Defining the professional NHS manager

The evolution of the professions is a rich source of academic study. The first serious focus on NHS management came with The Griffiths Report (really just a long letter) which opened the flood gates to “professional” managers.

Managers remain an easy target for politicians – because they echo Joe Public’s misplaced assumptions of waste and overheads. And for doctors, because if they aren’t getting what they think they need, the retort is “we are not engaged” and the manager is the first to feel their pain.

We spend little on managers compared to other national peers. We try and make up the deficit in part by buying capacity and uncertain capability periodically from management consultants, and pay eye watering day rates for magical checklists.

The appetite to regulate managers is growing, and easy to get wrong. Trial by HSJ isn’t just and the MHPS process for doctors is an example of how not to do it.

The Nolan Principles are a nice non-enforceable guide. The Fit and Proper Person Test was a rushed start.

The Kark Review recommendations do not address the professionalising of the professional; it wants competence (recommendation 1), a series of bureaucratic steps (recommendations 2,3,4) and rushes to regulation (recommendation 5).

Poorly thought through regulation being put ahead of what defines and secures the meaning of a profession is a danger.

Managers are certainly professional in what they do; try healthcare transformation without brilliant professional managers. But is management a profession? Can you regulate a profession if you haven’t defined the profession? Trying to set up regulation, as seems to be current NHS England and Care Quality Commission thinking, without first defining and framing the manager into a defined profession is setting them up for failure and plenty of HSJ copy.

The medicine fulfils the following criteria for a modern profession:

• Certified
• Ethical framework
• Transparent open to debate professional judgement
• Continued professional development
• Regulatory body managing professionalism standards

As your American cousins would say, ”this is not a Chinese menu”. You must have all of it. Doctors, nurses, lawyers, and to a point also chartered accountants are professions that fulfil the definition of a profession.

Look at a trust board. The medical director, The director of nursing, and finance director are all professionals, from professions that meet the definition. What of the chief executive, chief operating officer, HR director, director of strategy…? What of the managers in all the other layers?

What needs to happen to get managers recognised as a profession? Here are some suggestions:

• Certified: A degree in philosophy or psychology is probably more helpful than one in geography. A degree in business and management would be good; relevant postgraduate qualification ideal. The education market is not short of options.
• Ethical framework: Social science literature is a rich resource to define what matters ethically and what needs debating, constantly. Some of the NHS Constitution is worthy of inclusion for those debates.
• Transparent professional judgement: This requires internal and external instruments to enable constructive challenge and learning.
• Continued Professional Development: The medical and nursing profession have only recently formalised this principle. A self-reporting medical appraisal framework is not recommended. Evidence of development based on the body of knowledge is key to broadening horizons and learning from different disciplines. The education market is rich and varied and needs careful navigation, lest airport best sellers and management guru videos become the main source of learning.
• Regulatory body managing professionalism standards: Membership of the regulatory body would be mandatory. Who regulates how and with what consequences will take time to get right? The MHPS model is the wrong place to start. The original NCAS model is worth exploring. There are professional regulating bodies with teeth that can inform the start of meaningful professional regulation. Expulsion from membership should be the final peer sanction.

Without good quality professionalised managers, leaders generate Machiavellian noise pushing the workforce to the edge, as they bask in the latest ”well done, keep your chin up” tweet.

Once managers are framed properly as a profession, the doctor, the regulator, the media and the politician might have less excuse to target NHS managers.