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21 February 2019
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[FMLM] cannot do so on its own

 - Sir Robert Francis

by Mr Peter Lees

You do not need to be a cynic to read the recent Kark Review[i] of the Fit and Proper Person Test (FPPT) and be astonished at the inertia and expense of nearly two decades of navel gazing. Kark acknowledges the general recognition that the FPPT is not (and some would say never been) fit for purpose. In the 2001 Bristol paediatric cardiac surgery report, Sir Ian Kennedy stated there should be “for senior healthcare managers, a new professional body”. But, eighteen years later, we have yet to see that breakthrough. Furthermore, it is frustrating that this latest review has overlooked the fact that FMLM, through its standards and certification, is already delivering what so many seem to think is too difficult.

If you are interested in return on investment, Kark gives a depressing historic review of reviews in relation to the FPPT, with recommendations for leadership and management competence. Kark cites reviews of performance failure including Bristol Royal Infirmary and Liverpool Community Health NHS Trust, with reference to Mid-Staffs, Morecambe Bay and the Dalton Review; reviews of leadership span Smith, Rose, Manchester University and King’s Fund.

Francis did acknowledge FMLM by noting the Faculty’s establishment and “declared objective” to “advance medical management and leadership as a profession.” He continued: “There is little doubt that enhancement of the status of healthcare management and leadership as a profession is sorely needed.” He recognised the “gulf” between doctors and managers and saw a solution in professionalisation: “It would also encourage a wider range of potential candidates to aim their careers and personal development at achieving these essential positions in healthcare. That is something to which the Faculty can make a significant contribution, but it cannot do so on its own.”

Agreed, the Faculty “…cannot do so on its own”, but despite the lack of wider acknowledgement and support – as well as being entirely self-funded - FMLM has continued to serve the public good in this respect. While reactions to the Kark review debate the ‘too difficult’ box, FMLM has quietly (perhaps too quietly) got on and published Leadership and Management Standards for Medical Professionals and established a system of certification to benchmark them. While others continue the 18-year debate, 130 doctors and dentists across the UK have submitted their leadership and management performance and ‘satisfied’ a rigorous peer-review process.

Is it not incongruous that, in the NHS, heavily regulated clinical professions work cheek by jowl with a management profession that is largely unregulated (excepting finance colleagues)? Why is revalidation restricted to clinicians? Is it not also surprising that we have comprehensive training programmes for clinicians whilst our healthcare management colleagues’ only opportunity is the excellent (but limited access) NHS Graduate Management Training Scheme. Finally, the FTTP restricts Kark to senior managers, but clinicians are rightly regulated from the day they graduate. The same logic should apply to managers.

In FMLM’s review of the barriers facing clinicians, it is interesting to note that medical leaders reported reassurance in having a regulator to support their resolve when protecting quality and safety. Interestingly, the HSJ reported “More than 90 per cent of about 80 senior managers surveyed backed idea of professional regulation”[ii]. There is legitimate concern among managers of being scapegoated in a regulation process where the underlying issue is lack of resources, but I can hear the clinical community shouting ‘join the club’!

I have often likened management to the autonomic nervous system of healthcare, and we all know the devastating effects of autonomic failure. Managers play a crucial, often unseen, role and yet you could argue that they are victims of their own inability to professionalise, making it easier for them to be picked off by politicians, journalists et al. The systems of clinical regulation and training may be imperfect, but they breed a culture upon which both trust and respect are built.

It is surely time for the NHS to recognise the professionalisation that FMLM has delivered, heed Francis’ recommendation and follow our lead. If FMLM can establish the standards and process of professionalisation without recourse to public money, the NHS can utilise it. It is time also that the public had more respect for managers, but managers may wish to reflect that subjecting themselves to the same rigorous training and scrutiny that they expect of their clinical colleagues might be a helpful first step.



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