National standards
There should be national training standards for qualification as a registered nurse to ensure that newly qualified nurses are competent to deliver a consistent standard of the fundamental aspects of compassionate care.
- The NHS Long Term Workforce Plan includes work with regulators and education providers to review undergraduate degree programme structures (NHS Long Term Workforce Plan, NHS England, 2023).
- The Nursing and Midwifery Council launched a revalidation system on 1 April 2016, requiring all nurses to revalidate every three years to maintain registration (NMC Revalidation launch, Nursing and Midwifery Council, 1 April 2016).
- The Nursing and Midwifery Council published an updated Code of Professional Standards in March 2015, which included strengthened requirements for candour (The Code: Professional standards of practice and behaviour for nurses and midwives, NMC, March 2015).
- Academic research in 2023 found that while structural changes like revalidation were delivered, cultural change regarding the fear of speaking out remained inconsistent (Ten Years After Francis, Academic Review, 6 February 2023).
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: Implemented - Closed. The Nursing and Midwifery Council (NMC) undertake Education quality assurance (EdQA) to make sure that the education programmes for nurses, midwives and nursing associates meet the standards needed to prepare them to join their register. Please see response to recommendation 152 for information on NHS England's Education Quality Framework programme. The NHS Long Term workforce plan sets out NHS work with regulators, education providers and students to review the structure of undergraduate degree programmes.
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.