Employers should decide who is 'fit and proper'

Hands up who would like their career prospects to hang on the contents of the Grant Thornton report into the Care Quality Commission and University Hospitals of Morecambe Bay Foundation Trust? The forensic accountant, no doubt, did a professional job in trying to find out what took place, but its approach, analysis and conclusions continue to be hotly disputed.

‘Responsibility for fitness for employment should lie with employers alone’

Fast forward a few years. The fit and proper person test for the directors of health and social care providers has become law and the CQC is required to ensure organisations have carried out “general or financial background checks about the honesty and integrity, competence and capability” of their directors.

Clearly being namechecked or just referred to indirectly in a report like the one prepared by Grant Thornton would give employers pause for thought - and even if they were still prepared to offer a job, the regulator may disagree with that conclusion.

A good thing too, many would say, but let us think about the role directors of NHS hospitals have to play − especially in a period supposedly requiring radical change. It is very rare for a major reorganisation of hospital services not to bring out all kind of accusations about the “honesty and integrity, competence and capability” of those involved.

Brave boards

A glance at any local paper − or indeed HSJ’s inbox − confirms that. All kinds of “official” reports are produced by a range of vested interests, many hinting at underhand, or at least incompetent, actions.

‘The last thing the NHS needs is to encourage the growth of defensive leadership’

A brave board will realise this kind of noise sometimes comes with the territory and will back itself to sort the real causes for concern from the spurious allegations. But with a regulator − perhaps egged on by those with an axe to grind or a cause to pursue − second guessing their choices, they may be more cautious.

Those responsible for serious crimes have no place in the NHS, while those directors who play down the controversial nature of previous decisions should expect to be treated with suspicion. But responsibility for fitness for employment should lie with employers alone. Regulators must focus on the quality of patient care rather than distracting themselves with necessarily subjective judgements about what constitutes, for example, “competence”.

Defensive medicine is a bane of the US healthcare system and could yet become a problem here. The last thing the NHS needs is to encourage the growth of defensive leadership.