The SoR has offered conditional support for the government’s consultation on extending regulation for all managers and leaders in the NHS.
In the consultation, “Leading the NHS: Proposals to Regulate NHS Managers”, the government explained that it aims to take further action to strengthen the accountability of NHS managers, with the overarching aim of ensuring patient safety. It comes following several high-profile public reviews over the last two decades, which have identified "serious failures" in NHS leadership.
Dean Rogers, SoR executive director for industrial strategy, warned that regulation is not a “magic wand”, but could be a catalyst for a change in NHS workplace culture. In order to do so safely and effectively, however, change must be introduced carefully or it risks making the situation worse.
'A vehicle to drive change'
Mr. Rogers explained: “Introducing change in a space like this is very difficult and has to be done very carefully – or you can easily make things even worse. We don’t think regulation is a magic wand or can, in itself, improve patient safety or manager confidence and security.
“However, because we know how critical changing culture is to NHS improvement we are giving qualified support to these proposals – on the basis they can be a catalyst for positive change, a vehicle to drive a change in NHS workplace culture. We are also using the consultation to explain more about what and how change should look like.”
Risks if changes are introduced poorly include higher costs acting as barriers to promotion; a higher sense of professional risk from greater professional exposure; and control of extra costs arising from increased regulation falling upon individuals, rather than the taxpayer.
Existing differences in standards and interpretation of when cases should be referred to different NHS regulators should also be recognised. Challenges could arise from regulators being underfunded, taking too long to resolve cases, and losing credibility.
'Doing nothing isn't an option'
The SoR further emphasised that debate around extension of regulation has arisen not because of its lack, but because of the failure of extant regulation.
The vast majority of senior leaders involved in controversies and organisation failures prompting this consultation were already covered by professional regulation at the time of the alleged failures.
Mr. Rogers said: “Doing nothing isn’t an option for the NHS. Too many examples of failed accountability means the NHS has burned that bridge with the public already. The government starting the consultation has to be seen as a positive first step and our response shows we want to help them to make this the catalyst for real change – including some positive ideas about new things to do and some definite 'what not to dos'.”
Demonstrating real leadership
The SoR’s recommendations include:
- Clear, common, positive management standards that are contextualised for different management levels and areas
- Fully funded training and qualification pathways in engaged leadership and accountability, including access to qualifications in managing people and accountability
- Developing standards and training in genuine social partnership
- Aligning and standardising these across existing frameworks and minimising the risk of double registration
- Include a review of all internal NHS reporting and accountability mechanisms, and using opportunities to focus on priority areas such as improved EDI awareness, reduced harassment and violence against staff
- Appropriate professional qualifications in managing people being essential requirements for senior leadership posts
The SoR are also calling for a new duty on government to ensure regulators are able to secure fair, safe and timely outcomes in all cases.
“Culture is set from the top and cascades down,” Mr. Rogers added. “For this idea to have a positive long-term impact it has to be introduced positively. Deterrent theory doesn’t work. Increasing a sense of threat will only make senior leaders more defensive. But government has hidden from this to an extent as well.
“Their response to our idea of a duty on them to sustain fair safe and timely regulation will be an interesting test for them as well. By taking responsibility for finding the investment necessary to make this work and by including themselves in the scope of increased accountability, the government will show real leadership.”
Access the full consultation, “Leading the NHS: Proposals to Regulate NHS Managers”, online here.
(Image: Photo by Sturti via Getty Images)