Late last year the Department of Health and Social Care (DHSC) signalled its determination to push through its controversial plans to regulate NHS managers and leaders by setting out its proposals in its ‘Leading the NHS’ consultation that was launched in November 2024. The consultation is open until 18 February 2025. Leading the NHS: proposals to regulate NHS managers - GOV.UK
The proposals include a variety of options, from creating a register of professionals managed by a regulatory body to establishing a list of individuals who are barred from holding NHS management positions due to misconduct. Statutory regulation would also require managers to meet specific qualifications, similar to medical and nursing professionals, with further options for revalidation and annual registration fees.
Alongside these measures, NHS England is currently developing a set of professional standards for NHS managers, including a code of practice, core standards, and a national training curriculum. The Government is also exploring a new professional duty of candour for managers, aimed at fostering transparency and responsiveness in addressing patient safety concerns—as recommended by the Infected Blood Inquiry’s final report.
Under the proposed framework, managers and leaders at board levels of NHS organisations in England, arm's-length bodies, and Integrated Care Boards (ICBs) would be subject to the new regulations. However, the consultation also seeks views on expanding the scope to include Primary Care Network (PCN) managers and clinical directors.
It remains to be seen whether, if adopted, formal regulation of healthcare managers would be extended further to the independent sector. However, previous experience suggests that where the NHS leads in patient safety initiatives, others tend to follow.
Discussion
There does now appear to be considerable momentum in favour of fundamental change in the NHS leadership culture following the Hillsborough disaster report, the Infected Blood Inquiry and the ongoing Thirwall Inquiry. Supporters of this would say that regulation of healthcare managers will encourage consistency and lead to greater individual accountability. It will help to professionalise managers and enhance their credibility with clinicians, patients and the public. If nothing else, it should help to end the ‘revolving door’ culture that has sadly been prevalent for some time in the NHS, where managers with a history of misconduct simply move to another NHS post – often at significant cost to the taxpayer. It will also make the healthcare environment fairer by aligning managers’ accountability with that of doctors and nurses.
However, whether regulation would improve standards sufficiently to significantly move the dial on patient safety, which is surely the overarching aim, remains uncertain and contentious. Critics of the proposals would argue that formal regulation of managers will simply add another layer of bureaucracy and expense that isn’t needed. Managers’ performance is already specifically inspected and monitored by CQC under its ‘well-led’ domain. NHS directors already have to meet the fit and proper person test (FPPT), including an assessment of their qualifications, competence, skills, and experience. Perhaps more significantly, and maybe rather counter-intuitively given the stated aim to reduce risk, adding a further layer of regulation that increases personal accountability potentially risks creating the wrong sort of risk-averse leadership culture, in which innovation is stifled and proactive decision making is inhibited.
What’s next?
The Consultation closes on 18 February 2025. If, as seems likely, the government decides to press ahead, any legislation to implement a statutory regulatory regime for NHS managers will then be subject to further consultation before it becomes law.
We will be closely monitoring developments at Altea to ensure our clients are kept fully informed of how these changes will impact them, their staff and their service users.
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"The information contained in this article does not represent a complete analysis of the topics presented and is provided for information purposes only. It is not intended as legal advice and no responsibility can be accepted by Altea Insurance for any reliance placed upon it. Legal advice should always be obtained before applying any information to particular circumstances."
