Tom Kark QC and Jane Russell assess the application of the Fit and Proper Person Test and make recommendations on how it can be improved

policy digest

26 / 03 / 2019

Kark review of the Fit and Proper Person Test
Tom Kark QC & Jane Russell, February 2019

On the request of then-Minister of State for Health Stephen Barclay, Tom Kark QC and Jane Russell conduct this review into the application and efficacy of the Fit and Proper Person Test (FPPT) for senior NHS managers.

The report begins by outlining the Fit and Proper Person test – originally designed to ensure greater scrutiny in the recruitment and ongoing employment of board-level Directors, the test was established following the Francis report as a means of identifying and preventing significant breaches of patient safety, poor culture or serious misconduct attributable to poor leadership.

The review identified some serious shortcomings in the FPPT;

  • Inconsistencies in the methodology and application of the FPPT
  • No clear criteria for application of the FPPT
  • Shortcoming in the CQCs ‘well-led’ tests
  • A lack of coverage for non-provider organisations
  • Inconsistencies between the quality of information held between different trusts
  • An inability to bar directors from service where they have committed serious misconduct

The review claims that these shortcomings have been present since the inception of the FPPT and asserts that the service must take action to remedy them. Such action, it claims, would improve patient safety, public faith in the system and staff morale.

The report makes five key recommendations

  1. The design of a set of core competencies that at consistent across trusts which all board-level directors should be expected to meet
  2. The creation of a central database containing a history of employment and any serious misconduct of all board-level directors
  3. The creation of a mandatory reference form to be completed by trusts upon a board-level director moving to another post
  4. Extending the concept of FPPT to the commissioning sector and Arms-length bodies
  5. The creation of a regulator imbued with the power to bar directors found to have committed serious misconduct

In addition, it recommends a subsequent review be carried out into the feasibility of applying the FPPT in social care settings.


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