7 things NHS leaders need to know about the Rose review

At the back end of June, Lord Stuart Rose published his long-awaited review into NHS leadership, commissioned by the Secretary of State in 2014. The relatively short document answers the three questions his commissioner asked him to address…

  • Leadership is the key to making changes stick. How is great leadership recognised across the NHS?
  • How do we find and nurture the people that are needed to lead the NHS over the next 10 years?
  • How do we help all NHS staff become the best versions of themselves at work?
Karen Lynas
Deputy managing director, Karen Lynas


He’s made 19 recommendations grouped under five headings with three highlighted areas of concern.

The Secretary of State, Jeremy Hunt warmly welcomed the review in his introduction to it so I believe we can expect that much of these findings will impact on the development of leadership in health over the coming months and years.

So what might you expect to take from this paper? Here are my seven prompts and questions – borne of nothing but my own curiosity I’d welcome your own thoughts and comments.




1. Remind yourself, and those around you, that the NHS is doing well.

This isn’t just a glib aside. That someone with his background starts the review with a genuine recognition of the work that is going on under hugely pressured circumstances is a good thing. Every time we have someone who points to the evidence, the experience and reality of great care in the NHS we should recognise and acknowledge it. Rose does that in his opening and he questions often in his review how this good work gets recognised and rewarded. We can all start much more frequently from an appreciative perspective that begins by focusing on what is good, what we want more of and what we can improve on, and what we can celebrate rather than what’s wrong, what’s missing, what’s broken.

2. You are right to question and query change and find it tiresome, but do ask yourself why it comes so frequently…

Rose recognises the almost constant change, reorganisation, restructure that happens in the NHS. He questions its impact and to what extent changes are allowed to embed to create the intended outcome. It’s reassuring to have our sense of constant flux reinforced by an external observer. But we might want to ask ourselves if we do suffer under an endless series of restructures and reorganisations why that might be, and what we might do differently to make that less likely?

3. So much more unites us than separates us – let’s start behaving like that.

Rose’s two preconditions for the work are a single service wide communications strategy and a short handbook including structure, how the NHS works and its values. Many of his findings and recommendations refer to the one NHS. Now, we know that we mostly operate as single units of employers and organisations in a loose confederated system (insert your own description here), and not a big single organisation with a corporate headquarters. So it is easy to read the report and dismiss some of it as coming from a man who doesn’t understand the nature of the system he is talking about. But actually, don’t most of us feel that we work with a common purpose and collective endeavour? Doesn’t our public talk about The NHS? How hard would it be, if we chose to, to start acting more like that? And what might the positive benefits of that be? What would get in the way?

4. It’s all about the people, stupid.

OK, he’s not that blunt, but not far off. Many of his recommendations and much of his narrative is a really simple message – the NHS is a great organisation that is as good as it is because of its people, and as bad as it is for the exact same reason. If we want a better NHS we need to support, develop, train, appraise, promote and engage our most precious resource. We need to take the enormous resource our people represent and treat them with the respect and attention that suggests.

5. Don’t expect it to happen by accident or for someone else to do it.

Back to the people. Rose talks a lot about practice that is pretty routine in most big organisations, including M&S of course: spot great talent, train them, develop them, support them and promote them. Make sure that your place, your team, your organisation, your system isn’t scrambling around for talent when it’s needed. Plan for making sure everyone around you is properly developed and supported. I am still not sure why we don’t do this more routinely in the NHS. Look at your team, your organisation, your bit of the system – is everyone skilled up as they need to be and if not what are you doing about it? Do you have a succession plan for all of the key roles in the team, and if not what will you do when one of them leaves? This is your job as a leader.

6. Look less for control and more for influence and leadership through the change.

The change theme, the ‘done to’ theme appears often in Rose’s review and comes from lots of places. Whether you see it as externally imposed, centrally driven, nationally dictated or socially constructed, patient led, necessitated by demography and changing workforces, so much is going to happen over which you have no control at all. The key is to be prepared to lead yourself and your staff through this with elegance and creativity. How do you genuinely shift the nature of your relationship with patients, carers, communities and citizens so that you are comfortable with giving up the control you thought you had? How in periods of change and reorganisation do you retain focus on the purpose of your service and not the structure of it? Bend like the willow, not break like the oak. Remain constant in purpose, not in form. However you describe it, equip yourself and your team to flourish through change.

7. Take action now.

Whether or not the recommendations are all picked up or not, they are based on some truths and there is evidence behind them. There is a fierce search for talent at the moment – outside the public sector as well as within it. Our staff really are what makes us special, and they will be what the NHS needs to survive. Many of Rose’s recommendations are about those in positions of authority removing the obstacles that allow staff in the NHS to get on and do their job. But he is also very clear that from a leadership perspective we need to get on and do it, with greater skill, knowledge, experience and expertise. That we should recognise that if managers and leaders across the NHS want to be valued for the contribution they make they need to be both invested in and developed, but also weighed and measured to ensure they are doing that which is demanded of them well and to the best of their ability. Before you start being weighed and measured, as you surely will, you might want to start getting your house in order now.


Of course, it’s easy to ask the questions. But I don’t underestimate the complexity in taking these challenges up – but I’m confident we can because after all, you aren’t just any leader – you’re an NHS leader.


We’re not only making sure our programmes help us to continue to respond to the Francis Inquiry report and build strong leadership communities, we’re also thinking about how we can support more widely with succession planning and talent management to tackle some of the issues raised in the review.


Let me know how we can help you further.

4 replies on “7 things NHS leaders need to know about the Rose review”

  • From the humblest floor sweeper to the most exalted consultant, everyone can be a leader. At the very least, lead yourself to be the best you possibly can at what you do, take personal responsibility for the quality of your contribution and help others become even better at what they do.

  • Some parts of the NHS pays attention to developing their staff and ensuring that everyone have the necessary skills required to tak lead or fill a vacant role to avoid a vacuum. Unfortunately some not NHS organisations especially the larger ones falls short when it comes to the development of their most crucial resources. I’m glad this was highlighted in the Rose review. Thanks for providing your insight on the review Karen!

    Daniel Oyayoyi
  • Focusing on the good we do, the good we have and the further potential for good seems important. Alongside that we need a heavy dose of realism , once efficiency is achieved leaders must be allowed and enabled to speak truth to power about the decisions which are needed.

    Maxine Craig
  • Taking collective is that the easy bit? Let’s do it????


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