Recommendation 60

Regulation of governance

Accepted in principle
The Secretary of State should consider transferring the functions of regulating the governance of healthcare providers and the fitness of persons to be directors, governors or equivalent persons from Monitor to the Care Quality Commission.

However we believe that the best way to achieve the desired outcome is through closer co-operation between Monitor and the Care Quality Commission rather than through the transfer of functions. The Care Quality Commission’s inspection regime will include a focus on whether or not an organisation is ‘well-led’.

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 government issued in July 2013 a consultation on strengthening corporate accountability in health and social care. This 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 government proposes that the fit and proper persons test will now be used as a mechanism for introducing a scheme for barring directors who are unfit from individual posts by the Care Quality Commission at the point of registration.  Where a director is considered by the Care Quality Commission to be unfit it could either refuse registration, in the case of a new provider, or require the removal of the Director on inspection, or following notification of a new appointment.  Further details will be set out in the response to the consultation on corporate accountability which will be published shortly. The government plans to publish the draft regulations for consultation at the same time.

See also recommendations 79 and 80.

Update

The NHS Trust Development Authority, Monitor and the Care Quality Commission published How Monitor, the Care Quality Commission and the NHS Trust Development Authority will work together to assess how well led organisations are in May 2014.

The Department of Health has consulted on a new registration requirement that all directors of providers registered with the Care Quality Commission must meet a fit and proper person test. The Care Quality Commission will be able to insist on the removal of directors that fail this test. The consultation included how the revised fit and proper person requirement will work, and questions about the impact of the new regulations. The consultation ran from 27 March to 25 April 2014. The 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.