Regulators battling 'overlapping remits and confusion'

Parliamentary and Health Service Ombudsman CEO Rebecca Hilsenrath made the comment while giving evidence to the Commons health and social care committee.

She said her organisation had written to the Department of Health and Social Care in February to ask “for a review of the regulatory landscape”.

”It’s really quite challenging to get the health and social care regulators into one room,” she said.

“It’s a very fragmented landscape and, to offer a critical view, there is [a] slightly knee-jerk reaction when things go wrong to set up a new body, rather than think, ‘should this sit with somebody else?’”

This duplication was hindering safety and learning, Ms Hilsenrath said. The PHSO has raised similar concerns in the past.

Ms Hilsenrath added today: “There’s an issue of overlapping remits and confusion. [It] means all the individual organisations’ voices are weakened.

“[It] means there’s a lack of ownership and clarity, and barriers to taking things forward.”

A source said the health and social care secretary Victoria Atkins agreed the landscape was cluttered and would like to look at it.

NHS leaders too alone

Meanwhile, a former adviser to the government told the same committee hearing today that NHS leaders were often left “alone” and unsupported, and felt risk if they raised concerns.

General Sir Gordon Messenger, who reported to ministers on NHS leadership in 2022, was asked about Tom Kark QC’s review  including the question of whether there should be tighter professional regulation of NHS managers.

The retired senior Royal Marines officer, and former vice-chief of the defence staff, did not answer directly. Instead, he told MPs he was concerned NHS leaders were often “feeling reluctant, nervous, wary of highlighting problems they know exist [because] in doing so they might be… putting their head above [the] parapet when it comes to apportionment of responsibility for that”.

The question of tighter management regulation is back in the spotlight since last year’s conviction of Lucy Letby for murdering multiple babies at the Countess of Chester, with concerns apparently having been raised and not taken forward by some senior trust leaders. NHS England has indicated it might support professional regulation of managers.

It was not universal, he said, but common, adding: “That’s a real shame that is the natural inclination of many…. It’s a symptom of people not feeling supported, not feeling collectively responsible, and sometimes [feeling] too alone. They feel if they highlight a challenge the spotlight is on them.”

General Sir Gordon repeated his finding that the NHS needed a substantial culture change and said NHS leaders locally needed more space and time to focus on team development and engagement.

He said NHS leaders spent “an awful lot of effort on meeting stipulation, standards and targets”, which were “centrally imposed and sometimes politically imposed”.

This was “almost always to the detriment of time spent with patients”, said General Sir Gordon.

In contrast, he said, when someone joined the Marines, they rapidly developed “a sense of pride and belonging in the organisation I was part of… I don’t think that entry point into the health sector is utilised enough to drive that sense of cultural belonging in what they do”.

In addition, he said the NHS should adopt a military practice of more pro-actively managing senior staff, leaders and managers, moving them from job to job based on what was needed: “The workforce above a certain level needs to be seen as a cross-organisational asset, who obviously within different tolerances [from the military] can be veered and hauled to tackle the challenges that are considered the highest priority.”