The NHS’s means of dealing with disciplinary problems is outdated, contradictory and dangerous. Here Dean Royles offers his proposals for reform, while whistleblower Narinder Kapur offers a complementary view

Dean Royles

Dean Royles

Dean Royles

Dean’s solution

Trust between employers and an employee is the basis of a healthy and productive working relationship. This trust has been damaged, sometimes because managers and clinical leaders don’t get it right but it is also constantly undermined at national and system level by the vilification and the demonisation of NHS managers.

It appears anything positive in the NHS happens despite managers and anything negative is directly attributed to them. It seems funding decisions, national policy and regulations can only be seen as a force for good by politicians despite evidence to the contrary. Commentators only blame leadership for failure; rarely do they identify a lack of funding as the prime issue.

In this context trust is difficult to build, to maintain and to improve. Poor headlines have resulted in national and political solutions that introduce new ‘rules’, ‘guardians’ and ‘regulations’, all aimed at ‘protecting’ staff from apparently poor managers.

Maintaining High Professional Standards (MHPS), the disciplinary procedure for doctors, is a case in point. Unlike the disciplinary processes for all other NHS staff, MHPS is mandated nationally.

Hundreds of local employers are required to use a national policy. It’s a policy that is negotiated, negotiation has led to compromises and a wordy solution and that has in turn allowed managers and trade unions to interpret its meaning; cue more lawyers, more case law, more complexity, more undermining of trust.

Poor headlines have resulted in national and political solutions that introduce new ‘rules’, ‘guardians’ and ‘regulations’, all aimed at ‘protecting’ staff from apparently poor managers

As a result, many NHS HR professionals will privately admit to the abdication of informally trying to resolve issues of capability, conduct and poor behaviour of doctors. The problem gets passed to lawyers. The BMA do the same. This cannot continue. To overcome this we must allow employers to rebuild trust.

All other local disciplinary policies and procedures are developed locally in line with ACAS guidelines and the principles of national justice (they apply to more than a million non-medical staff). We have the local experience to gain trust, to use experts appropriately to train panels in fair processes and unconscious bias and to make compassionate decisions for staff and patients.

When we get it wrong, as we occasionally do, we should be held to account. It’s what we get paid for. Undermining local trust through imposed ‘independent experts’ and inappropriate national rules, more knee jerk regulations and more ‘guardians’ will only make matters worse.

Managers and leaders are trusted with huge budgets and the recruitment of thousands of staff each month. The healthcare of millions of patients is their responsibility. They should be trusted to manage staff when things go wrong too.

Without trust between employers and employees we inexorably erode the trust between the NHS and patients, and in so doing, undermine the NHS itself.  

Dean Royles is director of human resources and organizational development at Leeds Teaching Hospitals Trust

A new way forward for disciplinaries: the whistleblower's view