Recommendation F11: Fundamental standards of behaviour
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Healthcare professionals should be prepared to contribute to the development of, and comply with, standard procedures in the areas in which they work. Their managers need to ensure that their employees comply with these requirements. Staff members affected by professional disagreements about procedures must be required to take the necessary corrective action, working with their medical or nursing director or line manager within the trust, with external support where necessary. Professional bodies should work on devising evidence-based standard procedures for as many interventions and pathways as possible.
In brief (written by this site)
In February 2026, the Department of Health and Social Care and NHS England reported that the government had enacted legislation establishing fundamental standards as registration requirements for the Care Quality Commission, and that the regulator had worked with healthcare professionals and Royal Colleges in developing its approach (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that the government had accepted the recommendation and cited the introduction of fundamental standards under 2014 regulations alongside professional engagement during the regulatory process (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.
Where there is good evidence that standardised procedures minimise risk and promote safer care, then it is the responsibility of healthcare staff to comply with these. Healthcare professionals are obliged by their professional code of conduct to comply with local standardised procedures and employers and line managers should take responsibility for addressing non-compliance.
The Department of Health is drawing up a new set of fundamental standards of care that will sit within the legal requirements that providers of health and adult social care must meet to be registered with the Care Quality Commission. Fundamentals of care will be set out in regulations, supplemented by guidance about compliance developed by the Care Quality Commission, and will also signpost guidance produced by the National Institute for Health and Care Excellence and others. Many of the fundamental standards of care will include human rights dimensions, for example, they will (subject to Parliamentary approval) confer on providers a duty to, among other things, treat people with dignity and respect, protect them from abuse, involve them in their care, and look after their care and welfare. The fact that fundamental standards of care will cover issues also protected by human rights mean that patients and other service users will have additional protection to that which already exists under the Human Rights Act 1998 and equality legislation.
NHS England has agreed with the National Institute for Health and Care Excellence that the Inquiry’s concept of enhanced standards will be in the form of the existing quality standards, which are developed by National Institute for Health and Care Excellence and endorsed by NHS England. Commissioners will be expected to ensure compliance with these.
In terms of input by professional bodies, the Academy of Royal Medical Colleges and Faculties have always taken an active leadership role in setting clinical service delivery standards. The Academy of Royal Medical Colleges and Faculties is working with the Care Quality Commission and the National Institute for Health and Care Excellence on how professional bodies will contribute to the development of standards and compliance measures and through this work, the Academy of Royal Medical Colleges and Faculties will make a significant contribution to consistency of patient experience, patient safety and clinical efficiency.
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 Government passed legislation that put in place new fundamental standards as requirements for registration with the Care Quality Commission. These fundamental standards set the level below which care must not fall. As the Inquiry has noted, the Government’s response stated that the CQC worked with healthcare professionals and the Royal Colleges in the development of its new regulatory approach.
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. 11, PDF page 428.
Department of Health and Social Care says in progress (11 February 2015)
The Government has passed legislation that will put in place new fundamental standards as requirements for registration with the Care Quality Commission. These fundamental standards set the level below which care must not fall. Where providers fail to meet these standards the Care Quality Commission will be able to use its enforcement powers to protect patients and service users from the risks of poor care – including prosecuting providers where a failure to meet a fundamental standard results in avoidable harm to a patient or service user, or a significant risk of such harm.
The fundamental standards will come into force for all providers registered with the Care Quality Commission in April 2015. Two new regulations introducing a duty of candour for NHS bodies and a fit and proper person requirement for directors of NHS bodies came into force in November 2014. In July 2014, Care Quality Commission consulted providers, health care professionals and other key stakeholders on proposed guidance on meeting the new regulations. The Care Quality Commission has published final guidance on how organisations may comply with the duty of candour and the fit and proper person requirement for NHS bodies which came into force in November 2014.
The Care Quality Commission has also recently published a series of provider handbooks. These will sit alongside the guidance on the regulations and describe the end to end inspection process, including how the Care Quality Commission will judge what good quality care looks like and how the Care Quality Commission will rate providers. The handbooks cover hospitals, specialist mental health services, community health services, adult social care, and GP and out of hours services.
The Care Quality Commission has been working with healthcare professionals including the Royal Colleges and their faculties, as well as providers, the public and other stakeholders throughout the development of its new regulatory approach. This has included:
• engagement in the development of the Care Quality Commission’ s new approach to monitoring, inspecting and rating services and guidance on new regulations and enforcement powers;
• identification of healthcare professionals to participate in the Care Quality Commission’s inspections;
• support for the Care Quality Commission’s work on the use of clinical service accreditation schemes;
• commitment to working together through the development of memoranda of understanding, joint working statements and information sharing agreements.
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 healthcare providers, 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.
The tracker describes this as a long-term recommendation: systemic or cultural, with no single completion point.
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 referred to its enactment of fundamental standards in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The Government said that the Care Quality Commission had worked with healthcare professionals, including their Royal Colleges and their facilities, as well as providers, the public and other stakeholders throughout the development of its new regulatory approach.
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. 11, PDF page 389.
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