BRIS-49

Implement transparent, ability-based selection criteria for trust executive directors

Bristol Heart Inquiry · Bristol Heart Inquiry — Final Report · Issued 18 July 2001

Government responseNot tracked (historical inquiry)

DeliveryDHSC and NHS England say in progress (Feb 2026)

Recommendation, verbatim from the inquiry

●Inquiry recommendation

The criteria and process for selection of the executive directors of a trust board must be open and transparent. Appointments should be made on the basis of ability and not on the basis of seniority.

Bristol Heart Inquiry, Bristol Heart Inquiry — Final Report · 18 Jul 2001 Source PDF →

Government response

●No formal government response recorded

The Index has not yet recorded a verbatim government response to this recommendation.

Delivery

●DHSC and NHS England say in progress · 27 Feb 2026

NHS England publish guidance on Executive appointments.This guidance, originally produced by the Trust Development Authority on senior appointments in NHS trusts, has been updated. It provides advice to NHS trusts making permanent or temporary appointments to chief executive and director posts.

Since November 2014, providers of health and social care registered with Care Quality Commission, including Trusts have been required to comply with the requirements in Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (known as the Fit and Proper Person Regulation). These set fundamental standards and require that trusts do not appoint or have in place a person as an executive director (which included associate director roles) or a non-executive director unless the individual could satisfy certain criteria, including not having been responsible for, or privy to, any serious misconduct or mismanagement. Monitoring compliance is the responsibility of the Care Quality Commission.

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.

The Leadership Competency Framework is to be applied as part of recruitment and assessment for board roles, and annually as part of every board member’s appraisal and development. NHS England additionally published a Board member reference (BMR) template in October 2023, for use in all board appointments. An independent evaluation is planned for 2025.

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 “Implemented – Ongoing”. Table row: section 6.2 No. 49, PDF page 94-95.

What other bodies have found

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

●Thirlwall Inquiry legal team · 15 May 2024

The Government agreed with this recommendation.

In its January 2002 response, the Department of Health said that appointment procedures were rigorous, referring to guidance issued in December 1997.

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 6.2 No. 49, PDF page 89.

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.