Clarity of values and principles
All NHS staff should be required to enter into an express commitment to abide by the NHS values and the Constitution, both of which should be incorporated into the contracts of employment.
- The NHS Terms and Conditions, updated in August 2024, require that local appraisal policies for all staff are consistent with the NHS Constitution (NHS Terms and Conditions of Service Handbook, NHS Employers, August 2024).
- NHS England published the NHS Leadership Competency Framework for Board members in February 2024, which is based on six competency domains reflecting NHS values (NHS Leadership Competency Framework, NHS England, February 2024).
- The NHS Constitution was updated in July 2015 to incorporate duty of candour expectations (NHS Constitution for England, Department of Health, July 2015).
How was this evidence gathered?
Response
Accepted in Part
Response
Accepted in PartThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Progress Timeline
DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Partially Implemented - Ongoing. No systematic arrangements were put in place through contractual terms, but all regulated health care professionals are required, by their regulators, to practice in a way that is consistent with professional values. These professional values are themselves consistent with the values of the NHS Constitution. The NHS Terms and Conditions (last updated August 2024) require that local appraisal policies are consistent with the NHS Constitution for England (para 53). This applies to all staff. For Board-level leaders, Regulation 5 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014, specifies that service providers must only appoint executive and non-executive directors if they comply with the Fit and Proper Persons requirements. In September 2024, NHS England published the Fit and Proper Person Test Framework to strengthen accountability and transparency for individual Board members. This framework is underpinned by the values set in the NHS Constitution. To support this, NHS England has developed the NHS Leadership Competency Framework for Board members (February 2024). This is based around six competency domains which reflect the NHS values. An independent evaluation is planned for 2025. Professional behaviours and values are further mandated by professional regulatory bodies, such as the Nursing and Midwifery Council.
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
NHS Constitution was updated in July 2015, incorporating duty of candour expectations and strengthened staff/patient rights. Constitution is reviewed every 10 years (most recent review 2023). Handbook revised to include more prominent reference to professional codes.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.