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Weak NHS managers could be ‘struck off’


Plans to “strike off” underperforming managers have been announced by Gordon Brown as a way of dealing with failures such as the Mid Staffordshire Foundation Trust scandal.

The prime minister’s statement follows fears that the debate over whether to regulate NHS managers will be hijacked by politicians wooing voters.

Where management fails, just as with doctors, we should be able to strike off from a list those managers who are not acceptable to health authorities

As HSJ predicted last month, a Department of Health advisory group has recommended proposals to ensure the quality of senior NHS managers on boards.

These will be considered in a review now being carried out by Robert Francis QC, who chaired the Mid Staffordshire inquiry.

The proposals include clearer standards, strengthened recruitment and vetting processes, better corporate governance and a consultation on whether a formal system of regulation should be established.

But Mr Brown appeared to pre-empt this consultation in a Parliamentary exchange about Mid Staffordshire on the same day.

He said: “This is a failure in management that has to be dealt with. I am grateful to the secretary of state for health for bringing forward a series of recommendations, including a recommendation that where management fails, just as with doctors, we should be able to strike off from a list those managers who are not acceptable to health authorities.”

But this recommendation is not contained in the advisers’ report, which calls for further work assessing the different options.

Managers in Partnership chief executive Jon Restell said the issue of regulation needed “to be properly aired”.

He supported a voluntary process but said there were some “big human rights questions” about whether a more formal system could be implemented.

General Medical Council chief executive Niall Dickson said healthcare regulation was about protecting patients and maintaining trust in the profession.

He said: “That’s rather different from ‘let’s have something that strikes off doctors, or indeed managers’ and I think the understanding that regulation isn’t about punishment is really important if you’re going to have a proper regulatory system for any group.”

The advisory group did not find a consensus on whether there should be a system of accreditation, licensing or regulation. Support tended to be for voluntary accreditation rather than anything based on statutory powers that would enable managers to be “struck off”.

Most NHS bodies and patients interviewed by advisory group researchers felt regulation should only be considered after improving recruitment and vetting processes and strengthening corporate governance.

A statutory system was seen by many as “disproportionate for managers, costly to implement and unlikely to achieve buy-in from the sector”.

Advisory group lead and NHS North East chief executive Ian Dalton told HSJ there was strong support for allowing managers to register themselves as complying with set standards and ethics. But he said a “very extensive debate was needed” about whether “that necessary first step is sufficient in itself”.

The advisory group’s report came out on the same day the Francis inquiry was published. Health secretary Andy Burnham said he hoped it would address criticism that chief executives at failed organisations can move easily into other top NHS jobs.

Refined proposals are due later this year.

NHS East Midlands chief executive Dame Barbara Hakin said it would be useful for managers to be able to show they had reached a very high level of competence but warned there could be “some quite significant difficulties” in ensuring regulation did not prevent managers from moving in and out of the NHS.

A DH spokeswoman said the consultation would seek means of ensuring “that when senior NHS leaders let down their patients, their staff and the NHS, they should not simply move on to other jobs without proper consideration of their conduct”.

She said: “The results of the consultation will inform any decisions on whether such a system should be statutory.”


Readers' comments (2)

  • Populist headline from the Prime Minister? Could there be an Election round the corner?

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  • Managers should be knowledgeable in ethics. This is basic...

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