Should NHS managers be regulated?

NHS managers should be subject to professional regulation in the same way that doctors are – according to Sir Robert Francis QC – who led the public inquiry into failings at Mid Staffordshire NHS Foundation Trust. Speaking at a packed conference on litigation against doctors at the Royal Society of Medicine organised recently by the Urology Section, Robert Francis said that he thought doctors and managers should be on a “level playing field” in terms of regulation.

Sir Robert’s 2013 report on the Mid Staffordshire NHS Foundation Trust catalogued the managerial failings that led to the deaths of hundreds of patients. In the report, he stopped short of calling for professional regulation of NHS managers. Instead, he said that only people who passed a “fit and proper person” test should be allowed to become board level executives of trusts and other providers of NHS services. The fit and proper persons requirement for directors came into force for NHS bodies in November 2014 and is overseen by the Care Quality Commission (CQC).

However, speaking at the conference last week, Sir Robert said that the test would not, on its own, be enough to regulate those working as managers in the health system. “I do believe that, if we are going to have regulation of healthcare professionals, those that manage the health service should be within that system,” he said. “The system that we currently have is unlikely to solve the problem or to put everyone on a level playing field.”

Sir Robert added that there had been some difficulties with the “fit and proper person” test. “When we look at what really goes on in a hospital, we have consultants and, alongside them, managers. Together they are meant to manage a service and yet one side is subject to a regulator, and could be in jeopardy for any decision that they make, whereas the other side is not.” As an example, the GMC struck off the medical directors from a Trust in the West Country for failings related to gynaecological misadventures; while similar censure could not be applied to the hospital managers .

What are your views? Do you agree that hospital managers, who now wield so much of the power in NHS Trusts, should be regulated in the a similar manner to that of doctors?

Comments (4) Add yours ↓
  1. Louise de Winter The Urology Foundation

    It does seem unfair that hospital managers who, through their spending and management decisions set the tone and culture of the workplace, are not held responsible for the decisions they make in the same way that doctors are. However, while it might be easier to attribute cause and effect to the actions of a medic on their patient, it may be harder to draw the line between a management decision made under specific financial constraints and a particular medical outcome. But that doesn’t mean that regulation of managers can’t or shouldn’t be explored, and no doubt wiser, legal heads may be able to find a way how. After all, the threat of some form of sanction can do much to concentrate the mind and ensure it focuses on the right priorities…

    May 17, 2017 Reply
    • Christian Brown Urologist

      Louisa is right. Poor clinical decision making is usually obvious and easy to expose via many processes such as RCA’s and investigation of incidents but managerial decisions are not. Recently a trust near to mine cancelled all non cancer and non emergency surgery for a month to ease a bed crisis. Not a decision made lightly but the repercussions, particularly for a vulnerable patient (mental health issues, elderly, isolated, learning difficulties) and carers are huge and potentially life changing.

      I’m also now finding there is discordance between junior and senior management. Juniors working closely with clinicians and seniors working with colour coded dashboards and board level executives. I don’t believe the needs of the patient are put ahead of everything else anymore and centralisation and ‘lean thinking’ are destroying many of the clinicians clinical systems that work.

      When there is a query from a letter long waiter, cancelled patient, angry relative or a patient whose clinical course has been effected by managerial rather than clinical decision making – who deals with this? the clinician.

      Managers must be accountable for their decision making for as long as those decisions effect patient care. This may be many years longer than their interim placement of 4 months before the inevitable move to manage ophthalmology now run in a Tesco car park off the A3!

      May 18, 2017 Reply
  2. Simon St Clair Carter Consultant Urologist

    I have no doubt that a professional body for managers for both the NHS and private sector with a code of conduct, such as the GMC has for doctors, would not only improve the running of health services but could also give the managerial class a sense of pride and responsibility which may be lacking now.

    If such a body existed when there conflicts with government and the apparatchiks of the DOH occurred it might give local managers some courage to resist the more crazy initiatives and orders emanating from the centre. This professional body could also represent managers in employment disputes (such as the all too frequent summary dismissal of chief executives) for failing to do what the centre has unreasonably asked.

    Just as the GMC oversees medical training the new body could also ensure a basic level of training and accreditation in health service management, provide some core knowledge of medicine, in particular public health issues as well as a grounding in scientific method and statistical analysis – all of which could help them in their daily work.

    Ultimately once such a body was established it could then measure the performance of individuals against the new code of conduct and individuals could be judged by the new body for fitness to practice. While I do not believe that managers are the evil beings that many doctors think they are, I do not believe they currently have the framework to command the respect that many deserve.

    Unfortunately I suspect that creating such an authority would not suit our politicians who continue to mess with the health service often in an incredibly amateur fashion. Perhaps they do with some training and oversight as well!

    May 18, 2017 Reply
  3. Pam Garside manager and academic

    I think we should regulate fewer people, not more. Managers in the health sector and NHS should have a common value set- the training and development programmes we use emphasise these values.

    If we are no good we should be sacked (so should doctors, but generally aren’t). Employers should do due diligence and not employ people who are no good. Poor performance, if that’s the problem, is not dealt with by regulation.

    So let us make performance management systems work in the clinical professions and in management, or at least work better than they do currently. And let us invest in the development of clinicians and managers together, post qualification in the clinicians’ case.

    Note: my views are heavily influenced by the CEO of the Professional Standards Authority Harry Cayton,with whom I wholeheartedly agree

    May 18, 2017 Reply

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