We know that some sort of enhanced managerial accountability is on its way. The Secretary of State, Jeremy Hunt, wants to consider a range of options, and our discussion paper and consultation on the subject – published last week – lays out some possibilities.
For those of us used to juggling professional registration with a senior management position, this should not come as a shock. Medical, nursing and allied health professional (AHP) registration is always at risk when taking decisions – managerial or clinical – which could affect patient care. Walking this tightrope concentrates the mind and keeps the mantra of high-quality patient care at the forefront of every decision we make. That is not to say that managers without clinical professional qualifications don’t think the same way, but Francis’s recommendations are about personally taking responsibility as well as publicly owning accountability.
What might this look like? There are a range of possibilities.
Full regulation – an option which does not look particularly attractive and appears not to be the Government’s preferred option. Doctors and nurses at Mid Staffs Hospital were registered and regulated professionals, but poor care still happened.
Some form of voluntary register? If so, what would happen to those who choose not to take part? If this option is selected, it would rely on all boards taking it on. So one wonders then how it differs from full regulation, apart from the lack of a professional code against which standards are measured.
A negative register? This helps with the issue of people moving on to other organisations after presiding over failures in care, but the human rights implications would need to be careful assessed.
No one option stands out as a front runner. We are in difficult territory.
Hard decisions must be made over the next few years, decisions which will need to have public understanding and agreement if we are to sustain the NHS. The bond of trust between the public and NHS will be as important as that between doctor and patient. Knowing that someone will ‘carry the can’ when things go wrong and not simply be ‘recycled’ elsewhere – however good their previous track record – is something other industries take for granted. It may not be fashionable to say, but look at the impact the Financial Services Authority can have on the senior teams of financial services organisations, including most recently on the ‘fit and proper persons test’ of banks.
So, while being wary of the pitfalls, we should keep an open mind about what is brought forward to gain and retain public trust.
What might be the pitfalls? Well, whichever option is selected will potentially arrive with a slew of bureaucracy and the need for more training and development to support it. It will cost individuals and organisations money to set up and run. It will require time and effort at a time when focusing on the wider impacts of the recent reforms may make it seem an unwelcome burden.
Will it prevent another Mid Staffs?
What happened at Mid Staffs will always be possible on an individual basis. But the inquiry’s clear message that patient care is everyone’s responsibility and that everyone – manager and clinician alike – is equally and publicly accountable for preventing future failings, may not be a bad starting point for those new conversations with the public around the future of the NHS.
Jo Webber is interim director of policy at the NHS Confederation. Follow Jo on Twitter @nhsconfed_jo