Recommendation 217

Competencies for leaders

Accepted in part
A list should be drawn up of all the qualities generally considered necessary for a good and effective leader. This in turn could inform a list of competences a leader would be expected to have.

The NHS Leadership Academy has developed, with extensive stakeholder involvement, a new healthcare leadership model for the NHS.  In addition to technical competence, board-level leaders must also be ‘fit and proper persons’ in line with the registration requirements of the Care Quality Commission and Monitor.

The standards produced by the Professional Standards Authority, Standards for members of NHS boards and Clinical Commissioning Group governing bodies in England, provide the basis for standards for senior board-level leaders and managers. The combination of behavioural standards along with technical competence and business processes sends an important signal about the need for leaders who have the right values and behaviour as well as the ability to get the business done.

The public have the right to expect that people in leading positions in NHS organisations are fit and proper persons; and that where it is demonstrated that a person is not fit and proper, they should not be able to occupy such a position.  Monitor and the Care Quality Commission are committed to ensuring that, taken together, their processes for registration and licensing reflect these principles.  The Care Quality Commission’s inspection regime will include a focus on whether or not an organisation is ‘well-led’.

Monitor’s licence conditions already require providers to ensure that no person who is an unfit person may become or continue as a Director and that they ensure that its contracts of service with its Directors contain a provision permitting summary termination in the event of a Director being or becoming an unfit person.

In order to strengthen this, the government issued in July 2013 a consultation on Strengthening corporate accountability in health and social careThis proposes a new requirement that all board directors (or equivalents) of providers registered with the Care Quality Commission must meet a new fitness test. We are proposing that this test includeschecks about whether the person is of good character including past employment history, and if the individual has the qualifications, skills and experience necessary for the work or office as well as the more traditional consideration of criminal and financial matters.


The NHS Leadership Academy’s new healthcare leadership model for the NHS was published in November 2013. The Model is comprised of nine ‘leadership dimensions’ which set out the qualities that good leaders at all levels in the NHS should express. The importance of each dimension for an individual will vary based on the type of job they have, the needs of the people they work with, and the context of their role within their organisation.

The National Skills Academy for Social Care’s Leadership Qualities Framework describes what good leadership looks like in different settings and situations. It mirrors the NHS Leadership Framework so that it can be applied in integrated services. The Framework describes the behaviours and competencies a good leader should display. The Academy has also developed a series of supporting assessment tools and initiatives that enable leaders to determine what areas they need to improve on in order to become excellent leaders.

The Care Quality Commission is taking forward the development of a ‘fit and proper persons’ test for board-level leaders in the organisations registered with it, whether in the public, private or voluntary sectors. Fit and Proper Persons Test Regulations have been passed by Parliament and are in place in November 2014 for NHS organisations and from April 2015 for other organisations.