The author is chief executive of NHS Confederation
The full ramifications of the case of serial child killer Lucy Lebby will not be known until the investigation is complete.
However, questions were then raised about why senior managers in the National Health Service were not subject to the same oversight as doctors, nurses and other healthcare professionals. The government and NHS England, the independent body responsible for day-to-day oversight and management of the service, are in the early stages of considering new powers for senior managers who have engaged in serious misconduct – such as disregarding health care regulations. Warning of danger. Patient – discovered. Labor has also pledged to overhaul the rules governing the NHS.
This argument is not new. Indeed, Francis’ investigation into failures at Mid Staffordshire NHS Foundation Trust a decade ago led to the 2019 Carker review, which recommended “free speech” advocates within NHS organizations protect and encourage whistleblowers.
Of course, every case should be investigated. But it is vital that the wider NHS system is as robust and transparent as possible.
When it comes to NHS board appointments, tests have been put in place to ensure only the “right people” take up key roles. The checks are designed to prevent senior managers who have been involved in or contributed to serious misconduct or mismanagement from joining other NHS organizations.
While it is sensible to introduce a stronger regulatory framework, care needs to be taken to design a system that actually addresses the problems it is intended to solve. It is no good trying to view this challenge through the lens of “clinicians as heroes and administrators as villains” as some early comments did.
Managing risks, including patient safety risks, is at the heart of the work of senior managers and clinicians. Whether delivering services in crumbling hospitals, dealing with the impact of strike action, or simply meeting growing demand with limited resources, health leaders often have to make difficult choices. Partly due to the existing regulatory regime, turnover among senior leaders is high – nearly two-thirds of current NHS trust leaders are first-time chief executives. While bashing bureaucrats is a popular pastime, there is ample evidence that many of the challenges facing the NHS reflect a lack of managerial investment.
Of course, none of this removes the need for strict accountability when senior NHS managers, or anyone else, are found to have engaged in serious misconduct – those who failed must be prevented from taking on future NHS roles. Judgments on allegations must be made independently: regulators need to measure personal and professional conduct against clear standards and codes of conduct. This approach requires legislation.
But while more safeguards are needed, we should acknowledge that the NHS is already heavily regulated. The Patient Safety Incident Response Framework, published last year, sets out a health service approach to developing and maintaining effective processes for responding to patient safety incidents. The Care Quality Commission already inspects and rates hospitals, GP surgeries and other providers, including investigating cases where clinicians and managers have raised concerns about GP surgeries and other providers.
When designing any new regulatory framework for senior managers, our starting point should be to develop an appropriate approach. The NHS treats tens of millions of patients every year and must respond to many concerns and complaints. A key feature of any system must be a commitment to maintaining learning from mistakes. Simply seeking blame will only encourage cover-ups and blame-shifting, rather than transparency and improvement.
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