Recommendation F85: Accountability of providers' directors
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Monitor and the Care Quality Commission should produce guidance to NHS and foundation trusts on procedures to be followed in the event of an executive or non-executive director being found to have been guilty of serious failure in the performance of his or her office, and in particular with regard to the need to have regard to the public interest in protection of patients and maintenance of confidence in the NHS and the healthcare system.
In brief (written by this site)
In February 2026, the Department of Health and Social Care and NHS England stated that implementation was complete, referring to the Fit and Proper Performance Test Framework and Board Leadership Competency Framework (DHSC and NHS England, Feb 2026). Previously, in May 2024, the Thirlwall Inquiry legal team noted that the Care Quality Commission had published guidance on the application of the fit and proper persons test, with service misconduct included as a ground of unfitness (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. The record below is the sources' own words.
Government response
Accepted.
In cases where a Director was deemed by the Care Quality Commission to be unfit, the Care Quality Commission would be able to insist on their removal by placing a condition on the provider’s registration. If the provider then failed to remove the director that breach of the registration condition would be an offence for which the provider would be liable to prosecution.
The Care Quality Commission will publish guidance setting out how the process will work, and how it will co-operate with Monitor and the NHS Trust Development Authority.
Under the single failure regime, Monitor and the NHS Trust Development Authority would be able to use their existing powers to enforce fit and proper persons requirements (such as the removal of directors) on licence holders and NHS Trusts.
How this response relates to the recommendation
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.
Blanket government agreement does not establish acceptance or delivery by each addressee. Some response passages cover groups of recommendations.
Scope of the government response
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.
Delivery
DHSC and NHS England say completed (27 February 2026)
Please see response to recommendation 81 for detail on NHS England’s Fit and Proper Performance Test Framework and Board Leadership Competency Framework.
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 - Closed”. Table row: section 18.2 No. 85, PDF page 466-467.
Department of Health and Social Care says in progress (11 February 2015)
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. The fit and proper person test includes ‘service misconduct’ as a ground of unfitness.
In cases where a Director was deemed by the Care Quality Commission to be unfit, the Care Quality Commission would be able to place a condition on the provider’s registration. If the provider failed to demonstrate the director’s fitness, the resultant breach of the registration condition would create an offence for which the provider would be liable to prosecution. The Care Quality Commission published guidance on the duty of candour and fit and proper person requirement for NHS bodies in November 2014.
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 the Care Quality Commission, 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 published guidance on the application of the ‘fit and proper persons’ test, that test including ‘service misconduct’ as a ground of unfitness.
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. 85, PDF page 431.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding