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ackling trade deal with EU adds further pressure on prime minister after confidence vote Northern Ireland secretary Brandon Lewis. right, has warned Boris Johnson, left, that hardliners in the loyalist DUP could resist a return to Stormont. © Pippa Fowles/No 10 Downing Street
Health and social care leadership in England will be overhauled after a review found evidence of bullying and blame cultures, Sajid Javid has said.
Following a series of damaging scandals at NHS trusts, the government said the report found "institutional inadequacy" in how managers are trained and valued.
The health secretary said the findings - to be published in full later - were "stark".
He earlier likened the NHS to the defunct Blockbuster video rental shop.
Downing Street said Mr Javid told cabinet colleagues the NHS was a "Blockbuster healthcare system in the age of Netflix".
"The NHS is absolutely fantastic, we all rely on it, but much of how it's set up is a still very much 1948, we need to be thinking about 2048 and how we get from here to the needs of the British population when it comes to health in 2048," Mr Javid later explained to MPs.
Labour's shadow health secretary Wes Streeting responded: "I think it's slightly absurd that 12 years into a government we have government ministers who talk in the biggest generalities without plans to deliver anything."
Ahead of the full publication of the review into health management, the Department of Health and Social Care said in a press release that, while it highlighted instances of inspirational leadership, overall the report found "a lack of consistency and co-ordination".
It also said the report "identified a lack of equal opportunity for managers to access training and colleagues to progress in their careers, with those who have existing networks or contacts more likely to access these opportunities".
The review was headed by General Sir Gordon Messenger, a former vice chief of the defence staff who led the Royal Marines in the invasion of Iraq, and Dame Linda Pollard, chair of an NHS trust.
Mr Javid said: "The findings in this report are stark, it shows examples of great leadership but also where we need to urgently improve."
He fully supported the review's recommendations, which the government said include:
- action to improve equality, diversity and inclusion
- clear routes to progression and promotion
- a simplified appraisal system to focus on how people have behaved, not just what they have achieved
- the development of consistent management standards through accredited training
- encouraging the best leaders and managers to take on the most difficult roles, so they are seen as "the best jobs rather than the most feared jobs"
Ministers have their work cut out
The review's ideas for improving NHS and social care leadership in England seem to have been widely welcomed.
Few could disagree with the view that patient care will benefit from a well-led and motivated workforce and that staff should be empowered to develop their careers.
But how that will be achieved is another matter.
Persuading talented managers to take on the toughest roles in challenged areas won't be straightforward. Changing institutional culture will take a while.
The suggestion of discrimination and bullying at some organisations is concerning.
And as the King's Fund think tank notes, the report comes at a time of a workforce crisis with chronic staff shortages which have not yet been faced up to the government.
Ministers will have their work cut out to explain how this review will address the underlying problems of a health and care system under great strain.
NHS Chief Executive Amanda Pritchard said: "As this report recognises, leaders across the health service do a fantastic job in often very challenging circumstances.
"The NHS is a learning organisation - we welcome this report and are determined to do all we can to ensure our leaders get the support they need".
Gen Messenger said the recommendations could transform leadership in the sector, adding: "A well-led, motivated, valued, collaborative, inclusive, resilient workforce is the key to better patient and public health outcomes, and must be a priority."
Meanwhile, Matthew Taylor, the chief executive of the NHS Confederation which represents health and care leaders, said the review had shown the need for more diverse leadership.
"We can't hide from the fact that all too often staff from ethnic minority backgrounds are still not being provided with the support they need to progress to leadership roles," he said.
The review into health service leadership follows a series of damaging scandals at NHS trusts.
About three weeks after Russian troops invaded Ukraine, Indonesian housewife Liesye Setiana was forced to close her banana chip business as cooking oil supplies dried up across the country.
Millions of consumers and small business owners in the world's fourth most populous nation have been rattled for months by skyrocketing cooking oil prices.
As the war between the two major grain and sunflower seed producers sent jitters through global markets, many producers rushed to shift their goods abroad to cash in on soaring rates.
Setiana would travel to a supermarket over an hour from her remote East Java village of Baruharjo to buy a daily eight-litre batch of palm oil that could keep her business alive.
But the 49-year-old mother of two would be turned away, with sellers heavily rationing the commodity used in products ranging from cosmetics to chocolate spreads.
"I was fuming and told the employees that I really need the cooking oil for personal use, not for hoarding," said Setiana, who used to make up to 750,000 rupiah ($52) a day selling her savoury yellow snack.
"How come we have cooking oil shortages when Indonesia is the world's top palm oil producer?"
Her battle for supplies is just a snapshot of the cooking oil crisis that has spurred hours-long queues of residents with jerry cans in hand across Indonesia's most populous island, Java, and others such as Borneo.
Two people died in March from exhaustion -- including one who had queued at three different supermarkets, according to local media -- as they waited in searing heat to get their hands on a product that rose to 20,100 rupiah a litre at its height.
