NHS England boss backs tougher regulation of senior managers

Sir Simon Stevens also backs idea of a 10-year social care plan to mirror the NHS long-term plan from 2018

NHS England chief executive Sir Simon Stevens (PA)

The head of the NHS in England has backed stronger regulation of senior health service managers to prevent failed bosses from re-appearing in new jobs in other parts of the country.

Sir Simon Stevens told MPs on the Commons health committee on Tuesday that he believed there should be some form of register for senior NHS leaders who will run services, to ensure they are fit and proper.

This would apply to NHS leaders running new organisations known as integrated care systems, which will be set up as part of new legislation planned for the service by ministers.

Mr Stevens comments come after the former chief executive and finance director at University Hospitals Leicester Trust were referred to the Care Quality Commission over a £46m hole in the trust’s finances.

Auditors said the budgets for the trust appeared to have been “deliberately misreported” in 2018-19.

The chief executive Jon Adler retired after going on sick leave last year while finance director Paul Traynor is now chief finance officer at the Open University. The CQC has rejected the referrals as both no longer work in the NHS and are not covered by so-called fit and proper person regulations.

Asked by Conservative MP and GP Dr James Davis whether there should be a “reformed UK-wide fit and proper person register” to prevent bosses being able to “pop up elsewhere in the country”, Sir Simon agreed.

He said: “I would say yes to that. In the case of the University Hospitals Leicester situation, we obviously referred those individuals to the CQC and in the case of the former [chief financial officer] to the accounting professional regulatory body as well. We would expect them to fully weigh what action is required.”

In reference to the fact the CQC can take no action while the two directors are outside the NHS, Sir Simon added: “We’re obviously going to need to discuss with CQC whether or not, where any of those individuals seek to re-emerge, then at that point that will trigger a fit and proper person process, while parliament decides through this legislation, if there's a backstop arrangement that can be put in place that's not available to us right now.”

Under the government’s reform plans for the NHS, ministers want to expand the scope of regulation for clinicians like doctors and nurses to include NHS managers and would allow the statutory regulation of managers in the future.

The current fit and proper person test for senior NHS managers has been heavily criticised. A review by Tom Kark QC in 2019 called for tougher reforms and the ability to stop poor managers from working in the NHS.

Mr Kark said action was needed to close what he described as “revolving doors” for poor bosses but he also called for clearer standards and competencies as well as better support for managers working at senior levels in the NHS.

During his evidence session with MPs Sir Simon also backed the idea of a long-term plan for social care that mirrored that of the NHS.

He said: “I think there are certain inescapable facts about us as a country. We can see what our future will look like over the next five and 10 years, that are a consequence of demography.

“With an aging population, with higher health needs, with more people living with the challenge of dementia and Alzheimer's, we can see that there is going to be increasing pressure on adult social care, which is layered on top of a system that is already very stressed.

“Frankly, what I don't think anybody wants is just more of the same in social care. We need more adult social care, but not more of the same.

“We need more flexibility in care models, rather than people automatically having to move house when their needs accelerate, the ability for supported housing, flexibility to assign care to where people are living, as well as resilience in the care home sector.”

He said this would only work if there was a detailed workforce plan for social care where up to a quarter of staff are on zero hour contracts.

“This is not just a question of answering who should pay for care home residents, or how to ensure that people don't have to sell their house. This goes much more broadly than that.

“It's about increasing the overall availability of care. It's about the type of care that's on offer. And it's about making sure that it is sufficiently responsive to individuals and their families. And the point I think of a 10-year plan is to bring all of those pieces together to have that comprehensive look at how the services needs to change.”

Ministers have promised to bring forward proposals on social care later this year. In July 2019, Boris Johnson said as he entered Downing Street that the Conservatives had a “clear plan we have prepared”, but later admitted that was not the case.