Accountability probe could lead to regulation for managers

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”.