Focus on culture of caring
There should be an increased focus in nurse training, education and professional development on the practical requirements of delivering compassionate care in addition to the theory. A system which ensures the delivery of proper standards of nursing requires: Selection of recruits to the profession who evidence the: Possession of the appropriate values, attitudes and behaviours; Ability and motivation to enable them to put the welfare of others above their own interests; Drive to maintain, develop and improve their own standards and abilities; Intellectual achievements to enable them to acquire through training the necessary technical skills; Training and experience in delivery of compassionate care; Leadership which constantly reinforces values and standards of compassionate care; Involvement in, and responsibility for, the planning and delivery of compassionate care; Constant support and incentivisation which values nurses and the work they do through: Recognition of achievement; Regular, comprehensive feedback on performance and concerns; Encouraging them to report concerns and to give priority to patient well-being.
- Health Education England published its National Values Based Recruitment Framework in October 2014, setting expectations for higher education institutions to embed values-based recruitment into nursing selection processes by March 2015. The framework comprised tools for structured interviews and personality assessments to evaluate candidates' attitudes towards caring and compassion (Values Based Recruitment Framework, HEE, October 2014).
- The NMC published a revised Code of Professional Standards in March 2015, structured around four themes including "Prioritise people" and "Practise effectively." The NMC stated the Code reflected "patients' needs, modern healthcare practice and the recommendations of reviews such as the Francis Inquiry" (The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates, NMC, March 2015).
- Lord Willis of Knaresborough published "Raising the Bar: Shape of Caring" in March 2015, making 34 recommendations for nursing and care assistant education, including strengthening pathways from healthcare assistant to nursing and ensuring consistent high-quality education (Raising the Bar: Shape of Caring, HEE, March 2015).
- The Care Certificate was launched on 1 April 2015 as a standardised induction for all new healthcare assistants and social care support workers, covering 15 standards including privacy and dignity, safeguarding, and communication (Care Certificate, HEE/Skills for Care/Skills for Health, April 2015).
- NMC Revalidation launched on 1 April 2016, requiring all registered nurses and midwives to revalidate every three years, demonstrating continued fitness to practise through 450 practice hours, 35 hours of CPD, five reflective accounts, and third-party confirmation (NMC Revalidation, NMC, April 2016).
- The NHS Long Term Workforce Plan (June 2023) committed to increasing adult nursing training places by 92% to nearly 38,000 by 2031/32, backed by over £2.4 billion over five years for additional education and training (NHS Long Term Workforce Plan, NHS England, June 2023).
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
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.
Over 1,400 Freedom to Speak Up Guardians across healthcare organisations in England. 38,000+ cases raised in 2024-25, cumulative total exceeds 142,000 since inception. However, NHS Staff Survey 2024 shows only 71.5% of staff feel secure raising concerns about unsafe practice (stagnant for years), and only 57% are confident their organisation would address concerns.
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.
Sir Robert Francis published Freedom to Speak Up Review on 11 February 2015 with 20 principles and actions. Led to: Freedom to Speak Up Guardians mandatory in all NHS trusts from October 2016; National Guardian's Office established January 2016.
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.