
NHS managers who silence whistleblowers to be banned from senior health roles
Legislation is set to be put forward to Parliament next year to introduce professional standards and regulation of NHS managers.
Tens of thousands of clinical and non-clinical managers work in the NHS but there is currently no regulatory framework specifically for managers, as there is for doctors and nurses.
Health Secretary Wes Streeting said the reforms will 'slam the door in the face of unsuitable managers'.
Mr Streeting added: 'I'm determined to create a culture of honesty and openness in the NHS where whistleblowers are protected, and that demands tough enforcement.
'If you silence whistleblowers, you will never work in the NHS again.
'We've got to create the conditions where staff are free to come forward and sound the alarm when things go wrong. Protecting the reputation of the NHS should never be put before protecting patient safety.
'Most NHS leaders are doing a fantastic job, but we need to stop the revolving door that allows managers sacked for misconduct or incompetence to be quietly moved to another well-paid role in another part of the NHS.'
DHSC said a public consultation launched in November last year received more than 4,900 contributions on ways in which managers and leaders could be regulated.
The statutory barring system will be for board-level directors and their direct reports within NHS bodies.
Further legislation will set out new statutory powers for the Health and Care Professions Council to disbar NHS leaders in senior roles who have committed serious misconduct.
Separate NHS England professional standards for managers will establish a 'consistent, national set of expectations about NHS management and leadership competency and conduct', DHSC said.
Tom Kark KC, author of the Kark Review into the effectiveness of the fit and proper person test within the NHS, said: 'I am pleased that the recommendation made in my report into the application of the NHS fit and proper person test to create a power to disqualify board directors found guilty of serious misconduct is being implemented.
'Along with the ongoing implementation of my other recommendations for improving board competence, this is a positive move to strengthen management in the NHS by weeding out poor leadership.
'This is good news for whistleblowers and those looking for accountability in senior management which has long been lacking.'
Rachel Power, chief executive of the Patients Association, said patients expect NHS managers 'to be held to the same high standards as clinical staff, and that should include consistent regulation'.
Ms Power added: 'A clear, fair process to prevent those who commit serious misconduct from returning to senior roles will be an important step forward, and it's vital that patient involvement continues to shape proposals as further regulation is considered.'
Saffron Cordery, deputy chief executive of NHS Providers, said the membership organisation for hospital, mental health, community and ambulance services thought 'only 'fit and proper' people should be running NHS services'.
Ms Cordery added: 'Many big, complex NHS trusts employ thousands of people therefore we want to attract the very best to lead them.
'So we welcome the Government's commitment to developing and accrediting managers alongside proposals for disbarring those whose performance falls short.'
Sam Allen, NHS national director for leadership and management, said: 'Managers will welcome this new regulatory framework, as part of the broader package of actions set out in the plan to attract, develop, and retain the best possible leaders for the NHS of today and tomorrow.'

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BBC News
9 minutes ago
- BBC News
NHS consultant spoke to trans row witness despite warnings
An NHS consultant has admitted that she spoke to a potential witness despite being warned not to do so during an investigation into an altercation between a transgender doctor and a nurse.A healthcare assistant was alleged to have witnessed a separate incident involving nurse Sandie Peggie and Dr Beth Upton, days before they were involved in an encounter in a changing room at the Victoria Hospital in Kirkcaldy on Christmas Eve questioning from Ms Peggie's lawyer at a tribunal, Dr Kate Searle admitted that talking to the witness had been a "flagrant breach" of previous warnings not to discuss the she denied claims that she "left confidentiality in ruins" with her actions. Ms Peggie was suspended from work with NHS Fife after she told Dr Upton - a trans woman - not to be in the women's changing rooms. Dr Searle, who was Dr Upton's line manager, became involved with the case on 29 December and helped file a report on the NHS's datex complaints this period Dr Upton also accused Ms Peggie of walking out on treating a patient earlier in December due to the junior doctor's Searle later spoke to a healthcare assistant who was alleged to have witnessed this incident. However, the woman could not remember details of a conversation between Ms Peggie and Dr Upton. Dr Searle said she could not recall whether she had this conversation before or after Angela Glancy - a senior charge nurse involved in the investigation - had spoken to the Peggie's lawyer Naomi Cunningham said if Dr Searle had spoken to the witness before investigators it would be "grossly improper" added: "What possible business did you have making contact with the witness, who was a witness to a live investigation or pending employment tribunal proceedings?"Dr Searle replied "no business".The consultant said she "probably" spoke to the healthcare assistant after Dr Glancy had done so, but could not be sure as "times have blurred into one" during the later admitted that speaking to the witness was a "flagrant breach" of previous warnings not to discuss the case. Dr Searle became emotional after Ms Cunningham named the healthcare worker, saying that the person involved was desperate to avoid any media had to leave the stand at that point, which Ms Cunningham later dubbed "an outburst". The lawyer suggested the emotion was not to do with any concern for the healthcare assistant but out of "a desire to protect yourself."Dr Searle denied this, and NHS Fife's lawyer Jane Russell said Ms Cunningham's questions on the matter "left a little to be desired". Timeline of the Sandie Peggie tribunal Giving evidence for a second day, Dr Searle was again quizzed regarding emails exchanged between senior staff in the aftermath of the Christmas Eve Cunningham focused on one message said to mention avoiding "foot in mouth syndrome" and that not all messages had been provided to the added Dr Searle's search for emails related to the case had either been "surprisingly incompetent or deliberately withholding" the Searle said she rejected the latter Cunningham accused Dr Searle of "turning up the emotional heat" with how she reported the incident in the replied that she had reported the incident as she saw it, with a junior doctor upset about something that had happened at Searle had told the tribunal on Tuesday she considered reporting the matter to Police Scotland as it could be considered a hate Cunningham asked Dr Searle if she would have recognised Dr Upton as trans if she had not been told, and claimed the junior doctor was "obviously male".The lawyer added that the Christmas Eve incident could have been resolved by Dr Upton leaving the changing room, rather than telling Ms Peggie to speak to management about Searle said she disagreed this would have been a suitable way to end the tribunal continues.


Telegraph
an hour ago
- Telegraph
The truth behind the autism curve
In the year 2000, autism was considered a very rare condition, affecting just 1 in 150 British children. Now it's seen as common. According to a 2021 estimate from Newcastle University, as many as one in 57 British children are on the autistic spectrum. Those figures don't even touch on the number of people who have been diagnosed with autism in adulthood, or have come to the conclusion that they are autistic without having an official diagnosis. In March 2024, there were 89,531 open referrals for autism diagnoses for adults on the NHS, demonstrating just how dramatically perceptions of this condition have changed. Are people actually more likely to be autistic today than they were 25 years ago, or are they simply just more likely to be diagnosed as such? It's complicated, says Professor Gina Rippon, a neuroscientist at Aston University in Birmingham and a world-leading expert on autism. In the US, but also in Britain, there's 'a lot of self-diagnosing going on', she believes, which skews the picture: 'You don't need to register [in official statistics] to proclaim that you have autism on social media.' But when you look at how autism has been diagnosed in previous decades, it should be no surprise that some people have claimed the label for themselves, she says. 'Lots of autistic people have gone undiagnosed for years, many of them women and girls, because of fixed views of what autism is,' says Rippon. In recent years 'the idea of what autism is has become much more inclusive, but at the same time, it has also become much harder to pin down'. How has our understanding of autism changed? Today, autism is defined as 'a developmental disorder characterised by difficulties in social interaction, communication, and repetitive patterns of behaviour', according to the ICD-10, the diagnostic manual used in Britain and many countries around the world to assess people for autism and ADHD, as well as most health problems. But in the past, doctors – like many people outside the profession – had a fixed expectation of what constituted autism in a patient. It was typically thought of as a disability that severely impeded communication, which would mean that people with it needed to attend special needs schools and could never live independently. Cases of 'high-functioning' autism believed to be rare. These people would often be highly intelligent, but they would struggle to make eye contact, be uninterested in socialising and have few friends, and have little empathy for others – and inevitably, they'd be male. In Britain in 2000, four men were diagnosed as autistic for every one woman. When Rippon first began her work, in the 1970s, when it came to autism, 'people weren't looking at women,' she says. 'They couldn't find any to study who had been diagnosed, or at least there were too few to make up a reasonable sample for research.' Modern science suggests that there may be nearly as many autistic women as men, however. Rippon says previously girls might have been diagnosed 'with eating disorders or anxiety'. 'There is some recent research to demonstrate that women are making up the bulk of adulthood diagnoses,' she adds. These days, some experts like Rippon believe that adult women display a type of autism that is less easy to spot under the current diagnostic criteria. 'Autistic women are often desperate to be social and really want to belong, but they don't have the same social instincts as other people and struggle to understand social rules,' she explains. Women with autism may also be more likely to 'mask' their symptoms than men, which can take a toll emotionally. 'It's not that these are two different conditions, and it's also not a prescriptive rule,' Rippon notes. Some autistic men, many of whom might be highly intelligent and successful, display these behaviours too, and may also not have been diagnosed as children. The decision to fold Asperger's into Autism Spectrum Disorder (ASD) Asperger's syndrome used to be a diagnosis of its own, within the umbrella of autism, but the two were merged in 2013 to create a single diagnosis of Autism Spectrum Disorder (ASD). Though Asperger's is often thought of as 'mild' or high-functioning autism, it was formally defined as 'autism without any delay in language abilities,' says Geoffrey Bird, a professor of cognitive neuroscience at the University of Oxford. In practice, 'no one was using Asperger's correctly as a diagnosis, so it got thrown out,' he says. On top of that, autism has only been conceptualised as a 'spectrum' since the 1990s. The idea that autistic people can have a range of symptoms is also relatively new. 