Accountability of providers' directors

Accepted.
We agree that people in leading positions in NHS organisations should have the appropriate experience and training to take up those positions and that this should be one of the criteria for any assessment of whether someone is a fit and proper person. It is vital that they are assessed as a key element of the recruitment process and of ongoing appraisal. As set out in The Healthy NHS Board 2013, as well as experience and technical skill, values and behaviour are also critical to getting the right leaders in place. We also endorse the document’s advice that regular skills audits of current board members should be carried out.
Monitor’s Risk Assessment Framework sets out how it oversees NHS Foundation Trusts compliance with the provider licence. Where a breach has occurred in respect of governance, one of the areas Monitor may investigate is the Foundation Trust’s management and organisational capability in making an assessment about return to compliance. Monitor’s Code of Governance for Foundation Trusts sets a clear expectation that there should be a formal, rigorous and transparent procedure for the appointment of directors and that care should be taken to ensure that new appointees have relevant skills and experience.
Monitor is working with the Foundation Trust Network to offer a 2-day induction programme for new non-executive directors of NHS Foundation Trusts. The first of these programmes was run in September 2013. Monitor will be working together with the NHS Leadership Academy, NHS Trust Development Authority and Foundation Trust Network to increase external support for chief executives of NHS Trusts and Foundation Trusts. Monitor will also consider how best to support medical directors in the coming year.

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.

Monitor has run a series of events with Chief Executive Officers to help identify their support needs and the follow-on action is now under consideration. The development of an induction event for Executive Directors including Medical and Nursing Directors is in hand. The need for further support will be reviewed in light of this work.

This recommendation was accepted by the Government.

In the January 2014 Hard Truths report, the Government said that experience and training should be one of the criteria for any assessment of whether someone is a fit and proper person, and it was vital that these were assessed at the recruitment stage and during ongoing appraisal.

The Government also referred to Monitor’s Code of Governance as setting an expectation that care should be taken to ensure that new appointees have relevant skills and experience.