Recommendation F201: Strengthening the nursing professional voice
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The Royal College of Nursing should consider whether it should formally divide its "Royal College" functions and its employee representative/trade union functions between two bodies rather than behind internal "Chinese walls".
In brief (written by this site)
In February 2026, the Department of Health and Social Care and NHS England reported that while the Royal College of Nursing had sought to delineate its roles, it continues to act as both a trade union and a professional body (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that although the government accepted the recommendation, the college had decided in July 2013 against splitting its functions (The Thirlwall Inquiry legal team, May 2024). The department had previously affirmed in November 2013 that the college viewed its dual responsibilities as complementary and chose to remain a single entity (Department of Health response, Nov 2013).
Sources
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
The Royal College of Nursing has given careful consideration to whether it should split its trade union and professional functions and has decided that it should not. The Royal College of Nursing believes it is stronger as one organisation.
In its dual role, it believes that the elements are complementary to one another and make it a stronger organisation. It believes that trade union work is not simply consigned to fighting for better pay awards. Instead, it focuses on building a positive working environment for staff – and in healthcare that can have a direct impact on the quality of care delivered to patients.
The Government believes the separation of the Royal College of Nursing’s professional and trade union roles, which are both important, would enhance the authority of its work, so that those outside the profession would know when they were speaking in the interests solely of patients and when they were speaking solely in the interests of their members.
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 say in progress (27 February 2026)
While RCN has taken steps to seek to delineate these roles it continues to act both as a trade union and a professional body.
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 “Not yet actioned”. Table row: section 18.2 No. 201, PDF page 527.
Department of Health and Social Care states no delivery position (11 February 2015)
No further update is required. Please see response to the recommendation in Hard Truths
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.
Site note: The Inquiry addressed this recommendation to the Royal College of Nursing, not to the Department of Health. The annex gives this update in the Department's publication and does not say who wrote it, so the row is the Department's report of the progress made on 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.
The Royal College of Nursing considered the proposal in its July 2013 response, but decided it would not split its trade union and professional functions.
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. 201, PDF page 490.
Source
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