Is the regulation of health service managers a good idea? The man who watches the watchers - Harry Cayton, chief executive of the Council for Healthcare Regulatory Excellence - does not think so.
He writes: “Calls for the regulation of managers… fail the right-touch regulation test.” Rather than dragging managers through fitness to practise investigations, he argues that trust boards should take greater responsibility for the “selection, training, supervision and accountability of managers.” He concludes: “A list is not a solution.”
Mr Cayton is right. Management is not a profession (although managers may, of course, be members of the professions). To try and pretend it is and to regulate accordingly is to place a misleadingly reassuring fig leaf over the issues facing NHS management.
An updating of the 2002 management code of conduct as suggested by the Department of Health’s Enabling Excellence document is welcome and will be especially useful guidance for the increasing numbers entering management from clinical roles. The document also proposes a voluntary register for “unregulated” staff. Mr Cayton believes this would “bring greater clarity of standards for management” and, again, he is right - as long as it does not distract from the primary responsibility of employers.
HSJ has two further hopes. The first is that the government does not knee-jerk into a more hardline position following the final report of the Mid Staffordshire Foundation Trust inquiry. The second is that politicians will recognise that when managers do fall below expected standards they often do so in the context of a politicised environment in which honesty and transparency are sometimes actively discouraged.
The government has promised to take a step back from direct management of the NHS. If it does live up to its claims of increasing autonomy, NHS management decisions (whoever makes them) will improve in quality and consistency.
One final improvement is necessary: all politicians - government and opposition - should commit to raise the quality of the debate over the future of the NHS. Specifically they should stop the casual misuse of evidence and crude caricaturing of staff groups and organisations involved in healthcare to support their public grandstanding. HSJ will not hold its breath.