Recommendation BRIS-94: Appoint clinicians to managerial roles based solely on demonstrated competence
From Bristol Heart Inquiry — Final Report, published 18 July 2001.
Recommendation
Clinicians should not be required or expected to hold managerial roles on bases other than competence for the job. For example, seniority or being next in turn are not appropriate criteria for the appointment of clinicians to managerial roles.
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) and 93 (Fit and Proper Person Test and supporting guidance).
The new government manifesto includes a commitment to introduce professional standards for NHS managers. The department is currently exploring options for taking this work forwards.
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. 94, PDF page 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 referred to the development of the NHS Leadership Qualities Framework, which was published by the NHS Leadership Centre later in 2002. The Department said this would be applied to clinicians moving into managerial roles.
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. 94, PDF page 102.
Themes and tags
Who has spoken
- DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding