Requirement of training of directors
A requirement should be imposed on foundation trusts to have in place an adequate programme for the training and continued development of directors.
- NHS England published a directory of board-level learning and development opportunities listing 58 programmes across multiple providers including the NHS Leadership Academy, NHS Providers, The King's Fund, and NHS Confederation (Directory of board level learning and development opportunities, NHS England).
- The NHS England Leadership Competency Framework (February 2024) sets expectations about competencies required for board-level roles across six domains. Organisations must incorporate these into role descriptions and recruitment from 1 April 2024. The FPPT Framework requires annual assessment of directors' competence, which implicitly creates an expectation of ongoing development to maintain fitness (Leadership Competency Framework, NHS England, February 2024; FPPT Framework, NHS England, August 2023).
- No published evidence has been identified of a specific regulatory requirement that all foundation trusts must have in place a formal programme for the training and continued development of directors, as distinct from the extensive voluntary programmes available and the implicit expectation created by annual FPPT assessment. Director development remains a matter of individual trust governance rather than a mandated regulatory requirement.
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe 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.