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The Kark review: what it means for leadership in the NHS


By Hiba Mahamadi
8 February 2019

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This week saw the publication of the Government’s independent review into the fit and proper person test (FPPT) – commissioned by the then health and social care minister Stephen Barclay Stephen Barclay last year.

Carried out by Tom Kark QC, the review has suggested a number of changes designed to make the test more effective in ensuring that those in senior leadership positions in the NHS are qualified and equipped for the posts they hold.

The review was commissioned with a long list of hospital failures in mind, including the scandals at Mid Staffordshire NHS Foundation Trust; Gosport War Memorial Hospital; Liverpool Community Health NHS Trust; Morecambe Bay NHS Trust; and Winterbourne View Hospital.

Here are the most important things you need to know about the review:

1.The Government has agreed ‘in principle’ to set up a central database of every NHS director’s career history. The database will include details about directors’ qualifications, training, appraisals, any information relating to upheld disciplinary matters, employee tribunals or settlement agreements, and whether the director has ever been disbarred.

2. The Government has also agreed ‘in principle’ that new objective criteria for good performance need to be set up to hold senior managers accountable. Mr Kark suggested that all managers, regardless of the role they are in, should have knowledge of:

  • Board, clinical and financial governance
  • Patient safety and medical management
  • The importance of information on clinical outcomes
  • How to respond to serious clinical incidents and learning from mistakes
  • The importance of learning from whistleblowing incidents and of speaking up
  • Empowering staff to work independently and to raise concerns
  • Ethical duties towards patients and staff
  • The secure use of data
  • Information systems relevant for health services
  • Understanding the importance of equality and diversity as they apply to a hospital workforce and appointments to the board
  • The importance of complying on a personal basis with the Nolan principles of public life – applicable to anyone who holds public office

3. A mandatory reference requirement prior to the employment of directors has been suggested. Importantly, Mr Kark added that employees should have the right to see and challenge the contents and fairness of the reference and to add an explanation in writing if they wish.

4. The review recommended setting up a body with the power to suspend and disbar directors for serious misconduct. Suggesting that such a body could be housed within NHS Improvement and might be known as the Health Directors’ Standards Council – the review recognised that such a move would likely require legislation.

The review stated that ‘serious misconduct’ would need to be more closely defined. However, it added that it should include the following:

  • Dishonesty;
  • Deliberate bullying;
  • Deliberate discrimination, harassment or victimisation;
  • Sexual harassment;
  • Victimisation or knowingly allowing the victimisation of whistleblowers, those raising concerns with the freedom to speak up guardian or those complying with the duty of candour;
  • Falsification, concealment or suppression of records, data or other information which is required to be provided to any other person or organisation;
  • And other aspects

However, the review also suggested that there should be a five-year limitation period for historic complaints of serious misconduct unless public interest requires the case be reopened.

The Government has yet to fully commit to the implementation of the recommendations for a mandatory reference requirement or a body that could suspend and disbar directors.

In a statement the Government said that these recommendations will be considered as part of the workforce implementation plan – due later this year.

5. The reviews recommended that the FPPT should be extended to all commissioners and appropriate arms-lengths bodies – including NHS England and NHS Improvement. However, it suggested that this should initially be done on a voluntary basis.

6. The review suggests that FPPT may be amended to also apply to social care providers, but that this should not be done without an examination of ‘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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