Patient Safety Learning’s statement on proposals to regulate NHS managers (23 July 2025)

Summary

This article outlines Patient Safety Learning’s response to the UK Government’s announcement that it plans to bring forward secondary legislation to implement a statutory barring system for NHS leaders. These plans were announced as part of the Government’s formal response to the outcome of its public consultation on how to strengthen the oversight and accountability of NHS managers in England, published on 21 July 2025.

Content

Patient Safety Learning welcomes new proposals set out by the Government this week to introduce professional standards for, and regulation of, NHS managers. We believe there is a clear case for the regulation of NHS managers, for the protection and benefit of both staff and patients.

All staff have an important role to play in ensuring patient safety. As we see all too often in the outcomes of patient safety scandals and inquiries, there are too many instances of managers not acting on serious safety issues and suppressing concerns raised by those speaking up. We have also been highlighting these problems as part of a new interview series on the hub this year, Speaking up for patient safety.[1] [2]

Regulation of managers is an important step forward in tackling these issues, introducing greater accountability in how organisations respond to patient safety concerns. Below we note our reflections on other aspects of the Government’s response to its consultation earlier this year on regulating NHS managers.

Barring system and sanctions

We welcome the proposal to introduce a statutory barring system for removing unfit managers in the NHS.

We also support the proposed use of sanctions on managers who do not meet required standards. However, as noted in our consultation response, there will need to be clearly defined standards and effective oversight mechanisms so that all inappropriate behaviour is captured. We currently see evidence of managers weaponising other mechanisms against whistleblowers raising safety concerns, such as vexatious referrals to regulatory bodies.

Scope of regulation

The Government has stated it will initially introduce regulation for NHS bodies for board-level leaders and their direct reports, but notes:

“… we will consider whether to extend scope of regulation to other senior managers. This achieves the overarching objective of preventing unfit NHS managers from occupying senior leadership roles and enables initial implementation to focus on the parts of the NHS that are most ready for this new regulation.”

Patient Safety Learning believes this regulation should be extended to all senior managers (approximately bands 8d to 9) and mid-level managers (approximately bands 8a to 8c). Furthermore, all staff, including managers at all levels, should have competencies and behaviours regarding patient safety, in addition to any individual regulatory requirements.

Duty of candour

The consultation response states:

“The government will support a regulatory system for NHS leaders that gives consideration to the relevant legislation underpinning the statutory duty of candour. We are clear that there should be consistent and correct application of the existing statutory duty of candour across the NHS to increase accountability, openness and honesty. This should support the NHS to develop a just and learning culture where providers do not seek to blame individuals for what went wrong but acknowledge what happened and try to understand why it happened, how future risks can be reduced and how the needs of the patient and staff can be met in order to help them recover.”

Patient Safety Learning believes it should be a requirement to be honest and transparent with patients and their families when something goes wrong, and this should be fundamental for all staff. This is an essential requirement for creating a transparent learning culture in an organisation focused on improving patient safety and reducing avoidable harm. We therefore support the principle that individuals in NHS leadership positions should have a professional duty of candour as part of the standards they are required to meet.

However, we would note there remains a significant gap between what is said and understood regarding duty of candour, and what takes place in practice at many healthcare organisations. Clear evidence of this was found in the findings in last year’s call for evidence on statutory duty of candour.[3] These wider issues regarding the operation of duty of candour will need to be addressed if it is to apply in a meaningful way for NHS managers.

We also note that it is difficult to envision the statutory duty of candour working as intended in organisations where blame culture and a fear of speaking up persist. As outlined in our report last year, We are not getting safer: Patient safety and the NHS staff survey results, the NHS needs to introduce clearer requirements and plans to help organisations create and maintain safety cultures.[4] Without addressing the pockets of negative culture that exist in the NHS, this will continue to act as a limit on the proper application of the statutory duty of candour. Managers being asked to act in an inappropriate manner by an organisation with a toxic culture and leadership should also have protections and be able to raise themselves concerns about inappropriate behaviour.

Responding to patient safety concerns

The Government states in their response that:

“We will support a regulatory system that holds NHS leaders accountable for the mechanisms in their organisations associated with recording and responding to patient safety concerns to support organisational learning. This would be integral to the management and leadership framework being developed by NHS England, including professional standards and a single national code of practice. Mechanisms to advance patient safety should recognise the importance of staff and patients being able to freely raise concerns with management (without any negative consequences) and support the NHS to develop a just culture.”

Patient Safety Learning believes all staff in health and care have a responsibility to record, consider and respond to any concern raised about the healthcare being provided, or the way it is being provided, in the best interest of patients.

However, in practice, existing processes do not always support this. An example of this can be found in our blog earlier this year on reporting patient safety incidents and corridor care.[5] Taking this example, the existing incident reporting mechanism, the Learn from Patient Safety Events (LfPSE) service, heavily relies on digital tools for incident reporting. These infrastructure limitations impact in a range of areas, one of which can be the accessibility and ability to capture incidents comprehensively using the LfPSE service. This issue is amplified when working in overcrowded and chaotic environments like corridors, where staff may not have easy access to appropriate IT.

Existing processes need to function, and staff need to be properly supported before expectations are applied.

References

1. Peter Duffy and Helen Hughes. Speaking up for patient safety: A new interview series about raising concerns and whistleblowing. Patient Safety Learning, 15 January 2025.
2. Peter Duffy and Helen Hughes. Key themes from our ‘Speaking up for patient safety’ interview series. Patient Safety Learning, 14 May 2025.
3. Department of Health and Social Care. Findings of the call for evidence on the statutory duty of candour, 26 November 2024.
4. Patient Safety Learning. We are not getting safer: Patient safety and the NHS staff survey results, 26 March 2024.
5. Patient Safety Learning. The crisis of corridor care in the NHS: patient safety concerns and incident reporting, 6 February 2025.