Executive summary and action required
Publication of the Management and Leadership Framework (by autumn 2025) is a commitment within the 10-Year Health Plan. Following approval by Minister of State for Health Karin Smyth on behalf of Secretary of State for Health, and approval by the NHS Executive on 9 September, this paper seeks the NHS England (NHSE) Board’s final approval to launch the Framework. Options for the timing of the launch are in development and will be agreed with the Department for Health and Social Care (DHSC), including at which event the Framework will be launched.
The paper also:
- Seeks the Board’s approval to replace the Board Leadership Competency Framework from 2026/27 (proposal approved by the NHS Executive on 9 September),
- Provides an update on planned activity relating to the Board Member Appraisal Framework and new standardised appraisal framework, and
- Provides an update on establishing a new College of Executive and Clinical Leadership.
The Board is asked to review the contents of this report and to:
- Approve the Management and Leadership Framework for launch,
- Approve the approach to replacing the Board Leadership Competency Framework with the new standards, and
- Note the updates regarding appraisal frameworks and the College of Executive and Clinical Leadership.
Background / Issue and context
1. The NHSE Board last received an update on the Management and Leadership Programme in July 2025. This update set out the policy context and drivers for this broad programme of work, including the 2022 Messenger Review and the evidence base which underpins it. Since then, the 10-Year Health Plan has been published, confirming the government’s commitment to accelerating delivery of the Messenger Review recommendations and establishing a new College of Executive and Clinical Leadership.
2. The NHS Management and Leadership Programme was initiated in response to the Messenger (2022) and Kark (2019) reviews and is currently delivering year two of a three-year (2024/25 – 2026/27) roadmap of interventions to improve NHS management and leadership. Our ambition is to provide a world-class approach to NHS management and leadership; from ensuring a consistent approach to getting the basics right, to providing the best, accessible development for leaders and managers at all levels, and to embedding a system of effective talent management and career support, while upholding accountability and the high standards which patients and staff expect.
3. On 21 July 2025 the Government confirmed plans to regulate NHS managers via a disbarring system that will apply to Board-level leaders and their line reports within core NHS organisations, overseen by the Health and Care Professions Council (HCPC). The Government also stated that it will explore ‘whether there are forms of accreditation that could be implemented to recognise the professionalism of NHS managers and leaders’. The forthcoming Management and Leadership Framework will work alongside regulation and any potential future accreditation by providing a robust framework of standards for managers and leaders at all levels, including primary care.
Considerations and recommendation
Management and Leadership Framework
4. The NHS Management and Leadership Framework has been developed in response to the Messenger Review, which recommended ‘A single set of unified, core leadership and management standards for managers [and] training and development bundles to meet these standards’. The purpose of the Framework is to equip NHS managers – both clinical and non-clinical – with a Code of practice, defined set of standards and competencies (Appendix A), a national development curriculum, and practical, accessible learning resources to enable them to lead and manage with confidence, care, and consistency and elevate NHS management and leadership as a recognised professional discipline.
5. The standards will improve NHS management and leadership by:
- Reinforcing managers and leaders’ accountability requirements to act transparently, ethically and lead with integrity.
- Providing a strong and consistent benchmark expectation across the NHS for excellent operational delivery, focussing on performance and financial balance as well as driving improvement, innovation and change in line with the 10 Year Health Plan.
- Consistently assessing (via a standard appraisal approach) capability and performance against recognised standards, identifying development needs and enabling access to quality-assured training to achieve the standards and prepare managers for future regulation.
- Offering structured talent developmental opportunities, transparent expectations and career pathways for progression.
- Embedding inclusive, compassionate and collaborative leadership and management skills and behaviours at every level.
6. The Framework has been developed by NHS England in partnership with a consortium led by the Chartered Management Institute (CMI), including the Faculty of Medical Leadership and Management, the Florence Nightingale Foundation and KPMG. The national development curriculum includes Learning Outcomes, example facilitator-led activities and example self-directed activities at each of the five stages and across all standards and competencies and is ready to implement once the Framework has been signed off. The consortium has also undertaken a review of the seven main NHSE / Leadership Academy programmes, including the Aspiring Chief Executives programme, Graduate Management Training Scheme (GMTS) and Nye Bevan and has assessed alignment against the code, standards and competencies, identifying where updates need to be made.
7. Broad engagement with the service and stakeholders – including patients – has informed the design and content of the Framework, including a survey of 1,000 staff, multiple engagement events, focus groups and interviews. The 10 Year Health Plan commits to launching the Framework in autumn 2025.
8. Leaders and managers shape the culture, experience and outcomes across the service for patients and staff. Therefore, implementation of the Framework will be an essential expectation of all organisations, and all leaders and managers in scope (both clinical and operational) will be expected to engage with it. All elements of the Framework (Code, standards and competencies) will apply to NHS leaders and managers and the Code will also apply to leaders and managers in social care. Implementation of the Framework will bring the NHS in line with other public sectors with similar frameworks of professional standards, including the police and civil service.
