Hopson warns NHSI against 'inappropriate' regulation of managers

In a letter to Baroness Harding, Chris Hopson, chief executive of NHS Providers, said the NHS Improvement chair should set up a new inquiry to examine the Kark review proposals with a new consultation, reference group and round table discussions with a final report and recommendations.

NHS Providers has made clear it has serious concerns around the proposals made by Mr Kark off the back of his review of the fit and proper person test. Among his recommendations were setting up a new database for board directors, adopting new core competencies, introducing mandatory references and creating a new Health Directors Standards Council with the power to bar managers from sitting on boards.

In an interview with HSJ, published yesterday, Mr Kark said he believed his proposals were the only way of stopping the “revolving doors” that allowed managers guilty of misconduct from “rattling around the system”.

Speaking to HSJ, Mr Hopson denied NHS Providers was attempting to rerun the Kark review, saying: “The government appointed a single individual who does not have an NHS background to come up with a bunch of recommendations. What we didn’t have was a proper debate across the sector to try and identify where the common ground is and then effectively say this is how recommendations should be implemented.

“I recognise [the letter] is vulnerable to the charge that we are seeking to cover the same territory but the process we have put forward would enable all of us to have a grown-up proper conversation to find significant areas of agreement to motor ahead with all due speed and make them work.”

Mr Hopson said at present NHS directors felt the Kark proposals were “inappropriate” and risked making their jobs harder if imposed. 

He added: “If you’re going to do something that will have a major effect on a sector like NHS trusts you really do need to consult people before you go ahead and do all of this. We recognise ours aren’t the only views. This is about all of us having a sensible conversation about what we should do next.”

He accepted there have been examples of “clear serious failures at trust level”, adding there was a “legitimate question” as to whether the directors responsible should be allowed to serve elsewhere. But he disagreed with Mr Kark that his recommendations were the only way to stop directors from moving around the system.

In the letter to Baroness Harding, Mr Hopson said there could be “greater common ground than the current polarised debate suggests” if she was prepared to lead a process to find it.

NHS Providers said Mr Kark’s recommendations needed to be considered in a structured deliberate way using evidence-based policy-making principles which should include alternatives. It added any process should be open and transparent and ensure all views are considered, including those of patients and whistleblowers.

Mr Hopson said providers were disappointed the government accepted two recommendations without consulting affected NHS managers.

He added: “The logical first step of any deliberative process should be to encourage anyone with views on the recommendations to submit these to you and for you to publish them, to encourage debate. This should be an open process, unless there is [a] particular, good reason to withhold submissions.

“This element, which should be set up as a formal consultation, can be done relatively quickly and will establish the areas for debate and who has an interest.”

He also suggested a reference group of statutory organisations and representatives from NHS management, such as NHS Providers and NHS Employers, as well as patients and staff.

This reference group could then participate in “a series of expert policy roundtables to discuss the issues and seek to identify common ground” using issues identified beforehand using a “balanced secretariat”.

He also referred to some “who feel they have been excluded from offering their views face to face” and suggested Baroness Harding needed to find a way to hear them in person.

Mr Hopson said this process would then lead to a report setting out the common ground, issues where there was a difference of opinion and final recommendations.

Baroness Harding has publicly stated she believes in a form of professional regulation for managers. Mr Hopson’s letter said: “Given that you have the task of making the recommendations to the secretary of state, it will be important for you to have ultimate oversight of the process.

“However, as we discussed, given NHSI’s evidence to Kark and your recent evidence to the select committee, it will be important for you to demonstrate that you are genuinely prepared to consider the evidence offered and the discussions.”