I made enough of a fuss... the least I can do is read it. The Rose report into Leadership in the NHS. Mr Marks finding out why the NHS lacks a bit of sparkle.

There's been rumour and gossip about the delay. The DH came up with a cock and bull collection; extend to include CCGs, the 5YFV, the dog ate it... whatever. Here it is.

The first thing that strikes me is how utilitarian it is. No pictures, no graphs; has the layout and feel of an East German train time-table. It could have been hammered out in a 60's typing pool, on an Optima. Stark; Arial san-serif typeface. No paragraph numbers.

'Fifty carbon copies Frau Jenkinshopple... schnell!

Very Marx and not much sparkle. But, d'ya know what? It doesn't matter. This is a very astute piece of observation; has the feel of being written by someone who has taken the lid off the box and doesn't much like what he's seen inside.

At 60 pages it is too long. Too much time spent on context. Given the audience... unnecessary. But, from 'The Balkanisation of Trusts' and 'Bureaucracy' to 'Performance Management' and 'Support', it is penetrating and comprehensive.

Sum it up in a few words? 'How on earth the NHS muddles thought with all this stuff going on, is a miracle.'

My suspicion; there has been a carefully hushed-up row over this. Hence the delay. There are some pretty blunt references about the 'reforms' and their consequences, the money and the perpetual state of change. I get the feel it's been toned down.

Also, I am suspicious because there is a reference to the flattering findings of the Commonwealth Fund, rating the NHS above the rest. It reads like it has been shoehorned in. Am I right; the completion of the Rose report would have been out of sync with the publication of the Fund's conclusions?

What else does Rose say?  Here's a clollection 

"The NHS lacks; a common vision, no proper leadership training, no communication strategy, staff not nurtured, too many competing demands, insufficient leadership capacity to cope with the change agenda, over burdensome regulation, no talent management, buck passing and whistleblowing issues."

You could have written this, couldn't you? The remarkable thing is it has been written by a complete stranger. On second thoughts, maybe it isn't remarkable; just obvious. Or, just maybe; there was a ghost in the Optima? The report is very elegantly turned; unquestionably at the Whitehall end of the Gunning fog index. I'm suspicious.

The recommendations?

Merge Monitor with the TDA. An off-piste conclusion?  He's right and it is in train but I'm suspicious about how and why it got there.    Another; create a website to share best practice. Ahem... We've done that at the Academy of Fabulous NHS Stuff.

More; training, support, sort out the NEDS. Make a cuppa-builders and read the summary (Page 9). It's worth it.

Let me ask you a question.  Beside the bills and the mortgage and the credit cards and all the rest... what brings managers to work in what Rose describes as an environment that is;

"... fragmented, designed to defy collaboration, too many city states, not enough cooperation, too tactical, lacking in strategy, crippled by short-termism, over-burdened with regulator demands, medics versus managers, risk averse, avoiding failure a priority."

Rose notes; 7% of CEO position unfilled, average tenure 700 days, short-termism, the role of an impatient CQC, tribalism, lack of support for clinical managers, fragmented commissioning.

Grim isn't is? There' more:

"... As a whole, the performance management culture within the NHS is lacking: objective setting, reviewing, and clear lines of responsibility and accountability are absent...."

Is there a big 'thing' in the report? I think so. By chance I wrote about it last week. The NHS is complex everyone skilled and wanting to do their best it but somehow it manages to lack a common purpose. Rose calls it a 'common ethos'.

How many fingers poking the NHS pie? GMC, the NMC and eight other regulators.   Eleven watchdogs and authorities. CCGs and Trusts? Collectively probably over 1,000 mission and value statements.

No common purpose. Ask them all to write down what they're at and you'd likely have 1,000 versions. Can anyone whistle a tune everyone will recognise, and will make them want to march in step?

Lord Rose was not at the launch of his report (Suspicious?), nevertheless, he has given his name to a very interesting piece of work. This is definitely in the 'ouch' category and is a great credit to whoever wrote it...

There will be those in the DH who will be thinking this is one M&S product they'd quite like to take back.