Recommendation BRIS-93: Require managerial competence for clinicians appointed to managerial roles with training
From Bristol Heart Inquiry — Final Report, published 18 July 2001.
Recommendation
Any clinician, before appointment to a managerial role, must demonstrate the managerial competence to undertake what is required in that role: training and support should be made available by trusts and primary care trusts.
Government response
No government response to this recommendation is on the record yet.
Delivery
DHSC and NHS England say in progress (27 February 2026)
Please also see our response to Recommendation 91 (Leadership competency framework).
The new government manifesto includes a commitment to introduce professional standards for NHS managers.
Since November 2014, providers of health and social care registered with Care Quality Commission, including Trusts — have been required to comply with the requirements in Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (known as the Fit and Proper Person Regulation)
In August 2023, NHS England published a strengthened Fit and Proper Person Test Framework in response to the 2019 Kark Review to introduce: • a means of retaining information relating to testing the requirements of the FPPT for individual directors,
• a set of standard competencies for all board directors,
• a new way of completing references with additional content whenever a director leaves an NHS board and
• an extension of the applicability to some other organisations, including NHS England and the CQC.
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 – Ongoing”. Table row: section 6.2 No. 93, PDF page 112-113.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
The Government agreed with this recommendation.
In its January 2002 response, the Department of Health said that clinical director and medical director development programmes would be rolled out from January 2002.
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 6.2 No. 93, PDF page 102.
Themes and tags
Who has spoken
- DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding