Strengthening the nursing professional voice
A forum for all directors of nursing from both NHS and independent sector organisations should be formed to provide a means of coordinating the leadership of the nursing profession.
- The Health and Care Act 2022 mandates that each of the 42 Integrated Care Boards must include a Chief Nurse (Health and Care Act 2022, July 2022).
- A Chief Nurse for Adult Social Care was established within the Department of Health and Social Care (Chief Nurse for Adult Social Care role profile, DHSC, 2021).
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe 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 Reviewed extent of implementation: Superseded. The Chief Nursing Officer (CNO) for England is responsible for providing clinical and professional leadership for all nurses, midwives and nursing associates across health and social care in England (including the independent sector). Since last November, the CNO has since last November taken on professional responsibility for public health nursing. There is also a Chief Nurse for Adult Social Care based in the Department for Health and Social Care, and currently a Deputy Chief Nurse for Public Health. NHS England's CNO is supported by the chief midwifery officer, four deputy chief nursing officers and seven regional chief nurses. The 42 Integrated Care Boards are also required to have a Chief Nurse. To support cross-system working, there are also 42 ICB Chief Nurses. The CNO for England also provides clinical and workforce advice to the NHS and the board of NHS England, and to ministers and officials in the Department of Health and Social Care on relevant issues. Each of NHS England's seven regions also has a Regional Chief Nurses in place who provide professional leadership and a source of support for nurses and midwives in their area, alongside other duties. Regular networking opportunities will be provided as part of this activity.
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.
Tom Kark QC reviewed the Fit and Proper Person Test in 2019 and found it essentially "does not ensure directors are fit for the post they hold, and does not stop the unfit from moving around the system." NHS England published updated FPPT Framework effective 30 September 2023 requiring standardised board-level assessments.
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.
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 5: Fit and Proper Person Requirement came into force November 2014. Requires providers to ensure directors meet fitness requirements including good character, qualifications, competence. CQC can require removal of directors.
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.