Clarity of values and principles
Mid Staffs Inquiry · Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · Issued 6 February 2013 · Addressed to: NHS
Source — verbatim from the inquiry
●Inquiry recommendation
All NHS staff should be required to enter into an express commitment to abide by the NHS values and the Constitution, both of which should be incorporated into the contracts of employment.
Mid Staffs Inquiry, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · 6 Feb 2013 Source PDF →
Published evidence summary
Publicly available evidence relating to this recommendation:
- The NHS Terms and Conditions, updated in August 2024, require that local appraisal policies for all staff are consistent with the NHS Constitution (NHS Terms and Conditions of Service Handbook, NHS Employers, August 2024).
- NHS England published the NHS Leadership Competency Framework for Board members in February 2024, which is based on six competency domains reflecting NHS values (NHS Leadership Competency Framework, NHS England, February 2024).
- The NHS Constitution was updated in July 2015 to incorporate duty of candour expectations (NHS Constitution for England, Department of Health, July 2015).
Sources
How was this evidence gathered?
Response — verbatim from government
●Department of Health and Social Care
The 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
Department of Health and Social Care · 19 Nov 2013 Written response →
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: Partially Implemented - Ongoing. No systematic arrangements were put in place through contractual terms, but all regulated health care professionals are required, by their regulators, to practice in a way that is consistent with professional values. These professional values are themselves consistent with the values of the NHS Constitution. The NHS Terms and Conditions (last updated August 2024) require that local appraisal policies are consistent with the NHS Constitution for England (para 53). This applies to all staff. For Board-level leaders, Regulation 5 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014, specifies that service providers must only appoint executive and non-executive directors if they comply with the Fit and Proper Persons requirements. In September 2024, NHS England published the Fit and Proper Person Test Framework to strengthen accountability and transparency for individual Board members. This framework is underpinned by the values set in the NHS Constitution. To support this, NHS England has developed the NHS Leadership Competency Framework for Board members (February 2024). This is based around six competency domains which reflect the NHS values. An independent evaluation is planned for 2025. Professional behaviours and values are further mandated by professional regulatory bodies, such as the Nursing and Midwifery Council. Source →
- 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
- 27 Jul 2015 · UK Government - NHS Constitution Updates NHS Constitution was updated in July 2015, incorporating duty of candour expectations and strengthened staff/patient rights. Constitution is reviewed every 10 years (most recent review 2023). Handbook revised to include more prominent reference to professional codes. View source → Confirmed Completed
- 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
- 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.
How this page is built
Source and Response are verbatim from primary documents. The Evidence trail records published activity since — written statements, consultation outcomes, inspection findings, parliamentary references. The Index does not paraphrase or characterise intent; it tracks what has been published. Where the evidence is the absence of action (a missed deadline, a slipped timetable), that absence is documented from primary sources rather than inferred.
This recommendation's data is verified periodically against primary sources. The Index is monitored for staleness weekly.