Hygiene
All staff and visitors need to be reminded to comply with hygiene requirements. Any member of staff, however junior, should be encouraged to remind anyone, however senior, of these.
- The Health and Social Care Act 2008 Code of Practice on the Prevention and Control of Infections (updated 2015) sets out 10 criteria against which CQC judges providers on compliance with infection prevention and control requirements. Providers must demonstrate compliance with Regulation 12(2)(h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Health and Social Care Act 2008 Code of Practice on IPC, DHSC).
- The National Infection Prevention and Control Manual (NIPCM) for England, first published April 2022 and regularly updated (latest version v2.12, July 2025), is the national standard for IPC. It covers standard and transmission-based precautions, including hand hygiene following the WHO "5 Moments" framework (NHS England, NIPCM).
- The manual and associated national hand hygiene policy explicitly support Francis's recommendation that all staff and visitors should comply with hygiene requirements and that any member of staff should be empowered to challenge non-compliance regardless of seniority — a principle embedded in the broader "freedom to speak up" culture promoted by NHS England.
- CQC assesses IPC compliance under its "safe" key question within the Single Assessment Framework, with specific quality statements on infection prevention and control. Individual trusts conduct hand hygiene audits, though there is no centrally published national aggregate compliance rate.
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.
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.