Use of information for effective regulation
A coordinated collection of accurate information about the performance of organisations must be available to providers, commissioners, regulators and the public, in as near real time as possible, and should be capable of use by regulators in assessing the risk of non-compliance. It must not only include statistics about outcomes, but must take advantage of all safety related information, including that capable of being derived from incidents, complaints and investigations.
- The Learn from Patient Safety Events (LFPSE) service allows health and social care staff to record and download data regarding safety events within their organisations (DHSC and NHS England implementation update to the Thirlwall Inquiry, April 2025).
- An independent review in October 2024 found significant failings at the Care Quality Commission, including a backlog of 5,000 notifications of concern and a lack of specialist inspector expertise (Penny Dash Review of CQC, DHSC, October 2024).
- Academic research in 2023 found that while structural and legislative changes were largely delivered, cultural change regarding information use was not fully embedded (Ten Years After Francis, Academic Review, February 2023).
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Progress Timeline
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 Health and Social Care Information Centre was replaced by NHS Digital, which merged with NHS England. There are currently multiple coordinated collections of data for different audiences. They inform the actions of regulators and include outcomes but also wider information. These include: • Model Hospital: benchmarked insights across the quality of care, productivity and organisational culture to identify opportunities for improvement. • NHS Federated Data Platform: software to improve the sharing of data currently stored in separate systems. • NHS England's own approach to monitoring performance in trusts. • CQC's Insight tools: to monitor quality of care and indicate risks • CQC Inspection reports Through the Learn from patient safety events (LFPSE) service, health and social care staff can: • Record information about things that could have or did affect the safety of patients, or things that have gone well, in order to support learning and safety improvement • Access, review and update event records they have permission to edit, and undertake governance activities to support local patient safety response and improvement • View and download data about what patient safety events have been recorded within their own organisation, or by organisations within their Integrated Care Board (ICB) or region to the new Learn From Patient Safety Events (LFPSE) service according to their level of access
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Penny Dash Review (commissioned May 2024) found significant failings at CQC. Health Secretary declared CQC "not fit for purpose". Key findings: one in five services never rated; inspection levels well below pre-pandemic levels; lack of specialist inspector expertise; 5,000 notification-of-concern backlog. CQC consulting on resetting its approach from October 2025.
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.
Clinical Commissioning Groups replaced by 42 Integrated Care Boards from 1 July 2022 under Health and Care Act 2022. ICBs have broader responsibilities for population health, bringing together NHS organisations, local authorities and partners. Implements some Francis recommendations on commissioning integration.
PHSO developed NHS Complaint Standards framework providing consistent approach to complaint handling across NHS. Piloted 2021-2022, introduced across NHS from 2022. Applies to all NHS organisations and independent healthcare providers delivering NHS-funded care.
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.
New "Fundamental Standards" replaced previous CQC registration requirements from 7 November 2014. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 introduced clearer minimum standards including: person-centred care (Reg 9), dignity (Reg 10), safe care (Reg 12), staffing (Reg 18), good governance (Reg 17), fit and proper persons (Reg 5), duty of candour (Reg 20).
CQC overhauled its inspection regime in response to Francis. Professor Sir Mike Richards appointed as first Chief Inspector of Hospitals (July 2013). New methodology based on five key questions (Safe, Effective, Caring, Responsive, Well-led) rolled out nationally October 2014. Four-tier ratings introduced (Outstanding/Good/Requires Improvement/Inadequate). Specialist expert-led inspection teams replaced generalist compliance model.
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.
Ann Clwyd MP and Professor Tricia Hart published review of NHS hospital complaints handling on 28 October 2013. Key recommendations: Chief Executives must sign off complaint responses; Trust Boards must scrutinise complaints; trusts must publish annual complaints reports in plain English.