Delaying the inevitable - accrediting healthcare managers

Last November the UK government released its full response to the inquiry of events at Mid Staffordshire NHS Foundation Trust. It wholly or partially accepted 281 of the 290 recommendations made by Robert Francis QC in his final report.^{1, 2} The interesting aspects of the response are in the recommendations that the government only partially accepted - particularly with regards to medical training and leadership in the NHS.

Doctors are highlighted in both the report and the government response as a source of leadership that should be harnessed and nurtured. With this in mind it was peculiar that the government response was keen to promote the development of a “fast-track leadership programme” for senior clinicians. The implied notion that managers can be built after an intensive course is contradictory to the view, within the same document, that doctors who wish to become leaders should be supported early on and throughout their careers.

The Francis report suggested that a facility should be created with the aim of training healthcare leaders. The ultimate goal being a form of accreditation scheme, that eventually would provide “the basis for a regulatory regime.” The government accepted this in part stating that it did not accept the need for a heatlhcare leader to have a formal accreditation. However it felt that non-mandatory programmes for health-professionals from the NHS Leadership Academy such as the fast-track leadership programme were needed and would develop leaders with the right skills and behaviours.³

Accreditation can be defined as: “A means of assessing, in the public interest, the technical competence and integrity of the people or organisations offering services.”

One would assume that it must be in the public interest, that people who lead and organise services in the NHS are competent. Clearly the UK government feels that this is the case. It was announced today that former Marks and Spencer boss Sir Stuart Rose is to lead a review into how to improve management in the NHS in England. It was also announced that Sir David Dalton, the chief executive of the Salford Royal NHS Foundation, is to advise Jeremy Hunt on how successful trusts can take charge of failing hospitals. This is rumoured to be modelled on Michael Gove's "superheads" programme, in which successful headteachers take over failing schools.

Given the above, it must be in the public interest that these leaders have their competency assessed by others fit to do so. If this is not the case then why are doctors choosing to first develop leadership skills and competencies, rather than jumping straight into leadership roles?

Some doctors will innately have aspects of these skills and competencies, and others will have to learn them. In any case, all must develop these to a particular standard, maintain them and if possible improve upon them. The creation of the Faculty of Medical Leadership and Management was due to recognition that there are a growing number of doctors who wish to develop leadership skills and become involved in management.This recognition of the need of doctors to learn and maintain skills is explicit agreement that there are standards that need to be achieved in leadership - fertile ground for the creation of a formally accredited programme and regulator for healthcare leaders.

The UK government currently doesn’t feel that the accreditation and regulation of leaders and managers of healthcare services is warranted. This begs the question - why are doctors, and now nurses, who deliver the services led by managers, subject to both regulation and accreditation in the form of revalidation?

References 

1. Department of Health. Mid Staffordshire NHS Foundation Trust public inquiry: government response. 19 Nov 2013. http://francisresponse.dh.gov.uk/
2. Mid Staffordshire NHS Foundation Trust Public Inquiry. Final report. 6 Feb 2013. www.midstaffspublicinquiry.com/report
3. NHS Leadership Academy. Professional leadership programmes. www.leadershipacademy.nhs.uk/grow/professional-leadership-programmes/