Health and social care secretary Wes Streeting has unveiled long-awaited new proposals on regulating NHS managers, including executive-level nurses who sit on trust boards.
The proposals, which will be put before parliament next year, will set out the “first steps” to introduce professional standards and regulation for this staff group, the government said
“I’m determined to create a culture of honesty and openness in the NHS where whistleblowers are protected”
Wes Streeting
Currently, NHS managers who are registered clinicians, such as nurses, are subject to their own professional regulators, for example the Nursing and Midwifery Council and General Medical Council.
However, non-clinical managers are not subject to any professional regulation and those of a clinical background are not subject to regulatory frameworks specifically relating to their leadership work.
Under the new proposals, senior health service managers who commit serious misconduct would be banned from working in a senior NHS post elsewhere.
The Department of Health and Social Care (DHSC) stated that misconduct would include silencing whistleblowers or behaving “unacceptably”.
The announcement did not provide a definition of “manager”. However, it stated that a “statutory barring system” would be in place for board-level directors and their “direct reports” in all NHS organisations.
This, therefore, indicates that the new system will apply to trust nursing directors and chief nurses, and to their deputies as well.
Professional standards will also be introduced for managers to “establish a consistent, national set of expectations about NHS management and leadership competency and conduct”, the government said.
Managers will be given further support and development as part of the new regulatory regime, according to the statement from the DHSC.
“I’m determined to create a culture of honesty and openness in the NHS where whistleblowers are protected, and that demands tough enforcement,” Mr Streeting said.
“If you silence whistleblowers, you will never work in the NHS again. We’ve got to create the conditions where staff are free to come forward and sound the alarm when things go wrong. Protecting the reputation of the NHS should never be put before protecting patient safety.”
The regulation of NHS managers, particularly those at the top of an organisation, has been talked about for a long time, having repeatedly been recommended by a number of investigations into care failings.
For example, investigations into failures of care in the NHS, such as the Messenger Review and 2019 Kark Review, recommended that the health service hold leaders to account more strongly.
More recently, the Thirlwall Inquiry into how serial killer nurse Lucy Letby was able to go undetected for more than a year has sparked further discussion about accountability for leaders who fail to act on patterns of deaths at their organisations.
Robert Francis KC
Barrister Sir Robert Francis, who led an investigation into serious care failures at Mid Staffordshire NHS Foundation Trust, told the inquiry in 2024 that he would like to see independent regulation of NHS managers.
A consultation into how the regulatory regime could work opened at the end of last year, and closed in February. This has, the government said, informed how the proposed legislation would take shape.
Mr Streeting, speaking as he announced the new proposals, added: “I promised no more rewards for failure in the NHS, and these measures will deliver on it.
“Most NHS leaders are doing a fantastic job, but we need to stop the revolving door that allows managers sacked for misconduct or incompetence to be quietly moved to another well-paid role in another part of the NHS.”
Caroline Waterfield, director of development and employment at the organisation NHS Employers, welcomed the policy announcement.
She said: “Our members understand the need to reassure the public that they are subject to similar standards of regulation and accountability as clinical colleagues.
“In our response to the consultation we stressed the importance that any new regulation is proportionate and provides continued opportunities to raise standards over the long term.
“This initial response provides the opportunity to do both, with the right design,” she said.
Ms Waterfield said the regulation “must support a culture of openness, candour and learning to improve both patient safety and staff experience”.
“We look forward to working with the government as it designs, develops and consults on a new statutory barring scheme and our members are keen to contribute to its development so the way in which it is designed addresses the issues it is attempting to resolve,” she added.
Tom Kar, author of the Kark Review, said the proposed legislation was “good news for whistleblowers”.
He added: “I am pleased that the recommendation made in my report into the application of the NHS Fit and Proper Person Test to create a power to disqualify Board Directors found guilty of serious misconduct is being implemented.
“Along with the ongoing implementation of my other recommendations for improving Board competence, this is a positive move to strengthen management in the NHS by weeding out poor leadership.”
