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Managers fear ‘unfair’ professional regulation

Published on: 9 Jan 2024

More NHS managers support regulation of their roles than oppose it, despite many fearing its implementation will be unfair or disproportionate, a survey suggests. 

The trade union Managers in Partnership surveyed NHS managers working at Agenda for Change band 8a and above throughout the UK late last year, collecting 291 responses.

Asked whether they “in principle… support professional regulation of NHS managers”, 49 per cent said they supported or strongly supported it. Just 19 per cent said they opposed or strongly opposed, while the remainder were neutral.

However, respondents – 22 per cent of whom said they were already covered by a professional regulator, and likely to be nurses, doctors or finance or legal professionals – appeared sceptical about the benefits. 

Asked whether they thought professional regulation of NHS managers would make processes for raising concerns/whistleblowing better or worse, only 26 per cent said it would be better.

Twenty per cent said these would get worse, and the remainder said it would be “about the same”. 

There are also concerns about implementation.

More than 60 per cent of managers were “not so confident” or “not at all confident” that this regulation would be administered in a “fair, independent and proportionate” way.

Just 6 per cent were “extremely confident” or “very confident” of this, and the remainder were “somewhat confident”.

It follows renewed national interest in professional regulation of managers in the wake of the Lucy Letby murders, where it appears NHS leaders had been told of concerns about the neonatal nurse some time before taking decisive action.

NHS England chief executive Amanda Pritchard said in the autumn it was the “right to look again” at regulation, and shadow health and social care secretary Wes Streeting said a Labour government would “introduce a system of regulation, and, crucially, training, to promote excellent leadership and to protect patients”. It would include disbarring of those found guilty of serious misconduct, he said.

The MiP survey also revealed concerns about current handling of care quality concerns.

Of those who had raised a serious concern about quality, safety or standards, 66 per cent felt that their concern was not addressed well by colleagues and systems. Just 2 per cent of respondents described the culture around raising concerns in their organisation as “very good”.

Eighty-six per cent of managers believed concerns about quality, safety and standards will increase in the next 12 months, citing staffing issues and political pressures as reasons.

Commenting on the results, MiP chief executive Jon Restell said: “Regulating NHS managers will not be the silver bullet many politicians are hoping it to be.

“From our survey, it’s clear that managers feel improving existing processes around concern raising, creating an organisational culture where speaking up is encouraged and valued, and making sure teams have the capacity, resources and staff needed to safeguard the quality of day-to-day care, are all more urgent than setting up a regulatory body which will likely take years to get off the ground.

“Managers should be held accountable for the decisions they make, but must have agency in making them. Pressure from government to pursue short-term political priorities undermines managers’ ability to deliver the local interventions needed to get the NHS back to where it should be, delivering high-quality, timely care to those who need it.

“MiP encourage policymakers to engage with us and our members to develop the processes needed to maintain quality, safety and standards across the NHS.”