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.
- The NHS Leadership Competency Framework for Board members was updated in February 2024, providing six competency domains for director development (Board Leadership Competency Framework, NHS England, February 2024).
- NHS England developed a directory of support offers for executive and non-executive board members in August 2023 (DHSC/NHS England implementation update to the Thirlwall Inquiry, April 2025).
- The government reported in 2015 that 129 board-level changes had been made in trusts placed in special measures to improve leadership (Culture Change in the NHS, Cm 9009, February 2015).
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
Progress Timeline
DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Implemented – Ongoing. NHS England published an updated Code of governance for NHS provider trusts in April 2023. This sets out that all directors and governors should receive appropriate induction and regularly update and refresh their skills and knowledge. Directors should also have access at the trust’s expense to training courses and/or materials that are consistent with their individual and collective development programme. 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. An independent evaluation is planned for 2025. A directory of support offers for executive and non-executive Board members was developed in August 2023 and has been refreshed and updated recently.
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.