Baroness Harding: I support some form of regulation of managers

Giving evidence to the Commons health committee this afternoon, the chair of NHS Improvement said she backed the idea of a professional regulatory system for NHS management as one way to improve what she described as a “rotten culture” in the NHS.

The government has asked Baroness Harding to draw up and consult on responses to key recommendations made by Tom Kark QC, who examined the operation of the fit and proper person test regulations implemented after the Mid Staffs poor care scandal.

Ministers delayed making a decision on whether to introduce a regulator for NHS managers, accepting just two of the seven recommendations made by the Kark report.

The two accepted recommendations are the development of new core competencies for NHS directors and the establishment of a central database of information about directors’ experience and previous employment, including disciplinary and grievance issues.

Baroness Harding told MPs: “I completely agree regulation isn’t the only component in changing culture but it does have a role to play. We have to be clear what good looks like and then reinforce it with all of our financial and non-financial incentives. We need to look quite hard at the definition of good leadership in the well-led domain.

“We need to look at the financial incentives that we place on our trusts so we aren’t encouraging people inadvertently to behave inappropriately and there is no doubt unfortunately that is what was happening in Liverpool Community. That is an awful acknowledgement for a regulator that our financial regulatory regime was encouraging entirely the wrong behaviours.”

She added: “I do think there is a role in encouraging and incentivising the right behaviour… I do support some form of professional regulation.”

Commenting on why she believed this had been avoided in the past, she said: “I think the awful truth is the management culture in the NHS is quite rotten. A number of senior managers have experienced bullying on the way up and they are very nervous about a regulatory regime that could be captured.

“It would be an absolute travesty if in the desire to change the system we reinforced the rotten culture we are trying to change.”

During the evidence session, Baroness Harding said she was determined to act on the report by Tom Kark QC and was quizzed as to what that might mean by committee chair Sarah Wollaston. Baroness Harding said she hoped to consult on competencies against which managers would be measured during the summer with a database on managers’ careers established after that.

Giving evidence to MPs, Tom Kark QC told the committee his report was not just about bad boards but also about promoting standards that could help deliver better training and attract new people to roles in management.

But, for those managers who were below standard, he said: “There needs to be an independent tribunal that can look at serious complaints.”

He also said the recommendation to bring in mandatory references had already been used by the Financial Conduct Authority, adding: “The thinking behind the mandatory reference is to winkle out the information that is lurking in the trust archives.”

Ted Baker, chief inspector of hospitals at the Care Quality Commission, told the committee: “If we do this well it could have a big impact on the culture in the NHS and the culture of leadership in the NHS.”

Update: This story was updated at 8:40 on 14/03/19 to correct a typo.