Regulating managers will not resolve the issues they face
Is the regulation of health service managers a good idea? The man who watches the watchers - Harry Cayton, chief executive of the Council for Healthcare Regulatory Excellence - does not think so.
He writes: “Calls for the regulation of managers… fail the right-touch regulation test.” Rather than dragging managers through fitness to practise investigations, he argues that trust boards should take greater responsibility for the “selection, training, supervision and accountability of managers.” He concludes: “A list is not a solution.”
Mr Cayton is right. Management is not a profession (although managers may, of course, be members of the professions). To try and pretend it is and to regulate accordingly is to place a misleadingly reassuring fig leaf over the issues facing NHS management.
An updating of the 2002 management code of conduct as suggested by the Department of Health’s Enabling Excellence document is welcome and will be especially useful guidance for the increasing numbers entering management from clinical roles. The document also proposes a voluntary register for “unregulated” staff. Mr Cayton believes this would “bring greater clarity of standards for management” and, again, he is right - as long as it does not distract from the primary responsibility of employers.
HSJ has two further hopes. The first is that the government does not knee-jerk into a more hardline position following the final report of the Mid Staffordshire Foundation Trust inquiry. The second is that politicians will recognise that when managers do fall below expected standards they often do so in the context of a politicised environment in which honesty and transparency are sometimes actively discouraged.
The government has promised to take a step back from direct management of the NHS. If it does live up to its claims of increasing autonomy, NHS management decisions (whoever makes them) will improve in quality and consistency.
One final improvement is necessary: all politicians - government and opposition - should commit to raise the quality of the debate over the future of the NHS. Specifically they should stop the casual misuse of evidence and crude caricaturing of staff groups and organisations involved in healthcare to support their public grandstanding. HSJ will not hold its breath.
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Readers' comments (3)
Derek Mowbray | 3-Mar-2011 12:37 pm
A big risk is that any regulatory approach will regulate the wrong thing. There is an expectation in our society that everything has some kind of quick fix that can be easily applied to every situation. This gives rise to a focus on the idea of efficiency as the key attribute of managers, ignoring the far smarter idea of effectiveness. So we have bankers that are so focused on achieving their goals that the costs associated with their achievement are only measured when they become too great and register somewhere in someone's mind. Even then the Groupthink associated withi this obsession prevents much in the way of improvement. So too, with a large array of organisations, alas, including the beloved NHS.
We have to understand that all formal organisations are controlled communities, controlled by managers. The Quick Fix expectation places on managers the pressure to accomplish their tasks in the linear direction that is aimed at the goal. The costs involved in this are massive. The costs of psychological presenteeism are estimated to be two or three times the combined cost of sickness absence and staff turnover - in the NHS someone has suggested £4b per annum. That is the cost of a 'so called' efficient management approach, that has little interest in being effective in the achievement of tasks - being mindful of the wider implications of all controlling actions - the essential job of managers.
Unless and until there is a shift in the thinking about managers and their behaviours the massive costs will continue, and in current difficulties where staff are uncertain about their futures, the costs will rise. Worse still, are the by-products of linear efficiency - the stifling of engagement, of innovation, of shared responsibilities, of corporate responsibility, of all the attributes that make successful organisations hugely resilient.
Regulation of managers will have the risk of regulating the wrong thing. Licensing managers to practice, and to practice in accordance with the new Manager's Code, based on commitment and trust, that's a different matter altogether. Most professionals have a licence to practice. The term professional means an expert. What we need are expert managers - or professional managers who know that the way to persuade people to do things is to feed their self interest first, and then find they reciprocate by feeding the self interest of managers second. No Quick Fix, but hugely effective.
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Anonymous | 8-Mar-2011 8:54 pm
I was talking to my recently retired GP recently. He said that the NHS had become corrupt and that senior managers were appointed to their positions because of their willingness to bend and break the rules.
I had not prompted this exactly but it co-incided totally with my own feelngs having started looking in to the NHS culture and practices about three years ago.
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Anonymous | 9-Mar-2011 9:44 am
This government will regulate the wrong thing, of course, but part of the reason we got ourselves into this mess has to be laid at the door of some managers. I have seen an endless stream of highly paid people with no clinical or public health background come into the NHS and put in charge of projects or programmes they don't understand; they may know about management but nothing about health, patients and the culture of care.
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