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F83

Accountability of providers' directors

Mid Staffs Inquiry · Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · Issued 6 February 2013 · Addressed to: Monitor

Government responseDepartment of Health and Social Care: Accepted (Nov 2013)

DeliveryDHSC and NHS England state no delivery position (Feb 2026)Department of Health and Social Care says in progress (Feb 2015)

Recommendation, verbatim from the inquiry

●Inquiry recommendation

If a "fit and proper person test" is introduced as recommended, Monitor should issue guidance on the principles on which it would exercise its power to require the removal or suspension or disqualification of directors who did not fulfil it, and the procedure it would follow to ensure due process.

Mid Staffs Inquiry, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · 6 Feb 2013 Source PDF →

Published evidence summary

AI-generated evidence summary

In commentary published in February 2026, the Department of Health and Social Care and NHS England reported that the recommendation was superseded, noting that Monitor had merged with the latter (DHSC and NHS England, Feb 2026). They stated that the fitness requirement had been enacted under 2014 regulations, the Care Quality Commission had issued guidance, and a framework had been published on applying the test for directors (DHSC and NHS England, Feb 2026). Earlier, the Thirlwall Inquiry legal team found in May 2024 that the government accepted the recommendation and that the commission had provided guidance on how it would apply the test (The Thirlwall Inquiry legal team, May 2024).

AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 2026.

Report-level response context

Government responded via "Hard Truths: The Journey to Putting Patients First" (2014), a single document covering all 290 recommendations with a blanket acceptance. Individual recommendation responses were not broken out.

Government response

●Department of Health and Social Care · Accepted · 19 Nov 2013

Speaker not recorded. Source: Department of Health, Hard Truths: the Journey to Putting Patients First, volume 2 (Cm 8777-II), November 2013

Accepted.
Monitor and the Care Quality Commission are committed to ensuring that, taken together, their processes for registration and licensing work effectively to ensure that people in leading positions are fit and proper persons. The Care Quality Commission will set out in guidance how it will apply the fit and proper persons test as part of its regulatory regime and will ensure that as far as possible its approach in relation to registration is aligned with Monitor’s assessment of fitness as part of its licensing process (which applies to a narrower range of organisations than registration). Monitor has also published guidance on how it will exercise its enforcement powers which are used where there is a breach of licence conditions. This includes procedures for imposing additional licence conditions on NHS Foundation Trusts and removing, suspending or disqualifying directors or governors of NHS Foundation Trusts.

Extract from: Hard Truths: The Journey to Putting Patients First. Volume Two of the Government Response to the Mid Staffordshire NHS Foundation Trust Public Inquiry: Response to the Inquiry's Recommendations

Site note: This is volume two of "Hard Truths: The Journey to Putting Patients First" (Cm 8777-II), the government's response to the Inquiry's 290 recommendations, published by the Department of Health on GOV.UK on 19 November 2013 and dated to that day here. The PDF the row links to is the accessible edition, whose title page reads "January 2014". The Department of Health has been the Department of Health and Social Care since January 2018. The volume says it includes accounts from each of the national organisations the recommendations name, but it does not mark which passage each organisation wrote, so every row is filed under the Department that published it.

Delivery

●DHSC and NHS England state no delivery position · 27 Feb 2026

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

The CQC provided guidance on how it would apply the FPPT. NHS England Published the FPPT framework providing guidance on application of the FPPT for directors.

Monitor has merged with NHS England. Please see our response to Recommendation 35 for information on changes to the Regulatory Landscape.

Please see response to recommendation 81 for detail on NHS England’s Fit and Proper Performance Test Framework.

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.

From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025)

Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Superseded”. Table row: section 18.2 No. 83, PDF page 465.

●Department of Health and Social Care says in progress · 11 Feb 2015

The fit and proper person requirement was put in place in November 2014 for directors of NHS Trusts, and in April 2015 for all providers of health and adult social care registered with the Care Quality Commission.

The fit and proper person requirement provides an important mechanism to hold to account individual Directors that have been responsible for the provision of unacceptable standards of care and will assess whether directors:
• are of good character.
• have the necessary qualifications, skills and experience.
• are able to perform the work that they are employed for.
• can supply information, such as certain checks and a full employment history.

From: Culture Change in the NHS supporting Annex (annex to Culture change in the NHS: applying the lessons of the Francis Inquiries)

Site note: This is the supporting annex published on 11 February 2015 with "Culture change in the NHS: applying the lessons of the Francis Inquiries" (Cm 9009), attached to the GOV.UK page as "Culture change in the NHS supporting annex". The annex has no title page; that title is GOV.UK's and the PDF's own. Its table has four columns (No., Recommendation, Hard Truths Government response, Progress update), and the row carries the Progress update cell. No column says which organisation wrote an update, so the row is filed under the Department of Health (now the Department of Health and Social Care), which published it.

Site note: The Inquiry addressed this recommendation to Monitor, not to the Department of Health. The annex gives this update in the Department's publication and does not say who wrote it, so the row is the Department's report of the progress made on it.

What other bodies have found

In their own words. These do not change the delivery statement above.

●Thirlwall Inquiry legal team · 15 May 2024

This recommendation was accepted by the Government. The Care Quality Commission provided guidance on how it would apply the fit and proper purpose test.

From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024)

Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 16.2 No. 83, PDF page 430-431.

How this page is built

The recommendation and the government responses are verbatim from primary documents. Delivery statements and other bodies' findings are shown in their own words, each with its source. The summary is written by this site and labelled as such. The Index does not paraphrase sources or characterise intent; it records what has been published.