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F205

Strengthening the nursing professional voice

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

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

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

Recommendation, verbatim from the inquiry

●Inquiry recommendation

Commissioning arrangements should require the boards of provider organisations to seek and record the advice of its nursing director on the impact on the quality of care and patient safety of any proposed major change to nurse staffing arrangements or provision facilities, and to record whether they accepted or rejected the advice, in the latter case recording its reasons for doing so.

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

In commentary published in February 2026, the Department of Health and Social Care and NHS England stated that provider trust boards are required to include an executive nurse or midwife director, subject to narrow exceptions, alongside a 2023 governance code on managing risk (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team previously found in May 2024 that although the recommendation was accepted in principle, it remained unclear whether NHS England ever required nursing and medical directors to sign off on staffing changes and service provision (The Thirlwall Inquiry legal team, May 2024).

AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 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 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.
Compassion in Practice, the vision and strategy for nursing in England, asks Boards to sign off and publish staffing levels. NHS England has asked that decisions on quality improvement plans are signed off by medical and nursing directors, and will consider going further to ask for their sign off on staffing changes for clinical staff as well as service provision.
The NHS Standard Contract will be strengthened to require providers to set staffing levels on the basis of evidence, monitor actual versus intended staffing levels and share this information with commissioners and the public.
The Chief Nursing Officer is providing leadership through Compassion in Practice. Key action areas include:
• Boards to sign off and publish evidence based staffing levels at least every 6 months, linked to quality of care and patient experience; and
• deploying staff effectively and efficiently; identify the impact this has on quality of care and the experience of people in our care.

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 in progress · 27 Feb 2026

The Thirlwall Inquiry has noted action taken in relation to this recommendation following the conclusion of the Mid-Staffordshire Inquiry 2013.

All Boards are now required to have nurse/midwife exec director (aside from trusts which do not provide services directly to patients and those whose principal function is provide ambulance or patient transport services). .

NHS England has additionally developed a Code of governance for NHS provider trusts (2023) that sets out the expectation that the board of directors to establish procedures that manage risk.

Appendix A to the above sets out the role of the Trusts Secretary within this.

Please see recommendation 23 for information on safe staffing.

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 “Implemented – Ongoing”. Table row: section 18.2 No. 205, PDF page 529.

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

In December 2013 NHS England published the NHS Standard Contract for 2014–15, which strengthened the requirements for providers to set staffing levels on the basis of evidence, monitoring actual versus intended staffing levels and sharing information with commissioners and the public. Providers have operated under the new provisions from 1st April 2014. The requirements are detailed within General Condition 5.2 of the Contract.

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 commissioners, 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.

In the January 2014 Hard Truths report, the Government said that NHS England had asked that that decisions on quality improvement plans were signed off by medical and nursing directors, and were considering to ask for their sign off on staffing changes for clinical staff as well as service provision. It is unclear whether this was done.

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. 205, PDF page 491.

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.