Responsibility for setting standards
It is essential that professional bodies in which doctors and nurses have confidence are fully involved in the formulation of standards and in the means of measuring compliance.
- The Department of Health and Social Care and NHS England stated in April 2025 that the National Quality Board (NQB) includes representatives from NHS England, CQC, NICE, and professional regulators (DHSC and NHS England implementation update provided to the Thirlwall Inquiry, April 2025).
- The Nursing and Midwifery Council launched a new revalidation system on 1 April 2016 requiring all nurses and midwives to revalidate every three years (NMC - Nursing Revalidation, April 2016).
- The Nursing and Midwifery Council published an updated Code of Professional Standards in March 2015 requiring nurses to be open and candid (NMC - Updated Professional Code (2015), March 2015).
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe 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 - Ongoing. In developing their standards, professional regulators will regularly consult with a range of stakeholders, including their registrant population, to ensure policies and guidance meet the needs of the professionals they regulate. Professional regulators are members of the Joint Strategic Oversight Group (JSOG), which was established to support the joint working of regulators and oversight organisations including the General Medical Council, Nursing and Midwifery Council, Health Education England and Care Quality Commission. JSOG is the forum for sharing intelligence, enhancing the sharing of information and coordinating regulatory action in response to safety concerns. The National Quality Board (NQB) continues to champion the importance of quality and drive system alignment of quality across health and care on behalf of NHS England, the Care Quality Commission, the UK Health Security Agency, the National Institute for Health and Care Excellence, the Office for Health Improvement and Disparities, the Department of Health and Social Care, Healthwatch England and the Health Services Safety Improvement Body.
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.
NMC Revalidation launched 1 April 2016 in direct response to Francis Report. All nurses and midwives must revalidate every three years. Replaced the Post-Registration Education and Practice system. Updated NMC Code published March 2015 strengthened requirements around candour and raising concerns.
NMC published updated Code of Professional Standards for nurses and midwives (March 2015). Standard 14 specifically requires nurses and midwives to be open and candid with all service users about all aspects of care, including when mistakes or harm have occurred.
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.