Aptitude test for compassion and caring
The Nursing and Midwifery Council, working with universities, should consider the introduction of an aptitude test to be undertaken by aspirant registered nurses at entry into the profession, exploring, in particular, candidates' attitudes towards caring, compassion and other necessary professional values.
- Values-based recruitment was introduced across the NHS and incorporated into nurse training selection (Values-based recruitment in the NHS, Health Education England, February 2026).
- Health Education England and universities reported in February 2026 that there is limited evidence that values-based recruitment has been systematically applied or measurably improved compassion (Values-based recruitment review, HEE/Universities, February 2026).
- The NMC stated that programme learning outcomes must reflect standards of proficiency that emphasise compassionate and person-centred care (DHSC and NHS England implementation update provided to the Thirlwall Inquiry, April 2025).
How was this evidence gathered?
Response
Accepted in Part
Response
Accepted in PartThe 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: Partially Implemented – Closed. has undertaken a number of reviews into the need for aptitude test and entry criteria. It has updated standards for pre-registration nursing and midwifery programmes in 2018 and 2019, and again in 2023. Both updates state that programme learning outcomes must reflect the standards of proficiency, which in turn emphasise the importance of compassionate and person-centred care. The NMC provide guidance on health and character for approved education institutions. This requires that all student nurses, midwives and nursing associates seeking registration to be of good health and good character to satisfy to the NMC that they are capable of safe and effective practice. The NMC Code of Standards requires registrants and applicants to maintain a level of health needed to carry out their professional role. Health and character is considered on an ongoing basis as part of NMC revalidation process The pre-registration standards which students must meet in order to join the NMC register negate the need for a specific aptitude test.
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.
Francis recommended aptitude testing for compassion and caring in nurse recruitment. Values-based recruitment was introduced across the NHS and incorporated into nurse training selection. However, there is limited evidence this has been systematically applied or that it has measurably improved compassionate care delivery.
View detailed findings
Values-based recruitment introduced but evidence of systematic implementation and impact is limited.
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.