Accountability of providers' directors
Mid Staffs Inquiry · Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · Issued 6 February 2013 · Addressed to: CQC
Source — verbatim from the inquiry
●Inquiry recommendation
Consideration should be given to including in the criteria for fitness a minimum level of experience and/or training, while giving appropriate latitude for recognition of equivalence.
Mid Staffs Inquiry, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · 6 Feb 2013 Source PDF →
Published evidence summary
Publicly available evidence relating to this recommendation:
- The Kark review (February 2019) recommended (Recommendation 1) that all directors should meet specified standards of competence to sit on an NHS board. The Secretary of State accepted this recommendation (Kark review, DHSC, February 2019).
- NHS England published a Leadership Competency Framework for board members on 28 February 2024, with six domains of competency. Organisations must incorporate the competencies into board member role descriptions and recruitment from 1 April 2024. The framework sets expectations about the competencies required for board-level roles, while "giving appropriate latitude for recognition of equivalence" as Francis recommended, by not mandating specific qualifications or years of experience (Leadership Competency Framework for board members, NHS England, February 2024).
- The Kark review found that the existing FPPT was "essentially a self-certification exercise" and that "poor managers were moving around the system from high-profile job to high-profile job." The updated FPPT Framework (September 2023) requires documented assessments of competence at appointment and annually thereafter, strengthening the assessment process beyond self-certification (FPPT Framework, NHS England, August 2023; Kark review, DHSC, February 2019).
Response — verbatim from government
●Department of Health and Social Care
The government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Department of Health and Social Care · 19 Nov 2013 Written response →
Evidence trail — what's actually happened since
- 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.
How this page is built
Source and Response are verbatim from primary documents. The Evidence trail records published activity since — written statements, consultation outcomes, inspection findings, parliamentary references. The Index does not paraphrase or characterise intent; it tracks what has been published. Where the evidence is the absence of action (a missed deadline, a slipped timetable), that absence is documented from primary sources rather than inferred.
This recommendation's data is verified periodically against primary sources. The Index is monitored for staleness weekly.