Managers raising safety concerns ‘must not be jumped on’, says NHSE director

Regulation of managers must not lead to a disbarring process without the development and support of staff, NHS England’s national patient safety director has said.

Speaking at HSJ’s Patient Safety Congress, Aidan Fowler was asked whether NHS board members and managers should be regulated, amid calls for this in the wake of the Lucy Letby scandal. 

He said: “I think there are pros and cons to regulation… What I would say is that you just have to be cautious that you do not lead to a disbarring process without the developmental side of regulation, and the support side of regulation. For staff, to support them to do a good job.

“We have seen that there is a gap in patient safety training for boards, which we need to work on, for them to understand and to encourage them to talk about it more.

“I think there is a developmental part of regulation, which is really important… in any discussion. I know because we are already having discussions around it. That is a key part to pay attention to.”

Dr Fowler also warned that any changes should be “in step” with the recommendations from the public inquiry into the Letby case, which is not yet underway and is likely to take several years, so they do not end up “going in a different direction”.

Letby was convicted last month of murdering seven babies, and attempting to murder six more, during a year-long period between June 2015 and June 2016 at the Countess of Chester hospital. She indicated her intention to appeal the convictions last week.

Dr Fowler added, in relation to setting up a regulation system for managers separate from doctors, nurses and other clinical professions: “Just the final point, we all work together. Is it the right thing that we are all regulated by different bodies? I don’t know.”

It comes as another NHSE director, Sir Jim Mackey, also a successful trust CEO, told HSJ regulation of managers “is coming”, and that the health service should “go with it and make it as effective” as possible.

Meanwhile, the Healthcare Safety Investigation Branch’s chief investigator told the congress event she felt managers should be regulated, but that it was “the wrong question we are answering”.

Rosie Benneyworth, who was appointed to the role last summer and was on the panel, said: “I do not think regulation of managers will stop another Lucy Letby… I do not think we should be jumping on regulation of managers because of Lucy Letby.”

Dr Benneyworth added: “However, I think regulation done well can drive up standards, it can lead to improvements, and it can also make sure that there is an oversight on the national level of people working in the system.

“Managers are vital in healthcare and are as equally important to a person’s healthcare as a doctor and a nurse.”

Speaking about lessons from the Letby case more widely, Dr Fowler told the congress there was a danger in patient safety of “looking in the rearview mirror”, and said leaders needed to move to a system where concerns “are sensed in real time”, and they responded “at first sign of any concern”.

HSJ understands local NHS chairs and CEOs at a meeting last week with NHSE CEO Amanda Pritchard raised their worries about spotting the ’signal in the noise’ of serious problems, among widespread service pressures and concerns such as waiting times and staffing.

Dr Fowler said: “We need to move from a world in which we’ve tended — and this is at risk of being a terrible generalisation — to wait until we’ve got a signal that’s really clearly visible, and then leaders would go in and demand action, and demand assurance…

“We have to move to a system where we sense in real time and at the first sign of concern we move in as leaders to support and offer help.”

He went on: “Lucy Letby’s crimes are, fortunately, very rare, but… Concerns about [detecting safety] problems in among the noise are not uncommon.

“We have spent a lot of time building relationships with leaders so they can come to us and say, ‘we have just got a slight concern here,’ and that happens all the time.

“The key thing then is for my response, and other leaders’ response, not to be to jump on people and say ‘you must do things’ and demand. But work with them to help understand what is going on.

“Very often there may be nothing there, but it is that business of sensing in real time, and supportive responses, rather than this dismissive attitude, and being comfortable with the idea that a lot of the time you may find nothing there. That’s not a waste of your time… responding more frequently, and accepting perhaps there will be nothing there.”

Dr Fowler said safety research also advised ”deference to expertise”, which suggested better listening to clinicians who raise concerns, as doctors in Chester have said they did about Letby.