Recommendation F202: Strengthening the nursing professional voice
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Recognition of the importance of nursing representation at provider level should be given by ensuring that adequate time is allowed for staff to undertake this role, and employers and unions must regularly review the adequacy of the arrangements in this regard.
In brief (written by this site)
In September 2024 commentary published in February 2026, the Department of Health and Social Care and NHS England noted that part 4, section 25 of the NHS Terms and Conditions Handbook relates to time off and facilities for trade union representatives (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team recorded that the government had accepted the recommendation as a matter for local employers and unions, endorsed by the Royal College of Nursing, UNISON, and NHS Employees (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.
About this summary
This recommendation applies across many organisations. The record reflects central policy activity; adoption in individual organisations may vary.
Government response
Accepted.
Implementation is a matter for local employers and unions. The Royal College of Nursing, UNISON and NHS Employers have endorsed this recommendation and will work with providers and commissioners to try to ensure that this is built into workforce and financial planning.
We will explore further models to strengthen recognition of nursing representation with the Social Partnership Forum, which is a forum for employer and staff representatives.
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)
The NHS Terms and Conditions Handbook, part 4 section 25 relates to time off and facilities for trade union representatives.
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 “Implemented - Ongoing”. Table row: section 18.2 No. 202, PDF page 527-528.
Department of Health and Social Care says in progress (11 February 2015)
The issues raised in Recommendation 202 – and the Government response – have been discussed in the Social Partnership Forum Francis Working Group. The working group included representatives from trade unions, including the Royal College of Nursing, UNISON and NHS Employers. The group felt that professional representation, not just nursing, was important at all levels of partnership working. The working group recognised the value of partnership working in the drive to improve quality and patient safety and it asked the Regional Social Partnership Forums to identify examples of effective partnership working which will be promoted on the Social Partnership Forum website.
Although the group has now completed its work; it agreed that implementation and the development of further models would be best served locally by employers and unions.
Case studies of effective partnership working can be found online.
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 healthcare providers, 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.
The tracker describes this as a long-term recommendation: systemic or cultural, with no single completion point.
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 Government’s position (per the January 2014 Hard Truths Report) was that this was a matter for local employers and unions.
The Royal College of Nursing, UNISON and NHS Employees each endorsed the recommendation.
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. 202, PDF page 490.
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