Recommendation F216: Leadership framework
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The leadership framework should be improved by increasing the emphasis given to patient safety in the thinking of all in the health service. This could be done by, for example, creating a separate domain for managing safety, or by defining the service to be delivered as a safe and effective service.
In brief (written by this site)
In February 2026, the Department of Health and Social Care and NHS England reported that the first competency of the Leadership Competency Framework focuses on safe and effective services, and noted that the Patient Safety Incident Response Framework is a contractual requirement under the NHS Standard Contract (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that the recommendation had been accepted and that a healthcare leadership model comprised of nine leadership dimensions had been published in November 2013 (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 asks for cultural or behavioural change, which is difficult to verify from published sources alone. The record reflects policy commitments rather than measured outcomes.
Government response
Accepted.
The NHS Leadership Academy is developing, with extensive stakeholder involvement, a new healthcare leadership model for the NHS. This will give due emphasis to leading for patient safety.
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)
Please see response to recommendation 215 above for detail on the Leadership Competency Framework and associate resources.
Competency 1 of this framework focuses on high quality and sustainable outcomes with a strong focus on safe and effective services. The NHS Patient Safety Strategy, published in July 2019 and updated in 2021, and 2023 sets out the co-ordinated, long term and whole system vision to continuously improve patient safety. The Strategy is in its fifth year of operation and has demonstrated success in implementing initiatives, hitting milestones and improving outcomes.
The Patient Safety Incident Response Framework, which forms part of the strategy, is a contractual requirement under the NHS Standard Contract and puts a strong focus on compassionate engagement and involvement of those affected by patient safety incidents, including patients, families and staff. Guidance is available.
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. 216, PDF page 535-536.
Department of Health and Social Care says in progress (11 February 2015)
The NHS Leadership Academy’s new healthcare leadership model for the NHS was published in November 2013. The Model is comprised of nine ‘leadership dimensions’ which set out the qualities that good leaders at all levels in the NHS should express. The importance of each dimension for an individual will vary based on the type of job they have, the needs of the people they work with, and the context of their role within their organisation
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 the NHS Leadership Academy, 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 by the Government.
In the January 2014 Hard Truths report, the Government said that the NHS Leadership Academy was developing a new healthcare leadership model for the NHS. This was published in November 2013, and comprised of nine leadership dimensions, setting out the qualities that it thought good leaders at all levels in the NHS should express.
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. 216, PDF page 496-497.
Source
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