Performative activism, or real change?

The Regulation and training of NHS managers.

The Letby murders have placed the regulation of NHS managers firmly back on the agenda. I say ‘back’ because, as we shall see, big scandals can do that. At the moment, for a variety of good and bad reasons, a range of people and organisations are in agreement about the need to regulate managers.

But this agreement covers many different rationales. The Daily Telegraph (never a newspaper whose sub-editors know how to use the word ‘regulation’ in a favourable way) are unsurprisingly making an exception for NHS managers. Seeing a right-wing libertarian argument in favour of regulation raises the question of why – on this single occasion – they are in favour of regulating staff.

This is what is now described as performative activism. This argues that they don’t really want to think through the hard work of what the task of regulating NHS managers would actually entail – that’s not what this is about. They are arguing for it because doing it in public raises their standing in the right-wing political argument.

This is fun because performative politics is what the right usually accuse the left of. It’s true that a lot of politics at the moment is not thought through in practical terms. It’s about taking a stance because people want to be seen to taking it.

But rather than just the appearance of change, what would managerial regulation mean. How would it happen in reality?

Within the NHS, unlike other services, there are many examples of staff being regulated. Nearly all of them are regulated on the basis of their training. If you successfully pass the assessment of many years of training, you become regulated. Your regulation is then maintained provided you keep your training up to date and act within certain parameters.

But some of the current discussion is all about the tough bit of regulating managers and has little to do with the practicalities of training. The implication is that you can somehow regulate a group of staff without having minimum standards of training. This just won’t work.

If you suggested to the Royal College of Surgeons that someone could join the profession without being trained, you would be laughed at. If you were to suggest to the Royal College of Anaesthetists that they be regulated on a code of conduct and not bother with the training bit, going down for an operation might worry you a great deal.

But we can apparently discuss regulating managers just by looking at their behaviours rather than arguing that they need some common base of training. That’s what makes a lot of the discussion performative rather than real.

In the performative side of politics, regulation is used as a threat, a punishment. Given training is in some way a gift, it seems to detract from the feeling of punishment that comes with arguing for regulation. And given that at present there is a scent of retribution in the air, recognising that all managers need some training rather gets in the way of the need for retribution. Let’s face it, the Telegraph does not want to be seen as giving a gift to service managers. That’s why the politics is performative.

But if we move away from that politics to the real world of change, we will find that training and regulation will have to happen sequentially – with the training coming first.

Those of us that can remember what happened 10 years ago will recollect that the Francis report on mid-Staffs strongly raised the issues of training and regulation of managers and of doing them in the right sequence.

The number and quality of candidates for leadership posts could be enhanced by provision of some common training in a leadership college. This could in due course lead to the development of an accreditation scheme

Francis Report Vol 3 Page 1545

Francis, understanding this whole process as a real activity rather than the performance of being angry with NHS managers, recognises that if you are going to eventually have an accreditation scheme you need to start with the training. Just as with the surgeons, you need to complete the process of training before you can begin to accredit it.

This takes time..

“A leadership staff college or training system whether centralised or regional should be created to:

      • provide common professional training in management and training in management and leadership to potential senior staff;
      • promote healthcare leadership and management as a profession;
      • administer an accreditation scheme to enhance eligibility for consideration for such roles;
      • promote and research best leadership practice in healthcare”.

Recommendation 214, Volume 3 Page 1593

Because the training needs to come first, the regulation keeps not happening.

Rather than wait for another scandal in another decade, why not get on with creating a staff college and get the process underway?

As we will see in tomorrow’s post, this process is greatly assisted by there being one already in existence.