On 26 November 2024, the Secretary of State for the Department of Health and Social Care (DHSC), Wes Streeting, announced the launch of a consultation (Leading the NHS: proposals to regulate NHS managers) “on options for the regulation of NHS managers, as part of a programme of work to meet the government’s manifesto commitment to introduce professional standards for, and regulation of, NHS managers”.  

In this insight, we summarise the proposals, what to take away and the next steps. 

The consultation  

The DHSC is seeking views from all partners, including health and care organisations, regulators, professional bodies, health and care managers and senior leaders, the public, patients, and other health and care staff on the most effective way to strengthen oversight and accountability of NHS managers. 

The consultation closes at 11:59pm on 18 February 2025 and asks several open and closed questions about: 

• The type of regulation that may be most appropriate. Options under consideration are: a voluntary accreditation register, statutory barring mechanisms with a professional register, and full statutory regulation. 
• In addition to board level directors, which managers should be regulated. 
• What kind of body should exercise any regulatory function? Options include an independent regulatory body, the Care Quality Commission (CQC), an arm’s length body or a professional membership body. 
• What types of standards should managers be required to demonstrate as part of a future system of regulation, for example, a requirement to hold formal qualifications and/or to undergo a revalidation process. NHS England is currently undertaking work to further develop professional standards for managers , which could form the foundations for future regulatory standards for managers. 
• Options for managers who are also clinically registered professionals. These include; dual registration, broadening existing regulatory frameworks and/or for regulators to develop a set of mutually agreed standards. 
• When and how any regulation should be introduced, straight away or taking a phased approach. 
• Whether a new professional duty of candour should be introduced for those in executive positions and all board members (‘NHS leaders’) to ensure that the current organisational statutory duty of candour is correctly followed and, if so, whether they should be held accountable for this. 
• Whether NHS leaders should have a legal duty to record, consider and respond to any concerns raised about healthcare being provided and, if so, what duties they should have in relation to recording, considering and responding to safety incidents. There is a significant crossover here with the government’s parallel work on reforming the duty of candour, which is also under consideration now. 

What to take away 

Change is coming. Several high-profile public reviews have identified a need for professional standards for NHS leaders and managers to ensure that they are held accountable when things go wrong. The government agrees and wants to ensure that this need is met.   

Overall, the proposals for regulation of NHS leaders and managers have been widely welcomed as a positive step, and one that will align them with the regulated professionals whom they work alongside. However, if the additional formalisation and oversight goes too far, the extra pressures and fear of sanctions may result in the loss of existing managers and also deter people from taking on these already challenging roles. A successful approach will need to not only focus on delivering quality care and patient safety, but also recognise the challenges that managers in the NHS face, support them to meet the new standards and ensure that regulation is fair, proportionate and independent. 

Next Steps 

DHSC will consider all information submitted as part of the consultation in future policy decisions on regulating NHS managers. Any legislation brought forward to implement a statutory regulatory regime for NHS managers will be subject to further consultation.  

In the meantime, the statutory ‘Fit and Proper PersonRequirements’ (FPPR) for CQC-registered organisations’ directors and staff, NHS England’s FPPR processes and existing professional regulatory obligations will continue to apply - and these may also be subject to enhanced scrutiny. 

We encourage all NHS organisations to take this opportunity to respond to the consultation and try to influence what future regulations, professional standards and duties will look like for NHS managers and NHS leaders. 

How Capsticks can help 

Capsticks has significant experience in supporting NHS employers to navigate changes in employment law and policy, from conducting audits, reviewing current policies, contracts, practice and implementing change, to delivering training to employees at all levels. We can also deal with any complaints or specific issues that may arise in individual cases by conducting investigations, supporting decision-makers and HR, and defending any employment tribunal claims.  

For further information on how we might assist your organisation, please get in touch with Sian Bond, Jonathan Lewis or Alistair Kernohan.