The must-read stories and debate in health policy and leadership

Is fit and proper fit and proper?

Ever since they were introduced in November 2014, the fit and proper person regulations have been controversial. They have upset many managers who feel under attack for decisions and practices that are forced on them by the system they work in, while whistleblowers and harmed patients have complained the regulations have proven useless with not a single board level director being declared unfit and prevented from working.

The regulation had its genesis in the Mid Staffordshire Public Inquiry but after Dr Bill Kirkup’s review of board level failings at Liverpool Community Hospitals Trust and the ease with which its directors were moved on to other jobs a new government review was ordered.

Tom Kark QC was hired to look at the regulations. As lead counsel to the Mid Staffs Inquiry, he knows the issues well.

His review’s final terms of reference have been published and make clear Mr Kark will consider how effective the current rules have been (spoiler: they have been next to useless) and whether changes to legislation will be required that would see specific behaviours prescribed in the regulations. This includes bullying and harassment, inhibiting whistleblowers, falsifying records and failing to comply with reviews and investigations.

Given these are all either illegal or grounds for gross misconduct already, there really is a question about whether the fit and proper person test is needed.

Mr Kark may decide to sweep it away and replace it with a proper system of regulation for NHS managers – as Sir Robert Francis QC recommended in his very first inquiry into Mid Staffs.

The final report is due in the autumn.

Long distance pathology

Ten months on from NHS Improvement’s statement of intent to establish 29 pathology networks across England, the programme is gathering pace.

The majority of trusts have agreed to be part of a network, some begrudgingly so, and the regulator has expanded the scheme to include specialist trusts.

But two acute trusts have been put on the naughty step over their refusal to sign up to NHSI’s plans.

East Sussex Healthcare Trust is determined to look north rather than its neighbours, and wants to form a network with three London trusts – the nearest of which is Lewisham and Greenwich Trust (55 miles away).

Its plan was described as “ambitious” by NHSI, but failing to deliver the required level of efficiencies.

The other trust which is “in discussion” with the regulator is Epsom and St Helier University Hospitals Foundation Trust.

The trust, whose NHSI proposed network comprises Croydon, Kingston, and St George’s trusts, did not say what its own preference was.

Alongside the networking agenda, NHSI is also drawing up a list of pathology tests, which could lead to the development of a tariff price for pathology in the long term.