- Counting costs -
Indonesia produces about 60 percent of global palm oil supplies, with one-third consumed domestically. India, China, the European Union and Pakistan are among its major export customers.
The squeeze on cooking oil at home forced the Indonesian government to impose a now-lifted ban on exports last month, easing prices and shoring up domestic supplies.
But at the end of May, the price of bulk cooking oil, the most affordable in the country, still hovered at about 18,300 rupiah per litre on average, above the government's target of 14,000 rupiah, according to official data.
The price spike has left many with difficult decisions to make.
Sutaryo, who like many Indonesians goes by one name, runs a tempe chip business out of his home in South Jakarta. He was forced to jack up his prices and lay off four employees to stay afloat.
"After the surge of cooking oil prices, we have to be smart in calculating our production cost. Our consumers are left with no other choice but to accept a higher price for our kripik tempe," he said, referring to the traditional soy-based crackers.
With demand yet to recover, production at Sutaryo's home factory has slid from 300 to 100 kilogrammes a day, and daily revenue is down to six million rupiah from 15 million before the pandemic.
About half-a-dozen workers cut thin slices of tempe before throwing them into frying pans of hot oil, letting them sizzle until crispy.
It is a far cry from the hustle and bustle of the business's pre-pandemic peak, said Sutaryo, when he had workers frying tempe chips outside for lack of space.
In April, a damning report revealed catastrophic failings at Shrewsbury and Telford NHS Trust, where at least 201 babies and nine mothers might have survived with better maternity care. Last year, the care watchdog for England said patients' human rights may have been breached through "do not resuscitate" decisions made during Covid.
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Boris Johnson has been warned that his plan to rip up post-Brexit trade rules for Northern Ireland will provoke a new row with Conservative MPs without necessarily restoring the region’s power-sharing executive. Brandon Lewis, the Northern Ireland secretary, has told the prime minister that the pro-UK Democratic Unionist party, which refused to join the executive after elections in May, has not agreed that it will begin the process of rejoining if the new legislation is published. Meanwhile Conservative whips, who enforce party discipline, have told Johnson, who survived a confidence vote among Tory MPs on Monday by 211 votes to 148, that party grandees will fight the passage of the bill through parliament. Separately the EU has said that if Johnson unilaterally rips up the Northern Ireland Protocol, which is part of his 2020 Brexit deal, British scientists will be locked out of the €95bn Horizon Europe research project. Ministers had planned to publish legislation overriding the protocol on Wednesday but government officials said that could slip into next week, as Johnson tries to stabilise his party after the damaging revolt by 41 per cent of his MPs. Johnson has argued that the high-stakes move is needed to help shore up the peace process in Northern Ireland. He hopes to persuade the DUP to return to Stormont to share power with Sinn Féin, the nationalist party that won last month’s elections. But Lewis has warned Johnson that hardliners in the DUP could resist a return to Stormont. “Brandon hasn’t definitively said they won’t go in, but we have no firm commitments,” said one official briefed on the discussions. “There are no guarantees. They are in a better place, but it remains to be seen what course of action they take.” Some in the DUP have argued the party should refuse to take part in the executive in the hope that this would lead to new elections, which could allow them to fare better. Failure to form an executive effectively paralyses government in the region. Theresa May, former prime minister, last month said Johnson should consider what the proposed Northern Ireland legislation would say about the UK’s “willingness to abide by treaties which it has signed”. Meanwhile Jesse Norman, the former Treasury minister, told Johnson this week that any breach of the Northern Irish protocol would be “economically very damaging, politically foolhardy and almost certainly illegal”. The bill will also run into fierce opposition from the pro-EU peers in the House of Lords, and the government could face a challenge over the legality of the bill under international law. The legislation will hand ministers powers to switch off parts of the controversial protocol, which creates a trade border in the Irish Sea in order to avoid the return of a hard border on the island of Ireland. One senior Tory MP said: “This bill has law wobble, DUP wobble and party wobble.” Senior Whitehall insiders said Lewis had initially told Johnson that tabling the controversial Northern Ireland Bill would convince the DUP to at least agree that a Speaker be elected to the assembly, enabling caretaker ministers to take up their roles. DUP leader Jeffrey Donaldson © Brian Lawless/PA However, Sir Jeffrey Donaldson, the DUP leader, struck an uncompromising tone on Tuesday, writing in The News Letter, the region’s pro-Unionist newspaper, that if the issue of the protocol was not resolved, “then Northern Ireland would be without a devolved government”. A senior DUP insider added that Donaldson “felt under no pressure” to restore the region’s democratic institutions “until the protocol issue is dealt with”. The UK government has obtained legal advice arguing that the bill to override the protocol would be considered legal under international law, based on a higher obligation to protect the 1998 Good Friday peace agreement, but that view is expected to be challenged.