'A statistic that's always quoted is that autism diagnoses have risen by 787 per cent since 1998,' says Rippon. The decision to fold Asperger's into ASD was 'slightly political', she believes, and it also coincided with widespread internet use and the much greater awareness of autism that came with it. 'People in general, but especially teachers, have become much more aware of autism without intellectual disabilities, so children might be more likely to be referred for autism assessments and adults might be more likely to seek them out,' Bird says. Diagnosing autism is complex Unlike Rippon, Bird doesn't believe that autistic women 'tend to have a specific type of autism that previously we've been bad at spotting', though he agrees with Rippon that 'it might be the case that clinicians were previously biased against diagnosing women, which I think has changed'. More than anything else, he says, autism has become much less stigmatised, which is a positive for people with the condition, but can occasionally prove unhelpful for clinicians. On one hand, 'people who ought to have been diagnosed in the past are now seeking diagnosis and receiving support,' he says. On the other, 'I've heard from at least two clinicians that some patients who might better suit a different diagnosis, like borderline personality disorder, refuse to engage with clinicians when they are labelled in this way, but will engage once they're diagnosed with autism, as they feel that it's a less stigmatised label,' Bird says. 'I've also worked with HR professionals who have found that people suddenly produce autism diagnoses after they are accused of misconduct,' he adds. 'There are a million things that could make you behave in a way that looks like you're autistic, and it's very easy to fake. Certainly there are people who are being diagnosed with autism who shouldn't be, as well as many who should.' Every person with autism is different It isn't that rogue doctors are handing out labels to help people get away with bad behaviour. Rather, even world-leading experts disagree on what autism actually is and can find it hard to formally diagnose. The famous 'mind in the eyes test', developed by the Cambridge University Autism Research Centre, which asks people to guess another person's feelings from a picture of their eyes alone – something that autistic people were assumed to find hard, or even impossible – has been used for years to explain what autism is and who has it. It is based on the theory that autistic people struggle to read others' minds. But struggling to read others' emotions, to hold eye contact and empathise with other people, ' is actually a separate condition in itself, called alexythymia,' Bird says. Just half of autistic people display alexythymia, he believes, and non-autistic people can have it too. Professor Jen Cook, from the University of Birmingham, believes that autism could also have a lot to do with our bodies as well as our brains and how we empathise with others. 'There's a mathematical principle called the minimum jerk equation, which says that humans move in the most fluid way possible, and we used to believe that this applied to everyone. Now there is evidence that autistic people tend not to move in this minimally jerky way,' Cook says. 'In adults with autism, a lot of clinicians comment that their movements look similar to how people move when they have Parkinson's disease.' In future, she believes, assessments of how autistic adults move could be used as a diagnostic tool. This feature of the condition could even underlie some symptoms, 'as autistic people often struggle to imitate how other people move, or their facial expressions, which could be to do with the same mechanisms that cause them to move differently,' Cook explains. 'But that's not to say that all autistic people move in this way – just that it's common,' she adds. This is an example of the huge challenge that comes with diagnosing autism in children and adults alike: modern research increasingly points to the fact that it's a condition with no single symptom common to everyone who has it. There is also no blood test or brain scan that can be used to reach an objective conclusion. 'There are many ways that you can come to an autism diagnosis,' says Cook. This process can currently include assessments of everything from a person's ability to empathise, to the intensity of their personal interests, to how much rapport a clinician feels with them. Where one clinician might think that someone is clearly autistic, another would let them go without a diagnosis. Should autism be diagnosed in adults? Now that we understand the true scope of what autism can be, is it worth diagnosing the condition in adulthood at all? 'I've been overwhelmed by the number of people who have told me that finally having a diagnosis has been life-changing in a positive way,' says Rippon. 'It's not that people are waking up and wanting to adopt a label that they think is fashionable. Often, it's a way to make sense of life – and for people who are diagnosed in their thirties, forties or fifties, often those are lives that have been very difficult without that self-knowledge.' As for why there seem to be more autistic adults these days than there were in previous decades, 'I haven't seen any evidence to suggest that autism itself is becoming more common,' says Bird. 'I don't buy claims that it's all down to vaccines and chemicals in our water' and he also does not find the arguments that screen time or food additives cause autism to be convincing. The condition has a large genetic component, with almost 800 genes believed to be involved in determining whether someone is autistic. In a family where one child has been diagnosed with autism, the chance that one of their siblings will also be autistic is 20 per cent, much higher than the best estimate for the rate of autism in the general adult population, which is believed to be between 1 and 3 per cent globally. Perhaps the increase in awareness of autism in recent years, and the improved treatment of autistic people that has come with it, simply means that 'more autistic people are finding happy relationships and having children as a result,' Bird says. Surely that is no bad thing.


