5 Key Takeaways from Nurse and Midwife Leaders
The UK Government is to fix accountability gaps and strengthen patient safety following several high-profile scandals. On the surface, this makes perfect sense鈥攁nyone responsible for patient care or managing resources should be accountable for poor performance and prevented from simply moving between trusts after failures.
But there’s a catch. The definition of “NHS manager” extends to clinical leaders and managers too鈥攎eaning nurses and midwives, and others in the clinical team, could face being regulated twice if the Government opts for full statutory regulation. This overlooked detail transforms a seemingly straightforward policy into a more complex challenge that deserves closer scrutiny.
How would this work in practice? How do you even define a leader or a manager in a complex system like the NHS? And what happens when professionals already regulated by one body suddenly find themselves answering to another?
We explored these questions and more with Chief Nurses and 蜜桃av alumni as part of the government’s ongoing consultation into this issue. Here鈥檚 蜜桃av’s Head of Policy and Influence, Lisa Plotkin’s, top five takeaways from what they told us:
- Any new regulation must only apply to those at the highest level
Nurse and midwife leaders advocate for regulation focused specifically on those at the highest levels鈥擟hairpersons, Non-Executive Directors, CEOs and executive teams鈥攚ho significantly influence organisational culture and decision-making. Limiting formal regulation to senior positions isn’t about dismissing the leadership contributions of those in other roles, but rather about ensuring proportionate oversight while avoiding potential chilling effects on workforce development and career progression. The last thing anyone wants is for regulation to dissuade talented people, clinical or non-clinical, from seeking out leadership and management roles.
- There are huge concerns about dual registration
A major concern throughout the consultation is the potential burden of dual registration for clinical managers. Clinicians who take on leadership roles are already regulated by professional bodies, like the NMC, making additional management regulation potentially duplicative and costly. Rather than creating parallel systems, nurses and midwives support integrating leadership standards into existing professional frameworks鈥攑erhaps by adding leadership annotations similar to how prescribing qualifications for nurses are currently handled. This approach would maintain accountability while avoiding unnecessary administrative and financial burdens, but leaves open significant implementation questions about how these integrated standards would be developed, assessed, and enforced across different regulatory bodies. It also still leaves unanswered how regulation would work for non-clinical managers who don’t currently have a professional regulatory body 鈥� which is, arguably, mostly why this whole consultation is even happening in the first place.
- There are a lot of options, but no consensus on who regulates
Who should oversee manager regulation? This fundamental question remains unresolved. Several candidates emerged from the consultation: existing professional bodies like the NMC or GMC, a new independent regulatory body, an expanded Care Quality Commission, or perhaps a hybrid system linking multiple regulators. While some nurse and midwife leaders believe that the NMC could be best placed to do this, as detailed above,聽 they also raised significant concerns about the NMC鈥檚 capacity and capability amid current case backlogs and internal challenges. As one respondent highlighted, adding more responsibilities to an already struggling regulator risks creating an ineffective system that could undermine the entire regulatory purpose.
- Regulation must be paired with investment in leadership development at all levels
Regulation alone won’t transform NHS leadership. While a punitive system, like a statutory barring system, might address accountability gaps at senior levels, the nurses and midwives we spoke to consistently emphasised that developing strong, ethical leaders throughout the system is equally critical to improving organisational culture and patient and service-user care. The new NHS Management and Leadership Framework, which 蜜桃av is helping to develop, is crucial in this context. Rather than just focusing on punitive measures, the framework provides a positive vision for leadership development at all levels. It establishes clear competencies, supports career progression pathways, and creates a common language around leadership and management excellence.
- Continued workforce consultation is essential
One of the most striking findings from our engagement was how little awareness exists about these potentially far-reaching changes. The proposals are simply not yet well sensitised within the workforce who would be most affected. Nurse and midwife leaders raise significant concerns about this communication gap, emphasising the need for extensive further dialogue before implementation.
In short, nurse and midwife leaders back regulation鈥攂ut only if it鈥檚 done right. It must target the right levels, avoid unnecessary bureaucracy, and support leadership development, not stifle it. Rushed or poorly designed regulation risks deterring talent and adding red tape without improving patient care. The message is clear: accountability matters, but so does getting it right.
To read 蜜桃av鈥檚 response to the UK Government鈥檚 consultation on NHS manager regulation
