Coordination with internal procedures

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.. The NMC introduced a new Fitness to Practise Strategy in 2018. This is based on 12 key strategic principles which reiterate and promote a local first approach: "employers should act first to deal with concerns about a nurse, midwife or nursing associate's practice, unless the risk to people receiving care or the public is so serious that we need to take immediate action" (Principle 4). This principle reiterates that the NMC only needs to become involved early on if the registrant poses a risk of harm that an employer cannot effectively manage. The NMC has also published detailed guidance for employers on managing concerns, which explains which concerns should be raised with it and seeks to encourage employers to take steps to manage the referral locally where appropriate. It has a specific section dedicated to managing concerns locally. Its Employer Link Service (ELS) team also support this aim – please see response to recommendation 232. Safety culture is one of the two key foundations of the NHS patient safety strategy. PSIRF is a contractual requirement under the NHS Standard Contract and appropriate concerns about safety should be reported. By law, all employers must have a grievance policy and share that in writing For nurses, the RCN provide guidance on the grievance process. Revalidation and appraisal requirements for nurses are set by the NMC. 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.