Recommendation 81

Experience and training as fitness criteria

Consideration should be given to including the criteria for fitness a minimum level of experience and/or training, while giving appropriate latitude for recognition of equivalence.

We agree that people in leading positions in NHS organisations should have the appropriate experience and training to take up those positions and that this should be one of the criteria for any assessment of whether someone is a fit and proper person.  It is vital that they are assessed as a key element of the recruitment process and of ongoing appraisal. As set out in The Healthy NHS Board 2013, as well as experience and technical skill, values and behaviour are also critical to getting the right leaders in place.  We also endorse the document’s advice that regular skills audits of current board members should be carried out.

Monitor’s Risk Assessment Framework sets out how it oversees NHS foundation trusts compliance with the provider licence.   Where a breach has occurred in respect of governance, one of the areas Monitor may investigate is the foundation trust’s management and organisational capability in making an assessment about return to compliance. Monitor’s Code of Governance for Foundation Trusts sets a clear expectation that there should be a formal, rigorous and transparent procedure for the appointment of directors and that care should be taken to ensure that new appointees have relevant skills and experience.

Monitor is working with the Foundation Trust Network (FTN) to offer a 2-day induction programme for new non-executive directors of NHS foundation trusts.  The first of these programmes was run in September 2013.  Monitor will be working together with the NHS Leadership Academy, NHS Trust Development Authority and FTN to increase external support for chief executives of NHS trusts and foundation trusts. Monitor will also consider how best to support medical directors in the coming year.


Monitor has run a series of events with Chief Executive Officers to help identify their support needs and the follow-on action is now under consideration. The development of an induction event for Executive Directors including Medical and Nursing Directors is in hand. The need for further support will be reviewed in light of this work.