The Conservatives have ordered a shake-up of NHS leadership in England on the eve of their party conference, with Sajid Javid saying that with more funding must come “change for the better”. The health secretary said he wanted to see the most far-reaching review of NHS bosses in England for 40 years, appointing a former vice-chief of the defence staff, Gen Sir Gordon Messenger, to lead the work. However, some NHS bosses were furious about what they described as a political move to shift blame on to trust, hospital and social care leaders as the health service struggles with a big backlog. Under the terms of the review, Messenger will be asked to look at the best hospitals, GPs’ services and social care delivery to work out how this can be replicated across the country. Tory sources said it was not about a reorganisation of leadership structure or apportioning blame for failure but “identifying the best leadership, finding out why it’s so good and looking at how we roll it out more widely”. They said it was a key plank of “levelling up”. No structural shake-up is expected in social care, it is understood, but the government could be open to more national leadership in the sector. NHS bosses criticised the review as a “slap in the face” after the pandemic. Some said they saw it as a deliberate attempt to shift the blame for the health service’s fragility. In recent days Nottingham’s main acute NHS trust has had to cancel planned chemotherapy sessions due to a lack of nurses and East Surrey hospital declared a “critical internal incident”. One NHS chief said: “It’s hard not to interpret this as an attack. This will go down really badly, like a vat of cold sick.” NHS bosses also suspect the government has been “stung” by publicity around the fact that leaders of some of the new NHS “integrated care systems” – 44 regional groupings of health organisations across England that will become operational in April – will earn about £250,000, a lot more than the prime minister. Matthew Taylor, the chief executive of the NHS Confederation, which represents hospital trusts, warned that the review could hinder health service leaders. He said: “As the NHS changes and moves to system leadership, it is right that we need new leadership skills and approaches. But if we are going to look at leadership and leadership qualities, then we also need to review the context in which our leaders are operating. “The operating environment is among the most fraught that NHS leaders have experienced and this review will need to support, not hinder, their progress.” Johnson has tried to improve the Tories’ reputation on the NHS since becoming prime minister, with Labour traditionally seen as more trusted on the health service. He has promised £36bn for health and social care after the Covid pandemic, focused on addressing rising waiting list times, raised from higher national insurance contributions. In his announcement, Javid made clear the government would expect improvements from the NHS along with its extra budget commitment, even though it is focused on playing catch-up. “We are committed to providing the resources health and social care needs but that must come with change for the better,” he said. “This review will shine a light on the outstanding leaders in health and social care to drive efficiency and innovation. It will help make sure individuals and families get the care and treatment they need, wherever they are in the country, as we build back better.” Messenger was the vice-chief of the defence staff from 2016 to 2019 and he worked as head of operations for the community testing programme. The Conservatives said he would have a team of officials from the Department of Health and Social Care and the NHS, led by Dame Linda Pollard, the chair of Leeds teaching hospital.