Putting the patient first

Source — verbatim from the inquiry

Published evidence summary

Response — verbatim from government

Evidence trail — what's actually happened since

• 1 Apr 2025 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 Constitution provides that the NHS aspires to the highest standards of excellence and professionalism and to provide high quality care that is safe, effective and focused on patient experience. The Constitution sets out the six core NHS values. These include a commitment to quality of care and working together for patients. NHS values and standards are set at the highest level by the Department of Health and Social Care through the NHS Constitution and the Government's Mandate to NHS England. Leaders at all levels and across all organisations operating within the NHS are expected to model and embed these values. NHS England seeks to support and enable this nationally through training and development initiatives, as well as through its regional offices in the form of more localised support for providers. NHS England has a continuing focus on enhancing the offering for learning and development. Other recent developments include the publication of the Directory of Board level learning and development opportunities which sits as part of the NHS England Fit and Proper Person Test Framework for board members. In addition, the NHS England Culture and Leadership programme provides tools to enable individual Trusts to understand and improve their culture. The NHS staff survey and NHS People Pulse now provide a consistent and standardised framework to understand, measure and improve employee experience. Results are publicly available. Source →
• 6 Feb 2026 · NHS England / Department of Health The NHS Constitution was updated and values of transparency, honesty and candour were formally embedded. Duty of candour became law. Freedom to Speak Up Guardians were created. However, Francis himself said in February 2023 (10th anniversary) that NHS culture 'has not changed very much' and described the current NHS crisis as 'the Mid Staffordshire scandal playing out on a national level.' Subsequent scandals at Shrewsbury and Telford, East Kent, Nottingham, and the Countess of Chester (Lucy Letby) demonstrated persistent culture failures. View source → Reasonable Progress
• 26 Nov 2024 · DHSC - Duty of Candour Review DHSC published findings of call for evidence on statutory duty of candour. 261 responses received. Key finding: 52% of respondents said CQC had not adequately enforced the duty. Many reported it had become a "tick-box exercise". Only 40% thought the purpose was clear and well understood. Final government response still pending. View source → Reasonable Progress
• 6 Feb 2023 · Academic Review - Ten Years After Francis 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. View source → Reasonable Progress
• 11 Feb 2015 · UK Government - Culture Change in 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. View source → Good Progress
• 27 Nov 2014 · Legislation - Duty of Candour (Regulation 20) Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 20: statutory duty of candour came into force for NHS trusts November 2014, extended to all CQC-registered providers April 2015. Requires providers to notify patients/families of notifiable safety incidents and apologise. View source → Confirmed Completed
• 19 Nov 2013 · UK Government - Hard Truths Vol 1 & 2 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. View source → Good Progress

Each entry above links to a primary source — gov.uk written statement, consultation response document, or inspection report. The Index does not characterise government intent; it tracks what has been published.