Fundamental standards of behaviour
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.
- The NHS Standards of Business Conduct Policy, updated in April 2024, sets conduct and integrity standards for board members and employees (NHS Standards of Business Conduct Policy, NHS England, April 2024).
- The NHS Leadership Competency Framework for Board members, updated in February 2024, aligns competency domains with the Seven Principles of Public Life and the NHS Constitution (Board Leadership Competency Framework, NHS England, February 2024).
- The NHS Constitution was previously updated in July 2015 to incorporate duty of candour expectations and strengthened staff rights (NHS Constitution Updates, DHSC, July 2015).
- The Department of Health and Social Care stated in April 2025 that a management code and development pathway for all NHS managers is currently in development (DHSC/NHS England implementation update to the Thirlwall Inquiry, April 2025).
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: Implemented – Closed. 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.
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.