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Failed NHS managers could face blacklisting

Ministers are considering creating a “blacklist” of NHS managers who preside over failure and would be prevented from working in the health service again, HSJ understands.

A “negative register” would list the names of individuals who have been judged unfit to practise based on their previous performance.

HSJ understands the idea is one of a number being considered by ministers ahead of the publication of Robert Francis QC’s report into failure at Mid Staffordshire Foundation Trust. Mr Francis is widely expected to recommend strengthening the regulation of managers in the NHS.

The negative register was discussed at a private meeting earlier this month, hosted by the NHS Confederation and attended by health secretary Jeremy Hunt.

Mr Hunt is reported to be considering the idea but is waiting the publication of the Francis report before deciding upon on a preferred approach.

King’s Fund head of policy Anna Dixon, who was not at the meeting, told HSJ the negative register, or “blacklist”, could be an “attractive option” for ministers.

She said: “There isn’t a desire from anyone in government to introduce a large scale regulatory process for every manager; this idea has come up as a potentially low cost, low regulatory burden approach.”

However, she warned it could deter candidates for difficult chief executive roles if individual culpability was seen to take precedence over corporate governance.

The Department of Health has already asked the Health and Care Professions Council to draw up costings for a negative register for care assistants working in social care settings.

The council, which regulates professions including radiographers and occupational therapists, put forward the idea after concluding voluntary regulation would not work for this group.

In a recently published position statement the council argued there were “significant shortcomings” with a voluntary approach, notably that individuals judged unfit for one role could not be stopped from getting another job elsewhere.

The council suggested the negative register approach would be “scalable” to other health and social care settings and proposed it be funded through the Care Quality Commission licensing fee, paid by providers.

Voluntary regulation is currently the government’s favoured approach to regulation of healthcare assistants, another area in which Mr Francis is expected to make recommendations.

HSJ has learned the possibility of a negative register for healthcare assistants has also been discussed by DH officials.

The government introduced a similar scheme for teachers last year following the abolition of the General Teaching Council.

Mr Hunt has previously shown interest in adopting ideas from the education sector, commissioning the Nuffield Trust to explore the potential of introducing an Ofsted-style ratings system for hospitals and care homes.

Readers' comments (37)

  • I hope that "failure" is measured objectively and not defined by the local or nationall press, or a "failure" to tow the party or DH line

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  • Will there be a similar list for the MP's that preside over large scale change for which they are unqualified, create a mess and then get moved on to another portfolio without facing the consequence?
    It would be good to stop recycling poor managers, every organisation would benefit from this, but just take a moment to imagine the HR implications.
    Is this the gov way of indicating direction or a reflection on how ill informed they are about the legislation involved?

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  • Who will try to turn around a failing organisation? The key to success is choosing which organisation you work for.

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  • "A “negative register” would list the names of individuals who have been judged unfit to practise based on their previous performance."

    I hope that measures are in place to ensure it is truly based on THEIR previous performance - not necessarily the performance of the Health & Social Care economy or individual Trust where they work. As the article highlights, failure to do this could deter the best people from the hardest jobs.

    I would appreciate more information on the 'voluntary regulation' option as this is only mentioned in passing in the article.

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  • How about a "Positive" Register as well?

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  • The important issue is to include those from the clinical sections of Trusts who have steadfastly refused to share in the responsibilities of exercising joint leadership of their Trusts.

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  • If a government created database of 'failed NHS managers' come into being it will be deeply ironic, not to mention hypocritical, given that the investigation into the 'blacklisting' database of 3,000 contruction workers who were prevented from being taken on for Olympic building projects was driven by MPs.

    Agree, that a positive reigister which enables managers to show that they have good management skills and use these effectively over time, in whichever organisation they work for, would be a better idea. A bit like having to keep up your professional registration if you are a nurse etc. and should be seen as part of continuing professional development - which is in the interest of both the person and the organisation.

    I guess this next bit will be unpopular to suggest - but if the major burden of maintaining the cost of competence registration falls to the individual, the overall burden on the taxpayer would not be so great. This is common practice in many different professions already.

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  • Surely this cannot happen; whilst in theory it makes (some) sense, in practise it would be opening a huge can of worms that could easily lead to legal proceedings from 'blacklisted' managers against their former Trusts.

    There MUST be some HR and employment laws that forbid such lists existing...surely?!

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  • I suspect this list exists already and is used in what is clearly a 'bully' or be 'bullied' culture that is the current NHS.

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  • Will Nicolsonbe putting his name on the list for his role inthe Mid Staffs affair ?

