Shared code of ethics

Accepted.
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 standards for senior board-level leaders and managers. The combination of behavioural standards along with technical competence and business processes sends an important signal about the need for leaders who have the right values and behaviour as well as the ability to get the business done. The standards will form part of a wider system of ensuring that senior people are fit and proper persons that will be developed in detail in the coming months. In addition to the responsibility of individual leaders for compliance with technical and behavioural standards, the corporate structures of NHS organisations also need to both reinforce these standards and provide effective oversight of individual and corporate performance to determine whether they are being met, and what needs to be done to improve performance. The NHS Leadership Academy has published The Healthy NHS Board 2013, which includes guidance on supporting board effectiveness and emphasises the importance of values and behaviours.
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 and the Care Quality Commission are committed to ensuring that, taken together, their processes for registration and licensing reflect these principles. The Care Quality Commission’s inspection regime will include a focus on whether or not an organisation is ‘well-led’.
In order to support this, 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, and 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 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. This aligns to the already-established NHS Values as set throughout in the NHS Constitution, as well as our NHS People Promise, Our Leadership way, and the Seven Principles of Public Life. Compliance with the NHS Constitution is mandated via the NHS Standard Contract.

An independent evaluation of the NHS Leadership Competency Framework is planned for 2025.

Framework for all managers in all the NHS

As set out in Recommendation 1, NHS England is also 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.

See also response to recommendation 79 and 81 on the FPPT.

The Care Quality Commission is taking forward the development of a ‘fit and proper persons’ test for board-level leaders in the organisations registered with it, whether in the public, private or voluntary sectors. 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 omission rather undermines the document’s credibility. I recommend an urgent review of the code so that this may be remedied.

This recommendation was accepted by the Government.

The Professional Standards Authority published ‘Standards for members of NHS boards and Clinical Commissioning Group governing bodies in England’ in May 2013.

The NHS Leadership Academy published ‘The Healthy NHS Board 2013’, which included guidance on supporting board effectiveness and the importance of values and behaviours.

It is unclear the extent of steps taken to oblige staff to comply with the above guidance and standards and the steps by employers to enforce it.

In the February 2015 Culture Change report, the Government referred to the introduction of the fit and proper persons test.

We conclude that there are some specific issues in terms of enforcement and lack of investment in training. We therefore conclude that progress towards meeting this recommendation requires improvement.