i. DHSC and NHS England must develop and put in place a barring system for all managers
(clinical and non-clinical) by September 2027. It should be reviewed in 2030 with a view
to moving to a full statutory regulation system by September 2032.
ii. NHS England must require any Trust seeking approval for the movement of a senior
manager to another Trust to demonstrate that:
a. The move is not proposed because of the manager’s lack of capability or misconduct.
b. The manager meets the fit and proper person test.
NHS England must not grant approval, and Trusts must not seek approval, unless they
are able to demonstrate the matters at a. and b. above.
iii. In addition to the statutory duty for organisations, all managers must be subject to an
individual duty of candour to all patients and colleagues. This should be included in the
code of conduct and in the contract of employment for all managers.
iv. The NHS Leadership and Management Framework Code, a code of conduct for
NHS managers published in July 2026, must be amended urgently to set out, at the
beginning, the uncontroversial duty of every manager to put patients first. I suggest
the following wording, with thanks to Mr Jarrold: ‘I will make the care and safety
of patients my first concern and act to protect them from risk.’ What matters is that
patients come first.
v. In the Leadership and Management Framework Standards, the competency ‘delivering
across healthcare’ should be first (it is currently third). The first and fundamental
competency under this heading is, rightly: “I put patients first and report safety
concerns and incidents.”