Accountability of providers' directors

Source — verbatim from the inquiry

Published evidence summary

Response — verbatim from government

Evidence trail — what's actually happened since

• 1 Apr 2025 DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Implemented – Closed. Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 includes requirements for a fit and proper person. This includes having the qualifications, competence, skills, and experience necessary for the role. CQC guidance sets out that providers must have appropriate processes for assessing and checking that the candidate holds the required qualifications and has the competence, skills and experience required, (which may include appropriate communication and leadership skills and a caring and compassionate nature) to undertake the role. These must be followed in all cases and relevant records kept. The Fit and Proper Person Test 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. Furthermore, NHS England published the Board Leadership Competency Framework in February 2024. This has been designed around six competency domains to support the recently refreshed Fit and Proper Persons regime. NHS England’s Code of governance for NHS provider trusts, published in April 2023, sets out that directors and governors should meet the ‘fit and proper’ persons test. Since this recommendation, the Kark Review made further 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. Source →
• 6 Feb 2026 · CQC / Department of Health Francis recommended accountability mechanisms for providers' directors. The Fit and Proper Person Test (Regulation 5, in force November 2014) was introduced but the Kark Review (February 2019) found it 'not fit for purpose' -- no barring mechanism, no central database. The NHS England revised FPPT Framework (September 2023) improved reference systems but still created no statutory barring power. Following the Letby scandal and Thirlwall Inquiry (2024), the government announced on 21 July 2025 it would legislate to give the HCPC statutory barring powers for senior NHS directors. Draft legislation is being prepared but has not been enacted. View source → Insufficient Progress
• 30 Sep 2023 · UK Government - Kark Review of FPPT Tom Kark QC reviewed the Fit and Proper Person Test in 2019 and found it essentially "does not ensure directors are fit for the post they hold, and does not stop the unfit from moving around the system." NHS England published updated FPPT Framework effective 30 September 2023 requiring standardised board-level assessments. View source → Reasonable Progress
• 6 Feb 2023 · Academic Review - Ten Years After Francis Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS. View source → Reasonable Progress
• 11 Feb 2015 · UK Government - Culture Change in the NHS Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year. View source → Good Progress
• 27 Nov 2014 · Legislation - Fit and Proper Person Requirement Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 5: Fit and Proper Person Requirement came into force November 2014. Requires providers to ensure directors meet fitness requirements including good character, qualifications, competence. CQC can require removal of directors. View source → Confirmed Completed
• 19 Nov 2013 · UK Government - Hard Truths Vol 1 & 2 Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted. View source → Good Progress

Each entry above links to a primary source — gov.uk written statement, consultation response document, or inspection report. The Index does not characterise government intent; it tracks what has been published.