Standards for manager quality responsibilities

57. We accept these recommendations in principle. 58. Following the tragedies at Mid Staffordshire NHS Foundation Trust and University Hospitals of Morecambe Bay NHS Foundation Trust there has been a renewed focus on leadership and quality across the NHS, particularly for those in senior and executive clinical and management positions. It is helpful to see these two elements as equally important, and the most significant changes are likely to be made where these staff are brought together to provide input and challenge to each other's perceptions and roles. 59. Discussions are underway between the Department of Health, NHS England, the Care Quality Commission, the General Medical Council, the Faculty of Medical Leadership and others to address the professional duties of clinical leaders and clinical accountability. The General Medical Council and the Nursing and Midwifery Council already have guidance on leadership and management.15 60. The Faculty of Medical Leadership and Management has published the first UK standards of medical leadership16, explaining further how effective leadership is essential to good quality care. The Faculty is planning further work to make the links between the standards and appraisal and revalidation; to design a system of credentialing; to issue guidance for organisations as to the optimal resources required for medical leaders to be most effective. 61. An alliance of medical colleges, other health professional colleges and associations in partnership with the British Standards Institute are also working to create standards for accreditation of clinical services by June 2016. The prime purpose of these standards is to provide clinical services with a framework on which to base quality improvement. The standard on leadership will apply to all clinical leaders, not just doctors. 62. Good leadership by boards - setting and upholding values, holding the organisation to account and knowing where and when to challenge, is an essential prerequisite for quality and safety. The Professional Standards Authority updated http://www.gmc-uk.org/guidance/ethical_guidance/management_for_doctors.asp; http://www.nmc.org.uk/news/news-and-updates/new-code-comes-into-force-for-every-nurse-and- midwife/ their standards for members of NHS Boards and Clinical Commissioning Group Governing bodies in England in November 201317. 63. The NHS Leadership Academy's Healthcare Leadership Model, which is based on comprehensive research about what behaviours lead to effective healthcare, is also focused on improving the quality of leadership to ensure a culture based on openness and transparency. 64. In addition, the Secretary of State asked Professor Sir Bruce Keogh to review the Professional Codes for doctors and nurses. As part of this, Sir Bruce will work with regulators to develop a strengthened professionalism that always favours openness ahead of defensiveness. 65. As well as the work to improve and raise awareness of clinical and managerial staff's awareness of their responsibilities and behaviours in relation to clinical quality as part of the Care Quality Commission's new inspection regime, they ask five key questions of all health and care services: is the service safe, effective, caring, responsive and well-led. 66. Inspection teams use key lines of enquiry to organise evidence and inform judgements about these five questions. These key lines of inquiry include a focus on staff having the right skills and training to perform their role effectively. The approach means that the inspection team can assess how effectively an organisation monitors, investigates and addresses patient safety concerns and how it ensures staff, including key clinicians and managers, are able to perform their role effectively.

The FMLM published the 2nd edition of UK standards of medical leadership in Oct 2016 and 3rd edition in December 2020.

The NMC standards for professional competence include standards relating to leadership, management and team working. Within this area there are two main aspects to the standards: all nurses must demonstrate their knowledge and competence in both, in order to register as a nurse.

In addition, the NHS Leadership Academy has produced its Healthcare Leadership Model: the nine dimensions of leadership behaviour which applies to both clinical and non-clinical leaders.

The People Plan published in July 2020 set out actions to support leaders to continue building more compassionate and inclusive cultures in their teams. To strengthen the standards for NHS leaders, ‘Our Leadership Way’(formerly known as the Leadership Compact) outlines the best of leadership behaviour and the Board Leadership Competency Framework provides guidance for the recruitment and development of all leaders at board level. Initiatives to widen access to high quality leadership development for all managers at every stage of their career is underway. Work is also underway in response to recommendations 1 and 3 of the Messenger Review.

In addition, in 2019 NHS England published a framework for development for NHS provider chairs.

CQC considers these issues as part of its Well Led inspection of Trusts and will continue to reflect them in the new regulatory model and single assessment framework – see the detail under recommendation 28 above.

The Faculty of Medical Leadership and Management (FMLM) published the 2nd edition of UK standards of medical leadership in Oct 2016 and 3rd edition in Dec 2020.

The NMC standards for professional competence include standards relating to leadership, management and team working. Within this area there are two main aspects to the standards: all nurses must demonstrate their knowledge and competence in both, in order to register as a nurse.

In addition, the NHS Leadership Academy has produced its Healthcare Leadership Model: the nine dimensions of leadership behaviour, which applies to both clinical and non-clinical leaders.

The Faculty of Medical Leadership and Management is developing the third edition of the Leadership and management standards for medical professionals to be released in 2020.

The interim People Plan published in June 2019 gave a commitment to undertake a system wide engagement on a new ‘NHS Leadership Compact’ that will establish the cultural values and leadership behaviours we expect from National Health Service leaders, together with the support and development that leaders should expect in return. NHS England and NHS Improvement are working with the Care Quality Commission (CQC) to reflect the principles of the leadership compact in an updated version of the CQC’s Well-Led Framework, which will be consulted on and launched by spring 2021.

The NHS Leadership Academy’s Healthcare Leadership Model sets out the behaviours that are required of all NHS leaders in order to deliver effective, high quality care. Additionally, in November 2019, NHS England and NHS Improvement published a competency framework for Chairs and will publish further competency frameworks for executive and non-executive role on NHS boards, in line with the commitment set out in the interim People Plan.

Department of Health response (July 2015):

Recommendations accepted in principle.

“The General Medical Council and the Nursing and Midwifery Council already have guidance on leadership and management.” (p. 79)

The Faculty of Medical Leadership and Management has published the first UK standards of medical leadership. (p. 79)

Secretary of State asked Professor Sir Bruce Keogh to review the Professional Codes for doctors and nurses. (p. 80)

Whilst there is information online which shows that Sir Bruce Keogh sent a letter to the Secretary of State updating on his review, a complete report of his assessment of the professional codes could not be found. “As part of the Care Quality Commission’s new inspection regime, they ask five key questions of all health and care services … key lines of inquiry include a focus on staff having the right skills and training to perform their role effectively.” (p. 80)