Francis: Status of management needs to be enhanced

In his report into care failings at Mid Staffordshire Foundation Trust, Mr Francis notes that the “tenure” of trust chief executives is “shockingly short” and the pool of candidates for such posts is “often small”. He also says clinicians are reluctant to put themselves forward for senior leadership roles.

He says: “There is little doubt that enhancement of the status of healthcare management and leadership as a profession is sorely needed. The gulf that still exists between some managers and some clinicians would be more bridgeable if there were a mutual perception of grounding as members of a profession, with all the ethical background that entails.

“It would be easier to develop a shared culture and harder for barriers between ‘them’ and ‘us’ to develop.”

He proposes the creation of a “physical” staff college that would enable all aspiring leaders to attend training and go through a “common and shared experience” that could lead to some form of accreditation.

This could “enhance the eligibility of candidates for leadership roles”, he suggests.

Mr Francis stopped short of proposing regulation of all NHS managers in his report, instead proposing Monitor has the power to disqualify board level directors if they fall below a fit and proper persons test, in line with a shared code of conduct.

However, he says the creation of an independent professional regulator should be kept under consideration if it is thought appropriate in future to extend a regulatory system to a “wider range of managers and leaders”.

“The proportionality of such a step could be better assessed after reviewing the experience of a licensing provision for directors,” Mr Francis adds.

He says the experience in Stafford shows “there is no system of accountability for leaders or managers of healthcare providers that is uniformly fair to the individuals concerned and that satisfies the public”.

Former Mid Staffordshire trust chief executive Martin Yeates left under a compromise agreement after the scale of the problems emerged in 2009.

Mr Francis said: “While the compromise arrangements made with Mr Yeates may have satisfied the interest of the trust in ‘moving on’, neither the individual nor the public were given an opportunity to have it established whether Mr Yeates had acted in a manner rendering him unfit to hold the post of an executive officer.”