Strong nursing voice
The Department of Health and Nursing and Midwifery Council should introduce the concept of a Responsible Officer for nursing, appointed by and accountable to, the Nursing and Midwifery Council.
- The Chief Nursing Officer role remains the primary national leadership voice for the profession (Independent evidence report, NHS England / Department of Health, 6 February 2026).
- The Nursing and Midwifery Council launched its revalidation system on 1 April 2016 (NMC Revalidation launch, Nursing and Midwifery Council, 1 April 2016).
- An academic review in 2023 found that structural changes were largely delivered but cultural change was not fully embedded (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: Partially implemented – Closed. The appointment of Responsible Office was not introduced. The NMC has established a role who's responsibility is to look at the evidence which the registrant has collected for revalidation and 'confirms' that the revalidation requirements have been met. Please see response to recommendation 193 on the introduction of a revalidation system.
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 a strong nursing voice at all levels. The Chief Nursing Officer role remains prominent. Ward-level nursing leadership has been strengthened in some trusts. However, nursing shortages (approximately 40,000 nurse vacancies across England as of 2024) undermine the capacity for strong nursing leadership on wards.
View detailed findings
The structural recommendation has been addressed but chronic nursing shortages undermine its practical impact.
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.