Recommendation F8: Clarity of values and principles
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Contractors providing outsourced services should also be required to abide by these requirements and to ensure that staff employed by them for these purposes do so as well. These requirements could be included in the terms on which providers are commissioned to provide services.
In brief (written by this site)
In commentary published in February 2026, the Department of Health and Social Care and NHS England described implementation as ongoing, stating that the NHS Standard Contract requires providers to abide by staff pledges in the NHS Constitution and that contracted services remain subject to fundamental standards enforced by the Care Quality Commission (DHSC and NHS England, Feb 2026). Earlier, in May 2024, the Thirlwall Inquiry legal team found that the recommendation had been accepted and that contract revisions had been reported by the government (The Thirlwall Inquiry legal team, May 2024). The department had previously reported in February 2015 that the action was completed after the 2014/15 contract required providers to ensure all subcontractors abide by the constitution (Department of Health, Feb 2015).
Sources
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 applies across many organisations. The record reflects central policy activity; adoption in individual organisations may vary.
Government response
Accepted.
The NHS Standard Contract requires all providers to have regard to the NHS Constitution. NHS England will strengthen this requirement in respect of subcontractors in future.
The care patients receive should reflect NHS core values, as outlined in the Constitution, regardless of whether staff have been externally contracted. NHS commissioners are committed to ensuring core values permeate provider organisations and the wider system.
By December 2013, NHS England will amend the NHS Standard Contract for 2014–15 to require providers to ensure their subcontractors fully understand, and abide by, the importance of the Constitution.
NHS England will also include an equivalent requirement in November 2013 in standard contracts for commissioning support services. This will ensure the values outlined in the Constitution extend beyond providers of services through the wider system.
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)
The general conditions of the NHS Standard Contract (5.1) provide that the provider must apply the Principles of Good Employment Practice (where applicable), abide by the staff pledges and responsibilities outlined in the NHS Constitution and implement the actions expected of employers as set out in the NHS People Plan.
Fundamental standards were implemented via the Health and Social Care Act 2008 (Regulated Activities)) Regulations 2014 as amended, The fundamental standards are set out in regulations 8 to 20A are in place. Those contracted to provide patient services will be registered with the CQC and subject to these requirements. The CQC has enforcement powers in relation to these standards.
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. 8, PDF page 427.
Department of Health and Social Care says completed (11 February 2015)
NHS England published the NHS Standard Contract for 2014–15 in December 2013. In line with recommendation 8, the provisions of the NHS Standard Contract were revised to strengthen the requirements on all providers of commissioned healthcare services (other than primary care), including all staff and all sub-contractors, to abide by the NHS Constitution. The specific wording of the 2014/15 NHS Standard Contract now reads (Service Condition 1.3): “The Parties must abide by and promote awareness of the NHS Constitution, including the rights and pledges set out in it. The Provider must ensure that all Sub-Contractors and all Staff abide by the NHS Constitution”.
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.
Site note: The Inquiry addressed this recommendation to commissioners, not to the Department of Health. The annex gives this update in the Department's publication and does not say who wrote it, so the row is the Department's report of the progress made on 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.
In the January 2014 Hard Truths report, the Government said that NHS England published a New Standard Contract in December 2014 to strengthen the requirements on all providers of commissioned healthcare services, including staff and sub-contractors, to abide by the NHS Constitution.
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. 8, PDF page 387-388.
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