The Letby inquiry report makes one thing crystal clear: too much NHS management is scandalously poor | Tom Dolphin

The publication of the Thirlwall inquiry report is above all a moment to remember the babies who died or were harmed at the Countess of Chester hospital and the families whose grief was compounded by years of delay, institutional denial and defensiveness. The least we owe those families is a determination to now make the right changes – not the comfortable ones, not the partial ones, but the ones that will stop further avoidable deaths and injury.

Lady Justice Thirlwall’s report lays bare a total failure of NHS management. When doctors dared to raise concerns, they were rebuked and threatened with referral to the General Medical Council (GMC), which could have ended their career. The report describes a kind of “toxic negativity” all too familiar in the health service: a desperate culture of cover-up and denial that prizes saving face over saving lives.

Whistleblowers deserve respect, not ridicule or rejection. It takes courage to speak out against those in power, and the BMA has supported many such courageous doctors. They include Dr Susan Gilby, who at the very same Countess of Chester hospital refused to stay quiet about the failures she saw around her. She was punished with a shocking campaign of repression from management that resulted in her being awarded £1.4m in damages earlier this year. If it wasn’t clear before, Thirlwall has thrown into stark relief the plight of whistleblowers, and most importantly the patients whose lives and health are at risk.

But the real legacy of the inquiry may go even deeper, to the heart of how we think about regulation in the NHS. It is well known that doctors and nurses serve under our professional regulators, the GMC and the Nursing and Midwifery Council. We can be investigated, sanctioned, suspended or struck off if our conduct falls below expected standards. That is as it should be. Regulation protects patients, gives the public confidence and makes clear that authority in healthcare must always come with accountability.

What few know is that non-medical managers – those in charge of a hospital’s essential systems, such as its staffing, buildings, equipment and finances – do not face that accountability. Indeed, non-medical managers are the only safety-critical group in the NHS that does not have a regulator. It seems utterly backwards that some of the most powerful people in the health service face so little oversight, and it is not hard to draw a line between that and the abuses of power that led to the situation at the Countess of Chester and all the tragedy that followed. I am very glad, therefore, to see that Thirlwall has addressed this head-on, making the clear recommendation that it should be possible to strike off these managers just like any other NHS professional.

She has also recommended that the UK government seriously consider creating a statutory regulator for non-medical managers, which the BMA believes is long overdue. Their regulation shouldn’t be crammed in with that of the dozen or so other professions – physiotherapists, dieticians, radiographers to name a few – supervised by the already overloaded Health and Care Professions Council. They need and deserve an expert, dedicated statutory regulator that can give a clear, enforceable set of standards.

The BMA doesn’t just want non-medical managers to fear negative consequences for bad behaviour; we want them to have high standards so more of them can aspire to excellence. The culture of the NHS should be one where we welcome staff and patients raising concerns about failings, with adequate resources for fixing problems, so well-regulated managers can actually improve things rather than shooting the messenger.

That day still looks dangerously far off, though. Despite a Labour manifesto commitment, the inquiry sees these regulatory changes taking until 2032. In the meantime, we do not know how many more examples of poor or dangerous practice will be suppressed and ignored by managers who remain beyond the reach of accountability.

This must not be a commitment left to fall by the wayside in the aftermath of a general election. Work by government to create a statutory regulator must begin now, and by the end of this parliament, the families of those affected should have confidence that any institutional cover-ups will be tackled. For our patients and colleagues – and ultimately in the interests of managers, too – doctors are going to push for these changes to be implemented faster. Accountability matters.

• Dr Tom Dolphin is a consultant anaesthetist in London, and chair of council at the BMA

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