9. The Code and standards received approval from Minister of State for Health Karin Smyth on behalf of Secretary of State for Health on 9 September and were approved by the NHS Executive on the same date. Supporting implementation and communications plans have been developed and Appendix B contains a summary of the implementation timeline for reference. Options for the timing of the launch are in development and will be agreed with the Department for Health and Social Care (DHSC), including at which event the Framework will be launched.
Action required: The NHSE Board is asked to review the draft Code and standards (Appendix A) and approve them for launch as part of the NHS Management and Leadership Framework.
Fit and Proper Person Test Framework and Board Leadership Competency Framework
10. NHSE implemented the Fit and Proper Person Test (FPPT) Framework in September 2023 in response to the agreed recommendations from the 2019 Kark Review. The Framework introduced a means of retaining information relating to testing the requirements of the FPPT for individual directors within ESR, a set of standard competencies for all board directors (Board Leadership Competency Framework), a board member reference template which must be completed when a director leaves an NHS board, and extension of applicability to ALBs, including NHSE and CQC.
11. A paper to the NHS Executive on 9 September proposed that the Board Leadership Competency Framework (LCF) is replaced by Stage Four of the new standards (the stage for executive managers and leaders) within the Management and Leadership Framework, effective from 2026 /2027 – this proposal was approved by the Executive. Work will be undertaken between October 2025 and March 2026 to ensure the standards – or an adapted set – are fit for purpose for Chairs and NEDs. This period also allows for the Management and Leadership Framework to be implemented across the service, as described in paragraphs 2.1 to 2.6 above. Communications activity to support implementation of the Management and Leadership Framework will clarify these plans and ensure all stakeholders are engaged and informed. A risk to this approach is that expectations of board members might change once manager regulation is implemented. However, NHSE and DHSC are working with HCPC to seek to ensure continuity and implement a regulatory approach that builds on, rather than replaces, the Management and Leadership Framework.
Action required: The NHSE Board is asked to consider and approve this proposal for replacing the Board Leadership Competency Framework, effective from 2026/2027
Appraisal Frameworks: Standard Appraisal Framework (all staff) – update for information
12. Recommendation four of the Messenger Review is the implementation of ‘A simplified, standard appraisal system for the NHS’ and the 10 Year Health Plan commits to a ‘review of revalidation and appraisal processes’. 2024 NHS Staff Survey figures indicate that whilst 85% of NHS staff have had an appraisal, just 26% said it helped them to improve how they do their job, 35% to agree clear objectives and 33% to feel their work is valued. In February 2026, the Management and Leadership Programme will deliver a new standardised appraisal framework aligned to the standards within the Management and Leadership Framework. This will ensure that all managers and leaders are appraised against a consistent set of standards enabling comparative assessment, agreement of personal development plans and support for career conversations. The launch of the new framework is planned to be accompanied by training for line managers to improve confidence and competence in appraising and managing performance and motivating staff. This includes setting a baseline expectation that all line managers are trained to an agreed standard in delivering high-quality, values-led appraisals. The draft appraisal framework will be shared with the Executive for review Q3.
Appraisal Frameworks: Board Member Appraisal Framework – update for information
13. In April 2025, the Management and Leadership Programme published a new Board Member Appraisal Framework (BMAF) aligned to the six domains of the Leadership Competency Framework and forming part of the annual Fit and Proper Person Test (FPPT) attestations. Designed collaboratively with chairs, non-executive directors (NEDs) and other stakeholders across the service, the BMAF aims to ensure a consistent and standardised approach to board member appraisals.
14. The programme has gathered feedback from a range of board level directors on the BMAF, and there is some dissatisfaction with the underpinning Leadership Competency Framework (LCF) and the perception that board members must be appraised against all individual bullet points, which is not the case. As above, the LCF is planned to be replaced from 26/27, and guidance will be updated for the 25/26 appraisal round to ensure a clear understanding of the ask.
15. The 10 Year Health Plan commits to establishing a College of Executive and Clinical Leadership (a pre-election manifesto commitment). NHS England is working with DHSC on the shape and remit of the new College in consultation with NHS staff and leaders, in the context of wider changes to the NHS structures and operating model.
16. Subject to agreement by the NHSE CEO and ministers to the proposed scope, work will continue with DHSC to confirm the funding model, and if functions within the current NHSE leadership, management and talent portfolio (and accompanying people and budget) might move to the College, and when.
Risks to delivery
17. Longer term, there is a risk to continuity of leadership and management development offers unless functions are sustained, either in the future College or future DHSC or both. Managers and leaders shape the culture, experience and outcomes for patients and our staff. They have a pivotal role in delivering efficient and effective high-quality care and services to patients today, while also delivering the transformation described in the 10 Year Health Plan – and for this the NHS needs to recruit, develop and retain the very best managers and leaders.
Appendix A: Draft Management and Leadership Framework PPT
Appendix B: NHS Management and Leadership Framework – Implementation Timeline
