Consistent training
The Nursing and Midwifery Council and other professional and academic bodies should work towards a common qualification assessment/examination.
- The NMC stated that its role is to set standards and quality assure programmes rather than design curricula or set common examinations (DHSC and NHS England implementation update provided to the Thirlwall Inquiry, April 2025).
- Updated pre-registration standards were published in 2018 and 2019 which the NMC stated negate the need for a specific aptitude test (NMC Standards for Pre-registration Nursing Programmes, 2018).
- No further published evidence of a common national qualification assessment for nursing has been identified since 2019.
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. The NMC considered this recommendation in line with its core role to regulate. In terms of assessment and examination, its role is to set and promote high education and professional standards for nurses and midwives across the UK, and nursing associates in England and quality assure their education programmes. It does not design or set curricula or, for example, have degree awarding powers. With this in mind the NMC looked at the implications of setting an 'aptitude test'. This involved reviewing best practice across the sector and similar regulatory tests used by other professional regulators. Research showed that aptitude testing in this area could be beneficial. Given the size of our register, the number of students involved (at the time c100,000 students) and NMC priorities at that time, affordability, scalability and cost to applicant / registrant were recognised as substantial barriers. Furthermore, the NMC recognised that the aptitude test failed to take account of the fact that for its students 50 per cent of learning takes place in theory and 50 per cent takes place in practice. Stakeholder feedback also supported its decision that this was not the right thing to do. In 2016 the NMC undertook a comprehensive review of standards. Its pre-reg standards were updated in 2018 and 2019 which emphasise the importance of compassionate and person-centred care – its programme learning outcomes must reflect these, which students must meet in order to join our register - thereby negating the need for a specific aptitude test in this area. The NMC continues to regularly review its Code, standards and regulatory requirements as part of its governance cycle. The NMC's role in relation to assessment and examination, is to set and promote high education and professional standards for nurses and midwives across the UK, and nursing associates in England and quality assure their education programmes. It does not design or set curricula or, for example, have degree awarding powers. The NMC continues to regularly review its Code, standards and regulatory requirements as part of its governance cycle. Please see our response to recommendation 187 for update on the NHS Long-term workforce plan.
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.