Create a new regulatory body to hold NHS managers accountable

We would like NHS managers to be required to be registered and held to a set of professional standards, which are regulated by a governing body, similar to doctors and nurses.

This should include non-clinical directors, chief executives and other managers, so they are held accountable for decisions that affect patient care.

We believe this would help improve standards and safety for patients.

It is essential that managers within the NHS are held accountable. We are considering whether further measures are needed to improve the accountability of senior NHS managers, who have a significant level of responsibility for the quality and safety of NHS treatment and care.

All NHS organisations already have an obligation to ensure that only individuals who satisfy Fit and Proper Person (FPP) requirements are appointed at a director level, this includes all executive and non-executive, permanent, interim and associate positions. NHS organisations must not appoint individuals at a director level if they have been responsible for, been privy to, contributed to, or facilitated any serious misconduct or mismanagement (whether lawful or not).

The terms ‘fit’ and ‘proper’ are set out in Regulation 5 (Fit and Proper persons) of the Health and Social Care Act 2008. All providers that carry out a regulated activity listed in the Health and Social Care Act 2008 (Regulated Activities Regulations) Regulations 2010 must register with the Care Quality Commission (CQC). At the point of registration, and throughout the time a provider is registered with the CQC, providers must meet the FPP requirements and take proper steps to ensure that their directors, or equivalent, are ‘fit and proper’ for their role.

The responsibility for making the assessment sits with the provider. CQC do not undertake the FPP tests of directors or equivalent. Instead, the role of CQC is to scrutinise the administration of the FPP test by the provider and to assess whether they are properly discharging their duties under Regulation 5. CQC will not register a provider that does not meet these requirements.

CQC can also take regulatory action against any provider that fails to meet FPP requirements. For example, they could instruct the provider to improve their recruitment processes and associated checks.

In July 2018, the Government commissioned Tom Kark KC to review the FPP test as it applied under Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Kark review of the fit and proper persons test (https://www.gov.uk/government/publications/kark-review-of-the-fit-and-proper-persons-test) was published in February 2019 and made seven recommendations for the Government, CQC, NHS England and other relevant organisations on how to improve the operation and effectiveness of Regulation 5.

In response, in August 2023, NHS England published the FPP Framework. This introduces a standardised reference system and a means of retaining information regarding background checks for individual directors. This also applies to board members taking on a non-board role.

The new Framework is effective from 30 September 2023 and all boards are expected to begin implementing the new Framework from this date. By 31 March 2024, organisations will need to have fully implemented the Framework, incorporating a Leadership Competence Framework and updating the Electronic Staff Record database.

The FPP Framework assessment will be refreshed annually and, for the first time, recorded on the Electronic Staff Record system so that it is transferable to other NHS organisations.

Beyond the steps already taken by NHS England above, the Government is currently exploring whether further mechanisms are needed to hold NHS managers accountable, including the possibility of a disbarring system. This will be considered alongside the actions recommended by General Sir Gordon Messenger’s review of leadership published in June 2022 (https://www.gov.uk/government/publications/health-and-social-care-review-leadership-for-a-collaborative-and-inclusive-future). The Government has accepted all seven recommendations from this report.

The Government is committed to ensuring that the right standards, support and training are in place for the public to have confidence that NHS managers have the skills and experience needed to provide safe, quality care.

Department of Health and Social Care