- Sir Robert Francis QC accepts fit and proper person test has not worked
- Mid Staffs inquiry chairman says it is now time for a professional regulator
- He says any changes must be extended to CCGs and those in national bodies
The Mid Staffordshire Public Inquiry chair has said he believes it is time for a professional regulator to oversee senior NHS managers after admitting his fit and proper person test was “not fit for purpose”.
Sir Robert Francis QC said the fit and proper person regulations, brought in following his recommendations after the Mid Staffs care scandal, had failed, adding: “The system devised following my inquiry has not delivered the desired level of accountability or been effective in protecting the public from the very limited number of directors who should be considered to lack fitness to hold such a post.”
In written evidence to MPs on the Commons health select committee, Sir Robert admitted: “This way of ensuring that only fit and proper persons are appointed and retained as directors is not working and has regrettably been found to be not fit for purpose.”
His evidence to the committee forms part of its inquiry into Tom Kark QC’s recent review of the test. Off the back of his findings, Mr Kark has called for a new regulator with the ability to bar senior managers from sitting on boards of NHS organisations.
Sir Robert, who was interviewed by Mr Kark as part of his review of the fit and proper person test, said: “I have now come to the conclusion, based on the experience of the current regulatory framework, that such a body is required. This would in effect be the implementation of what I envisaged in [my recommendations].
“It is the best way of correcting the deficiencies in the present system I have summarised. It would provide a body which would have the power to obtain the necessary evidence to support or refute an allegation; would be able to provide a fair and objective judgment of the issues; would offer due process which would protect the public interest and the legitimate rights of the individual.”
In his evidence Sir Robert, who chaired two inquiries into the Mid Staffs disaster and recommending regulation of managers in his first report, revealed his reasoning behind suggesting the fit and proper person test was “informed by a perception that there was likely to be a governmental reluctance to the creation of an additional [arm’s-length body] to regulate directors, let alone managers as a class”.
He added: “The most appropriate alternative seemed to be to build on the then current “fit and proper person” test applied by Monitor in its licensing requirements.”
Sir Robert said he was concerned about the lack of accountability for serious mismanagement, as was the case at Mid Staffs. He repeated his observation that the former chief executive of Bristol Royal Infirmary at the time of the children’s heart surgery scandal, John Roylance, was struck off by the GMC. Sir Ian Kennedy, who led a review into the issues at Bristol Royal Infirmary, recommended a single professional regulator to oversee healthcare professionals whether clinical or managerial.
Sir Robert told MPs: “I considered then, as I do now, that it is important for there to be a level playing field between all members of a health service board. All should be held to account for compliance with the same set of standards when performing this important role.”
He backed the other recommendations from the Kark review, including mandatory references and a database of past employment history, codes of conduct and more support and training for managers.
Many of these formed part of his own recommendations following the Mid Staffs inquiry, but he said: “It is open to question whether the developments in training, standards and regulation have matched this aspiration in the intervening years.”
Sir Robert also backed extending regulation to those working in clinical commissioning groups and national bodies, calling it an “essential step”.
He added: “It would be quite wrong if people disqualified from being directors of NHS trusts to be able in theory to escape to other organisations closely associated with the health service.”
He told the MPs: “My observation is that we do not lack for authoritative advice on what action is needed to fix the problem, but actual effective action to take that action.”
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- Care Quality Commission (CQC)
- Department of Health and Social Care (DHSC)
- Francis report - recommendations
- General Medical Council (GMC)
- Government/DH policy
- Mid Staffs Inquiry
- NHS Improvement
- Patient safety
- Policy and regulation
- Regulation of managers
- Robert Francis QC