Previous Next
Jump to 9 Recommendations

Mid Staffordshire NHS Foundation Trust Public Inquiry

Completed

Mid Staffs Inquiry

Chair Robert Francis QC Legal professional (non-judge)
Established 09 Jun 2010
Final Report 06 Feb 2013
Commissioned by Department of Health and Social Care

Public inquiry into the serious failings in care at Mid Staffordshire NHS Foundation Trust between 2005-2009, where patients were routinely neglected and standards of care were appalling. The Francis Report made 290 recommendations for fundamental culture change to put patients first, including statutory duty of candour, enhanced CQC powers, nursing standards, and NHS leadership reforms.

Evidence & Impact
The Mid Staffordshire NHS Foundation Trust Public Inquiry, chaired by Sir Robert Francis QC, examined serious failings in care at Mid Staffordshire NHS Foundation Trust between 2005 and 2009. The inquiry's report, published in February 2013, made 290 recommendations aimed at preventing similar failures in patient care.

The government responded to the Francis Report through two key documents. An initial response, 'Patients First and Foremost', was published in March 2013, followed by a comprehensive response, 'Hard Truths: the Journey to Putting Patients First', in November 2013. The government accepted 201 recommendations (69%), accepted in principle 60 recommendations (21%), partially accepted 20 recommendations (7%), and did not accept 9 recommendations (3%).

According to the government's response, key reforms introduced included the creation of a Chief Inspector of Hospitals, a strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. The response indicated these measures were designed to address the inquiry's findings about regulatory oversight, transparency, and leadership accountability.

However, the available evidence indicates that published progress updates have not been identified for 281 of the 290 recommendations (97%). While the government's initial response outlined various reforms and initiatives, no formal implementation reviews or systematic progress updates appear to have been published. This absence of published evidence makes it difficult to assess what specific actions have been taken on individual recommendations beyond the headline reforms mentioned in the government's response.

The inquiry's recommendations covered fundamental areas including patient safety culture, professional standards, regulatory effectiveness, complaints handling, and information systems. Without published progress updates, the extent to which these broader recommendations have been addressed remains unclear from the available evidence.
Reforms Attributed to This Inquiry
- Creation of the Chief Inspector of Hospitals role within the Care Quality Commission
- Introduction of statutory duty of candour for NHS providers through the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
- Establishment of fit and proper person test for NHS directors through the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
- Strengthened Care Quality Commission inspection regime with new fundamental standards
- Publication of staffing levels data on NHS wards
- Introduction of Friends and Family Test across NHS services
- Establishment of patient safety collaboratives across England
- Creation of Sign up to Safety campaign
- Introduction of medical revalidation requirements for doctors
Unfinished Business
- No published evidence has been identified for progress on 281 of the 290 recommendations (97%)
- Recommendations on establishing a common culture throughout the NHS focused on patients
- Proposals for fundamental standards of behaviour and competence
- Recommendations on openness, transparency and candour throughout the healthcare system
- Proposals for improved support for compassionate caring and committed care
- Recommendations on stronger healthcare professional regulation
- Proposals for enhanced patient and public involvement
- Recommendations on effective complaints handling
- Proposals for improved information systems and data quality
- Recommendations on leadership development and management training
Generated 18 Mar 2026 using claude-opus-4. Assessment is indicative, not authoritative.
2 years, 8 months Duration
£13m Total Cost
250 Witnesses
139 Hearing Days
1,000,000 Documents
1,781 Report Pages
Inquiry Website
Government Response
Accepted 201
Accepted in Part 80
Not Accepted 9
Total Recommendations 290
Data last updated: 19 Nov 2013 · Source
Data verified: 25 Mar 2026 (import)
Blanket response: 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.
How to read this

Government Response tracks what the government said it would do (accepted, rejected, etc.).

Full methodology

09 Jun 2010
Inquiry Announced
01 Nov 2010
Inquiry Established
06 Feb 2013
Final Report Published
Clear

Recommendations (9)

F19
Not Accepted
Gaps between the understood functions of separate regulators
Recommendation

There should be a single regulator dealing both with corporate governance, financial competence, viability and compliance with patient safety and quality standards for all trusts.

