a Communicator

● The Leader as a Manager

● The Leader as a Negotiator

● The Leader as an Innovator and Entrepreneur

● The Leader as a Follower

● The Leader as a Philosopher

When we design HLA Leadership programmes, one principle that we have consistently focussed on is that leadership is within a context. When thinking about leadership, and particularly training leadership skills, if it is done in an environment or context that is not how you intend that individual to apply those skills and learning, then the value of the training is lost.

Therefore we have built programmes that do not take people out of their normal environment, but build programmes that fit contextually around the immediate – often clinical – environment they find themselves in. The participants undertake projects from within their context and build on that immediate space they find themselves in.

The input from our programmes adds the necessary theory, but also space to reflect and then test out the individual’s learning. The process of trial and error is important, with the safety of reflection and space to think through improvements.

4. A simplified, standard appraisal system for the NHS

Our ethos at the HLA has always been focused on meaningful professional development and our programmes are designed so that each individual can derive unique value from this learning experience.

The core of the HLA programmes is focussed on reflection, reflecting on practical leadership experiences within a safe environment. The HLA creates environments and contexts where clinicians are encouraged to test their leadership skills, make mistakes and learn from those mistakes.

We foster an environment where daring to be ambitious, and then reflecting on success and challenge, allow the individual to then take their experience into meaningful appraisals that can help them move forward in their leadership journey within the healthcare environment.

5. A new career and talent management function for managers

We already recruit for the best talent in the NHS and beyond, but more than that – we retain talent by focusing on this meaningful professional development. We nurture excellence to support individuals to reach their potential in the way that is most meaningful and value laden for them. Clinical leaders need as much support on their leadership development as they receive in their clinical training.

The type of support and the nature of the training are very different, and this is one of the biggest challenges. It is important to not focus on the simple learning elements such as knowledge transfer, but to move up the taxonomy. Managing the careers of clinical leaders is part of all our programmes, knowing that unlike standard clinical careers, the pathways are often not formulaic.

Individuals need support and guidance in many of the unknown steps in their career and a network to develop very disparate experiences that ensure successful leadership careers.

6. More effective recruitment and development of non-executive directors

Part of our HLA work involves supporting and nurturing interested scholars into cohort director, supervisor and board member roles.

Often clinicians are unable to get into board/non-exec roles because previous non-exec or board experience is required. We have a board advisor training pathway which trains the future non-execs of the NHS on how to be effective and supportive at board level.

In this programme we train talent to develop their non-exec and board skills and support them into these roles. This is the first initiative of its kind supporting NHS clinicians.

7. Encouraging top talent into challenged parts of the system

Philosophy, Innovation & Entrepreneurship are key parts of our core curriculum. We have done this in anticipation of the changing landscape of healthcare in the NHS and therefore aim to equip healthcare professionals with the leadership arsenal they need to tackle challenges with resourceful, innovative thinking.

Once in the HLA we commit to supporting our scholars for the rest of their healthcare career, so we invest in healthcare professionals for the long haul, giving them access to evolving leadership knowledge through HLA think, HLA listen, HLA ideas and the alumni programme for the rest of their careers.

Next steps

Having reflected on this review over nearly a year, there is a lot that healthcare and the NHS in the UK needs to consider for its immediate and longer-term future.

The NHS can at times be insular, often scared that solutions must come from within. The HLA has taken an approach of looking across the various professions, drawing help and ideas from a lot of other pathways and industries, and looking internationally.

Not just looking at the published and high-level reports globally, but creating real world, practical networks of global clinicians that allow joint reflection and support. Creating strong relationships that can develop over the entire careers of those clinicians.

The HLA is encouraging many of the lessons of the last 6 years to be actively taken up across healthcare. In the UK we have seen reviews like this review focus attention on leadership. 5 years after the HLA forming, our organisation and community welcomes these positive steps and hope this will lead to even greater focus on this vital area for health systems.

The HLA was founded to help healthcare professionals and students develop their leadership credentials – and our programme has expanded a lot in recent years, as far wide as Bristol, Belfast, Edinburgh, London and Amsterdam.

To learn more about our work and the ways we are helping to create the healthcare leaders of the future, click here to read our 2021 community report. Find out more at:

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