Shared code of ethics
A common code of ethics, standards and conduct for senior board-level healthcare leaders and managers should be produced and steps taken to oblige all such staff to comply with the code and their employers to enforce it.
- The Code of Conduct for NHS Managers was issued in October 2002 under the Code of Conduct for NHS Managers Directions 2002, originally developed in response to the Bristol Royal Infirmary Inquiry. It sets out core standards of conduct including the Nolan Principles on Conduct in Public Life, but has not been substantially updated since 2002.
- The NHS Constitution (first published 2009, most recently updated 2024) includes pledges to staff and sets out expectations of managers, but does not constitute a dedicated professional code for senior board-level healthcare leaders with enforcement mechanisms.
- On 26 November 2024, the government launched a consultation "Leading the NHS: Proposals to Regulate NHS Managers." The consultation response (July 2025) confirmed the government will bring forward secondary legislation for a statutory barring system for senior NHS leaders, operated by the Health and Care Professions Council (HCPC). 92% of 4,924 respondents agreed NHS managers should be regulated (Leading the NHS: Consultation Response, DHSC, July 2025).
- Draft legislation is subject to a further 3-month statutory consultation, with parliamentary laying anticipated in H2 2026. The statutory barring mechanism will apply to board-level leaders and their direct reports, partially fulfilling this recommendation 13 years after the Francis Report.
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.
Care Certificate launched 1 April 2015 as standardised induction training for all new healthcare assistants and social care support workers. Covers 15 standards (updated to 16). Implements recommendations from Cavendish Review (July 2013) and Francis Report on healthcare support worker training.
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.