Published evidence summary
The government did not accept the recommendation for a single regulator combining corporate governance, financial competence, and patient safety/quality standards (Mid Staffordshire NHS FT public inquiry: government response, 2013-11-19). Instead, regulatory functions were consolidated with Monitor and the NHS Trust Development Authority merging into NHS Improvement (2016) and then into NHS England (2022), while the Care Quality Commission (CQC) remains a separate body for quality standards (NHS England / Department of Health, 2026-02-06). A Penny Dash Review (2024-10-15) found significant failings at the CQC, with the Health Secretary declaring it "not fit for purpose."
Department of Health and Social Care (Primary)
View Details
F61
Not Accepted
Consolidation of regulatory functions
Recommendation
A merger of system regulatory functions between Monitor and the Care Quality Commission should be undertaken incrementally and after thorough planning. Such a move should not be used as a justification for reduction of the resources allocated to this area … Read more
Published evidence summary
The government explicitly "Not Accepted" this recommendation in 2013 (Official government response, 19 Nov 2013). While the recommendation for a merger between Monitor and CQC was not accepted, Monitor itself underwent mergers, first with the Trust Development Authority to form NHS Improvement in April 2016, and then NHS Improvement merged with NHS England in July 2022 under the Health and Care Act 2022 (Legislation - Health and Social Care Act 2012 (Monitor reformed), 1 Apr 2016; Legislation - Integrated Care Boards (Health and Care Act 2022), 1 Jul 2022).
Department of Health and Social Care (Primary)
View Details
F64
Not Accepted
Authorisation of foundation trusts
Recommendation
The authorisation process should be conducted by one regulator, which should be equipped with the relevant powers and expertise to undertake this effectively. With due regard to protecting the public from the adverse consequences inherent to any reorganisation, the regulation … Read more
Published evidence summary
The government did not accept this recommendation in November 2013, as detailed in "Hard Truths: the Journey to Putting Patients First" (Cm 8777). While structural changes to the NHS regulatory landscape have occurred, including the replacement of Clinical Commissioning Groups with Integrated Care Boards in July 2022 under the Health and Care Act 2022 (Health and Care Act 2022, 2022), the specific proposal to transfer the authorisation process for foundation trusts to a single regulator, the Care Quality Commission, was not adopted. A DHSC-commissioned Penny Dash Review (October 2024) later identified significant failings at the CQC, including issues with service ratings and inspection levels.
Department of Health and Social Care (Primary)
View Details
F137
Not Accepted
Intervention and sanctions for substandard or unsafe services
Recommendation
Commissioners should have powers of intervention where substandard or unsafe services are being provided, including requiring the substitution of staff or other measures necessary to protect patients from the risk of harm. In the provision of the commissioned services, such … Read more
Published evidence summary
The government did not accept this recommendation in its November 2013 response, "Hard Truths: the Journey to Putting Patients First" (Cm 8777). While Clinical Commissioning Groups were replaced by Integrated Care Boards (ICBs) from July 2022 under the Health and Care Act 2022, and an academic review in February 2023 noted structural changes like the CQC overhaul were largely delivered, the specific powers of intervention for commissioners as recommended were not adopted. Furthermore, the Penny Dash Review of the CQC in October 2024 found significant failings, indicating ongoing challenges with regulatory effectiveness in the system.
Commissioners (Primary)
View Details
F145
Not Accepted
Structure of Local Healthwatch
Recommendation

There should be a consistent basic structure for Local Healthwatch throughout the country, in accordance with the principles set out in Chapter 6: Patient and public local involvement and scrutiny.

Published evidence summary
The government did not accept this recommendation, as stated in its "Hard Truths: the Journey to Putting Patients First" response (Cm 8777) published in November 2013. No further specific evidence regarding the establishment of a consistent basic structure for Local Healthwatch has been identified.
Department of Health and Social Care (Primary)
View Details
F183
Not Accepted
Criminal liability
Recommendation
It should be made a criminal offence for any registered medical practitioner, or nurse, or allied health professional or director of an authorised or registered healthcare organisation: Knowingly to obstruct another in the performance of these statutory duties; To provide … Read more
Published evidence summary
The government did not accept this recommendation in its November 2013 response to the Mid Staffordshire NHS FT Public Inquiry (Official government response, 2013). No further published evidence has been identified since the government's rejection.
Department of Health and Social Care (Primary)
View Details
F209
Not Accepted
Registration of healthcare support workers
Recommendation
A registration system should be created under which no unregistered person should be permitted to provide for reward direct physical care to patients currently under the care and treatment of a registered nurse or a registered doctor (or who are … Read more
Published evidence summary
The government did not accept this recommendation in November 2013 (Official government response, 2013-11-19). A government source from February 2026 confirms that the recommendation for a registration system for healthcare support workers was not implemented, and healthcare assistants remain unregistered and unregulated (Government, Not Implemented, 2026-02-06). Instead, the Care Certificate was introduced in April 2015 as a minimum training standard for new healthcare assistants (HEE/Skills for Care - Care Certificate, 2015-04-01).
Department of Health and Social Care (Primary)
View Details
F212
Not Accepted
Training standards for healthcare support workers
Recommendation
The code of conduct, education and training standards and requirements for registration for healthcare support workers should be prepared and maintained by the Nursing and Midwifery Council after due consultation with all relevant stakeholders, including the Department of Health, other … Read more
Published evidence summary
The government did not accept this recommendation in November 2013, which proposed that the Nursing and Midwifery Council (NMC) should be responsible for preparing and maintaining the code of conduct, education and training standards, and registration requirements for healthcare support workers (Official government response, 2013-11-19). Instead, the Care Certificate, which provides national standards for HCSW training and conduct, was launched by Health Education England and Skills for Care in April 2015 (HEE/Skills for Care - Care Certificate, 2015-04-01). The NMC's revalidation process, launched in April 2016, applies to registered nurses and midwives, not healthcare support workers (NMC - Nursing Revalidation, 2016-04-01).
NMC (Primary)
View Details
F213
Not Accepted
Training standards for healthcare support workers
Recommendation
Until such time as the Nursing and Midwifery Council is charged with the recommended regulatory responsibilities, the Department of Health should institute a nationwide system to protect patients and care receivers from harm. This system should be supported by fair … Read more
Published evidence summary
The government did not accept this recommendation in November 2013, which proposed that the Department of Health should institute a nationwide system to protect patients and care receivers from harm, including fair due process for dismissed healthcare support workers, until the Nursing and Midwifery Council (NMC) was charged with regulatory responsibilities (Official government response, 2013-11-19). As the NMC was not given these regulatory responsibilities for healthcare support workers, and no such nationwide system was instituted by the Department of Health, the recommendation was not implemented.
Department of Health and Social Care (Primary)
View Details