Senior NHS Managers to Face Competency Standards

Peter Russell

February 06, 2019

The Department of Health and Social Care (DHSC) said it had accepted in principle two of the recommendations in a review of the 'fit and proper person test' for NHS board managers in England.

The review, led by Tom Kark QC, made seven recommendations for how the Government could help ensure health service leaders were capable of delivering high quality and safe care.

In its response, the DHSC said it was prepared to:

  • Set up a central database of information about the qualifications, previous employment, and performance of directors

  • Create new competency standards to help people know what to expect of senior managers

The other recommendations would be considered later this year, it said.

The fit and proper person test (FPPT) came into force for all NHS trusts and foundation trusts in November 2014. The regulation requires NHS trusts to seek the necessary assurance that all executive and non-executive directors are suitable and fit to undertake their job responsibilities.

The test is overseen by the Care Quality Commission as part of its regular inspections of NHS trusts. It applies to directors in the NHS, the independent healthcare sector, and the adult social care sector.

Health Leadership Failings

The test came under scrutiny following a report into widespread failings at Liverpool Community Health NHS Trust between November 2010 and December 2014.

That report by Dr Bill Kirkup, published in January 2018, found the trust was "dysfunctional" and lacked competent leadership.

Following the report's publication, Mr Kark, previously counsel to the Mid Staffordshire public inquiry, was commissioned to conduct a review into the effectiveness of the FPPT.

Among the review's recommendations were that:

  • All directors – executive, non-executive, and interim – should meet specified standards of competence to sit on the board of any health providing organisation, with training given when necessary

  • A central database of directors should be created holding relevant information about qualifications and history

  • Appointees must be able to provide references

  • An organisation with powers to suspend and disbar directors for serious misconduct should be created

'Good Hospitals Need Good Leaders'

The report said: "No hospital can run well with poorly led medical staff who do not or cannot focus on the care of the patients as being their first concern.

"Good hospitals run well because they have good, focussed leadership and well-trained and enthused staff who are enabled to focus on providing good, safe and compassionate care for their patients."

The DHSC said that the remaining recommendations would be considered as part of the workforce implementation plan later this year, which will be led by Baroness Dido Harding, chair of NHS Improvement.

John Kell, head of policy at the Patients Association, commented: "We told the Kark Review that we had not noticed any particular change since the NHS had introduced the Fit and Proper Person Requirement (FPPR). We also identified that there is a clear, if complex, through-line from poor leadership to inadequate patient safety and poor patient experiences.

"We are pleased to see that the review has recognised that the NHS's use of its FPPR has serious deficiencies, and we hope the Government's tentative response so far, only accepting two of the seven recommendations, does not indicate that these problems will not be fully addressed. 

"We understand that Baroness Harding's workforce review will consider the other recommendations, and await her findings with interest."

In a speech on Wednesday at the Improving Patient Safety and Care Conference in London, Matt Hancock, secretary of state for health and social care, said: "Getting the right leadership is vital. We need more people with clinical backgrounds and more people from outside the NHS.

"All directors must meet minimum competency standards to sit on the board of any health organisation. And where training is needed to meet those new standards, then it should be made available.

"We should also have a central directors’ database where information about qualifications and employment history can be easily accessed.

"I know that NHS leaders have some of the toughest jobs in the country. We need to support them with the skills and training they need so they can lead their organisations effectively and create the right culture for staff and patients."

Support for Whistleblowers

Mr Hancock also spoke in support of whistleblowers who were brave enough to speak up on concerns about patient safety. He said: "Mistakes should be seen as an opportunity to learn and improve, not a need for cover-up and denial.

"So whistleblowers are doing the NHS a great service. Someone, who has the courage to speak up and put their head above the parapet, should be encouraged and embraced.

"Yet, sadly, all too often, they’re ignored, bullied and worse – forced out.

"Making someone choose between the job they love, and speaking the truth to keep patients safe, is morally abhorrent and operationally foolish. 

"It’s an injustice I am determined to end."

On Twitter, Baroness Harding said she shared Mr Hancock's "commitment to an open and honest culture within the NHS, which is key to enabling staff to deliver the care patients deserve".

She said she also looked forward to working with the NHS Workforce Implementation Plan Team in taking forward Tom Kark QC's recommendations.

Editor's Note: This article was updated to include comment from the Patients Association.

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