F188

Aptitude test for compassion and caring

Mid Staffs Inquiry · Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · Issued 6 February 2013 · Addressed to: NMC

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

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

Recommendation, verbatim from the inquiry

●Inquiry recommendation

The Nursing and Midwifery Council, working with universities, should consider the introduction of an aptitude test to be undertaken by aspirant registered nurses at entry into the profession, exploring, in particular, candidates' attitudes towards caring, compassion and other necessary professional values.

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

The Inquiry asked the Nursing and Midwifery Council to consider an aptitude test for compassion. The Department of Health and Social Care (DHSC) and NHS England, in commentary of September 2024 published in February 2026, reported that the regulator reviewed entry criteria and updated pre-registration standards to emphasise compassionate care, concluding that these requirements "negate the need for a specific aptitude test" (DHSC and NHS England, Feb 2026). Earlier, the Thirlwall Inquiry legal team found in May 2024 that no aptitude test appeared to have been established for nurses trained in England (The Thirlwall Inquiry legal team, May 2024).

AI-generated summary of the record on this page, checked by a second model and automatic checks, 1 Oct 2026.

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 in part · 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 in principle.
The Government’s Mandate to Health Education England contained a requirement to ensure that selection into all new NHS funded training posts incorporates testing of values. In addition, NHS England is working with Health Education England and NHS Employers to support the introduction of values-based recruitment and appraisal for all registered and unregistered staff.
We believe that placing a strong emphasis on values at the outset of training potential staff is vital to embed the principles of compassion and caring from the very beginning in those who will one day provide care to patients. It is essential that the staff of tomorrow are able to demonstrate not only academic and technical ability, but also that they have the values of kindness and compassion that are needed to care for patients in an emotionally demanding environment.
The Nursing and Midwifery Council introduced new education standards in 2010. These require students to be tested for aptitude in literacy, numeracy and communication skills and assessed as to health and good character on admission to programmes. Students must also pass all assessments at every progression point before they complete their programmes and be assessed for good health and good character as to their fitness for award and fitness to practice. Education programmes are half theory, half practice, and education and training takes place as a partnership between a university and practice environment. Students must meet all theory and all practice requirements to complete a programme, and there is no facility to compensate for poor performance in one area with strong performance in the other.
The Nursing and Midwifery Council’s standards for competence reinforce this, identifying the knowledge, skills and attitudes students must acquire by the end of their programme. For example, students must ‘practise in a holistic, non-judgmental, caring and sensitive manner that avoids assumptions, supports social inclusion, recognises and respects individual choice and acknowledges diversity’.
The Nursing and Midwifery Council has committed to undertaking a full evaluation of its new education standards, commencing in 2014, and will have particular regard to issues of caring and compassion. This will give the Nursing and Midwifery Council an evidence base for any further revisions to these new standards, including the need for an aptitude test.

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 partially delivered · 27 Feb 2026

has undertaken a number of reviews into the need for aptitude test and entry criteria. It has updated standards for pre-registration nursing and midwifery programmes in 2018 and 2019, and again in 2023. Both updates state that programme learning outcomes must reflect the standards of proficiency, which in turn emphasise the importance of compassionate and person-centred care.

The NMC provide guidance on health and character for approved education institutions. This requires that all student nurses, midwives and nursing associates seeking registration to be of good health and good character to satisfy to the NMC that they are capable of safe and effective practice.

The NMC Code of Standards requires registrants and applicants to maintain a level of health needed to carry out their professional role. Health and character is considered on an ongoing basis as part of NMC revalidation process

The pre-registration standards which students must meet in order to join the NMC register negate the need for a specific aptitude test.

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 “Partially Implemented – Closed”. Table row: section 18.2 No. 188, PDF page 520.

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

NHS Employers is working on a Values Based Recruitment project in partnership with Health Education England, to ensure that staff who are recruited into the NHS are recruited for values, to deliver the best possible care for patients. This includes a number of resources to support employers including good practice case studies and a model policy. Further resources including case studies and podcasts will continue to be developed during this financial year.

The Nursing and Midwifery Council has commenced the evaluation of their standards for pre-registration education for nurses and midwives. Central to the evaluation are questions about the effectiveness of standards in preparing nurses and midwives for their professional roles and responsibilities which include care, compassion and leadership. The Nursing and Midwifery Council is in the final stages of appointing an independent evaluation supplier and they will proactively share any interim findings with Health Education England to tie into the Shape of Caring Review. The Nursing and Midwifery Council’s final report should be available in September 2015. The outcomes of the evaluation will provide an evidence base for future reviews of their pre-registration standards for education so that they can, where necessary, enhance the UK standards for nurse and midwifery competence and education.

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.

Site note: The Inquiry addressed this recommendation to the Nursing and Midwifery Council, not to the Department of Health. The annex gives this update in the Department's publication and does not say who wrote it, so the row is the Department's report of the progress made on it.

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 principle.

The January 2014 Hard Truths report said that the Nursing and Midwifery Council had introduced new education standards (these were introduced in 2010, with all universities required to be compliant by September 2013), requiring students to be tested for aptitude in literacy, numeracy and communication skills, and assessed as to health and good character on admission to programmes. Students would be required to pass all assessments at every progression point before they completed their programmes and be assessed for good health and good character as to their fitness for award and fitness to practice.

It does not appear an aptitude test was introduced for nurses trained in England.

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. 188, PDF page 483-484.

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.