Recommendation F204: Strengthening the nursing professional voice
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
All healthcare providers and commissioning organisations should be required to have at least one executive director who is a registered nurse, and should be encouraged to consider recruiting nurses as non-executive directors.
In brief (written by this site)
In commentary published in February 2026, the Department of Health and Social Care and NHS England stated that trust and foundation trust boards, with limited exceptions, are required by regulation to include a nurse or midwife executive director, with governance assured under the Care Quality Commission's Well-led framework (DHSC and NHS England, Feb 2026). Previously, in May 2024, the Thirlwall Inquiry legal team noted that the recommendation was originally accepted only in part, observing that regulations required clinical commissioning groups to include a nurse on governing bodies though not necessarily at executive level (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 in part.
All provider organisations have at least one executive director who is a registered nurse. NHS England has the Chief Nursing Officer on its executive board, and director level (although not executive level) representation at area and regional team levels.
The National Health Service (Clinical Commissioning Groups) Regulations 2012 require clinical commissioning groups to have a nurse on their governing body, though not necessarily at executive level. This enables local flexibility. NHS England will consider the added value of, and mechanisms for, amending or strengthening the guidance for clinical commissioning groups on nurse leadership.
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)
Under regulation 4 of the National Health Service Trusts (Membership and Procedure) Regulations 1990/2024, aside from trusts which do not provide services directly to patients and those whose principal function is provide ambulance or patient transport services Trust and Foundation Trust Boards are both required to have a clinical (medical or dental) and a nurse/ midwife executive director.
Corporate governance is assured as part of the CQC’s Well-led framework.
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. 204, PDF page 528-529.
Department of Health and Social Care says in progress (11 February 2015)
NHS England is working with members of the Commissioning Nurse Leaders Network and the Royal College of Nursing to review the role of Clinical Commissioning Group nurses, including their leadership role.
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.
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 in part by the Government.
In the January 2014 Hard Truths report, the Government said that all provider organisations had at least one executive director who is a registered nurse and that NHS England had a Chief Nursing Officer on its executive board and director level (although not executive level) representation at area and regional team levels.
The Government referred to the National Health Service (Clinical Commissioning) Regulations 2012 as requiring clinical commissioning groups to have a nurse on their governing body, but not necessarily at executive level with the Government saying this enabled local flexibility.
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. 204, PDF page 491.
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