Kark review of the fit and proper persons test

A review of the fit and proper persons test
DHSC 6 February 2019

• The current fit and proper persons test is designed to ensure that senior staff who are responsible for quality and safety of care are fit and proper to be in their roles.
• This review, which was led by Tom Kark QC, sets out 7 recommendations, including:
• developing competencies for directors
• making a central database of directors’ qualifications, training and appraisals
• expanding the definition of serious misconduct
• The test applies to directors in the NHS, the independent healthcare sector and the adult social care sector.
• In a speech to healthcare professionals at the Royal Society of Medicine,  Matt Hancock accepted the recommendations that all directors must meet minimum competency standards to sit on the board of any health organisation, and for a central directors’ database where information about qualifications and employment history can be easily accessed. These recommendations will be implemented immediately. Other recommendations will be considered for future implementation.

Kark Review of the Fit and Proper Persons Requirement

Kark Review of the Fit and Proper Persons Requirement
Department of Health and Social Care 20 July 2018

• The Kark Review, led by Tom Kark QC, will look at how effective the Fit and Proper Persons Requirement is in preventing unsuitable staff from being redeployed or re-employed in the NHS,  CCGs, and independent healthcare and adult social care sectors.

Fit and proper directors

Regulation 5: Fit and proper persons: directors - Information for NHS bodies
CQC March 2015

• Guidance on meeting the regulations as well as information about the processes regarding appointment of all board level appointments of NHS foundation trusts, NHS trusts and special health authorities. 

New laws for a more open and safer NHS

Duty of Candour and Fit and Proper Person’s Test
CQC, 27 November 2014

• "Regulation 5: Fit and proper persons: directors and Regulation 20: Duty of candour" comes into force for NHS bodies on 27 November 2014 where 'NHS bodies' means NHS trusts, NHS foundation trusts and special health authorities.
• The Duty of Candour places a legal duty on hospital, community and mental health trusts to inform and apologise to patients if there have been mistakes in their care that have led to significant harm.
• All NHS board members will be required to undergo the Fit and Proper Person’s Test before they are appointed. This will be extended to other providers in April 2015.

CQC has a power to inspect commissioners

Requirements for registration with the Care Quality Commission :Response to consultations on fundamental standards, the Duty of Candour and the fit and proper persons requirement for directors - Response to a consultation.
Department of Health, July 2014

• From April 2015, subject to parliamentary approval, all health and social care providers will be required to meet fundamental standards of care as a condition of their registration with the Care Quality Commission. This document sets out the CQC approach to introducing new fundamental standards, the Duty of Candour and the fit and proper persons requirement.
• The registration requirements apply only to providers of regulated activities that require registration with CQC. The commissioning of health or adult social care services is not a regulated activity, and the registration requirements do not, therefore, apply to commissioning. However, CQC has a power to carry out a special review or investigation of commissioning with the specific agreement of the Secretary of State. 
• See all consultation documents and regulations here

Hard truths - the government recommendations from the Francis inquiry

Hard Truths: the journey to putting patients first - government response to Staffordshire NHS FT public inquiry

DH, 19 November 2013
(These reports builds on the government’s initial response to the Francis enquiry: Patients First and Foremost, March 2013).

• The reports explain the changes that have been put in place since the initial response, and set out how the whole health and care system will prioritise and build on this. Volume 2 outlines the responses to each of the 290 recommendations made by the public inquiry.
• Ministers have rejected nine of Robert Francis’ 290 recommendations, accepted 20 in part and 57 in principle only. Recommendations include:
• Statutory duty of candour on organisations and professional duty on individuals 
• Trusts that don’t stick to the duty of candour face losing their litigation cover.
• Trusts also face a new “willful neglect” offence.
• There will be no centrally-set, mandatory nurse to patient ratios, but there will be guidance and tools for setting staffing levels and trusts will have to publish regular ward data on staffing.
• Regular publication of patient safety data 
• Greater senior involvement in complaints handling 
• Fit and proper persons test for Board members and greater performance management of very senior managers 
• A 'Clinical Bureaucracy Index' for trusts and Concordat between national bodies to reduce bureaucracy.
• Read the NHS Confederation reaction and briefing.
• Read the speech given by Jeremy Hunt  - Learning lessons of Mid Staffordshire and the importance of building a culture of compassionate care

Website - Mid Staffordshire NHS Foundation Trust public inquiry: government response http://francisresponse.dh.gov.uk/

• The website created for the response has five key categories with links to each for a summary, each with sub-links. They are:
• Compassion and care http://francisresponse.dh.gov.uk/compassion-and-care
• Values and standards http://francisresponse.dh.gov.uk/values-and-standards
• Openness and transparency http://francisresponse.dh.gov.uk/openness-and-transparency
• Leadership http://francisresponse.dh.gov.uk/leadership
• Information http://francisresponse.dh.gov.uk/information
• See recommendations of interest to 46 different organisaitons and groups including CCGs , NHS providers, social care