Accountability of providers' directors
A finding that a person is not a fit and proper person on the grounds of serious misconduct or incompetence should be a circumstance added to the list of disqualifications in the standard terms of a foundation trust's constitution.
- The Kark review (February 2019) recommended a power to disbar individuals from board positions for serious misconduct (Recommendation 5). The Secretary of State did not accept this recommendation at the time (Kark review, DHSC, February 2019).
- The government subsequently reversed its position. A consultation on regulating NHS managers ran from 26 November 2024 to 18 February 2025. The consultation response, published 21 July 2025, confirmed that the government will bring forward secondary legislation to implement a statutory barring system for senior NHS leaders, to be operated by the Health and Care Professions Council. Those found to have committed serious misconduct will be added to a barred list preventing them from holding senior NHS management roles. Draft legislation is to be subject to further public consultation, with parliamentary debate anticipated in the second half of 2026 (Leading the NHS: proposals to regulate NHS managers, DHSC, consultation response, July 2025).
- The NHS England FPPT Framework (effective September 2023) introduced mandatory Board Member References when directors leave, which must include information about investigations relevant to serious misconduct within six years preceding departure. This aims to prevent unfit directors moving between organisations, though it operates through a reference system rather than a formal disqualification register (FPPT Framework, NHS England, August 2023).
How was this evidence gathered?
Response
Accepted in Part
Response
Accepted in PartThe 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
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
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.
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.
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.
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.
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.