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.
- DHSC and NHS England stated in April 2025 that an independent evaluation of the NHS Leadership Competency Framework is planned for 2025 (DHSC and NHS England implementation update provided to the Thirlwall Inquiry, April 2025).
- NHS England is leading work on a management and leadership framework that will include a Code of Practice for all leaders and managers (DHSC and NHS England implementation update provided to the Thirlwall Inquiry, April 2025).
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: Implemented - ongoing. The NHS Leadership Competency Framework for Board members, was published in February 2024 and has been designed around six competency domains to support the recently refreshed Fit and Proper Persons regime. This aligns to the already-established NHS Values as set throughout in the NHS Constitution, as well as our NHS People Promise, Our Leadership way, and the Seven Principles of Public Life. Compliance with the NHS Constitution is mandated via the NHS Standard Contract. An independent evaluation of the NHS Leadership Competency Framework is planned for 2025. Framework for all managers in all the NHS As set out in Recommendation 1, NHS England is also leading work on the co-development of a management and leadership framework, which will include a Code of Practice for all leaders and managers, standards and competencies at all defined levels of manager and a core curriculum to ensure all leadership and management training contains the most impactful elements as defined in the standards. This is being co-designed with key health and social care stakeholders, and engagement commenced over summer 2024, supported by a national steering group. Wider stakeholder engagement is planned over autumn/winter 2024/25. See also response to recommendation 79 and 81 on the FPPT.
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.