Recommendation F51: Enhancement of monitoring and the importance of inspection
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The Care Quality Commission should develop a specialist cadre of inspectors by thorough training in the principles of hospital care. Inspections of NHS hospital care providers should be led by such inspectors who should have the support of a team, including service user representatives, clinicians and any other specialism necessary because of particular concerns. Consideration should be given to applying the same principle to the independent sector, as well as to the NHS.
In brief (written by this site)
In February 2026, the Department of Health and Social Care and NHS England reported that the Care Quality Commission retains specialist inspectors across hospitals, mental health, primary care, and adult social care within regional integrated assessment and inspection teams, while internal work reviewing the split between inspectors and assessors remains ongoing (DHSC and NHS England, Feb 2026). Previously, in May 2024, the Thirlwall Inquiry legal team recorded that the government had accepted the recommendation and noted the introduction of three Chief Inspector roles alongside multidisciplinary inspection teams (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.
The Chief Inspector of Hospitals has begun inspecting in this way. Useful lessons were learnt from the Care Quality Commission’s targeted inspections of 150 learning disability in-patient units following events at Winterbourne View hospital; these benefitted enormously from the involvement in inspection of trained and supported learning disabled self-advocates and family carers.
Also, building on the approach developed by Professor Sir Bruce Keogh’s reviews of mortality in 14 NHS trusts, the Chief Inspector of Hospitals has started inspections involving teams made up of senior and junior doctors, nurses and allied health professionals; senior managers; and people with experience of using hospital services. Six thousand individuals put themselves forward to be part of these inspections, and the number continues to increase. This is encouraging progress towards ensuring that inspection teams with a range of specialist and lay perspectives will be sustainable.
Through its Chief Inspector of Hospitals, the Care Quality Commission will extend this approach to mental health, community healthcare and ambulance services during 2014–15, with appropriate adaptation and tailoring to those sectors. The approach will be adapted to independent as well as NHS providers.
New Chief Inspectors of General Practice and of Adult Social Care took up post in October 2013, and will similarly spearhead the extension and development of new approaches to monitoring and inspecting standards of care in those sectors.
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)
CQC retain specialist inspectors in hospitals, mental health, primary care and adult social care, but in the new structure they work in Integrated Assessment and Inspection Teams across a regional area. Work is also ongoing to review the 'inspector' / 'assessor' split internally, with an update on this work expected in due course.
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. 51, PDF page 451.
Department of Health and Social Care says in progress (11 February 2015)
In January 2014, the Care Quality Commission started its new inspection programme for mental health trusts, community trusts and general practice out of hours services. In April 2014, the first new style inspections started in adult social care. The Care Quality Commission’s rating of providers will commence in Independent Mental Health (community and hospitals), NHS Specialist Acute Hospitals and NHS Ambulance Trusts is expected to start in early 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 Care Quality Commission, 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 the January 2014 Hard Truths report, the Government referred to 3 new roles – Chief Inspector of Hospitals, Chief Inspector of Primary Care and Chief Inspector of Adult Social Care —tasked to ensure that inspections were no longer a tick box exercise. The Care Quality Commission was said to have developed a new inspection framework which set out five domains against which to assess providers. New inspection regime. Inspection teams were to be made up of senior and junior doctors, nurses, allied health professionals, senior managers and people with experience of using hospital services.
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. 51, PDF page 415.
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