Unfortunately, your browser is too old to work on this website. Please upgrade your browser

Better leadership for tomorrow: NHS leadership review

Before the general election, the Secretary of State for Health, Jeremy Hunt, had asked Lord Rose to conduct a review into leadership in the NHS. He was asked to consider:

  • what might be done to attract and develop people to take on leading positions in the NHS
  • how strong leadership in hospital trusts could help to transform care delivery
  • how best to equip clinical commissioning groups to deliver the Five year forward view for the NHS in England.


The final report contained 19 recommendations covering training, performance management, bureaucracy and management support.

Lord Rose highlighted three areas of particular concern:

  1. Vision: the lack of a single NHS vision and a common ethos.
  2. People: insufficient management and leadership capability to deal effectively with the challenges associated with the scale of planned reforms and changes
  3. Performance: a lack of overall direction for careers in management across medical, administrative and nursing staff.

The report's recommendations included:

Overarching recommendations:

  • develop a single, service-wide communications strategy within the NHS to cascade information
  • create a short NHS 'handbook' summarising core values.


  • require Health Education England (HEE) to coordinate the content, progress and quality of all NHS training and promote cross-functional training across disciplines and levels
  • move the sponsorship of the NHS Leadership Academy from NHS England to HEE
  • review, refresh and extend the NHS graduate management training scheme
  • refresh middle management through training and a more porous approach to recruitment
  • require senior managers to attend accredited courses to ensure consistent levels of experience and training across the NHS.

Performance management:

  • embed core management competencies and associated expected behaviours at each level
  • establish ongoing career support for those in management roles
  • establish a system of rational and simple appraisal.


  • review the data demands of regulators and oversight bodies and rationalise requirements
  • merge the NHS Trust Development Authority and Monitor
  • require the Health and Social Care Information Centre (HSCIC) to develop an easily accessible 'Burden Impact Assessment' template and protocol.

Management support:

  • create NHS-wide comment boards to share best practice
  • set minimum term contracts for some very senior managers
  • formally review non-executive director and CCG lay member activity.

Rose S.
Better leadership for tomorrow; NHS Leadership Review.
Department of Health; 2015.