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.
- The NMC launched a revalidation system on 1 April 2016, requiring all nurses and midwives to revalidate every three years (NMC Revalidation, April 2016).
- The updated NMC Code published in March 2015 introduced strengthened requirements for candour and raising concerns (The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates, NMC, March 2015).
- The NMC stated in April 2025 that it moved from a prescriptive, input-driven approach to an outcome-focused, evidence-based model of regulation (DHSC and NHS England implementation update provided to the Thirlwall Inquiry, April 2025).
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.. NMC standards for competence for registered nurses sets out that all nurses must act first and foremost to care for and safeguard the public. They must practise autonomously and be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing that respects and maintains dignity and human rights. The NMC commissioned IFF Research to evaluate its pre-registration standards in July 2014 in direct response to this recommendation. This identified a particular call for a more explicit reference to compassion in the standards for midwifery pre-registration education. It also suggested that the NMC should consider adding to the standards a requirement that AEIs conduct values-based recruitment (in particular, ensuring that motivation and compassion are considered). The NMC's approach to education standards was transformed as a result of this report; from reviewing standards with a piecemeal approach to undertaking a whole scale review of all our education standards in the education change programme. The NMC moved from a prescriptive, input driven approach to an outcome focussed, evidence-based model of regulation. In 2016 the NMC launched a programme of change for education and undertook a major review of all pre-registration nursing and midwifery education standards. Following this, new standards for pre-registration nursing and midwifery programmes were published in 2018 and 2019 respectively. It's important that the NMC's education standards are considered together as a package. The NMC's pre-registration nursing and midwifery programme standards state that programme learning outcomes must reflect the standards of proficiency, which in turn emphasise the importance of compassionate and person-centred care. Revalidation is the process that all nurse and midwives in the UK and nursing associates in England need to follow to main their registration with the NMC. This process needs to happen every three years. Revalidation encourages reflection on the role of the Code of professional standards for practice and behaviour for nurses, midwives and nursing associates.
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.
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 "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.