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  • What a brave step!
    Who decides who should go on the list?
    What objective criteria will be used?
    What steps can an individual take to be taken off the list? (i.e. some form of appeal process which will guard against the manager losing his/her job simply because their face no longer fits or they've stood up the powers that be).
    What provision is there against the manager that goes into a Trust, puts in a whole load of "quick fixes" which might initially look good and then moves onto the next Trust before the cracks appear?
    Surely, at the level of the manager we're talking about, their reputation generally precedes them and if they get moved from job to job because they have chums in high places then what will a blacklist achieve?
    There is an alternative proposal which is generally used for the rest of us; take up references and take action against a referee that gives glowing reference that later turns out to be unreliable (there is legal precedent for this).

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  • Will this principle of blacklisting the "managers" who have presided over failure, extend to those at the very top of the NHS who have presided over some spectacular failures of policy. a total breakdown in compassion & patient centred care and some the worst examples of corporate bullying ever seen?

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  • Some questions:

    1. What qualifies to go on the register?
    2, If it is not underwritten by some overarching ethical and public interest principles and the sort of processes regularity bodies should have surely it would be open to tribunal challenge? Will it have to reach a fair dismissal bar and what if the employer doesnt want to sack them?
    3. Will it apply to private sector health service employers - either as those dismissing or those appointing previously unfit managers?
    4. Will it include culpability for issues such as dismissing whistleblowers or systematically discriminating or bullying where the rest of the Board have colluded?
    5 Far better, surely, to have a positive register, also covering private sector providers to the NHS from which poor managers can be removed?

    Or is it a quick fix that suits Ministers but no one else and doesnt really address toxic management or recognise good management?

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  • If an individual has a track record of success and then has a significant failure in one organsiaiton should that mean that they are unfit to practice 'based on thier previous performance'?

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  • Neil Goodwin

    This is tricky but not impossible.

    Successful implementation will rest on a number of variables including: a sound, universally understood and objectively applied performance framework; differentiation and understanding of the roles and responsibilites of the CEO, chair and board (not an issue for teachers, where I imagine performance in the class room is more clear-cut), etc. The proposal also begs at least three further issues for addressing.

    First, ensuring there's a sound recruitment and selection process for CEOs including, among other things, avoiding appointing first-time CEs into known difficult jobs or very big organisations. There's little point establishing the register unless the basics are in place.

    Second, ensuring there's an equally robust and sound process for appointing (and appraising) board chairs. If there is a stronger role for regulators in senior personnel issues then it has to be this because if there's one relationship that could precipitate failure it's that between the chair and CEO.

    Third, understand that just because someone fails at being a CEO it doesn't mean they will fail as a senior manager (unless what precipitated their failure was a potential criminal act). In my experience as a former SHA CEO who 'moved on' CEOs, some realised that they hadn't enjoyed being a CEO and welcomed the opportunity to pursue their career at director-level, thereby not wasting their skills.

    In short, for this to work successfully process will be important but perception will be crucial.

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  • Neil's comments I wholeheatedly agree with. "Failure" as a CEO or Director (objectively assessed) should not preclude working in the NHS at another level or in a different capacity. Even the nursing profession, well renkowned for hanging their members out to dry, allow downgrading of people to take place according to an objective assessment of their competency.

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  • Personally I feel there is a need to focus on core business and do it well. Less politics - don't forget what you are paid to deliver

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  • I am interested to see the legal framework this sits on. When would you have "spent" your time on this blacklist - even criminals get a second chance!!

    If we had a decent system which supports managers through their career like most private companies have then you wouldn't need to do this. People would be managed through to the right level for their skills or out of the service if necessary and employment references would have real value. You wouldn't need a name and shame culture. It is time we developed a culture of managing for success rather than our "every man for themselves approach" whilst waiting to punish failure. In this way we might make NHS management more attractive.

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  • If we take this back a step please. These people in positions of accountability could be managed by being held to account - or is this too difficult? What we currently can see happening & is the root cause of the growing culture of poor leadership - they are simply moved on and turn up elsewhere. The message is overwhelming at all levels of leadership - when we see this happen - it is ok to fail! you wont be held to account for your failures & you will have simply left them behind. It self perpetuates of course - as you wont be held to account for the failures of the individual you are replacing neither. The lst will not resolve the problem. Holding people to account for their poor performance will.

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  • A decent performance management framework for the leaders of NHS organisations would do nicely.

    It is rare indeed for a CEO or Executive Director to be sacked for poor performance.

    A recent Select Committee meeting with England's Chief Nurse was pretty cringeworthy to be honest and clearly demonstrated how people right at the top of the NHS don't really own the problems. It was a study in waffley answers and "not my job" protestations.

    Personally I would do away with specialised roles such as directors of nursing altogether. They seem totally ineffective in today's NHS.

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