• Government accepts only two of seven recommendations from Tom Kark QC
  • Review warns fit and proper person test is not working
  • Matt Hancock says he can see “attraction” of striking off failed managers

The government has delayed making a decision on whether to introduce a regulator for NHS managers, after a review recommended those guilty of misconduct should be barred from sitting on NHS boards.

Health secretary Matt Hancock announced this morning the government would accept only two of seven recommendations made by Tom Kark QC following his review of the fit and proper person test.

The two accepted recommendations include the development of new core competencies for NHS directors and the establishment of a central database of information about directors’ experience and previous employment, including disciplinary and grievance issues.

The Kark review, published this morning, also recommended creating a new body, the Health Directors’ Standards Council, with the power to investigate complaints of misconduct by senior directors and bar them from sitting on NHS boards.

This was the original intention of the fit and proper person test, which was brought in following the Mid Staffordshire care scandal. However, the review said the test was not working.

In his report, Mr Kark said there were “few fans” of the test, adding: “Essentially it does not ensure directors are fit and proper for the post they hold, and it does not stop the unfit or misbehaved from moving around the system.”

He warned failed managers were being recycled, saying: “Sometimes they are quietly moved on, sometimes to another well-paid post within their own trust or through the ‘revolving door’, into another section of the NHS or another trust.

“Sometimes a settlement agreement and a pay-out are involved together with a bland agreed reference and the wrongdoing is hushed up by a confidentiality clause. The can is thus kicked down the road to become a problem for the next trust along.”

The government’s proposals did not include the ability to strike off failing managers. However, in response to a question from HSJ about whether he supported striking off such managers, Mr Hancock said: “I can see the attraction and the opportunities we will get from being able to ensure we have a system in place where if somebody has demonstrated behaviour that is unacceptable that action such as striking off their ability to be a director can be taken.

“We have to get it right because at the same time we also need to be able to encourage more people and people of great calibre into positions of leadership within the NHS. So getting the balance right so that this strengthens the system and encourages people in is what I would be looking for.”

NHS Improvement chair Baroness Harding has been asked to consider the other recommendations as part of her workforce plan.

The Kark review also highlighted the current lack of centralised information about NHS board members and their experiences or qualifications.

It said: “A system has to be devised to ensure that those who take on the role of senior management at board level in the NHS are equipped with the skills necessary to undertake that important function; that they can be critically assessed to ensure they have those skills; that such assessment is continuous throughout their career; that they can be supported where appropriate to improve their skills; that they are supported and receive further training if things go wrong or if they are found not to have all the skills necessary.

“By requiring directors to have the necessary skills and competencies, and by providing them with training where they lack those skills, we hope that the job of director would be made more attractive and better shielded from the slings and arrows of political interference.”

Some of the core competencies the Kark review recommended for board members include: knowledge of clinical and financial governance, patient safety and medical management, the importance of clinical outcomes, responding to serious incidents, whistleblowing, and complying with the duty of candour.

Key recommendations from the Kark review

  • Core competencies should be established for all directors to be assessed against. The assessment would be carried out by trusts and examined by the Care Quality Commission. Directors could not be appointed without meeting these competencies.
  • A central database of NHS directors’ qualifications and history should be established. It will also hold information about any upheld grievance or disciplinary matters.
  • A mandatory reference form should be used when a director moves from one trust to another and will require full, open and honest information about the director concerned, which could not lawfully be curtailed by the terms of a settlement or compromise agreement.
  • The fit and proper person test should be extended to commissioners and NHS national bodies.
  • The creation of a new body, the Health Directors’ Standards Council, which would have the power to bar directors where serious misconduct is proven.
  • Work to define what is meant by serious misconduct with a focus on deliberate or reckless but not inadvertent behaviour. Examples suggested by Kark include bullying, suppression of whistleblowers or discouraging staff to follow the duty of candour, and reckless mismanagement which endangers patients.