• NHSI chair says “transparent and fair” process needed for senior managers in trouble
  • At present they can face “trial by HSJ”, Dido Harding says
  • Says improving pension problem for senior clinicians “urgent”

The lack of a “fair” and “just” process for dealing with senior managers who have failed in their role has left them facing “trial by HSJ”, NHS Improvement chair Dido Harding told the NHS Confederation conference. 

Baroness Harding also said NHS staff should talk less about “how miserable it is to work” in the service, and that it was “urgent” for changes to be made to senior clinicians’ pension arrangements by “the next tax year”.

The NHSI chair was asked by a delegate to address the nervousness felt in some NHS organisations about the introduction of a “just culture”, in which the focus is on resolving problems rather than apportioning blame, especially when it applied to the actions of senior managers.

Baroness Harding said: “We need to build a just and fair culture – but that’s not the same as saying there are no consequences ever for senior managers, or that we should never move senior managers on from one role to another. What I do think we need to have is a much more of transparent and overtly fair way of doing so.”

She added that managers who run into difficulties now face a “trial by HSJ process”.

Referring to the recent review of the “fit and proper persons test”, Baroness Harding said: “I want to start a proper debate across the NHS on how we take what Tom Kark QC recommended, [and] try and address the underlying real issues he was looking at.”

She said she wanted to “build a consensus on what we do when things [go wrong] and it is the right time for a senior leader to move on from an NHS organisation - and what we actually do to make sure that judgement is made fairly and that we support them to learn and then to move on to whatever the next step is in their careers”.

“We have to be brave enough to have those discussions, rather than just immediately assume that this is another stick to beat senior folk – it isn’t, it’s an attempt to find a just and fair approach to managing.”

Asked about the challenges of attracting staff to the NHS, Baroness Harding said the service had many ways of changing “people’s mindsets about what working in the NHS looks like”.

However, she said: “We’ve got to shift our own narrative. If we keep talking about how miserable it is to work in the NHS, we shouldn’t be surprised that outsiders don’t like the idea.

“That is not in any way to dismiss the issues [which undermine morale]. We’ve also got to address the issues that are making things miserable for people, we’ve got to convince outsiders that we’re taking those issues seriously [and are] committed to making the NHS a great place to work and we’re proud of what we all do.”

She also said NHSE/I chief nurse Ruth May was leading efforts to launch a major recruitment campaign for nursing.

Turning to the issues of pensions, she said it was “urgent” that government did “something about the perverse incentives of the pension scheme”.

She noted that it was “pretty clear over the last couple of weeks that the government proposals [on changing pension arrangements] have not been met by universal enthusiasm” but she urged people to suggest what “practical changes we could make for the next tax year”.

“The changes we make for the coming tax year will not be perfect, but they need to remove some of these perverse incentives where people are being expected to work for nothing or are costing them money to work.”