Recommendation F22: Responsibility for regulating and monitoring compliance
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The National Institute for Health and Clinical Excellence should be commissioned to formulate standard procedures and practice designed to provide the practical means of compliance, and indicators by which compliance with both fundamental and enhanced standards can be measured. These measures should include both outcome and process based measures, and should as far as possible build on information already available within the system or on readily observable behaviour.
In brief (written by this site)
In September 2024, the Department of Health and Social Care and NHS England reported that an April 2021 memorandum of understanding between the National Institute for Health and Care Excellence and the Care Quality Commission establishes a framework to align clinical guidance and quality standards with regulatory assessment frameworks (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that the recommendation had been accepted in principle, recording earlier actions by the government to introduce developmental statements and establish joint working between the organisations (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.
A range of guidance, indicators and measures will be provided to support the implementation of quality standards. Guidance, technology appraisals and standards provided by the National Institute for Health and Care Excellence make an essential and key contribution to how the Care Quality Commission assesses the quality of NHS services, alongside bodies accredited by the National Institute for Health and Care Excellence and other appropriate sources of guidance and standards. The National Institute for Health and Care Excellence, the Care Quality Commission and NHS England will work together on the objective of ensuring that authoritative guidance is available on fundamental and enhanced standards. The National Institute for Health and Care Excellence already develops indicators to go alongside quality standards, and the National Institute for Health and Care Excellence and NHS England develop tools to support commissioners in commissioning for quality.
The Department of Health will shortly consult on new regulations that will set out fundamental standards of care. The Care Quality Commission will then consult on sector-specific statutory guidance for providers that it will take into account when enforcing those regulations, including prosecution, and how it decides a rating. In this guidance the Care Quality Commission will signpost guidance and measures by the National Institute for Health and Care Excellence and other appropriate bodies.
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)
The Thirlwall Inquiry has noted action taken following the conclusion of the Mid-Staffordshire Inquiry 2013.
The existing MoU between NICE and CQC (dated April 2021), sets out the framework to support the working relationships between the two organisations, describing how both organisations will align to support achievable standards for high quality care. It states that CQC and NICE will work together to ensure, where appropriate, there is alignment between NICE guidelines, interventional procedures guidance and quality standards, with the CQC's assessment frameworks. This will encourage achievable improvements in the provision of safe and high-quality care and treatment (paragraph 13).
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. 22, PDF page 434-435.
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.
At the end of 2014, the Care Quality Commission and the National Institute for Health and Care Excellence published a Memorandum of Understanding that sets out how the two organisations work in partnership to encourage improvement in the quality of care. This includes the guidance, advice and other tools that the National Institute for Health and Care Excellence provides for the health and care system, the support the Care Quality Commission provides for the development and implementation of the National Institute for Health and Care Excellence guidance, quality standards and indicators, and the support the National Institute for Health and Care Excellence provides to the Care Quality Commission in order for the Care Quality Commission to fulfil its role in the regulation of health and social care services.
In July 2014, the Care Quality Commission consulted providers, health care professionals and other key stakeholders on proposed guidance on meeting new fundamental standards regulations. The draft guidance referenced the National Institute for Health and Care Excellence’s technology appraisals, guidelines and quality standards. The Care Quality Commission has published final guidance on how organisations may comply with the duty of candour and the fit and proper person requirement for NHS bodies which came into force in November 2014. The Care Quality Commission will publish guidance on meet the remaining fundamental standards prior to them coming into force in April 2015.
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 the National Institute for Health and Care Excellence, 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 referred to the introduction by the National Institute for Health and Care Excellence of developmental statements in its quality standards where appropriate.
In the February 2015 Culture Change report, the Government also referred to the 2014 Memorandum of Understanding between the Care Quality Commission and the National Institute for Health and Care Excellence, which set out areas of cooperation between the two organisations, including development of guidance, advice and other tools by the National Institute for Health and Care Excellence, and the Care Quality Commission’s support for the development of such guidance, quality standards and indicators.
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. 22, PDF page 396.
Source
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