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Accountability probe could lead to regulation for managers

The government signalled a possible move towards the regulation of NHS managers as new health secretary Jeremy Hunt launched a probe to determine how they might be held to account for care failures.

Mr Hunt used his speech to the Conservative party conference to reveal that the issue will be examined by the Department of Health and the Care Quality Commission.

One departmental insider said it was too soon to predict whether this could lead to the regulation of managers.

However, most informed observers viewed Mr Hunt’s move as a response to the likely recommendations of Robert Francis’s report into the failures at Mid Staffordshire Foundation Trust, due to report early next year.

Mr Hunt told the conference: “We have many committed managers in hospitals and care homes, but I need to say this to all managers – you will be held responsible for the care in your establishments.

“You wouldn’t expect to keep your job if you lost control of your finances. Well, don’t expect to keep it if you lose control of your care.

“So, as of today, I have asked my department and the Care Quality Commission how we can make sure managers are held accountable for the care they provide, both in the NHS and social care sectors.”

A source close to Mr Hunt said he was currently merely “asking” the DH and CQC for “suggestions” on how to make managers more accountable. They cautioned against assuming it would lead to the regulation of NHS managers.

However, Mr Hunt’s predecessor Andrew Lansley told HSJ: “It’s always been intended from all the way back when we were first thinking about all of the responses to Mid Staffordshire that [we look at] a framework that managers share with other NHS staff which is accountable and transparent.”

Anna Dixon, policy director of the Kings Fund think tank warned that the government “must not rush to introduce regulation of managers”. She added: “Trust boards are accountable for quality of care. Regulation must support good governance and effective leadership within providers.”

NHS Confederation chief executive Mike Farrar said the organisation would have an “open mind” about any proposals resulting from Mr Hunt’s request, but added that “we will want to be sure that they truly add benefit compared to the costs they impose”.  “They must not represent a heavy-handed and disproportionate response that takes time and money away from patient care for little benefit,” he said.

CQC Chief Executive David Behan said he had had an “initial conversation” with Mr Hunt about “holding managers to account for the care they deliver”. He added the CQC would now “work with the Department of Health to take this forward”. He continued: “CQC believes that primary responsibility for good care is with those who deliver that care.”

Jeremy Taylor, chief executive of the patient group National Voices, said he believed the announcement on the accountability of managers was “an anticipation” of what the “Francis report will say about the scope for regulation being extended to cover managers”.

“If you have accountable services working correctly [under] the boards of providers it would not seem to me to be necessary to have regulation on top,” Mr Taylor said.

Mr Hunt also used his speech to confirm that from next year all hospitals would be assessed using the friends and family test currently being piloted in the Midlands and East of England. The test involves asking people if they would recommend organisations’ care to people they know.

Speaking elsewhere in Birmingham this week, he confirmed he wanted to publish a “simple and short” mandate for the NHS Commissioning Board. “I want to be as un-prescriptive as possible in the Mandate because I think the whole spirit of the reforms is to unleash local innovation - to set outcomes we are aiming for and allow local solutions”, he told attendees at one event.

He also called for “much greater integration and working between sectors” in health and social care, saying integration was “going to be as important as competition”.

Readers' comments (17)

  • Phil Kenmore

    I'm not against regulation for managers (it will after all potentially instill more confidence in the public - in the shrot term at least) but Doctors, nurses etc are all regulated and that does not always prevent appaling care and abuses from happening. Mid Staffs was not all about poor management - Francis will have also have something to say about clinical leadership and the roles taken by clinicians in the events there.

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  • does mr hunt not already know that managers are already held to account and that given all the changes in the NHS this is not the time for more manager bashing - that wont help develop the culture of trust and openess that we want in our services

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  • No doubt it will apply to all people in management posts providing or commissioning NHS services

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  • 12:18 - probably not.

    But it would serve to make the NHS a closed shop for managers.

    Which is just what we need when we want fresh thinking.

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  • By and large managers, whether general or from a clinical background are only doing what their Boards want.

    Far cheaper to make the FT Boards regulated with dismissals and revoking of rights to work again in the NHS and loss of pension.

    But then that would hurt the nobby classes - far easier to keep shooting the underlings and plebs.

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  • What is the difference between this and clinical governance, which already covers the management of clinical care?

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  • Andrew Craig

    Hunt's speech was lacklustre. This point is nonsensical: "I have asked my Department and the Care Quality Commission how we can make sure managers are held accountable for the care they provide, both in the NHS and social care sectors." The CQC should be clear back to Mr Hunt that this misuse of regulation will not work. Managers are not care providers. Even if they were, to regulate them individually would be a behemoth task that would never be achieved and would not ensure quality. Far better to license the boards of directors of care providers and hold them collectively to account for safe and effective care in their establishments, with penalties for failure that really bite on individuals and reputations. Does no one at DH understand corporate governance any longer? We wait to see what Francis has to say about all of this.

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  • I agree that the key difficulty is that it runs the risk of creating a closed sop for managers. It also could create a major hurdle in manages easily moving between health and social care at a time when integration is fairly high on the agenda.

