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F3

Clarity of values and principles

Mid Staffs Inquiry · Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · Issued 6 February 2013 · Addressed to: Department of Health and Social Care

Government responseDepartment of Health and Social Care: Accepted (Nov 2013)

DeliveryDHSC and NHS England say completed (Feb 2026)Department of Health and Social Care says in progress (Feb 2015)

Recommendation, verbatim from the inquiry

●Inquiry recommendation

The NHS Constitution should be the first reference point for all NHS patients and staff and should set out the system's common values, as well as the respective rights, legitimate expectations and obligations of patients.

Mid Staffs Inquiry, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · 6 Feb 2013 Source PDF →

Published evidence summary

AI-generated evidence summary

In September 2024 commentary published in February 2026, the Department of Health and Social Care and NHS England stated that implementation was complete, noting that the NHS Constitution was updated in August 2023 and healthcare providers are required under standard contract terms to take account of it in their decisions (DHSC and NHS England, Feb 2026). Previously, in May 2024, the Thirlwall Inquiry legal team noted that Health Education England maintained a values hub to support understanding of the constitution alongside earlier guidance on patient feedback (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.

About this summary
This recommendation asks for cultural or behavioural change, which is difficult to verify from published sources alone. The record above reflects policy commitments rather than measured outcomes.

Report-level response context

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.

Government response

●Department of Health and Social Care · Accepted · 19 Nov 2013

Speaker not recorded. Source: Department of Health, Hard Truths: the Journey to Putting Patients First, volume 2 (Cm 8777-II), November 2013

Accepted.
We agree that the NHS Constitution should be the central reference point for all NHS patients and staff. The Constitution sets out principles and values to guide the NHS, as well as rights, pledges and responsibilities for patients and staff, and it has a powerful role to play in shaping the culture of the NHS. The Secretary of State for Health, all NHS bodies, private and voluntary sector providers supplying NHS services, and local authorities (in the exercise of their public health functions) are required by law to take account of the NHS Constitution in their decisions and actions. NHS England and clinical commissioning groups and Health Education England also have a legal duty to promote the Constitution.
We recognise that levels of awareness of the Constitution are low among patients, the public and staff, and that we must raise the profile of the Constitution if it is to genuinely become the first reference point for patients and staff. To achieve this, the Department of Health, NHS England, Health Education England and clinical commissioning groups are working with relevant partners to embed and promote the Constitution across the system. The Department of Health is also developing options to increase the impact of the Constitution so that patients and the public understand their rights and responsibilities and are clear about what to do when their expectations are not met.

Response document: Hard Truths: The Journey to Putting Patients First. Volume Two of the Government Response to the Mid Staffordshire NHS Foundation Trust Public Inquiry: Response to the Inquiry's Recommendations

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.

Delivery

●DHSC and NHS England say completed · 27 Feb 2026

The NHS Constitution was last updated in August 2023. Under the terms of the NHS Standard Contract (SC1), all NHS bodies and private and third sector providers supplying NHS services are required take account of the constitution in their decisions and actions.

From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025)

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 - Closed”. Table row: section 18.2 No. 3, PDF page 424-425.

●Department of Health and Social Care says in progress · 11 Feb 2015

The Department of Health sought advice from an independent Expert Advisory Group about how to increase impact and raise awareness of the NHS Constitution amongst the public and patients. On 13 March 2014 the Expert Advisory Group published its advice in a report to the Secretary of State for Health and relevant system bodies, outlining how to embed and strengthen the impact of the NHS Constitution within the system. For example, the Department of Health has published a new guide which helps patients and the public understand how to give feedback and make complaints if the standards described in the NHS Constitution are not met. The Department will continue working with key partners to consider ways to increase the impact of the NHS Constitution

From: Culture Change in the NHS supporting Annex (annex to Culture change in the NHS: applying the lessons of the Francis Inquiries)

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.

The tracker describes this as a long-term recommendation: systemic or cultural, with no single completion point.

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 it recognised that levels of awareness of the NHS Constitution were low among patients, public and staff. The Government referred to work by the Department of Health, NHS England, Health Education England and clinical commissioning groups to promote the NHS Constitution across the system. The Department of Health said it sought advice from an independent expert advisory group about how to increase impact and raise awareness of the NHS Constitution amongst the public and patients. Their advice was published in a report to the Secretary of State for Health and other relevant bodies on 13 March 2014. The Department of Health said it published a guide to help patients and the public understand how to give feedback and make complaints if standards described in the NHS Constitution were not met.

Health Education England hosts a ‘NHS constitutional values hub’ the aim of which is to collect best practice and resources to help healthcare staff and organisation better understand the NHS Constitution.

The Department of Health said it would continue working with key partners to consider ways to increase the impact of the NHS Constitution.

From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024)

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. 3, PDF page 384-385.

How this page is built

The recommendation and the government responses are verbatim from primary documents. Delivery statements and other bodies' findings are shown in their own words, each with its source. The summary is written by this site and labelled as such. The Index does not paraphrase sources or characterise intent; it records what has been published.