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Kark review: current test doesn’t ensure NHS leaders are fit for their posts


By Hiba Mahamadi
7 February 2019

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Senior NHS directors should have to meet an objective set of competency standards before being hired, an independent review of the fit and proper persons test (FPPT) has recommended.

The review, led by Tom Kark QC, was commissioned by the Department of Health and Social Care in July 2018. It had been recommended by Dr Bill Kirkup in his report into severe bullying and harassment at Liverpool Community Health NHS Trust in February last year.

Mr Kark, who previously served as counsel to the Mid Staffordshire public inquiry, said in the review that:

‘Our extensive reading and discussions have revealed few fans of the FPPT as it is currently applied.

‘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.’

Mr Kark made seven recommendations for improving the ability to ensure that NHS leaders have the skills and qualifications required for their roles.

These include judging directors’ performance against an objective criteria and setting up a central database where directors’ qualifications and career history can be viewed at a glance.

The database would hold information about directors’ historic and current assessments and details about any upheld grievances or disciplinary matters.

The Governenment announced yesterday that is has ‘accepted in principle’ to set up the central database of information, as well as to implement new competency standards to increase transparency around what employees can expect from senior managers.

The review also wants the Government to create a mandatory reference form that has to be filled out by the director’s employer when they move from one health trust to another.

The form would not be curtailed by any non-disclosure terms in a settlement or agreement.

The review’s recommendations also included setting up a body to bar directors who have committed serious misconduct.

However, Mr Kark stressed how important it is to define the phrase ‘serious misconduct’ in an objective manner.

He stated that is should not just entail overt crime and dishonesty but also more subtle forms of bullying and harassment that could, for example, prevent whistleblowers from speaking up.

The review additionally recommended that the concept of the FPPT is extended to board level directors of commissioners and appropriate NHS arms’ length bodies.

An important distinction was made between managers who have been found guilty of misconduct and those who are struggling to perform but who could, with the right training, achieve the required level of performance.

The review stressed the need to check how effectively the test works in the context of social care provision.

Describing social care as ‘a very different animal to the NHS’, it advised that the recommendations should not be applied to social care without further examination of ‘how the regulations work in this complex area’.

The Kark review recommendations are: 

  1. All directors should meet specified standards of competence to sit on the board of any health providing organisation. Where necessary, training should be available
  2. A central database of directors should be created holding relevant information about qualifications and history
  3. [There should be] the creation of a mandatory reference requirement for each director
  4. The FPPT should be extended to all commissioners and other appropriate arms-length bodies, including NHS Improvement and NHS England
  5. [There should be the] power to disbar directors for serious misconduct
  6. That further work is done to examine how the test works in the context of the provision of social care and whether any amendments are needed to make the test effective.
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