Recommendation F5: Clarity of values and principles
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
In reaching out to patients, consideration should be given to including expectations in the NHS Constitution that: Staff put patients before themselves; They will do everything in their power to protect patients from avoidable harm; They will be honest and open with patients regardless of the consequences for themselves; Where they are unable to provide the assistance a patient needs, they will direct them where possible to those who can do so; They will apply the NHS values in all their work.
In brief (written by this site)
In September 2024 commentary published in February 2026, the Department of Health and Social Care and NHS England recorded the recommendation as implemented and closed, referring to their response to earlier recommendations (DHSC and NHS England, Feb 2026). Earlier, the Thirlwall Inquiry legal team found in May 2024 that following a July 2015 government consultation response, these expectations had been included in the NHS Constitution under staff responsibilities (The Thirlwall Inquiry legal team, May 2024).
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.
The NHS Constitution already addresses some of the issues highlighted in this recommendation, and when it is next updated the Department of Health will consult with stakeholders on how to best reflect other issues.
We agree that staff should be honest and open with patients, and the Constitution already makes clear that these are staff responsibilities. The Constitution also includes an expectation that staff will raise concerns early, in the public interest about risk, malpractice or wrongdoing (such as a risk to patient safety, fraud, or breaches of patient confidentiality) and a pledge that their employer will support staff to raise these concerns and act upon them. In addition, we are introducing a statutory duty of candour on all heath providers, making it a requirement for them to be open and honest where there have been failings in care (see recommendations 174 and 181 for more on our response about openness and candour).
We agree with the principle that patients should come first in everything the NHS does, and this is explicitly stated in the Constitution. We do not propose to include the more explicit wording ‘staff put patients before themselves’ suggested by the Inquiry, as we have heard concerns from stakeholders that such an expectation may also have a negative impact on staff safety and wellbeing.
The Constitution also already states that its values should underpin everything the NHS does.
We agree with the importance of protecting patients from avoidable harm. The Constitution already includes an expectation that staff will raise concerns early, such as a risk to patient safety; however, there is scope to further reflect the issue of staff protecting patients from avoidable harm. More broadly, as part of their code of conduct, regulated healthcare professionals already have a duty to comply with standardised procedures that protect patients from avoidable harm. Other work to help protect patients from avoidable harm includes introducing the new fundamental standards of care which will set out the level below which care should not fall (refer to the responses to recommendations 13-18 for more information), and ensuring that the NHS takes a zero tolerance approach to all healthcare associated infections (refer to the response to recommendation 107 for more information).
When the Constitution and the Handbook to the NHS Constitution are next updated, the Department of Health will consider, in consultation with stakeholders, how best to further reflect the importance of staff:
• protecting patients from avoidable harm
• directing patients to other sources of assistance, in situations where they themselves are unable to help.
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 completed (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 - Closed”. Table row: section 18.2 No. 5, PDF page 425-426.
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.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
This recommendation was accepted by the Government. The Government published its response to a consultation on amending the NHS Constitution in July 2015. These expectations are now included in the NHS Constitution under the heading “Staff: your responsibilities”.
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 colours its Extent of Implementation cell for this recommendation green, which it uses to mark evidence, identified by the legal team, that a recommendation has been clearly implemented. Table row: section 16.2 No. 5, PDF page 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