letters

Since the introduction of corporate governance and subsequently clinical governance to the NHS, the need for appropriate cultures and infrastructures to develop them is well recognised and supported. Clinical governance in particular has been embraced by the whole NHS with some seriousness - if not necessarily enthusiasm.

Senior managers' role in ensuring effective corporate and clinical governance has been emphasised. In particular, chief executives' duty as accountable officers has concentrated our attention on these issues. However, little consideration has been given to how the NHS can ensure the quality of its managers.

Introducing 'evidence-based' management is difficult because, unlike the regulated professions of medicine and accountancy, establishing links between management theory and practice would be highly complex and subjective. Nevertheless, we should not be surprised if before too long the clinical professions ask questions about regulating the quality of NHS management as well as themselves.

Trusts are starting to develop 'no blame' cultures, succession and personal development planning for clinical leaders, peer review of practice and continuing professional development. But it is being made clear that chief executives will be blamed for failures in clinical quality. If we are not careful we will perpetuate the managerial blame culture so prevalent in the public sector for three decades.

So what of self-regulation for health service managers? We are a notoriously badly organised trade union or pressure group (witness the continuing demise of the Institute of Health Services Management) compared with, say, chief police officers, directors of social services or prison governors - not to mention doctors and nurses.

How is the NHS to ensure and promote the quality of its senior managers, including chairs and non-executive directors? With some trepidation we suggest the need for 'management governance'. This should be founded on the same supportive and developmental principles as clinical governance, but reinforced with clearer frameworks and support mechanisms from the centre. Perhaps as a start, annual personal development reviews for senior NHS managers should be regulated on a regional basis.

Interest in NHS management and leadership development looks like being a hot issue for the millennium, so perhaps we could start a debate on 'management governance' through the letters page of HSJ?

Peter Coles

Chief executive

Homerton Hospital trust

Neil Goodwin

Chief executive

Manchester health authority