Overview of consultation

Between November 2024 and February 2025, the government will undertake a consultation to seek the views from all stakeholders on the most effective way to strengthen oversight and accountability of NHS managers. More information can be found at the government's consultation page.

MPS submission

Q 1. Do you agree or disagree that NHS managers should be regulated?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

We believe that NHS managers should be regulated.

Healthcare managers have a huge impact on the organisations they lead. The culture, environment and behaviour of other staff are greatly influenced by their conduct and actions.

Q2. Do you agree or disagree that there should be a process to ensure that managers who have committed serious misconduct can never hold a management role in the NHS in the future?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

We believe that serious misconduct needs to be appropriately defined to avoid misjudgement and unclear definitions.

More broadly, we would argue that the sanctions a professional receives from their regulator should always be proportionate to the risk that they pose and this should include consideration of the ability of that professional to remediate. We believe it would therefore be ill advised to set out dogmatic rules which state that set sanctions should always be determined in certain circumstances. It would therefore be appropriate for the regulator concerned to in all cases have the ability to use the full range of sanctions available to existing healthcare professional regulators, such as conditions to be placed on their registration, or their registration to be suspended if their fitness to practise if found to be impaired.

Q3. If there was a disbarring process, do you agree or disagree that the organisation responsible should also have these sanctions available to use against managers who do not meet the required standards?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

We believe that the organisation with the disbarring responsibility being able to sanction managers who do not meet the required standards would be a positive step towards discouraging poor management processes.

A professional register

Q4. Do you agree or disagree that there should be a professional register of NHS managers (either statutory or voluntary)?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

We believe that ensuring that there is a professional register for NHS managers who are considered fit to hold such a role – as opposed to a blacklist of managers who have been disbarred – would provide a more effective system of regulation.

Registers demonstrate that the professionals listed are considered qualified and monitored. It enables a less reactive approach to a disbarring scheme which by its nature can only address problems only after misconduct or incompetence has occurred.

Registers provides a clearer, accessible resource for stakeholders and the public to verify that the registrant is in good standing.

Registers also offers options like temporary suspension, remediation, or conditional registration to address concerns, whereas a disbarring scheme makes it harder to address concerns about individuals who can remediate.

A register for managers would also provide additional reassurance to patients and staff that managers are held to a more comparable standard as clinicians.

A positive unintended consequence could also be that a register provides managers with a sense of pride and responsibility by being part of a recognised body of competent professionals. The value that NHS managers bring is often denigrated or overlooked. They do however play a very important role. Creating a sense of professional pride and identity should never be the purpose of creating a register, but it could be a positive unintended consequence.

If you agreed, do you agree or disagree that joining a register of NHS managers should be a mandatory requirement?  This could be either a statutory requirement or made mandatory through NHS organisations choosing only to appoint individuals to management positions who are members of a voluntary register.

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

We believe a mandatory register of regulation would create much more confidence. It would also imply a shared professional curriculum and standard, otherwise, it could lead to a variation of skillset, educational background or entry point.

If it is a voluntary register, it should absolutely be the case that NHS organisations should only be able to recruit those on the register.

Scope of managers to be included

Q5. Which, if any, of the following categories of managers within NHS organisations do you think a system of regulation should apply to?

• Chairpersons
• Non-executive directors
• Senior strategic level managers and leaders or very senior managers (includes CEOs and executive directors, some medical and dental directors, for example clinical directors)
• All NHS staff aspiring to be board level directors
• Senior managers and leaders (approximately bands 8d to 9, for example service manager, clinical lead, nurse consultant, deputy director or director - usually band 9 - and head of department)
• Mid-level managers and leaders (approximately bands 8a to 8c, for example operations manager, programme manager, senior clinician and matron, up to head of service, for example head of nursing, head of performance and delivery)
• First-time line managers (approximately bands 6 to 7, for example project manager, staff nurse, occupational therapist, team supervisor, team manager)
• Foundation managers (approximately bands 4 to 5, for example administrator, receptionist, medical secretary, clinical support worker, clinical assistant, healthcare assistant)
• Don’t know
• Not applicable - managers should not be regulated

MPS are not best placed to provide views on which categories of managers should be regulated.

We do however believe that such decisions should ultimately be determined by the extent to which the people concerned have an influence on patient care and patient safety. Clearly the most senior of managers should be regulated but we believe other respondents will be better placed to state at which point a manager’s level of seniority and influence means they should be required to be on the register.

Q6. Which, if any, of the following categories of managers in equivalent organisations do you think a system of regulation should apply to?

