Accountability of providers' directors

Accepted in principle.
We agree that the public have the right to expect that people in leading positions in NHS organisations are fit and proper persons; and that where it is demonstrated that a person is not fit and proper, they should not be able to occupy such a position. Monitor’s licence conditions for providers of NHS services already prevents licensees from allowing unfit persons to become or continue as governors or directors (or those performing similar or equivalent functions. They are also required to ensure that their contracts of service with its Directors contain a provision permitting summary termination in the vent of a Director being or becoming an unfit person. The Licensee is also required to ensure that it enforces that provision promptly upon discovering any Director to be an unfit person.
The Government issued in July 2013 a consultation on Strengthening corporate accountability in health and social care. This proposes a new requirement that all Board Directors (or equivalents) of providers registered with the Care Quality Commission must meet a new fitness test. We are proposing that this test includes checks about whether the person is of good character including past employment history, if the individual has the qualifications, skills and experience necessary for the work or office, as well as the more traditional consideration of criminal and financial matters.
The Government proposes that the fit and proper persons test will now be used as a mechanism for introducing a scheme for barring Directors who are unfit from individual posts by Care Quality Commission at the point of registration. Where a Director is considered by Care Quality Commission to be unfit it could either refuse registration, in the case of a new provider, or require the removal of the Director on inspection, or following notification of a new appointment. Further details will be set out in the response to the consultation on corporate accountability which will be published shortly. We plan to publish the draft regulations for consultation at the same time.
The standards produced by the Professional Standards Authority (Standards for members of NHS boards and Clinical Commissioning Group governing bodies in England) provide the basis for assessing the fitness of senior board-level leaders and managers.

See response to recommendation 60. The relevant fitness requirement was enacted as regulation 5 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014.

The Fit and Proper Person (FPPT) Framework for board members sets out the FPPT core elements to be considered in evaluating whether a board member is fit and proper to perform a board role. This includes possessing the qualifications, competence, skills required and experience.

The NHS Leadership Competency Framework for Board members, was published in February 2024 and has been designed around six competency domains to support the recently refreshed Fit and Proper Persons regime. An independent evaluation is planned for 2025.

Framework for all managers in all the NHS

As set out in Recommendation 1, NHS England is leading work on the co-development of a management and leadership framework, which will include a Code of Practice for all leaders and managers, standards and competencies at all defined levels of manager and a core curriculum to ensure all leadership and management training contains the most impactful elements as defined in the standards.

This is being co-designed with key health and social care stakeholders, and engagement commenced over summer 2024, supported by a national steering group. Wider stakeholder engagement is planned over autumn/winter 2024/25.

The Kark Review has since made recommendations in relation to the Fit and Proper Persons test under Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as it applies to directors.

The Department of Health has consulted on a new registration requirement that all directors of providers registered with the Care Quality Commission must meet a fit and proper person test. The Care Quality Commission will be able to insist on the removal of directors that fail this test. The consultation included how the revised fit and proper person requirement will work, and questions about the impact of the new regulations. The consultation ran from 27 March to 25 April 2014. The Fit and Proper Persons Test Regulations have been passed by Parliament and are in place in November 2014 for NHS organisations and from April 2015 for other organisations.

This recommendation was accepted in principle by the Government.

The Government introduced a fit and proper persons test, requiring directors of providers registered with the Care Quality Commission to meet a fit and proper persons test.