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  • I fully agree with Mr Craig - yet again recruitment procedures are not open and it seems there are glass ceilings for people who truly care for patients rather than covering up for corrupt bosses to include the ones who moved to the private sector...

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  • The most important point of Jeremy Hunt's speech has been completely lost - it is a focus on raising standards, patient care and health outcomes -

    "why are our survival rates from the big killer diseases still not the best in Europe?.....

    If our mortality rates for the five major killer diseases were as good as the best in Europe, we would save 20,000 lives a year. 20,000 personal tragedies that we could be avoiding - but are not. "

    It is extrememly important we raise health standards, and outcomes should be on a par with other leading health economies. It is not acceptable that my mother (and other family's loved ones)who died from colon cancer 2 years ago, if she had been treated in many other EU countries, should is likely to have survived longer and might still be alive.

    It really is important that outcomes are improved - probably the most important NHS target there has been.

    I also welcome the new patient assessment -
    "And as of next year all hospitals will be assessed against the number of patients who would recommend the care they received to friends or family. "

    This is a great improvment from former patient surveys and experience measurements as I mentioned in my HSJ article some years ago - ( )
    As I mention in this article "Some private sector healthcare organisations take this very seriously and the patient ratings are part of their managers' appraisal and bonus scheme."

    There was no mention of regulating NHS managers in Jeremy Hunt's speech - I was there.
    In fact managers were congratulated alongside doctors and nurses - "Thanks to their commitment, our nurses, doctors, managers and professional staff have delivered brilliant results over the last 2 years"

    As well as being congrtaulated it is also important that managers work together with their clinical colleagues and others to raise standrads and outcomes and all take responsibility for this. So why not introduce rewards for the excellent as well as taking responsibility and remedial action for poor outcomes?

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  • This proposal would be complete nonsense irrespective of its origins. You can't regulate by job title (people would pop on and off the register as their jobs changed?) and the skills of managers vary so widely, you'd have to pick a tiny core set, which would be practically meaningless.

    Management isn't a profession with it's own defined set of knowledge and techniques, but a set of practical and personal skills which can be used to motivate teams and coordinate processes & resources. Many people can use such skills and do. They aren't always in management jobs. You don't need to exclude the incompetent from an area of practice - if they don't improve in response to feedback, just sack them and ensure their references are truthful.

    Much better to have decent evidence based standards for service outcomes and really monitor performance against these standards. In addition to this direct & meaningful approach, monitor staffing levels, sickness rates and morale surveys to help to drive out the mindlessly obedient and the downright psychopathic. Job done.

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  • The Government today announced the formation of the NHS GMC (General Managers Council ): to be or not to be confused with the other GMC. NHS Managers will be obliged to be registered with the new body and a fee will be payable of around the cost of servicing a Mercedes Benz, and for which your employer will not refund you. You will pay the same fee, irrespective of how much or how little you earn. I.e. you will pay as much as your Chief Executive. Managers will have to keep records of appraisals, conferences attended, CPD and KPIs. A national register of performance against target KPIs will be established and managers will be given their funnel plots w.r.t. colleagues. So will their Chief Executive. Outliers will be 'counselled'. Anyone will have the right to lodge a complaint against any manager and the NHS GMC will investigate each one. The investigation will involve writing to anyone the manager has worked for [even outside the UK] in the last five years. The previous employers will be asked if they had any - and I mean any - concerns of even the slightest about your performance, conduct, probity etc, etc.

    You will have to revalidate as a manager every 5 years. If you fail to revalidate or any serious concern about your performance as a manager is upheld [see above] you may be struck off and be unemployable as an NHS manager. Learn to drive a bus. Even if not struck off, you may go through years of stress and anxiety while 'remedial measures' are applied, or until your name is cleared.

    Unbelievable? Try being a doctor registered with the GMC, because that is exactly what we have to put up with.

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  • @1.50 I'd like to say I empathise. But it comes with the territory. Having referred several doctors to the GMC, I don't know what your worried about? They're even more ineffective than CQC - always no case to answer - even after prosecution. I'd like to see you held more to account and a tougher scheme of regulation for doctors.

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  • At least the GMC does act and does attempt to ensure that professional standards are met.

    Try instead being registered with the incompetent and failing NMC, which does neither effectively and in some areas of professional practice, sets no professional standards whatsoever. Unlike medicine, NMC registered professions don't have Royal Colleges which set standards for specialist practice, so this is a bit like having validation for every medical practitioner except the GPs or the obstetricians, if you can imagine such a thing!

    Now try looking at your fees to remain on this useless NMC register being almost doubled.

    Feeling better yet, Doc?

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  • 12:19 Much better thanks! Don't you just love the comment above "it comes with the territory"? As if because I am a doctor and you are a nurse/similar this kind of ritualised abuse is OK.......

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  • Agreed, Doc! Mutual respect is so much nicer. Best to ditch the dumb stereotyping and recognise we both have much to contribute.

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  • The regulation of managers is still pretty irrational. I suspect this is one which won't get past any sensible civil servant.

    Anonymous | 12-Oct-2012 12:27 pm (again)

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