• Appropriate arm’s length body board members (for example, NHS England)
• Board level members in all Care Quality Commission (CQC) registered settings
• Managers in the independent sector delivering NHS contracts
• Managers in social care settings
• Don’t know
• None of these

As above, we believe decisions about which managers are regulated should ultimately be determined by the extent to which they have an influence on patient care and patient safety. We believe other respondents will be better placed to advise on the extent to which this applies to those working in these sorts of positions. Ultimately, we do not feel our organisation is suitable to answer this question.

The responsible body

Q7. If managers are brought into regulation through the introduction of a statutory barring system, which type of organisation do you think should exercise the core regulatory functions outlined above?

• Executive agency of DHSC
• Professional membership body
• Don’t know
• Other type of body
• Not applicable - managers should not be regulated through a barring system

As mentioned above, we do not favour the option of a system of disbarring, and we strongly favour statutory regulation.

If, however, the government decides to proceed with a system of disbarring, we would advise against such a role being taken on by a professional membership body. It is well established that there could be a conflict of interests when the roles of a professional membership body and a regulatory body are held within one organisation as they serve two very different purposes.

Q8. If managers are brought into regulation through the introduction of a professional register (either a voluntary accredited register or full statutory regulation), which type of organisation do you think should exercise the core regulatory functions outlined above?

• Independent regulatory body
• Executive agency of DHSC
• Professional membership body
• Don’t know
• Other type of body
• Not applicable - managers should not be regulated through a professional register system

We would favour an independent regulatory body. This would be the best model for demonstrating that managers are regulated by an organisation that is free from political control and also which does not have a conflict of interests in the roles and responsibilities that it holds. It would also help to demonstrate a degree of parity between the regulation of NHS managers and healthcare professionals

In the absence of regulation by an independent regulatory body, our next preferred option would be an executive agency of the DHSC. Such a body would however have to be constituted in a way that it is free from political influence both in reality and perception.

As above, we would advise against a regulatory role being taken on by a professional membership body. It is well established that there could be a conflict of interests when the roles of a professional membership body and a regulatory body are held within one organisation as they serve two very different purposes.

Q9. If managers are brought into some form of regulation, do you have an organisation in mind that should operate the regulatory system?

• An existing regulator
• An existing membership body
• An existing arm’s length body (for example, an executive agency)
• Establish a new independent regulatory body
• Establish a new membership body
• Establish a new arm’s length body (for example, an executive agency)
• Don’t know
• Other
• Not applicable - managers should not be regulated

Other considerations: professional standards for managers

Q10. Do you agree or disagree that there should be education or qualification standards that NHS managers are required to demonstrate and are assessed against?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Ensuring that an education or qualification standard is set, would ideally look at having a background in management of people at some level. This would help to establish a baseline for management expertise and ensure that NHS management attracts candidates with appropriate leadership skills.

Having an appropriate education or qualification should also have a positive impact on patient care, where the manager would be expected to understand policies, governance and have the appropriate leadership skills to ensure the working environment is efficient for patients and clinicians.

Having a set of recognised professional standards for NHS managers, could also help to ensure there is a greater consistency in skillset all across the board.

If you agreed, which categories of NHS managers should this apply to?

• Chairpersons
• Non-executive directors
• Senior strategic level managers and leaders or very senior managers (includes CEOs and executive directors, some medical and dental directors, for example clinical directors)
• All NHS staff aspiring to be board level directors
• Senior managers and leaders (approximately bands 8d to 9, for example service manager, clinical lead, nurse consultant, deputy director or director - usually band 9 - and head of department)
• Mid-level managers and leaders (approximately bands 8a to 8c, for example operations manager, programme manager, senior clinician and matron, up to head of service, for example head of nursing, head of performance and delivery)
• First-time line managers (approximately bands 6 to 7, for example project manager, staff nurse, occupational therapist, team supervisor, team manager)
• Foundation managers (approximately bands 4 to 5, for example administrator, receptionist, medical secretary, clinical support worker, clinical assistant, healthcare assistant)
• Don’t know

Other considerations: revalidation

Revalidation is a periodic check that someone remains fit and competent to remain on a professional register. Certain types of regulation, such as being part of a statutory professional register, can involve a revalidation process. It can include confirming or providing evidence that an individual has kept their skills up to date and continues to meet the standards.

Q11. If a professional register is implemented for NHS managers, do you agree or disagree that managers should be required to periodically revalidate their professional registration?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Revalidation would mean that managers are expected to have continual professional development. This would help to ensure that managers standards are not ‘one off’ tick boxes when they commence a role, but they work towards continuing competence. Revalidation would encourage managers to be up-to-date with the latest policies, governance procedures and best practices.

