Practical hands-on training and experience

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: Partially implemented - Closed. While the NMC understood the basis for this recommendation, it was their position that these concerns had been addressed through the introduction of the UK-wide pre-registration education standards for nurse and midwives since. Under these changes, all education programmes last at least three years and require 50 percent of time to be spent in practice learning and 50 percent in academic study. The first progression point cannot be passed unless the student takes a period of practice learning and assessment. The NMC felt that this met the spirit of the recommendation. Whilst its requirements for practice learning remain the same today, the NMC have kept these under regular review, ensuring they reflect best available evidence, and that people are safe and fit to practise at the point of entry. In particular, in July 2014 the NMC commissioned IFF Research to evaluate its pre-registration standards. With regards to practice-based learning, this identified a broad consensus that the split between academic and practice-based elements of undergraduate programmes is appropriate so long as the quality of placements (and mentorship) is high and effectively facilitates the attainment of skills. Whilst some stakeholders wanted to see an increased emphasis on practice, pushing it up closer to 60-70%, it was acknowledged that this is unlikely to be feasible in a context of limited placement opportunities as well as limited mentor numbers. A further review of the NMC's education and training standards was undertaken in September 2021. Considering the number of academic theory and practice hours, the review found that there is no agreement on the type, quality or quantity of hours necessary. In 2022 the NMC also undertook specific research to understand more about practice hours in other countries and whether alignment with EU law is appropriate. This found that the number of practice hours were often lower in other countries when compared to the UK, but that this was a result of political or pragmatic reasons as opposed to evidence on the number of hours required for safe and effective practice. All sets of research provided us with assurance as to the level of practice hours set. The NMC's education standards were updated in 2023 following the UK's withdrawal from the EU. The amount of practice learning hours remains the same - all education programmes must meet the equivalent minimum length of three (academic) years for full time programmes which consist of a minimum of 4,600 hours. 50 percent of time (2,300 hours) must be spent in practice learning, of which a maximum of 600 hours can be simulated practice learning. The number of practice learning hours are in line with those mandated by EU law. The NMC first introduced emergency standards during covid to allow education institutions to deliver a proportion of practice learning through simulation. Following extensive review, the NMC has made this a permanent standard in recognition that simulated practice learning methods are becoming increasingly sophisticated and help students build their confidence and skills in a range of situations they may not otherwise encounter frequently in practice. Following changes made to its education programme standards in 2023, the NMC has committed to reviewing its nursing and midwifery practice learning to ensure requirements support students to deliver the best possible person-centred care for people across a range of practice learning environments. This will also consider how changes to simulated practice learning are being delivered. 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
• 1 Apr 2016 · NMC - Nursing Revalidation NMC Revalidation launched 1 April 2016 in direct response to Francis Report. All nurses and midwives must revalidate every three years. Replaced the Post-Registration Education and Practice system. Updated NMC Code published March 2015 strengthened requirements around candour and raising concerns. View source → Confirmed Completed
• 31 Mar 2015 · NMC - Updated Professional Code (2015) NMC published updated Code of Professional Standards for nurses and midwives (March 2015). Standard 14 specifically requires nurses and midwives to be open and candid with all service users about all aspects of care, including when mistakes or harm have occurred. 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.