NHSE board members face regulation under government proposals
A major consultation on introducing professional regulation of NHS managers and leaders proposes applying the measures to NHS England board members.
One of the questions in the Department of Health and Social Care’s consultation on regulating NHS managers, published this afternoon, asks participants whether “appropriate board members at arms-length bodies (for example, NHS England)” should face a system of regulation.
However, the consultation does not ask participants whether NHSE employees should be included in plans for an individual statutory duty of candour, which could see managers face legal penalties for failing to report safety concerns.
Instead, it only asks if managers at Care Quality Commission-regulated organisations should face tougher legal accountability, and at which level this should be considered.
The consultation, set to run for 12 weeks, will consider the type of regulatory system that would be deemed appropriate, which managers should be in scope, what kind of body should be responsible for its regulation, and what types of standards managers should be required to demonstrate.
It comes alongside a review examining the effectiveness of the duty of candour, which ministers launched last December prior to the July general election.
The document said that “despite [previous] measures to improve NHS leadership and leadership accountability, those affected when things go wrong have been left feeling that NHS managers and leaders are not properly held to account for their actions or that people raising legitimate concerns are not always heard.
“The ongoing Thirlwall Inquiry into events at the Countess of Chester hospital continues to highlight these concerns. The Infected Blood Inquiry further highlighted the devastating impacts a lack of senior leadership accountability can have and emphasised the need for candour to apply across the NHS, regardless of position.”
It added: “It is therefore vital that we take further action to strengthen the accountability of managers, with the overarching aim of ensuring patient safety.”
The four regulatory approaches being considered by the government are: a statutory barring system, a professional register, other “full statutory regulation”, and an accredited voluntary register. The type of regulatory system adopted will determine who bears the cost and how much it is, the consultation says.
The Thirlwall Inquiry is due to hear from former Countess of Chester CEO Tony Chambers, as well as ex-medical director Ian Harvey, later this week.
Earlier this month, the inquiry heard a former regional director was asked to “rehabilitate” Mr Chambers following a falling out with his board and paediatricians.
At a minimum, all board-level directors in English NHS organisations, arms-length bodies, and integrated care systems will be under the new framework, the DHSC said.
Jon Restell, chief executive of the Managers in Partnership trade union, told HSJ that managers “care deeply about patient safety and standards of care, working to uphold them in tough operational conditions”.
However, while previous MiP surveys have shown support in principle for statutory regulation, he said some lack confidence that it will be “applied proportionately, fairly and openly, and that the process will be truly independent”.
Mr Restell added: “Managers must be accountable for the decisions they make, but they need clear responsibilities and the right tools to do their work well.
“It is vital that regulation comes with a fully resourced package to develop, train and support NHS managers as seen in other professional regulatory frameworks. We must be careful not to talk of regulation as a silver bullet: it can only play a part in improving the capacity, capability and culture of NHS management.
“MiP will engage with an open mind in this consultation, and make sure that the government hears our members’ concerns.”
UPDATED, 09.21: This article has been updated to include a comment from Managers in Partnership
Operating in a bubble
The DHSC has also published the findings of its review into the effectiveness of the duty of candour across health and social care providers.
It revealed just 40 per cent of respondents felt the purpose of the duty was clear and well understood, while some believed it has become a “tick-box exercise”.
More than a third (38 per cent) of health and care staff had adequate systems for ensuring senior-level accountability for monitoring the use of the duty, with one respondent adding: “Managers operate within a bubble and do not look to each other, or other services to benefit from learning opportunities available…”
Some said staff are reticent about complying with the duty for fear that they are admitting guilt.
Others reported instances where staff were empathetic and aimed to follow the process, however, senior management did not support them amid fears of not being protected from possible repercussions if they were deemed a whistleblower.
Additionally, more than half of respondents (52 per cent) felt the CQC’s regulation and enforcement of the duty of candour was inadequate.
Karin Smyth, a health minister and former NHS manager, said: “To turn around our NHS, we need the best and brightest managing the health service, a culture of transparency that keeps patients safe, and an end to the revolving door that allows failed managers to pick up in a new NHS organisation…
“Today’s announcement builds on that promise and help us build a health system that protects patients and is fit for the future.”