Consultation launched on regulation of NHS managers

DHSC has published a major consultation seeking views on options for regulating NHS managers and on the possibility of introducing a professional duty of candour for NHS managers. 

The consultation supports the Government’s manifesto commitment to introduce professional standards for regulating NHS managers with the overarching aim of ensuring patient safety. They are part of a broader effort to improve leadership within the NHS, ensuring that managers are both accountable and supported in their roles. 

Work around a new leadership and management framework is already being developed by NHS England which will introduce a code of practice, a set of core standards and development curriculum for managers. 

As part of the first annual Fit and Proper Person Test reporting this year, the consultation document states that “a small number of board members have been identified as not being fit and proper, and in other cases action is underway to support development and improvement.”

We're also told that organisational culture continues to remain a challenge, despite efforts to improve it following the publication of the Messenger Review in 2022.

Recent public inquiries continue to highlight the “devasting impacts a lack of senior leadership accountability can have…[and] the need for candour to apply across the NHS, regardless of position”.

Objectives of the consultation 

Stakeholders from across the health and care system are invited to share views on the most effective way to strengthen oversight and accountability of NHS managers working in both primary care and secondary care in England.

The consultation, which is set to run for 12 weeks, seeks views on:

• the type of regulatory system that would be most appropriate for managers
• which managers should be in scope for any future regulatory system
• what kind of body should exercise such a regulatory function
• what types of standards managers should be required to demonstrate as part of a future system of regulation

It also asks the question on sequencing of the introduction of a regulatory mechanism for NHS managers, alongside NHS England’s work on professional standards.

Any legislation brought forward to implement a statutory regulatory regime for NHS managers will be subject to further consultation. 

Approach to regulatory models

The consultation document sets out the range of regulatory options and includes:

• Non statutory mechanisms such as a voluntary accreditation register
• Statutory barring system, full registration and revalidation mechanisms

Depending on the regulatory model chosen there will be different requirements and processes to the regulatory regime. 

There will also likely be a need for one or more new or existing bodies to take responsibility for all or part of the regulatory system. Options range from the CQC, as they run the existing fit and proper persons test, to a professional membership body or an independent regulatory body such as the Health and Care Professions Council.  

So, who would be in scope? The regulatory framework would, at a minimum, apply to board level directors in the NHS, arm’s length body board level directors and integrated care board members.

As readers can imagine, the potential costs are in the millions.

Consideration also has to be given to how to regulate those with other professional registrations.

Statutory barring system

A list of individuals who are barred from practising due to serious misconduct. This list would be enforced through legal obligations on employers not to appointment barred individuals. An individual may be disbarred for ‘serious misconduct’, which includes behaviour such as criminal convictions or offences, deliberate bullying and harassment or dishonesty (as outlined in the Kark review of the fit and proper persons test). If this system is introduced, it would mean the introduction of a national code of conduct for managers or leaders, and a body would be given legal responsibility to consider serious complaints.

A professional register 

This would include a list of individuals who are fit to practise, which can be either voluntary or statutory. This would be similar to professional registers held by some healthcare regulators, such as the GMC for doctors and the NMC for nurses and midwives and nursing associates. 

Full statutory regulation 

Requires professionals to register and periodically revalidate their fitness to practise. Full statutory regulation would require NHS managers to register with a regulator, demonstrating their qualifications and fitness to practise. Managers could face sanctions or be struck off for misconduct. This system aligns managers with the regulatory standards of medical and nursing professionals.

Accredited voluntary register

A quality-assured list of individuals who meet certain professional standards, but joining would not be mandatory. A voluntary register may be accredited similar to those assured by the Professional Standards Authority. If introduced this would require a set of professional standards which managers would be required to meet in order to join the register. 

A question of candour

One of the consultation questions asks whether NHS leaders (not managers) should have a duty to ensure that the statutory duty of candour (organisational duty) is correctly followed in their organisation, and if they should be held accountable for this. 

The consultation will also collect views on whether a professional duty of candour should be introduced – a duty professional regulators (such as GMC, NMC and HCPC) introduced as part of the professional standard for their registered members to encourage open behaviours. 

Patient safety incidents – new duties?

What duties should NHS leaders (not managers) have in relation to recording, considering and responding to safety incidents? This is a question raised in the consultation following the Infected Blood Inquiry recommendation.

Have your say

You can respond to the consultation using the online survey.

The consultation closes on 18 February 2025.

Comment

The discussion around regulating NHS managers has been ongoing for some time, as we have seen following several healthcare inquiries or investigations. While regulation is crucial for management and leadership development, it must be part of a broader initiative to foster a culture of openness, acknowledge challenges, and provide support. As we have seen, the public demands greater scrutiny and accountability from those in senior positions.

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