Training and training establishments as a source of safety information

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. In 2014 the GMC began including more patient safety questions in its National Training Survey (NTS). The questions ask how participants feel that concerns raised in their responses to the survey will be addressed and how that information will allow local providers to identify patient safety problems that may not have been reported. All the concerns raised with the GMC are bought to the attention of local education and training boards (LETBs), deaneries and local education providers to investigate further and take action where needed. The changes made are then reported back to the GMC. The GMC routinely shared published information about the fitness to practise of individual doctors and the quality of medical education and training with the CQC. Some examples of current routine information sharing include: • Information provided by the GMC for CQC inspection activity, including data from the GMC's annual national training survey, primarily through provision of the Regulator / Designated Body Dashboard. • The GMC shares its monthly summary on enhanced monitoring with the CQC. This lists all organisations delivering medical education or training where the GMC's Education team has active concerns, has set conditions on approval, or is preparing to remove approval from a training environment. The GMC also shares emerging and urgent concerns with the CQC, and other health and social care regulators, through the Emerging Concerns Protocol. The protocol is an agreement to provide a mechanism for organisations with a role in the quality and safety of care provision to share information that may indicate risks to people who use services, their carers, their families, or healthcare professionals. Areas of information sharing include: concerns about individuals or groups of professionals; concerns about healthcare systems and the healthcare environment (including the learning environments of professionals); and concerns that might have an impact on trust and confidence in professionals or the healthcare professions generally. NHS England The National Education Training Survey (NETS) is the only national survey open to all undergraduate and postgraduate students and trainees undertaking a practice placement or training post in healthcare as part of their education and training programme. This includes profession specific questions for student nurses, student midwives, allied health professional learners, pharmacy learners, healthcare science trainees, paramedicine learners, doctors and dentists in training, and independent learners. These were last reviewed in October 2023. Health Education England has now merged with NHS England. Source →
• 15 Oct 2024 · DHSC - Penny Dash Review of CQC Penny Dash Review (commissioned May 2024) found significant failings at CQC. Health Secretary declared CQC "not fit for purpose". Key findings: one in five services never rated; inspection levels well below pre-pandemic levels; lack of specialist inspector expertise; 5,000 notification-of-concern backlog. CQC consulting on resetting its approach from October 2025. View source → limited_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
• 1 Jul 2022 · Legislation - Integrated Care Boards (Health and Care Act 2022) Clinical Commissioning Groups replaced by 42 Integrated Care Boards from 1 July 2022 under Health and Care Act 2022. ICBs have broader responsibilities for population health, bringing together NHS organisations, local authorities and partners. Implements some Francis recommendations on commissioning integration. 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
• 7 Nov 2014 · Legislation - CQC Fundamental Standards New "Fundamental Standards" replaced previous CQC registration requirements from 7 November 2014. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 introduced clearer minimum standards including: person-centred care (Reg 9), dignity (Reg 10), safe care (Reg 12), staffing (Reg 18), good governance (Reg 17), fit and proper persons (Reg 5), duty of candour (Reg 20). View source → Confirmed Completed
• 1 Oct 2014 · CQC - New Inspection Regime CQC overhauled its inspection regime in response to Francis. Professor Sir Mike Richards appointed as first Chief Inspector of Hospitals (July 2013). New methodology based on five key questions (Safe, Effective, Caring, Responsive, Well-led) rolled out nationally October 2014. Four-tier ratings introduced (Outstanding/Good/Requires Improvement/Inadequate). Specialist expert-led inspection teams replaced generalist compliance model. 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
• 3 Dec 2012 · GMC - Medical Revalidation GMC medical revalidation launched December 2012. All licensed doctors must demonstrate fitness to practise every five years through appraisal and evidence. Francis Report endorsed and recommended strengthening revalidation. View source → Confirmed Completed

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.