College response to the DHSC consultation on regulating NHS managers

Disagree

While we acknowledge the positive intentions behind introducing such regulation, we believe that NHS managers should be subject to enhanced support and stringently applied recruitment and performance management processes, rather than additional regulation. An effective way to support NHS managers is by fully implementing existing NHS resources and processes, such as:

• NHS England’s leadership competency framework. This framework promotes leadership development for all clinical professions that work in health and care. It provides a standardised and consistent approach to leadership development, relates to clinicians' practitioner roles and applies to every clinician at all stages of their professional journey.
• NHS Standards of Behaviours and Conduct Policies. Developed and implemented at Trust level, they provide clear guidelines for managers and create a more consistent approach to leadership. The Policy applies to all employees, whether on permanent or temporary contract. It also applies to employees that are managed through an external organisation.

These frameworks already play a crucial role in ensuring that leaders are fit to serve in the NHS. Refining them would help avoid duplicating efforts or additional regulatory bureaucracy, while enhancing the current processes. Further strengthening these frameworks could have a more immediate and meaningful impact.

We are of the opinion that improving existing processes around concern raising, creating an organisational culture were speaking up is encouraged and valued, providing comprehensive training and making sure teams have the capacity, resources and staff needed to safeguard the quality of day-to-day care, will better support NHS managers and will lead to better outcomes for patient safety and care quality.  NHS managers should be subject to more regular, effective and stringently applied performance management processes. We also recommend improving access to existing NHS training opportunities that will better equip managers with the necessary skills and knowledge (see our response to Q10).

Neither agree nor disagree

See our response to Q1. We believe that NHS managers should be subject to more stringently applied NHS management and recruitment processes, rather than additional regulation. An effective way to support NHS managers and improve accountability, and thus improve patient’s safety, would be by fully implementing existing NHS resources and processes, such as:

• NHS Fit and Proper Person Test which was introduced as a result of the Francis Inquiry into care failings at Mid Staffordshire NHS Foundation Trust. This was designed to help prevent senior NHS managers who have been involved in or enabled serious misconduct or mismanagement from joining a new NHS organisation. This was updated in July 2024 to ensure it was more effective. Every NHS new and existing chair and non-executive director of NHS Trusts and chairs of integrated care boards (ICBs) have to meet this statutory fit-and-proper-person test, on appointment and every year after that.

Neither agree nor disagree

See our responses to Q1 and Q2.

Disagree

See our response to Q1 and Q2.

Not applicable - managers should not be regulated

See our responses to Q1, Q2 and Q10.

None of these

See our response to Q1, Q2 and Q10.

Not applicable - managers should not be regulated through a barring system

See our response to Q1 and Q2.

Not applicable - managers should not be regulated through a professional register system

See our response to Q1 and Q2.

Not applicable - managers should not be regulated

See our response to Q1 and Q2.

Neither agree nor disagree

See our response to Q1 and Q2.

We believe that NHS managers should be subject to more regular, effective and stringently applied performance management processes, rather than additional regulation. An effective way to support NHS managers and improve accountability, and thus improve patient’s safety, is by fully using existing NHS management resources, such as:

• The NHS Leadership Academy which offers valuable leadership development programmes at various levels, from first-time managers to senior leaders.

Expanding access and ensuring these programmes are widely utilised would help strengthen leadership across the NHS. We recommend improving access to these training opportunities. Ongoing, high-quality training will better ensure that managers are well-equipped with the necessary skills and knowledge. This will also create a workforce that is both competent and confident in its leadership responsibilities.

This, in addition to more effective and stringently applied recruitment and performance management processes will better support NHS managers and will lead to better outcomes for patient safety and care quality.

Neither agree nor disagree

See our response to Q1, Q2 and Q10.

Agree.

We believe that all managers in the NHS should be required to meet equal standards of behaviour and performance, but this does not mean that they need to be regulated as managers to achieve this.  For more detail, see our responses to Q1, Q2 and Q10.

Q. If you agreed, how should clinical managers be assessed against leadership or management standards?

They should only hold registration with an existing healthcare professional regulator that will determine any leadership and managerial competencies.

Clinical managers should only be registered with their existing healthcare professional regulator and not subject to dual regulation.  Both clinical and non-clinical managers should be subject to enhanced support and stringently applied recruitment and performance management processes by fully implementing the existing NHS resources and processes mentioned in our responses to Q1, Q2 and Q10.

Neither agree nor disagree

See our response to Q1, Q2, Q10 and Q12.

Neither agree nor disagree

See our response to Q1, Q2, Q10 and Q12. All healthcare professionals – including optometrists and dispensing opticians – already have a duty of candour. This is a professional responsibility to be open, honest and transparent with patients when things go wrong.

This professional duty of candour was agreed in October 2014 in a joint statement from eight regulators of healthcare professionals in the UK. This was in response to findings and recommendations from both the Mid Staffordshire NHS Foundation Trust Public Inquiry (the Francis Inquiry) into poor patient care at Mid Staffordshire NHS Foundation Trust in 2013 and the UK Government’s response to this Inquiry: Hard Truths: The Journey to Putting Patients First published in January 2014.

Non-clinical managers should have a similar duty of candour as part of their role as an employee of an organisation with statutory duty. This does not need regulation to enforce, as this should be part of their employment contract with the NHS. These contracts should clearly outline all responsibilities, including reporting policies, induction procedures, and the need to be familiar with and follow relevant policies.

Agree

All NHS managers should have a duty to ensure that the existing statutory organisational duty of candour is correctly followed in their organisation. This could be achieved through their contract of employment and other existing processes – which may need review or updating to ensure such a duty is included and all responsibilities, such as reporting policies, induction procedures, and the need to be familiar with and follow relevant policies, clearly outlined.

Agree

See our responses to Q1, Q2, Q10, Q12 and Q14.

All NHS managers should have a duty to record, consider and respond to any concern raised about healthcare being provided, or the way it is being provided (or pass on to an appropriate senior manager to respond on the organisation’s behalf). This could be achieved through their contract of employment and other existing processes – which may need review or updating to ensure such a duty is included and all responsibilities, such as reporting policies, induction procedures, and the need to be familiar with and follow relevant policies, clearly outlined.

We believe that improving the culture of organisations, particularly regarding the raising of concerns, is a far more urgent and effective strategy than introducing new layers of regulation. Encouraging an open culture, where staff feel safe to speak up without fear, is vital.

Ensuring that NHS teams have the necessary capacity, resources, and staffing levels will safeguard the quality of care and enhance patient safety. These factors, combined with effective leadership and clear processes, will drive better outcomes without the need for a lengthy and costly regulatory overhaul.

Regulation of NHS managers, while well-intentioned, has its limitations.

Regulation cannot:

• guarantee the identification and prevention of serious misconduct or patient safety incidents.
• enforce the cultural changes needed to support patient safety or create an environment where staff feel empowered to speak up.
• be quickly designed and introduced.

Clarity and transparency in accountability processes are essential, and the focus should be on improving the existing structures, such as:

• NHS Patient safety incident response framework setting out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents.

As mentioned in our response to Q1, NHS managers should be subject to more regular, effective and stringently applied performance management processes as well as NHS Standards of Behaviours and Conduct Policies.