Recommendation F17: Responsibility for setting standards
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The NHS Commissioning Board together with Clinical Commissioning Groups should devise enhanced quality standards designed to drive improvement in the health service. Failure to comply with such standards should be a matter for performance management by commissioners rather than the regulator, although the latter should be charged with enforcing the provision by providers of accurate information about compliance to the public.
In brief (written by this site)
In February 2026, the Department of Health and Social Care and NHS England stated that the NHS Standard Contract covers operating standards, meeting quality standards, and continuous improvement, supported by commissioning incentives through the Commissioning for Quality and Innovation framework (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that the government had accepted the recommendation in principle, relying on existing standards from the National Institute for Health and Care Excellence alongside joint oversight by the Care Quality Commission and Monitor (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. The record below is the sources' own words.
Government response
Accepted in principle.
NHS England and clinical commissioning groups will have regard to enhanced quality standards in the way they commission services, and the Care Quality Commission will use them to inform their ratings of providers.
NHS England will work with clinical commissioning groups to use enhanced quality standards to drive improvements in the health service. NHS England has agreed with the National Institute for Health and Care Excellence that the concept of enhanced standards is represented by the existing quality standards, developed by National Institute for Health and Care Excellence and endorsed by NHS England. Compliance with these standards should indeed be a matter for commissioners rather than the regulator. NHS England is currently required in legislation to have regard to quality standards, and clinical commissioning groups are required to do the same through NHS England’s planning guidance.
The Care Quality Commission will use enhanced quality standards to inform its quality ratings of providers. In line with recommendation 13, where there are emergent evidence-based technologies with the potential to drive widespread improvements, the National Institute for Health and Care Excellence will also include developmental standards within quality standards.
As outlined in the response to recommendation 249, providers are required to publish a Quality Account each year, providing accurate information on their performance in relation to quality standards. NHS England will review Quality Accounts before the 2014–15 cycle to ensure that they give patients appropriate information on the services they use, and that they add value to the quality assurance infrastructure used by trusts, local and national organisations.
How this response relates to the recommendation
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.
Blanket government agreement does not establish acceptance or delivery by each addressee. Some response passages cover groups of recommendations.
Scope of the government 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.
Delivery
DHSC and NHS England say in progress (27 February 2026)
Please see response to recommendation 13 referring to the NHS Oversight Framework, oversight metrics and NHS provider licence
The NHS Standard Contract covers several areas including
• operating standards
• meeting quality standards
• continuous improvement.
The Commissioning for Quality and Innovation (CQUIN) framework uses commissioning incentives to deliver specific quality improvements through the standard contract.
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. 17, PDF page 431-432.
Department of Health and Social Care says in progress (11 February 2015)
The National Institute for Health and Care Excellence has introduced developmental statements in its quality standards where appropriate. Between June and September 2014 it published the National Institute for Health and Care Excellence quality standards - the process guide, a consultation on its updated quality standards process guide which made detailed proposals for how developmental statements would be identified and produced.
The Care Quality Commission and Monitor work together to assess the capability of a Foundation Trust and/or its leadership to ensure safe and quality care. Monitor makes this assessment from the Board down, the Care Quality Commission from the ward up. The Care Quality Commission and Monitor have a new single, overarching framework for judging whether or not an organisation and/or service are well-led. The Care Quality Commission and Monitor use the framework to help inform their assessments and inspections.
The framework is used during the routine inspection of Foundation Trusts where the Care Quality Commission requests information from Monitor in preparation for an inspection. The Care Quality Commission’s inspection provides a judgement on the quality of services and Monitor will then take action where necessary to support improvement. The Chief Inspector of Hospitals can also recommend that a Foundation Trust be put in special measures. As part of this, Monitor provides intensive support, including appointing an Improvement Director. The Care Quality Commission will then re-inspect and recommend whether the Foundation Trust should be kept in, or taken out of, special measures.
For example in July 2013, after the Care Quality Commission inspection identified significant concerns about the quality of care, the Chief Inspector of Hospitals recommended that North Lincolnshire & Goole NHS Foundation Trust be placed in special measures. Monitor initially used its powers to agree a programme of work with the Foundation Trust to address issues in governance, clinical effectiveness, patient safety and experience. Monitor subsequently oversaw the Foundation Trust’s delivery of this programme, resulting in the quality issues being addressed. Following a recommendation from the Chief Inspector, the Foundation Trust was removed from special measures in July 2014.
The Care Quality Commission, Monitor and the NHS Trust Development Authority have jointly developed and published guidance on how the special measures programme worked for NHS trusts and Foundation Trusts. The Care Quality Commission and Monitor have also published a joint working agreement document setting out how they will work together.
A review of Quality Accounts has taken place in 2013/14 and engaged 180 stakeholders, including patients, carers, service providers, Healthwatch, NHS England, NHS Trust Development Authority, Care Quality Commission and Monitor. As a result of this review, there is now an area on NHS Choices providing presentational guidance and as part of the review, it was recommended this should be further developed to include guidance about publishing data in a more patient friendly way. This will be further developed in 2014/15. The Quality Accounts review also identified the need to provide local Healthwatch organisations with guidance on how to effectively challenge local Quality Accounts. This is being taken forward by NHS England and Healthwatch with a view that this will help to inform the approach Healthwatch take to commenting on Quality Accounts in 2014/15.
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 NHS England, 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)
The Government accepted this recommendation in principle.
In the January 2014 Hard Truths report, the Government decided that the enhanced quality standards would be represented by the existing quality standards developed by the National Institute for Health and Care Excellence. The Government said that the National Institute for Health and Care Excellence had introduced developmental statements in its quality standards where appropriate.
The Government said that NHS England and clinical commissioning groups would have regard to enhanced quality standards in the way they commissioned services and the Care Quality Commission to use them to inform rating of providers.
In the February 2015 Culture Change report, the Government also referred to the Care Quality Commission and Monitor working together to assess the capability of foundation trusts and/or their leadership to ensure safe and quality care, with both having a single, overarching framework for judging whether or not an organisation/service were well-led. The Care Quality Commission’s inspection was to provide a judgment on the quality of services and Monitor was to take action where necessary to support improvement.
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. 17, PDF page 392-393.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding