Recommendation F187: Practical hands-on training and experience
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
There should be a national entry-level requirement that student nurses spend a minimum period of time, at least three months, working on the direct care of patients under the supervision of a registered nurse. Such experience should include direct care of patients, ideally including the elderly, and involve hands-on physical care. Satisfactory completion of this direct care experience should be a pre-condition to continuation in nurse training. Supervised work of this type as a healthcare support worker should be allowed to count as an equivalent. An alternative would be to require candidates for qualification for registration to undertake a minimum period of work in an approved healthcare support worker post involving the delivery of such care.
In brief (written by this site)
The Department of Health and Social Care and NHS England reported in September 2024 that implementation was ongoing, explaining that updated 2023 Nursing and Midwifery Council standards maintained the requirement that 50 percent of degree hours be spent in practice learning (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that while earlier government pilot programmes had run through 2015, the regulator had not considered that requiring candidates to undertake a healthcare support role would advance patient safety (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 applies across many organisations. The record reflects central policy activity; adoption in individual organisations may vary.
Government response
Accepted.
In its initial response to The Inquiry, Patients First and Foremost, the Government committed to a pilot programme, whereby every student who seeks NHS funding for nursing degrees will serve up to a year as a healthcare assistant.
The pilot is an opportunity for aspiring nurse students to get real, paid caring experience for up to one year as a healthcare assistant before entering undergraduate nursing education, to see if nursing is right for them and they are right for nursing.
In September 2013, Health Education England established the first set of pilots, and approximately 150 aspiring student nurses began working as healthcare assistants. Health Education England is looking to introduce further pilots in Spring 2014. On completion the pilot will be evaluated to see how pre-degree care experience could be rolled out in an affordable and cost-neutral way, so that everybody who wants to train to be a nurse is able to get caring experience before they start their studies. The evaluation results of the pilot scheme will need to be considered in the context of the Nursing and Midwifery Council’s 2010 pre-registration nursing standards and their application across the four countries of the United Kingdom.
We believe that students will enter their nursing degree course with increased confidence that this is the career for them, along with a genuine and demonstrated aptitude for caring. In addition, all nursing degree programmes last at least three years and require that 50 per cent of time is spent in practice learning and 50 per cent in academic study. The first progression point cannot be passed unless the student undertakes a period of practice learning and assessment, and so nursing students will continue to gain experience in care environments throughout their studies.
Alongside this, work is on-going to make a career in nursing more accessible for those staff who already give care, as set out in the Government’s Mandate to Health Education England.
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 partially delivered (27 February 2026)
As set out in response to the recommendation above, the NMC’s education standards were updated in 2023 following the UK’s withdrawal from the EU. The amount of practice learning hours remains the same - all education programmes must meet the equivalent minimum length of three (academic) years for full time programmes which consist of a minimum of 4,600 hours. 50 percent of time (2,300 hours) must be spent in practice learning, of which a maximum of 600 hours can be simulated practice learning. The number of practice learning hours are in line with those mandated by EU law. Further details on NMC standards are in response to recommendation 186.
The NHS Long Term Workforce Plan (June 2023) sets out a series of interventions to train, retain and reform the workforce, and put the NHS on a sustainable footing into the future. Backed by more than £2.4 billion in government investment it outlines how the NHS will address existing vacancies and meet the challenges of a growing and aging population by recruiting and retaining hundreds of thousands more staff over the next 15 years and reforming the way the service works. NHS England has committed to review the plan at least every two years. This has a key focus on nursing.
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 “Partially implemented - Ongoing”. Table row: section 18.2 No. 187, PDF page 519.
Department of Health and Social Care says in progress (11 February 2015)
In September 2013, Health Education England established the first set of pilots, and approximately 150 aspiring student nurses have now completed up to one year working as healthcare assistants, gaining experience of caring prior to starting their studies. In April 2014, a further 90 aspiring student nurses began work, with a further 160 healthcare assistants entering the programme in September 2014. Between approximately 250 and 400 further participants are expected by Spring 2015.
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 the Nursing and Midwifery Council, 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.
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.
The Government, through Health Education England, established a pilot programme placing students seeking NHS funding for NHS degrees on placements up to a year-long working as a healthcare assistant, which extended into spring 2015. The Nursing and Midwifery Council’s July 2013 response was that the requirement for all full time nursing education programmes to involve at least 50% of time spent in hands-on training in a practice setting, met the ‘spirit as well as the letter’ of the recommendation. The Nursing and Midwifery Council did not consider that requiring candidates for nursing education programmes to undertake a minimum period in a healthcare support role would advance patient safety.
The Royal College of Nursing’s view was that this recommendation failed to acknowledge the extent of practical experience which was already on offer.
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. 187, PDF page 482-483.
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