Amid ongoing debates about NHS management accountability, the Department of Health and Social Care (DHSC) recently proposed regulating NHS managers as a distinct profession. Triggered partly by high-profile cases such as the Letby affair, these proposals aim to enhance patient safety by holding managers accountable in ways comparable to clinical professionals. As researchers from the University of York that have embarked on a two-year project (funded by the Health Foundation) focusing on NHS management capacity and capability, we question whether statutory regulation is the right tool at the right time.
The call for regulation has its merits, notably the potential for enhancing professionalism, accountability, and public trust. Yet, significant concerns exist around the premature imposition of strong, statutory regulation. The stakes are high; a rushed approach could reinforce a blame culture, stifle managerial innovation, and exacerbate existing workforce shortages and morale issues. More fundamentally, regulation alone may fail to address the systemic factors underlying patient safety failures.
Risks of rushed regulation
The first concern is the punitive framing of regulation. Managerial roles within the NHS have long been subject to a ‘blame culture’, and regulation conceived primarily as disciplinary risks deepening this negative narrative. This could further erode morale at a time when the NHS critically needs to attract and retain skilled managers. While current policy rhetoric suggests a shift away from ‘manager bashing,’ the underlying emphasis on discipline remains worryingly prevalent.
Second, the unintended consequences of regulation could be substantial. Managers might become excessively cautious, stifling innovation and deterring talented candidates from managerial roles. Regulation inherently involves compliance and reporting requirements, potentially creating cumbersome administrative burdens in an already heavily regulated NHS. Managerial effectiveness relies heavily on adaptability, discretion, and rapid decision-making in complex situations, attributes that rigid professional regulation may compromise.
Third, the direct and indirect costs associated with statutory regulation could be significant and overlooked. Increased mandatory training, revalidation processes, and administrative overheads would inevitably add financial burdens, potentially diverting resources away from patient care and frontline services. Moreover, if NHS management becomes a protected profession with stringent entry and revalidation requirements, labour market scarcity could ensue, driving up salary costs and exacerbating workforce shortages.
Lastly, the effectiveness of statutory regulation in genuinely improving patient safety remains uncertain. Historical and systemic analyses of NHS scandals frequently highlight broader organisational dysfunctions rather than simply individual managerial incompetence. The punitive regulation of managers alone may do little to resolve systemic issues such as staffing shortages, organisational cultures resistant to transparency, and competing operational priorities.
Laying the Right Foundations
Before jumping to statutory regulation, we argue for a thoughtful reconsideration of foundational elements crucial for any professionalisation effort:
1. Alternatives to regulation: The NHS already utilises multiple oversight mechanisms, such as the Fit and Proper Persons Test (FPPT) and organisational duties of candour. Rather than layering further regulation, efforts should focus on enhancing and fully implementing these existing frameworks.
2. Clarity on regulatory scope: There must be clarity regarding who constitutes a manager and what managerial activities are subject to regulation. Given the NHS’s move towards distributed leadership and collaborative practices, traditional regulatory models centred on individual accountability may be outdated and counterproductive.
3. Strategic workforce planning: Professional regulation should be embedded within a comprehensive strategy addressing training, development, and workforce sustainability. The NHS already faces a severe management training backlog and chronic understaffing. Without addressing these fundamental issues, regulation risks becoming a superficial remedy that does not address underlying capability and capacity problems.
Towards meaningful professionalisation
Professionalising NHS management is a commendable long-term goal, but statutory regulation, at this stage, is premature. Instead, exploring voluntary regulation could be a pragmatic first step, aligning with existing frameworks and supporting rather than penalising managers.
Effective regulation must be part of a broader, strategic approach that includes investment in leadership and management development, rigorous workforce planning, and systemic reforms. Without this, regulation may merely be symbolic, failing to achieve its stated goal of improved patient safety and managerial accountability.
To genuinely enhance NHS management capacity and capability, it is vital to engage in careful, evidence-based planning. Rushed regulation risks undermining the very foundations necessary for creating a capable, supported, and empowered managerial workforce, ready to innovate and lead the NHS effectively into the future.
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Professor Ian Kirkpatrick