Strengthening the nursing professional voice
The effectiveness of the newly positioned office of Chief Nursing Officer should be kept under review to ensure the maintenance of a recognised leading representative of the nursing profession as a whole, able and empowered to give independent professional advice to the Government on nursing issues of equivalent authority to that provided by the Chief Medical Officer.
- The Chief Nursing Officer for England role has been maintained as a senior leadership position within NHS England and the Department of Health and Social Care. Dame Ruth May held the role from 2019 to 2024 and was succeeded by Duncan Burton, appointed on 25 July 2024 (CNO Appointment, NHS England, July 2024).
- The CNO is supported by a Chief Midwifery Officer, four Deputy Chief Nursing Officers, and seven Regional Chief Nurses, providing a structure for national professional nursing leadership. The CNO office leads on workforce policies, patient safety, and professional standards for approximately 373,000 NHS nurses and midwives (Chief Nursing Officer for England, NHS England).
- The CNO Policy Network, established in 2019, enables registered nurses, midwives, and nursing associates to engage with and influence healthcare policy. The CNO also chairs the CNO Summit, an annual national event for directors of nursing, and participates in the Social Partnership Forum (CNO Policy Network, NHS England, 2019).
- The NHS Long Term Workforce Plan (June 2023) references the CNO's role in leading the nursing workforce strategy, including targets to expand nursing training places by 92% by 2031/32 (NHS Long Term Workforce Plan, NHS England, June 2023).
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
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.
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.
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.