Recommendation F9: Fundamental standards of behaviour
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The NHS Constitution should include reference to all the relevant professional and managerial codes by which NHS staff are bound, including the Code of Conduct for NHS Managers.
In brief (written by this site)
In commentary from September 2024 published in February 2026, the Department of Health and Social Care and NHS England stated that the change was complete, explaining that the NHS Constitution references standards of professional practice rather than specific codes, though a management code remained in development (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team found in February 2026 that although the recommendation was accepted in principle, the Handbook to the NHS Constitution gives examples of where codes can be found without expressly referencing them (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 applies across many organisations. The record reflects central policy activity; adoption in individual organisations may vary.
Government response
Accepted in principle.
We support the principle of making clear which codes staff are expected to follow. However, as the NHS Constitution is intended to be a succinct and enduring document, the details of codes are more appropriately set out in the Handbook to the NHS Constitution rather than the Constitution.
The Constitution already includes a duty for staff ‘to accept professional accountability and maintain the standards of professional practice as set by the appropriate regulatory body applicable to your profession or role’. The handbook, which provides more detailed guidance on each of the rights, pledges and responsibilities included in the Constitution, sets out the relevant professional bodies but does not currently reference the relevant codes of these bodies nor any managerial codes.
When the Constitution is next updated, the Department of Health will consider how best to reflect in the Handbook the codes of conduct including the relevant professional and managerial codes, by which NHS staff are bound at that time.
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)
Under Staff responsibilities, the NHS Constitution (as last updated in August 2023) requires that staff have a duty to accept professional accountability and maintain the standards of professional practice as set by the appropriate regulatory body applicable to their profession or role. Reference is made to the relevant standards of professional practice rather than the codes.
The NHS Standards of Business Conduct Policy, published in April 2013 (and updated in April 2024), sets the standards of conduct and integrity expected from Board members, employees and all that work in the NHS.
The NHS Leadership Competency Framework for Board members was first published in February 2004, and most recently updated in February 2024. It has been designed around six competency domains to support the recently refreshed Fit and Proper Persons regime.
This sets out domains aligned to the NHS values described in the NHS Constitution. The competency domains are aligned to Our NHS People Promise, Our Leadership Way and the Seven Principles of Public Life/Nolan Principles. Additionally, a management code and standards – supported by an accredited development pathway covering the management of people, operations (including data and analytics), finance and self – is in development for all NHS managers.
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. 9, PDF page 427-428.
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. These 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 (27 February 2026)
This recommendation was accepted by the Government in principle.
The NHS Constitution includes a general requirement for staff to aim to follow all guidance, standards and codes relevant to one’s role. The Handbook gives examples of where those codes can be found but does not include express reference to them. The Government response explained this was because the NHS Constitution was intended to be a succinct and enduring document.
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. 9, PDF page 427-428.
Earlier findings (1)
Thirlwall Inquiry legal team (15 May 2024)
This recommendation was accepted by the Government in principle.
The NHS Constitution includes a general requirement for staff to aim to follow all guidance, standards and codes relevant to one’s role. The Handbook gives examples of where those codes can be found, but does not include express reference to them. The Government response explained this was because the NHS Constitution was intended to be a succinct and enduring document.
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. 9, PDF page 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