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A Labour government would rapidly introduce measures to disbar NHS managers found guilty of wrongdoing and boost protections for whistleblowers, in the wake of failings uncovered by the trial of child serial killer Lucy Letby.
In a letter seen by the Financial Times, shadow health secretary Wes Streeting told the two biggest NHS membership bodies that his party would reform regulation of health service administrators if it won the general election expected next year.
Streeting said the need for a shake-up had been sparked by Letby’s conviction for the murder of seven babies and the attempted murder of six more between June 2015 and June 2016, which he termed “acts of unspeakable evil”.
Some clinicians have said they tried to raise concerns about Letby after babies began dying at a far higher rate than normal in the neonatal unit at the Countess of Chester hospital. They claim that managers were slow to act on their concerns.
Streeting told the heads of the NHS Confederation and NHS Providers that he was giving “the health service notice now that Labour is committing to act, and to state my intention that we work collaboratively towards delivering a regulatory framework that strengthens the accountability of managers and enhances patient safety”.
“I am clear that those found guilty of serious misconduct should be disbarred from the NHS,” he added.
Health secretary Steve Barclay last week told MPs that the government-commissioned Kark review, which examined a Fit and Proper Person test for board members, had in 2018 recommended powers to disbar directors found guilty of serious misconduct.
But he said the NHS had decided other proposed changes “mitigated the need to accept this specific recommendation on disbarring”.
“In light of evidence from Chester, and ongoing variation in performance across trusts, I have asked NHS England to work with my department to revisit this,” said Barclay.
Streeting told Matthew Taylor and Sir Julian Hartley he wanted to take into account the views of their members on “how a professional register might work and how we avoid unnecessary bureaucracy, minimise overlap and streamline existing regulation”.
In particular, Streeting said he wanted to consider how “we ensure whistleblowers are listened to and empower staff to raise concerns”.
The Letby case was not the first time NHS whistleblowers had been ignored at a cost to patient safety, and the case for regulation had been made “pointedly and repeatedly in the past decade”, Streeting noted, yet little action had been taken.
“That is not good enough. The system must change,” he wrote.
Hartley said NHS Providers accepted “that much more needs to be done to demonstrate the NHS’s commitment to patient safety”, and that it was “completely understandable” that regulating managers was on the table.
But he added that any discussions about regulation should “explore how we can better support managers to create an open and learning culture in the NHS” — including by offering professional support and skills development —“alongside any possible sanctions”.
Taylor said NHS leaders fully understood the renewed public and political interest in the regulation of senior managers and that it was “sensible to look again at potential regulation in a way which better enables open and inquiring cultures”.
Health department officials said ministers had accepted the first two recommendations of the Kark review — the introduction of competence standards and a central database of trust directors’ qualifications and career history.
A new Fit and Proper Person Framework, strengthening the accountability of NHS directors and helping prevent unfit board members from moving between health service bodies, would be implemented by all boards by the end of March, they added.