The Ward Round: Regulation of managers is the easy answer

Revelations that leaders at the Countess of Chester Hospital had questioned the integrity of paediatric consultants who raised concerns about neonatal nurse Lucy Letby – who last week was found guilty of murdering seven babies and seven counts of attempted murder – were shocking.

If the consultants’ concerns had been taken more seriously, it looks very much like some of the babies could have been saved.

During the fallout, there have unsurprisingly been renewed calls for NHS managers to be regulated, which was recommended by the Kark review in 2019, to “deal with serious matters such as serious dishonesty, deliberate victimisation or harassment”. According to The Telegraph, this was resisted by former health secretary Matt Hancock.

But it is unclear how such a “register” would have made a difference at CoCH.

Much of the Letby commentary has questioned how former CEO Tony Chambers was able to take interim roles at Barking, Havering and Redbridge University Hospitals and Queen Victoria Hospital Foundation Trust. But it’s unlikely that a register would have prevented that.

The allegations which have emerged against Mr Chambers over the last week had not been subject to any form of review or investigation when he was appointed to those roles (and still haven’t been to date), so there would have been no formal basis on which to sanction or exclude him.The same goes for other managers involved in handling the concerns over Letby.

Mr Chambers has defended his actions at CoCH and said he intends to support the inquiry set up by ministers.

The two other executives at CoCH that have been accused of failing to take the concerns over Letby seriously – former nursing director Alison Kelly and ex-medical director Ian Harvey – were both already referred to professional registers.

Ms Kelly was referred to the Nursing and Midwifery Council, but the case was paused while the police investigations into Letby were ongoing. She has been working at the Northern Care Alliance in an interim role, until being suspended after the guilty verdicts.

Before he retired, Mr Harvey was referred to the General Medical Council by the paediatric consultants, but the case against him was closed after an investigation found the evidence did not meet the threshold for a full misconduct case.

NHS Leaders I’ve talked to about this case are clear they wouldn’t have a problem being regulated, and according to the Managers in Partnership union, half of members would support this. But some have also questioned how it would stop bad behaviour and become an easy win for ministers who want to be seen to do something.

MiP’s chief executive Jon Restell said there is already a “wealth of regulation” around executives, including Care Quality Commission inspections and the statutory fit and proper persons test, while tricky decisions would have to be made on the standards, accreditation, revalidation and the creation of an independent body. Mr Restell suggests this would need “attention and resources that thus far politicians and systems leaders have been unwilling to give”.

He also suggested professional regulation could expose “chronic underinvestment in NHS management”, which could “lead to the change the NHS needs”.

But, he is clear, this should not descend into “false assurance and PR, which would be the insulting opposite of what is owed to the public, the families of victims and the memory of the babies murdered by Letby”.

The danger is that if the knottier and more complex parts to this story – around whistleblowing concerns, clinical governance, patient safety, and perhaps how senior leaders are supported by regional and national teams to make difficult decisions – are not tackled, and within time, another scandal will emerge.