F198

Measuring cultural health

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

Government responseDepartment of Health and Social Care: Accepted (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

Healthcare providers should be encouraged by incentives to develop and deploy reliable and transparent measures of the cultural health of front-line nursing workplaces and teams, which build on the experience and feedback of nursing staff using a robust methodology, such as the "cultural barometer".

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 recommended incentivising healthcare providers to measure the cultural health of nursing workplaces. In commentary of September 2024, published in February 2026, the Department of Health and Social Care (DHSC) and NHS England stated that the National Health Service (NHS) staff survey and NHS People Pulse provide a standardised framework to measure employee experience, with results publicly available (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team found that a guide on implementing the culture barometer was published in April 2017, but noted that it was unclear what incentives, if any, were implemented (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.

About this summary
This recommendation applies across many organisations. The record above reflects central policy activity; adoption in individual organisations may vary.

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.
Both teams and organisations should develop ways to measure their cultural health, and act on these measures to improve. Cultural health is a matter for all staff groups; everybody who works in the health and care system is integral to improving and maintaining good cultural health. Many tools and methods are available and the Department of Health and other arm’s length bodies are promoting these. For example, the Cultural Barometer, which was highlighted as a case study in the Government’s initial response to The Inquiry, Patients First and Foremost, is being developed and piloted. The National Nursing Research Unit at Kings College London are evaluating the pilot and are expected to publish their report in November 2013. NHS England supports the use of tools such as the cultural barometer and real time staff experience feedback. The friends and family test for staff will be rolled out from April 2014.
The Chief Nursing Officer is providing leadership through Compassion in Practice, the vision and strategy for nursing in England. Key action areas include:
• developing a set of tools that enable organisations to measure their culture;
• providers undertaking a review of their organisational culture and publish the results;
• reviewing implementation of the cultural barometer once pilots have taken place;
• strategies to secure meaningful staff engagement;
• commissioning leadership role (build into Action Area 4 in Compassion in Practice); and
• commissioning an approach to ensure that staff feedback is being used to develop cultural health of front-line staff.

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

The NHS staff survey and NHS People Pulse now provide a consistent and standardised framework to understand, measure and improve employee experience. Results are publicly available.

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 – Ongoing”. Table row: section 18.2 No. 198, PDF page 526.

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

Promoting positive and learning cultures remains critical to supporting service improvement. The Staff Friends and Family Test was introduced in April 2014. It is a feedback tool for staff, predominantly for local improvement work. It consists of two questions (with options to give free text feedback for each) through which organisations can take a temperature check of how staff are feeling. It is a quicker feedback mechanism than the existing NHS annual staff survey, and will help staff to voice their concerns (on a regular basis if they wish to) and help organisations to respond. Following the first pilot phase of the cultural barometer by King’s College London, further work has taken place in two community and mental health sites to develop the tool further. Piloting will be complete by the end of the year and work is now underway to consider how best to make the barometer accessible and enable uptake. Further information on the barometer is available online.

The Social Partnership Forum produced guidance on staff engagement and partnership working and highlights areas of excellence in NHS organisations where management and trade union representatives work together effectively to identify and resolve issues. The need for this guidance was indicated in Hard Truths and builds on the six key messages developed by the forum to support the development of the values, culture and working environment in the NHS that would best ensure that patients receive safe, effective and compassionate care.

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 healthcare providers, 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 its January 2014 Hard Truths repot, the Government said that the Department of Health was promoting various tools and methods to maintain good cultural health. T

In the February 2015 Culture Change report, the Government said that the Staff Friends and Family Test was introduced in April 2014, providing a feedback tool for staff. Piloting was carried out for the “Culture of Care Barometer”, which resulted in the publication of a guide for how organisations could implement the Barometer in April 2017.

It is unclear what, if any, incentives were implemented.

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. 198, PDF page 488-489.

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.