Recommendation F196: Nurse leadership
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The Knowledge and Skills Framework should be reviewed with a view to giving explicit recognition to nurses' demonstrations of commitment to patient care and, in particular, to the priority to be accorded to dignity and respect, and their acquisition of leadership skills.
In brief (written by this site)
In commentary provided in September 2024, the Department of Health and Social Care and NHS England stated that the recommendation had been superseded, noting that the Knowledge and Skills Framework is no longer updated by NHS Employers and that an improved national appraisal framework was scheduled to launch in 2025/26 (DHSC and NHS England, Feb 2026). Previously, in May 2024, the Thirlwall Inquiry legal team found that the framework was absent from a 2015 government update and that "it is unclear whether any review of the Framework was undertaken" (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.
Government response
Accepted.
Employers have the freedom to use the Knowledge and Skills Framework to develop their own local arrangements to ensure that dignity, respect and leadership is fully reflected in staff training and development and that capability, learning and development is part of local appraisal systems. This is made clear in the national Agenda for Change agreement which links pay progression mor strongly to performance from March 2013, for more than 1.1 million NHS staff. NHS Employers are already working hard to help employers realise the benefits of the new national agreement on performance.
The Department of Health will commission NHS Employers to encourage NHS organisations to strengthen their local knowledge and skills frameworks so that there is a clear line of sight between the NHS Constitution, the values and behaviours set out in the ‘6Cs’ of Compassion in Practice, the vision and strategy for nursing in England, and local values, performance and appraisal systems.
In addition, the Nursing and Midwifery Council’s standards for competence require nurses to demonstrate their potential to develop management and leadership skills during their period of preceptorship after registration and beyond. This means that the public can trust the newly registered nurse to be an autonomous and confident member of the multi-disciplinary or multi-agency team, and to inspire confidence in others. Nurses can then become more involved and responsible for the planning and delivery of care and improving future services. NHS Employers will encourage NHS organisations to make the necessary links with the work the Nursing and Midwifery Council is leading on revalidation as they develop new local performance and appraisal arrangements.
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 state no delivery position (27 February 2026)
The Knowledge and Skills Framework is no longer updated by NHS Employers. Please see recommendation 193 in respect of the annual appraisal of nurses.
NHS England has developed the NHS Leadership Competency Framework for Board members (February 2024), around six competency domains which reflect the NHS values. An independent evaluation is planned for 2025.
Planning is also taking place for an improved national appraisal framework for all staff, which is due to launch in 2025/26.
Please see response to recommendation 194 above on approaches to appraisal for all NHS staff.
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 “Superseded”. Table row: section 18.2 No. 196, PDF page 525.
Department of Health and Social Care says in progress (11 February 2015)
With Health Education England, NHS Employers has developed a mapping tool to allow local organisations to map their values to those in the NHS Constitution. NHS Employers has also produced guidance for employers linking pay progression, appraisal and performance management to values and commitment to patient care. This includes a number of resources to support employers including good practice case studies and a model policy. Further resources including case studies and podcasts will continue to be developed during the year.
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.
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.
In the January 2014 Hard Truths report, the Government said had the Freedom use the Knowledge and Skills Framework to develop their own local arrangements to ensure that dignity, respect and leadership is fully reflected in staff training and development and the same is part of local appraisal systems.
The Knowledge and Skills Framework was not mentioned in the 2015 Culture Change report and it is unclear whether any review of the Framework was undertaken.
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. 196, PDF page 487-488.
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