On the surface, the NHS Ten-Year Plan for England doesn’t say much NHS managers that they haven’t heard before. It would be easy to dismiss the Plan as just another big-picture strategy document with limited immediate policy implications. But buried within its 168 pages are some proposals that could have a significant impact on managers.

These include a new statutory barring scheme for senior managers found guilty of serious misconduct, a commitment to accelerate the reforms recommended by Sir Gordon Messenger’s 2022 review and a new range of powers and penalties for very senior managers in trusts and ICBs. While further detail and legislation are still to come, let’s look at how these measures may affect managers in the years ahead.

Regulation of NHS managers was already Labour policy before the party came to power last year. Shortly after the election, the government opened a public consultation to explore the options for regulating managers. MiP’s response was covered in a previous Healthcare Manager article. A few weeks after the consultation closed in February, the government set out its vast programme of cuts to management throughout the NHS in England. 

Thankfully, the Ten-Year Plan acknowledged that introducing full scale regulation would be a monumental waste of resources, particularly when managers are already grappling with major organisational upheaval. MiP agrees with the government’s decision to go with a more limited barring system instead.

A statutory barring list will be easier to implement. Rather than maintaining a list of all registered managers who hold a formal qualification or have otherwise demonstrated they meet the requirements to practise, a barring system only requires a list of senior managers who have been found unfit to practise. Omission from the barred list will be evidence of being fit to practise, saving unnecessary bureaucracy for the system and the individual.

In its response to the consultation, the government confirmed that the disbarring scheme will cover very senior managers (VSMs) at NHS trusts, foundation trusts and ICBs, subject to legislation. It will not apply to managers currently working in NHS England due to the organisation’s abolition and transfer of functions to the DHSC.

Ministers will consider extending the scope beyond VSMs, to Agenda for Change band 9, but only following a review period after legislation is enacted.

The scheme will be run by the Health and Care Professions Council (HCPC). HCPC will be known to most managers; it’s an existing statutory regulator which covers 15 health and care professions, including paramedics, physiotherapists and occupational therapists.

While the details of how the HCPC will run the barring-system alongside their existing regulatory duties remain unknown, it will be given further powers through legislation during this parliamentary term.

The government acknowledged in its consultation response that there are potential issues with dual registration. Many NHS leaders, such as clinicians and finance directors, will already have a separate regulator. Concerns were raised in the consultation about double jeopardy, additional fees and overlapping processes.

The government is considering how to address this. One option, they suggested, would be to only apply the statutory barring system to non-clinical managers, with clinical regulators adopting “common management standards” to assess clinical management practices against. Another option is for HCPC to investigate all cases involving senior managers and refer to other regulators when appropriate—with cases mainly involving managerial situations being dealt with primarily by HCPC.

The government is aware of complications with both options. These will be considered, and ministers will consult further with stakeholders, including MiP, before legislation is drafted.

The government is also considering options for the adjudication process. As the right “to pursue a chosen livelihood” under the European Convention on Human Rights would apply to a barring mechanism, the government has confirmed that there will be a legal appeal mechanism, likely through the High Court.

Ministers have not yet decided if the regulator will have powers to implement sanctions short of permanent barring, or if it will be able to implement interim measures in the public interest while an investigation is ongoing. The government has said that this will also be under consideration while legislation is developed.

A clear definition of what would lead to disbarment is also needed to ensure the system is objective. Safeguards must be in place to prevent the barring system being used to deal with issues normally handled through performance management, appraisals or an employment contract.

MiP will be meeting with HCPC and the Department of Health and Social Care to ensure these issues are addressed as the statutory barring mechanism takes shape.

To be effective, regulation of any kind must come with support and development. The government says it agrees, and we’ve now heard some of the ways it plans to offer that support. The Ten-Year Plan says the government is committed to “accelerating” the delivery of Sir Gordon Messenger’s recommendations on management set out in his 2022 review. Chief among them are:

MiP supported Messenger’s recommendations when they were published and accepted by the previous government in 2022. And we still support them now. But set against the backdrop of the most significant cuts to NHS management since Lansley, is it really enough?

Time will tell what impact these measures will have. MiP has had assurances from the DHSC that Messenger’s recommendations are a priority and that there is a commitment to make them work well for managers. That’s a start.

Wes Streeting has promised more freedom to the best performing VSMs, but also to dock the pay of those deemed to be failing. It’s another example of the health secretary’s self-proclaimed “carrot and stick approach”—reward for success, penalty for failure.

These much-trailed reforms to the VSM pay framework are now in force. VSMs at organisations in the lowest segment of the NHS Oversight Framework, or any VSM who does not meet individual appraisal objectives, will not receive annual pay uplifts. In October, NHS England told trusts and ICBs to withhold this year’s 3.25% VSM pay rise uplift from all executives working in organisations in the national “recovery support programme” and from any others who failed to meet “local eligibility criteria”.

Under the new framework, high performers will continue to receive pay awards, gain more flexibility over budgets, be eligible for bonus payments and be given the “power to act decisively when they identify underperformance” in their organisations. Other ‘freedoms’ are promised but not yet outlined. Just like its approach to regulating managers, the government’s approach to supporting them clearly remains a work in progress.

As Streeting’s ‘carrot and stick’ approach comes fully into effect, MiP will continue to push for more incentives, better support and greater development opportunities for managers at all levels. The true test of the Ten-Year Plan, statutory regulation and pay reforms will not be the impact of the new penalties they introduce, but whether they create the conditions for managers to thrive and lead the NHS through the challenges ahead.