Ensuring that NHS Managers are subject to revalidation would also inadvertently put the trust back into the profession from colleagues and patients as it reassures them that they are consistently held to high professional standards.

If you agreed, how frequently should managers be required to revalidate their professional registration?

• Annually
• Every 2 years
• Every 3 years
• Every 5 years
• Less frequently than every 5 years
• Don’t know

Doctors have annual appraisals locally and are revalidated every five years. To ensure consistency, we suggest managers are also revalidated every five years.

Q12. What skills and competencies do you think managers would need to keep up to date in order to revalidate?

A range of experience, skills and competencies should be considered during their appraisal processes with their employers and at revalidation. In our Our suggestions for matters that should be considered during revalidation could include:

1. Understanding of the regulatory and legal knowledge that is constantly being updated
2. Crisis management
3. Continuous understanding of leadership skills and people management
4. Patient care and safety, including the manager’s role in promoting a culture of safety, handling of adverse events and their contribution to achieving measurable improvements in patient care.

Other considerations: clinical managers and dual registration

Dual registration is where individuals are required to register with more than one professional regulatory body at a time. Many individuals who hold management and leadership positions in the NHS will also be registered clinicians, who are already regulated as part of their clinical profession.

Q13. Do you agree or disagree that clinical managers should be required to meet the same management and leadership standards as non-clinical managers?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don't know 
• Other

The standards should be aligned as the alternative of having different standards between clinical and non-clinical managers would be divisive. A memorandum of understanding should be established between regulators to define the framework for addressing matters related to clinical managers.

If you agreed, how should clinical managers be assessed against leadership or management standards?

• They should hold dual registration with both their existing healthcare professional regulator and the regulator of managers
• They should only be required to hold registration with their existing healthcare professional regulator who will hold them to account to the same leadership competencies as non-clinical managers
• They should only hold registration with an existing healthcare professional regulator that will determine any leadership and managerial competencies
• Don’t know
• Other

Other considerations: phasing of a regulatory scheme

A phased approach may begin with the implementation of a voluntary register or a barring mechanism, with a view to transitioning to a full system of regulation in the longer term.

Q14. Do you agree or disagree that a phased approach should be taken to regulate NHS managers?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

While we do not have a strong view on this matter, our concern would be that the introduction of a voluntary register or disbarring scheme could take a lot of time and resource away from developing a more long-term approach, and that the end result could be that the intended temporary solution lasts much longer than intended.

Duty of candour for NHS leaders

The professional duty of candour forms part of the professional standards for regulated professions, overseen by professional regulators such as the GMC, NMC and HCPC to encourage open behaviour. There is also a statutory (organisational) duty of candour.

Q15. If managers are brought into a statutory system of regulation, do you agree or disagree that individuals in NHS leadership positions should have a professional duty of candour as part of the standards they are required to meet?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

We have long stated that whilst you can mandate for openness and honesty through transparency this is likely not the best way to create the culture change needed to ensure healthcare professionals feel able to raise concerns and learn from mistakes and that patients get an apology when things go wrong as well as an explanation.

However, in a system where there is a professional duty of candour for healthcare professionals, we feel there would be a strong argument for there being an alignment between managers and other healthcare professions in this regard (as mentioned above).

Leaders in a healthcare setting should set the example around honesty and transparency and it is therefore important they are held to a similar standard

If you agreed, which categories of NHS managers should a professional duty of candour apply to?

• Chairpersons
• Non-executive directors
• Senior strategic level managers and leaders or very senior managers (includes CEOs and executive directors, some medical and dental directors, for example clinical directors)
• All NHS staff aspiring to be board level directors
• Senior managers and leaders (approximately bands 8d to 9, for example service manager, clinical lead, nurse consultant, deputy director or director - usually band 9 - and head of department)
• Mid-level managers and leaders (approximately bands 8a to 8c, for example operations manager, programme manager, senior clinician and matron, up to head of service, for example head of nursing, head of performance and delivery)
• First-time line managers (approximately bands 6 to 7, for example project manager, staff nurse, occupational therapist, team supervisor, team manager)
• Foundation managers (approximately bands 4 to 5, for example administrator, receptionist, medical secretary, clinical support worker, clinical assistant, healthcare assistant)
• Don’t know

There is an existing organisational statutory duty of candour that already applies to providers. We do not feel it is appropriate for us to respond to this as an organisation.

Q16. Do you agree or disagree that NHS leaders should have a duty to ensure that the existing statutory (organisational) duty of candour is correctly followed in their organisation and be held accountable for this?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Managers are responsible for creating and maintaining a professional organisation that has transparency and encourages such transparency, especially in a healthcare setting. It not only improves organisational culture but ensures patient safety and trust isn’t broken.

