NHSE’s leadership standards ‘wordy and woolly’

Tom Kark KC, who led an official review of the “fit and proper person test” and was previously involved in the Francis inquiry into the Mid Staffs care scandal, was giving evidence to a public inquiry into the events at The Countess of Chester Hospital Foundation Trust.

Neonatal nurse Lucy Letby was convicted in 2023 of murdering seven babies, and attempting to murder seven more while working at the hospital during 2015 and 2016 – something doctors say they raised the alarm over and were not taken seriously enough.

NHS England published a new leadership framework last February, in response to a string of recommendations for clearer national standards, including by Mr Kark in 2019, and a 2022 review by Sir Gordon Messenger.

The framework is intended to sit behind new training and development of leaders, and potentially formal professional standards and regulation, which are now being considered by the government.

But Mr Kark said on Friday he found it “very aspirational” and a “bit fuzzy”.

“I can understand these are high level or almost aspirational expectations, but I would hope… that there would be much more specific competencies required of particular areas of expertise on a trust board,” he said.

“This sort of language, ‘I contribute as a leader to… the develop of strategy’, ‘I assess and understand the importance…’. Well, that’s great, but what about: ‘I have got this qualification because…’, or ‘I have this experience, and I will set out…’

“Maybe that’s just because one looks at this as a lawyer and you are looking for something concrete. I find these quite high level and aspirational and I suppose I expect something more concrete, although I accept that may be much harder to formulate.”

He also told the inquiry he felt appointed trust executives “should also be expected to have some understanding, for instance, of clinical governance”.

Mr Kark added: “I think some of the great disasters that we had at Mid Staffs and Liverpool are subject to this, [where] the finances overtook patient care. You had these cost improvement plans that resulted in a huge degradation of the staff at the hospital.

“I just wonder if there was sufficient challenge, in fact, we know there wasn’t sufficient challenge on those boards from the non-exec directors, just by way of example.

“When I suggested [in my review] there should be specific competencies or qualifications, that’s what I thought we were going to see [in the framework].

“I think some of the language, as I have said, is either too wordy or quite woolly.”

‘A problem for the next trust’

The inquiry also on Friday heard about agreed wording in Tony Chambers’ settlement agreement, the CEO of CoCH at the time of the murders, when he departed in autumn 2018.

The announcement said Mr Chambers was stepping down due to “extraordinary circumstances” and his departure was “not a judgement on his ability as a CEO but more a reflection on his integrity as a leader”.

Inquiry counsel Rachel Langdale KC asked whether these types of developments led to Mr Kark’s previous recommendation that trusts be required to make full and honest references.

While he stressed he did not know Mr Chambers’ specific circumstances, Mr Kark said: “There has been, I think, a real problem, probably contributed to by us lawyers, who make part of a settlement agreement an agreed reference.

“I think that is very often something which goes contrary to the wider duty of candour.

“In particular, it’s been used as a method of avoiding a full disciplinary hearing. It’s much easier for a trust, and one can readily understand this, to come to a settlement agreement if they can pay the individual off and agree a reference and make the problem go away.

“That is often far cheaper for the trust to do but it has extremely unfortunate potential consequences because that then becomes a problem for the next trust.”

The inquiry has finished hearing evidence and will reconvene on 17 March for closing submissions. Its findings are expected to be published this autumn.