Recommendation F4: Clarity of values and principles
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The core values expressed in the NHS Constitution should be given priority of place and the overriding value should be that patients are put first, and everything done by the NHS and everyone associated with it should be informed by this ethos.
In brief (written by this site)
In commentary provided in September 2024, the Department of Health and Social Care and NHS England recorded the recommendation as implemented and ongoing, referring to their responses to earlier recommendations (DHSC and NHS England, Feb 2026). In a review published in February 2026, the Thirlwall Inquiry legal team reported that the government accepted the recommendation, noting that the department updated the NHS Constitution in March 2013 to state that “patients come first in everything we do” and amended it further in July 2015 (The Thirlwall Inquiry legal team, Feb 2026).
AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 2026. The record below is the sources' own words.
About this summary
This recommendation asks for cultural or behavioural change, which is difficult to verify from published sources alone. The record reflects policy commitments rather than measured outcomes.
Government response
Accepted.
In the Statement of Common Purpose, all the leaders of the health and care system have personally committed to the values of the Constitution.
The Constitution sets out the following values for the NHS:
• Working together for patients
• Respect and dignity
• Commitment to quality of care
• Compassion
• Improving lives
• Everyone counts.
The Constitution notes that these values should underpin everything the NHS does and ‘provide common ground for co-operation to achieve shared aspirations, at all levels of the NHS’.
In response to this recommendation, the Department brought forward the values section so that it appears early in the document (directly following the principles section) and re-ordered the values so that they start with ‘working together for patients,’ in the updated Constitution published on 26 March 2013. The text of this value explicitly states that ‘patients come first in everything we do.’ The work we are currently undertaking with stakeholders to increase awareness levels of the Constitution, as well as increase its impact, seeks to ensure that everyone is informed by the ethos that patients come first.
We note that Principle 4 of the Constitution currently states that ‘the NHS aspires to put patients at the heart of everything it does.’ The Department of Health will consult on how this statement might be strengthened when we next update the Constitution.
How this response relates to the recommendation
Site note: This is volume two of "Hard Truths: The Journey to Putting Patients First" (Cm 8777-II), the government's response to the Inquiry's 290 recommendations, published by the Department of Health on GOV.UK on 19 November 2013 and dated to that day here. The PDF the row links to is the accessible edition, whose title page reads "January 2014". The Department of Health has been the Department of Health and Social Care since January 2018. The volume says it includes accounts from each of the national organisations the recommendations name, but it does not mark which passage each organisation wrote, so every row is filed under the Department that published it.
Blanket government agreement does not establish acceptance or delivery by each addressee. Some response passages cover groups of recommendations.
Scope of the government response
Government responded via "Hard Truths: The Journey to Putting Patients First" (2014), a single document covering all 290 recommendations with a blanket acceptance. Individual recommendation responses were not broken out.
Delivery
DHSC and NHS England say in progress (27 February 2026)
Please see response to recommendations 2 and 3.
Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Implemented - Ongoing”. Table row: section 18.2 No. 4, PDF page 425.
Department of Health and Social Care says in progress (11 February 2015)
Sir Robert Francis QC was clear in his Inquiry report that the principal message of the NHS Constitution should be that patients and their safety come first. In Hard Truths, the Department of Health committed to strengthening the NHS Constitution to make this clearer for patients, staff and the public. To this end, The Government has launched a consultation into, amongst other things, refreshing the NHS Constitution to reflect the recommendations made by Sir Robert Francis QC. The key elements are:
• duty of candour;
• safe care and avoidable harm;
• staff guidance, and;
• a patient-centred NHS.
Site note: This is the supporting annex published on 11 February 2015 with "Culture change in the NHS: applying the lessons of the Francis Inquiries" (Cm 9009), attached to the GOV.UK page as "Culture change in the NHS supporting annex". The annex has no title page; that title is GOV.UK's and the PDF's own. Its table has four columns (No., Recommendation, Hard Truths Government response, Progress update), and the row carries the Progress update cell. No column says which organisation wrote an update, so the row is filed under the Department of Health (now the Department of Health and Social Care), which published it.
The tracker describes this as a long-term recommendation: systemic or cultural, with no single completion point.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (27 February 2026)
This recommendation was accepted by the Government.
The Department of Health published an updated NHS Constitution on 26 March 2013, which contained text explicitly stating that “patients come first in everything we do”. This was amended to “The patient will be amended at the heart of everything the NHS does” in July 2015.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 18.2 No. 4, PDF page 425.
Earlier findings (1)
Thirlwall Inquiry legal team (15 May 2024)
This recommendation was accepted by the Government.
The Department of Health published an updated NHS Constitution on 26 March 2013, which contained text explicitly stating that “patients come first in everything we do”. This weas amended to “The patient will be amended at the heart of everything the NHS does” in July 2015.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 16.2 No. 4, PDF page 385-386.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding