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Should NHS managers be professionally regulated?

A lot of people say they are professionals and a lot of others (not necessarily the same) act professionally. But when we speak of ‘the professions’ it conjures up an image of doctors, lawyers and accountants - and one theme that joins them is the idea of professional regulation.

There have been debates about some kind of professional regulation for managers for years, but what prompted the overwhelming vote in the ARM was undoubtedly the Francis Inquiry.

In his report on failings at the Mid-Staffordshire NHS Foundation Trust, Robert Francis QC stopped short of recommending compulsory regulation, although he said there should be a shared professional culture between doctors and non-clinical managers, and that Monitor should have the ability to disqualify unsuitable NHS directors.

In its response to the Francis report, the NHS Confederation has launched a public consultation into restoring quality in NHS management but does not seem enthusiastic about regulation.

The NHS Confederation’s deputy director of policy Jo Webber, writing in February, reasoned that: ‘Doctors and nurses at Mid Staffs Hospital were registered and regulated professionals, but poor care still happened.’

If the argument is that there shouldn’t be regulation because failings still happen, it does not seem very strong. You could follow the same logic with doctors and nurses and say because their system of regulation is not perfect, then they shouldn’t have such a system either.

At the ARM, there were different arguments against managers being regulated. Hertfordshire GP Michael Ingram argued that NHS managers were not part of an autonomous profession, and were instead part of a management structure. He was also concerned about a regulatory body’s processes being bureaucratic and cumbersome.

But Derbyshire GP Peter Holden said salaried doctors were part of a management structure and they still managed to be part of a regulated profession. And in response to a question whether medical managers would have to be registered with both the GMC and the new regulator, he said one would suffice.

He received overwhelming support for his call, which also included condemnation of secrecy and bullying within health services and that the culture of the NHS must move away from the pursuit of financial and activity targets and revert to the attainment of quality.

Neil Hallows is BMA views and analysis editor