Recommendation R4: No nursing employment where major personality disorder
From The Allitt Inquiry Report, published 11 February 1994.
Recommendation
We recommend that no candidate for nursing in whom there is evidence of major personality disorder should be employed in the profession (para 5.4.11)
Government response
Guidance on occupational health is to be issued shortly which will cover all these recommendations. Together with the English National Board's new guidelines, this guidance will establish better procedures for selection of student nurses for training, the selection of staff to work on children's wards and the follow up of staff who have a history of excessive absence through sickness.
Delivery
DHSC and NHS England state no delivery position (27 February 2026)
As set out in Recommendation 1, this recommendation has been superseded, including by legislative changes, particularly in this context the Equality Act 2010, the Data Protection Act 2018 and the UK General Data Protection Regulation.
The NHS Terms and Conditions of Service Handbook (as revised February 2024) requires that employee health and wellbeing is monitored and reviewed on a regular basis (35.47). This handbook is published on the NHS Employers website. It is amended whenever new agreements are reached in the NHS Staff Council.
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 Their reviewed extent of implementation reads “Superseded”. Table row: section 3.2 No. 4, PDF page 15.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
In November 1994, the Secretary of State for Health said that guidance on occupational health was to be issued shortly to cover this recommendation. The Secretary of State said that, together with the English National Board’s new guidelines, this guidance would establish better procedures for selection of student nurses for training, the selection of staff to work on children’s wards and the follow up of staff with a history of excessive absence through sickness.
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 3.2 No. 4, PDF page 15.
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding