Recommendation 215

Standards for senior managers and leaders

A common code of ethics, standards and conduct for senior board-level healthcare leaders and managers should be produced and steps taken to oblige all such staff to comply with the code and their employers to enforce it.

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 standards will form part of a wider system of ensuring that senior people are fit and proper persons that will be developed in detail in the coming months. In addition to the responsibility of individual leaders for compliance with technical and behavioural standards, the corporate structures of NHS organisations also need to both reinforce these standards and provide effective oversight of individual and corporate performance to determine whether they are being met, and what needs to be done to improve performance.  The NHS Leadership Academy has published The Healthy NHS Board 2013, which includes guidance on supporting board effectiveness and emphasises the importance of values and behaviours.

We agree that 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’.

In order to support this, the fovernment 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 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.