NHS managers’ regulation: A step towards professional accountability

Under new government proposals to improve patient safety, NHS managers who commit serious misconduct or silence whistleblowers will be barred from taking up other senior roles. The proposals will introduce professional standards for regulating NHS managers, ensuring that only individuals deemed “fit and proper” are responsible for running NHS services.

The Department of Health and Social Care’s (DHSC) announcement on 21 July follows its consultation in November on whether to introduce regulation for managers working in the NHS. The consultation, which received nearly 5,000 responses, makes for interesting reading. Overall, stakeholders were highly supportive of regulating managers albeit there were differing views on the appropriate type of regulation to take forward.

There was no beating around the bush with the headline “Health bosses won’t be rewarded for failure under new regulations”. Health and Social Care Secretary Wes Streeting went on to say, “the reforms will slam the door in the face of unsuitable managers”. He did acknowledge that “most NHS leaders are doing a fantastic job”.

The consultation outcome starts by referencing both the Infected Blood Inquiry and the Thirlwall Inquiry.

Key proposals

A new statutory barring regime will be introduced for NHS managers. It will apply to board-level directors and their direct reports within NHS organisations, ensuring accountability at senior leadership levels.

This prevents an individual from practising in the profession for as long as they remain on the list. A statutory barring mechanism does not usually include a register of individuals who are fit to practise. Rather, it holds a list of those unsuitable to practise.

The Health and Care Professions Council (HCPC) has been identified as the most suitable body to oversee this regulatory function. New legislation will be introduced to provide HCPC with the statutory powers to disbar NHS leaders in senior roles who have committed serious misconduct from holding such roles.

The government’s approach is guided by the principle of “right-touch regulation”, aiming to:

• Ensure those guilty of serious misconduct are barred from senior NHS roles.
• Promote a culture of openness, honesty, and professional accountability.
• Prevent the recycling of poor leadership across NHS organisations.

This barring system avoids some of the challenges inherent in full statutory regulation such as revalidation and complex transitioning arrangements. It was felt to be more appropriate for non-executive directors too. The government has highlighted that safeguards will ensure that the system is not replacing those matters which would otherwise be dealt with through performance management, appraisals or employment contract. They will continue to consider how frameworks such as the fit and proper person test should interact with the new regime.

An independent legal appeal process will be available, with most appeals directed to the High Court.

The government acknowledges that there are dual registration considerations that need to be worked through too.

Duty of candour

DHSC reference their current review into the effectiveness of the statutory duty of candour. They note that the findings of the call for evidence showed that in some places it is “underwhelming in totality”.

The consultation also asked about the introduction of the duty of candour for NHS leaders, if leaders should be under a professional duty to ensure that the existing statutory (organisational) duty is correctly followed in their organisation and about the responsibility of leaders to respond to patient safety concerns.

Previous reviews, including the 2019 Kark review, the 2024 Infected Blood Inquiry and the current Thirlwall Inquiry have consistently highlighted the need for accountable and transparent leadership.

The government’s consultation response reinforces the critical role of leaders and managers in upholding candour and patient safety. It says that as it implements the regulation of managers and takes forward the recommendations from the Infected Blood Inquiry alongside the proposed Hillsborough law, the government will assess whether additional sanctions are necessary for those who fail to uphold the principle of candour.

At this stage, the government does not propose to take forward a duty to record, consider, and respond to concerns raised about healthcare being provided, or the way it is being provided, as they are of the view that this would be complex to implement and enforce, have significant resourcing implications, and could be counterproductive in terms of advancing candour and safety culture.

Strengthening NHS leadership and professional standards

Supporting the government’s plans, NHS England is developing a leadership and management framework, which is due to be completed in “summer” 2025, to ensure that current and future managers and leaders have the right skills and values and “nurture” a positive culture in the NHS.

The new framework will include:

• A code of practice
• Core standards for leadership
• A development curriculum to support continuous professional growth 

DHSC has committed to establishing a college of executive and clinical leadership to support and professionalise managers across the NHS.

These measures build on the workforce proposals set out in the 10-year health plan, with training and development being one of the five areas of HR policy. A dedicated 10-year workforce plan is expected later this year.

Next steps

Draft legislation to provide the HCPC with the powers to implement a statutory disbarring regime for NHS managers will be introduced “subject to parliamentary time”. It will be subject to a further 3-month consultation and include further details on the role of HCPC as the regulator. We understand that this is likely to take place in the second half of 2026.

The HCPC will then develop and consult on make its rules and put in place processes, including a Code of Conduct needed to hold a barring list for NHS managers with a view to commencing regulation within 12 months of the legislation being made.

The government had already committed to reforming the legislative framework of HCPC within this parliament, but the legislation to regulate NHS managers is expected to have completed its passage through Parliament prior to the broader HCPC modernising legislation.

Looking ahead

Professionalising NHS management is a positive step – and long overdue. The regulation of NHS managers was recommended by the Mid Staffs Inquiry 12 years ago and subsequently by the Kark review in 2019.

Interestingly, the consultation revealed a willingness to extend the scope of regulation to include broader parts of the healthcare system, such as primary care, arm’s length bodies and the private sector, and to bring in additional management levels – specifically, those at NHS Agenda for Change pay scale band 8d and above. The government has pledged to keep this policy under review to ensure it continues to serve the best interests of patients and the public, acknowledging the significant impact future regulation could have across the NHS. They have noted concern about managers moving to other sectors, such as social care, if disbarred from the NHS.

Commenting on the announcement, Tom Kark KC, author of the Kark Review, said:

“I am pleased that the recommendation made in my report into the application of the NHS fit and proper person test to create a power to disqualify board directors found guilty of serious misconduct is being implemented.

“Along with the ongoing implementation of my other recommendations for improving board competence, this is a positive move to strengthen management in the NHS by weeding out poor leadership. This is good news for whistleblowers and those looking for accountability in senior management which has long been lacking.”

Saffron Cordery, NHS Providers deputy chief executive, welcomed the government’s response:

"NHS leaders should be held to the highest standards. We agree that only “fit and proper” people should be running NHS services.”

But she also said: "We must focus on where regulation can add value while minimising burden and bureaucracy.”

Watch this space as the plans develop.