57. We accept these recommendations in principle.
13 http://www.gmc-uk.org/guidance/good_medical_practice/respond_to_risks.asp
14 http://www.nmc.org.uk/standards/code/read-the-code-online/
58. Following the tragedies at Mid Staffordshire NHS Foundation Trust and
University Hospitals of Morecambe Bay NHS Foundation Trust there has been a
renewed focus on leadership and quality across the NHS, particularly for those in
senior and executive clinical and management positions. It is helpful to see these
two elements as equally important, and the most significant changes are likely to be
made where these staff are brought together to provide input and challenge to each
other’s perceptions and roles.
59. Discussions are underway between the Department of Health, NHS England,
the Care Quality Commission, the General Medical Council, the Faculty of Medical
Leadership and others to address the professional duties of clinical leaders and
clinical accountability. The General Medical Council and the Nursing and Midwifery
Council already have guidance on leadership and management.15
60. The Faculty of Medical Leadership and Management has published the first UK
standards of medical leadership16 , explaining further how effective leadership is
essential to good quality care. The Faculty is planning further work to make the links
between the standards and appraisal and revalidation; to design a system of
credentialing; to issue guidance for organisations as to the optimal resources
required for medical leaders to be most effective.
61. An alliance of medical colleges, other health professional colleges and
associations in partnership with the British Standards Institute are also working to
create standards for accreditation of clinical services by June 2016. The prime
purpose of these standards is to provide clinical services with a framework on which
to base quality improvement. The standard on leadership will apply to all clinical
leaders, not just doctors.
62. Good leadership by boards - setting and upholding values, holding the
organisation to account and knowing where and when to challenge, is an essential
prerequisite for quality and safety. The Professional Standards Authority updated
http://www.gmc-uk.org/guidance/ethical_guidance/management_for_doctors.asp;
http://www.nmc.org.uk/news/news-and-updates/new-code-comes-into-force-for-every-nurse-and­
midwife/
15 https://www.fmlm.ac.uk/professional-development/accreditation-and-standards/the-leadership-and­
management-standards-fo
16 https://www.fmlm.ac.uk/professional-development/accreditation-and-standards/the-leadership-and­
management-standards-fo
their standards for members of NHS Boards and Clinical Commissioning Group
Governing bodies in England in November 201317 .
63. The NHS Leadership Academy’s Healthcare Leadership Model, which is based
on comprehensive research about what behaviours lead to effective healthcare, is
also focused on improving the quality of leadership to ensure a culture based on
openness and transparency.
64. In addition, the Secretary of State asked Professor Sir Bruce Keogh to review
the Professional Codes for doctors and nurses. As part of this, Sir Bruce will work
with regulators to develop a strengthened professionalism that always favours
openness ahead of defensiveness.
65. As well as the work to improve and raise awareness of clinical and managerial
staff’s awareness of their responsibilities and behaviours in relation to clinical quality
as part of the Care Quality Commission’s new inspection regime, they ask five key
questions of all health and care services: is the service safe, effective, caring,
responsive and well-led.
66. Inspection teams use key lines of enquiry to organise evidence and inform
judgements about these five questions.
These key lines of inquiry include a focus
on staff having the right skills and training to perform their role effectively. The
approach means that the inspection team can assess how effectively an organisation
monitors, investigates and addresses patient safety concerns and how it ensures
staff, including key clinicians and managers, are able to perform their role effectively.
Approach to investigations: 30 + 44