Issues continue to fall-out from the events surrounding the Letby debacle.
A consultant who raised concerns, Dr Stephen Brearey, told the BBC; NHS managers should be regulated, as are medical and clinical professionals.
If only!
In July 2018 Tom Kark KC., was commissioned by the then minister for health; one Steve Barclay, to make recommendations in relation to the Fit and Proper Person Test…
… as it applies under Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
This was prompted by one of the recommendations from Dr Bill Kirkup in his report (Feb 2018) into the problems at Liverpool Community Health Trust.
It wasn’t the first time regulation for senior managers had come up, there’s a lot of history…
Five years, before that in Feb 2013, The Francis Report into events at Mid Staffs, raised concerns that were directly relevant to the role of senior management in hospital Trusts.
Francis said (Exec Summary 1.144);
‘There has been understandable concern at the circumstances surrounding the departure from the Trust of the Chair and Chief Executive… the public demand for accountability was left unsatisfied…
… directors should be liable to disqualification from the role…’
Following the Francis Report the government published its response ‘Hard Truths’, accepted the recommendations and assured;
‘There will be a new, stronger Fit and Proper persons test for Board level appointments which will enable the Care Quality Commission to bar directors who are unfit … the barring mechanism will be.. robust.’
NHS Employers and the Trust Development Authority, were tasked to work with the CQC to;
‘… develop guidance to support the effective performance management of very senior managers in hospitals through appraisal and other means, including linking the Chief Inspector’s ratings to individual contracts.’
The upshot was the CQC was never given a barring mechanism, nor authority to oust directors. Nothing happened.
Why? Dunno. Too difficult?
The FPPTest is primarily concerned with bankruptcy, DBS and convictions. Less so about competence, experience and qualifications. The CQC ‘well-led inspections’ focus on process and systems, not the quality of the individuals.
A report from Manchester University (Jan 2018) into the consequences of the Francis report makes dismal reading…
‘… a warning … Boards …[are]… focussed on reputation and image rather than substance … outwardly projecting an image of success whilst not having grip on operational performance’.
I wonder how much has changed?
The NHS is not a national, central organisation…
… Trusts are independent entities. There’s a huge variation in competence.
There are over 200 Trusts and about 3,500 Board members. Is it conceivable that without training, development and supervision, they will all be good enough to manage multi-million pound, safety-critical organisations?
Five years after Kark, NHSE have just got around to a strengthened the FPP framework… to include;
- specified standards of competence for board directors, a framework to be developed and implement from March next year;
- an appraisal system to be ready next Spring;
- a database of directors;
- a mandatory reference requirement for each director;
- the extension of the FPPT to arms-length bodies including NHSE and the Care Quality Commission.
… and a panic round-robin letter, last week from Amanda Pritchard, reminding Trusts of their current responsibilities.
The failures of the past are all indicative of a lack of management ability coupled with pressures to prioritise reputation damage, meaning a loss of focus on the central goal… providing safe, quality care for patients, ensuring they are protected.
In 2018 the DH+ and NHSE took an interest in the prospect of regulating all managers.
The IHSCM did a snapshot poll of its members and found over 70% in favour.
In the light of recent events, they are asking the same question again – you can take part here.
At that time it was widely know the DH was not in favour because of the cost and complexity.
Along came Covid and the work and good intentions got parked. Probably binned.
Pointedly, the Kark report said, about barring directors and serious misconduct;
‘… apart from obvious … dishonesty and crime… there should be a focus upon behaviour which suppresses the ability of people to speak up about serious issues … whether by … bullying or victimisation of those who … blow the whistle, or … any form of harassment of individuals’.
The whole process has taken the best part of ten years to get from legislation, to today.
The facts are, some Boards are very good and we don’t hear about them, often enough. We only hear about the bad ones and we hear too late.
Boards are, largely, left to ‘get on with it’, with little management training, nor a clear idea of what a ‘good board’ looks like…
In the face of problems and disaster HMG, the nation’s ultimate regulator, instinctively reach for more regulation.
Regulation so often, creates fear, tension, pressure and the wrong answers.
When Dr Breary and colleagues were threatened with their regulator, it was to effectively shut them down.
Regulation makes organisations isolate themselves, fend for themselves, often in environments that make it impossible.
Stronger regulation aimed at problems just creates the moral hazard of regulation.
Stronger emphasis on solving the problem, to remove the hazard is more complex and takes a great deal more skill.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
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