Gordon Brown’s knee-jerk reaction to Mid Staffs is doomed to failure
Gordon Brown wants the power to strike you off.
Pre-empting a carefully worded Department of Health consultation paper on raising the quality of senior managers, published in response to the Mid Staffordshire inquiry led by Robert Francis QC, Gordon Brown made clear to the Commons that he wants them to be regulated.
The Department of Health’s proposals on assuring the quality of managers are teetering on the brink of excessive bureaucracy
When faced with a public outcry ministers too often feel compelled to do something. Impractical, unwieldy plans are drawn up which owe more to the need for a soundbite than to common sense. The vetting and barring system established in the wake of the Soham murders is a striking example of this knee-jerk approach to policy development.
The Department of Health’s proposals on assuring the quality of managers are teetering on the brink of such excessive bureaucracy.
Three of the four recommendations from the working group set up by health secretary Andy Burnham are sensible and proportionate, building on existing structures; the fourth - regulation - could create a vast, costly and pointless superstructure to oversee a system which would fail.
The three proposals more likely to win support - or at least acceptance - are to use a framework of standards and ethics to clarify the standards patients and staff can expect; encourage employers to drive professional standards through their recruitment procedures; then use governance measures such as appraisal and development to keep leaders on track.
At a time when money is tight and the regulatory and bureaucratic burden on managers too great, any response to public concern about management competence needs to come with a large dollop of common sense. As long as these three ideas do not grow in their development, they could all be implemented quickly and effectively at modest cost.
Indeed, voluntary accreditation may well appeal to managers on the foothills of NHS greatness. The ability to demonstrate their commitment and talent through such a scheme could provide a crucial advantage over less diligent competitors at interview.
When it came to full-blooded regulation, the DH was at pains to stress in its report that there was no consensus on whether it should be pursued. HSJ’s conversations with a wide range of opinion formers suggest even this may be a generous interpretation of the reaction. We found widespread scepticism.
NHS North East chief executive Ian Dalton, who chaired the advisory group which wrote the report, was clear in an interview with HSJ that any move to regulation would require extensive debate.
Apart from the cost, just think of the problems and pointlessness of it all. Imagine top flight chief executives with years of achievement to their name being compelled to fill in some worthless assessment form; think of the ire of a medical director - already regulated - now having to answer to a second regulator. How much form filling would be required before a manager from local government or the private sector was allowed on board?
Effective recruitment and governance are all that are needed. Voluntary accreditation may be a useful addition. Yet another health regulator is unnecessary.
But at prime minister’s questions the same day the report was published, Gordon Brown had no such inhibitions. He made plain in reply to a question on Mid Staffordshire that he supported a recommendation that failing managers could be struck off.
No such recommendation has been made. Instead, the report simply says the National Leadership Council should consult widely on the benefits and costs of regulation, and make a recommendation to ministers later this year. If anything, the advisory group’s tone is sceptical.
The Department of Health needs to reassert its grip on this debate, before casual soundbites for the consumption of voters push the NHS towards a regulatory system that will waste time and money while doing nothing for patients.
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Readers' comments (7)
Anonymous | 4-Mar-2010 1:44 am
It's always a disappointment when you agree
with an editor... Regulating managers makes for good sound bites so I expect the NHS isn't going to get a grip of this one again.
With so much attention on management at mid staffs
one must conclude there is much more to this story. But we'll never know until a full public inquiry is held. Of course that won't happen as the trail would lead all the way to the top.
SunTzu
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Peter West | 4-Mar-2010 11:34 am
While I broadly agree, I can't help feeling that doctors and other professionals used some of these arguments to oppose reaccreditation, but nonetheless we now have it. Directors of Finance, Nursing and the Medical Director are already subject to professional disciplines if they foul up badly and unprofessionally. Is there a case for professional management standards and qualifications that all must have? I agree that a bureaucracy would be another costly item but on the other hand, it does seem an anomaly that other senior staff face a professional standard they must keep up when managers as such do not. I speak as a health economist, a "profession" that anyone can join more or less by self-declaration and certainly with no professional tests that all must pass. Would I welcome professional standards and disciplines? Probably not, but of course I have a vested interest in an easier life.
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Anonymous | 4-Mar-2010 1:21 pm
Management will have to enter into the real world at some point and be accountable in a way that also allows us to be able to protect ourselves in what will be an increasingly stormy sea as budgets begin to shrink.
The main risk with voluntary accreditation is the badge collecting manager who ticks the box and fails to exhibit the competencies in the working environment.
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Derek Mowbray | 4-Mar-2010 1:31 pm
As the author of The Manager's Code that is currently our for consultation I have sought to address the root problems - the paucity of candidates for senior positions, the fear of taking top jobs, the general negativity that clouds the management of the NHS. What I wanted to achieve was a Code that didn't adopt the same approach to NHS management that has caused the root problems - a culture of threats and targets, but to promote a culture of wellbeing and performance. The difficulty with regulation outside of professional regulation is that it will be bureaucratic regulation, and will have all the hallmarks that have emasculated some previously successful services such as the Guardian-ad-Litem service now posing as the massively incapable CAFCASS. The Manager's Code has the content to enable managers to acquire a licence to practice with a Practice Certificate renewable every two years on demonstration of suitable CPD. This is an enabling process, that is designed to help managers grow and acquire skills at levels A, B and C, which are essential for successful leadership. The Practice Certificate could be granted by the IHM and other professional bodies that have managers within their membership, such as BMA and RCN, or all the professional bodies could have a joint venture with a Centre for Wellbeing and Performance that grants the PracticeCertificate on their behalf. The policing approach will not address the problems and may well make them worse - although it's now difficult to imagine how much worse the situation can get.
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John Adsett | 4-Mar-2010 4:15 pm
Clunk, wooops!
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Anonymous | 4-Mar-2010 5:15 pm
There are several tribes in Mid Staffs already with a professional code of conduct for their personal practice. Irrespective of the system, they all say "by act or ommission" and we're not striking off them for fear of the professional reprisals?
The danger is creating a buffer of middle management fall-guys between practice and the real power brokers at the top. Management has always been the firey pit between a rock and hard place. So regulation (which I agree with) needs to come with powerful professional representation not the political dimwits we've got now.
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Anonymous | 4-Mar-2010 11:05 pm
You are quite right anon 5:15. Gordon Brown's cheap political diversion onto managers away from Government is obvious! Derek's suggestion of those professional bodies joining up is fanciful and has been tried once before in the early 90's. It was considered an act of treason to participate in such thoughts! The issues at mid staffs are much more complex than will be fixed by regulation. But of course we'll never know how deep the rabbit hole goes because there will be no public inquiry into the conduct of those regulating that Trust!
However, sad to say there is a need to regulate and accredit managers. I have worked with the best and dismissed many of the worst. The DH want to lead regulation. They must be regulated themselves and any organisation regulating managers must be as independent as those already in existence.
SunTzu
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