If you agreed, which categories of NHS managers should a professional duty of candour apply to?

• Chairpersons
• Non-executive directors
• Senior strategic level managers and leaders or very senior managers (includes CEOs and executive directors, some medical and dental directors, for example clinical directors)
• All NHS staff aspiring to be board level directors
• Senior managers and leaders (approximately bands 8d to 9, for example service manager, clinical lead, nurse consultant, deputy director or director - usually band 9 - and head of department)
• Mid-level managers and leaders (approximately bands 8a to 8c, for example operations manager, programme manager, senior clinician and matron, up to head of service, for example head of nursing, head of performance and delivery)
• First-time line managers (approximately bands 6 to 7, for example project manager, staff nurse, occupational therapist, team supervisor, team manager)
• Foundation managers (approximately bands 4 to 5, for example administrator, receptionist, medical secretary, clinical support worker, clinical assistant, healthcare assistant)
• Don’t know

NHS leaders’ duty to respond to safety incidents

This considers if a duty should be applied to NHS leaders in relation to recording, considering and responding to any concerns about the provision of healthcare that might be brought to their attention.

Q17. Do you agree or disagree that individuals in NHS leadership positions should have a statutory duty to record, consider and respond to any concern raised about healthcare being provided, or the way it is being provided?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

We can understand why such a policy proposal might be considered attractive as it is very important that concerns raised are given consideration. We would however advise against what seems to be a broad and quite targeted requirement. Healthcare managers and clinicians deal with a high volume of concerns, many of which may be minor or unfounded and a statutory duty could lead to an unmanageable caseload, detracting from their ability to focus on broader strategic and operational issues. Such an approach could also reduce flexibility in addressing concerns with rigid processes introduced that add unnecessary bureaucracy and which do not account for the complexity or context of specific concerns. It could also create to a hesitancy to adopt flexible or creative solutions to addressing concerns for fear of non-compliance with such requirements.

If you agreed, which categories of NHS managers should this apply to?

• Chairpersons
• Non-executive directors
• Senior strategic level managers and leaders or very senior managers (includes CEOs and executive directors, some medical and dental directors, for example clinical directors)
• All NHS staff aspiring to be board level directors
• Senior managers and leaders (approximately bands 8d to 9, for example service manager, clinical lead, nurse consultant, deputy director or director - usually band 9 - and head of department)
• Mid-level managers and leaders (approximately bands 8a to 8c, for example operations manager, programme manager, senior clinician and matron, up to head of service, for example head of nursing, head of performance and delivery)
• First-time line managers (approximately bands 6 to 7, for example project manager, staff nurse, occupational therapist, team supervisor, team manager)
• Foundation managers (approximately bands 4 to 5, for example administrator, receptionist, medical secretary, clinical support worker, clinical assistant, healthcare assistant)
• Don’t know

Q18. Do you agree or disagree that individuals in NHS leadership positions should have a statutory duty to ensure that existing processes in place for recording, considering and responding to concerns about healthcare provision are being correctly followed?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

For the same reasons as set out in our answer to question 17, while we can understand why such a policy proposal might be considered attractive, we would advise against such a broad and untargeted requirement.

If you agreed, which categories of NHS managers should this apply to?

• Chairpersons
• Non-executive directors
• Senior strategic level managers and leaders or very senior managers (includes CEOs and executive directors, some medical and dental directors, for example clinical directors)
• All NHS staff aspiring to be board level directors
• Senior managers and leaders (approximately bands 8d to 9, for example service manager, clinical lead, nurse consultant, deputy director or director - usually band 9 - and head of department)
• Mid-level managers and leaders (approximately bands 8a to 8c, for example operations manager, programme manager, senior clinician and matron, up to head of service, for example head of nursing, head of performance and delivery)
• First-time line managers (approximately bands 6 to 7, for example project manager, staff nurse, occupational therapist, team supervisor, team manager)
• Foundation managers (approximately bands 4 to 5, for example administrator, receptionist, medical secretary, clinical support worker, clinical assistant, healthcare assistant)
• Don’t know

About MPS

MPS is the world’s leading protection organisation for doctors, dentists and healthcare professionals with more than 300,000 members around the world. 

Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.

MPS is not an insurance company. We are a mutual non-for-profit organisation and the benefits of membership of MPS are discretionary as set out in the Memorandum of Articles of Association.

Contact

Should you require further information about any aspects of our response to this consultation, please do not hesitate to contact us.

Ceylan Simsek
Policy and Public Affairs Officer
[email protected]