NHS managers should be regulated in a similar way to doctors and nurses amid concerns about an accountability vacuum in the health service, the Senedd heard.

Mabon ap Gwynfor, Plaid Cymru’s shadow health minister, led a debate on establishing structured oversight of NHS managers.

He called for a professional regulatory body to be set up with powers to warn, sanction or strike off any manager from a register.

Mr Gwynfor said while clinicians are rightly held to the highest standards, the same cannot be said about managers who make decisions which can have a huge impact.

He told the chamber: “For decades, we have seen the commitment of professional healthcare workers – doctors, nurses, therapists and many other staff – who are fully committed to safeguarding public health. 

“However, their efforts are often hampered by a system that isn't accountable enough at a management level. It's about time that we secured the needed change.”

The Dwyfor Meirionnydd MS said a crucial link in the accountability chain is missing.

He raised special measures at Betsi Cadwaladr University Health Board and the Cwm Taf maternity scandal as examples of a lack of proper oversight.

Mr Gwynfor warned that this allows a culture of silence and impunity to fester, ultimately compromising the safety of patients.

He said: “Why should teachers, lawyers and doctors be held to rigorous ethical codes and disciplinary processes, while those entrusted with the helm of our healthcare system operate in a regulatory vacuum? 

“The answer is clear: it's simply unacceptable.”


James Evans, for the Conservatives, backed calls for greater accountability, saying it would be a transformative step towards rebuilding trust.

The Brecon and Radnorshire MS argued an independent body would give whistleblowers the confidence to come forward with their concerns.

He said: “For too long, whispers of concern have lingered around NHS management, decisions have been made behind closed doors, and frustrations met with silence.

“Questions about competence sometimes remain unanswered.

“This isn't a system that inspires confidence, nor does it empower those who have the most at stake: patients, staff and the communities they serve.”

Eluned Morgan raised the benefits of the current broadly UK-wide system, saying it ensures consistent standards and enables clinicians to work in different nations.

Arguing any new regulatory framework would be best taken forward on a four-country basis, she said powers over the regulation of health professionals are reserved to Westminster.


Wales’ health minister told the chamber: “The regulation of NHS managers is an issue that has been raised and considered very seriously by the Welsh Government previously.

“We found that there would be significant practical barriers to regulating NHS managers in Wales only, and establishing a system for Wales alone would require a substantial mechanism and the creation of a Welsh regulatory body at significant cost.”

Baroness Morgan recognised the governance and safety concerns brought to light by the case of Lucy Letby, a former neonatal nurse convicted of killing seven babies in Chester.

She said Welsh ministers will carefully consider the recommendations and findings of a public inquiry, led by Lady Justice Thirlwall, which will hold hearings in autumn 2024.

While the motion was agreed with 28 for and none against, 22 ministers and Labour MSs abstained in the vote on January 31 – meaning the proposal is unlikely to go any further.