The Independent
an hour ago
- The Independent
Top medics ask union to row back hard stance on doctors' strikes, warning they risk patient safety
Top medics have urged doctors to soften their stance and tell hospitals if they are striking amid fears they will risk patient safety. The Academy of Medical Royal Colleges (AMoRC), which represents medical colleges across the country, has urged the British Medical Association (BMA) to suspend its guidance for doctors, which suggests they should not inform their employers whether they plan to strike or not. In a rare intervention on Wednesday, the AMoRC said this would make it extremely difficult for health service leaders and managers to maintain safe patient care. Resident doctors are set to strike on Friday at 7am for five consecutive days after talks with the government broke down and failed to avert the action. The BMA is calling for a 29 per cent pay rise, claiming doctors have seen a 20 per cent pay erosion in their salaries since 2008. Wes Streeting, the health secretary, described the strike action as 'completely unjustified'. He added: 'It shows a complete disdain for patients and the wider recovery of the NHS.' The BMA said the health secretary's offer did not go far enough on pay. Royal Colleges' pleas come as The Independent understands that in at least one area of the country, Cheltenham, hospital chiefs have been considering reducing one full A&E service, following mandates that NHS trusts must not cancel routine care. This would likely result in similar measures to those taken during strikes in December 2023, when Cheltenham A&E changed to a minor injury unit during the day due to concerns over the ability to staff the full A&E. The trust is due to announce whether changes will go ahead on Thursday morning. Elsewhere, hospital leaders have said they will likely have to cancel some operations and appointments during the strikes, despite NHS England's official mandate to continue with routine care. Ahead of the strikes, the BMA has published guidance for striking doctors who are asked by trusts if they intend to take industrial action, stating that they are 'not legally required to respond to such questions' and that the BMA has advised them are not obliged to answer. Now the Academy of Medical Royal Colleges has said it 'recognises the right of resident doctors to take industrial action, including by striking. However, following the disappointing news that talks with the Government seem to have broken down, the Academy is today calling on the BMA to suspend its guidance to doctors, which states they should not inform their employers whether they plan to strike or not. 'We know that legally those striking need not inform their employers, but by withholding this vital information, health service leaders and hospital managers have said it will be extremely difficult to maintain safe patient care when they have no idea how many doctors will be absent during the five days of strike action, which begin on Friday.' Other senior medics speaking with The Independent have said they do not support the planned strikes this week. One, who asked to remain anonymous, said: 'I think it's the wrong time. I think the sympathy's gone. So many people are frightened of speaking out, really frightened. They get abused. 'I think [resident doctors] are very angry. I think this is wrong for them to take it out like this – they need to think again. I think about what's good for the country, because what's good for the country is good for the NHS, and what's good for the NHS is good for them. Ahead of the strikes, the BMA and NHS England have clashed over plans for routine care to go ahead. NHS England chief Jim Mackey told NHS trusts they must not cancel routine operations. However, the BMA has warned that this will put patients at risk as consultants will not be able to manage both emergency and routine care demands. Several hospital leaders told The Independent they will likely have to cancel some routine care, with emergency care being the priority in terms of safety. One trust executive said cancelling operations where patients would have to prep was the 'humane thing to do'. They said: 'Even though we come under a lot of pressure [not to cancel] we've always taken the view that the humane thing to do... It's not responsible to put people through that kind of physical and emotional preparation.' During the previous round of strikes in June 2024, around 64,000 operations and patient appointments were cancelled.