Recommendation F57: Care Quality Commission independence strategy and culture
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The Care Quality Commission should undertake a formal evaluation of how it would detect and take action on the warning signs and other events giving cause for concern at the Trust described in this report, and in the report of the first inquiry, and open that evaluation for public scrutiny.
In brief (written by this site)
In commentary from September 2024 published in February 2026, the Department of Health and Social Care and NHS England recorded the recommendation as implemented, stating that Keiran Walshe evaluated the Care Quality Commission's approach in 2014 and that the commission developed its monitoring framework largely in response to the Mid Staffs review (DHSC and NHS England, Feb 2026). Previously, in May 2024, the Thirlwall Inquiry legal team noted the recommendation, observing that the government had accepted it and had reported the regulator's creation of indicator sets and an Intelligent Monitoring system (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 Care Quality Commission has carried out a significant review of how it uses information to identify potential failures in the quality of care in hospitals. Taking each of five key questions – is a service safe, effective, caring, responsive and well led – the review undertook to define an ‘ideal’ set of indicators that the Care Quality Commission could routinely monitor to identify these potential failures. The review then scoured national and international best sources in quality measurement. A short list of potential measures was then identified and tested through analysis and a series of engagements with the sector and experts in the measurement of quality. In A new start – Consultation on changes to the way Care Quality Commission regulates, inspects and monitors care the Care Quality Commission consulted on the set of indicators. It analysed the resulting set of indicators, and published on 24 October 2013 for the first time the analysis outputs, which it will publish quarterly. This way it will ensure wider feedback on its approach. It is also committed to on-going evaluation of the indicators to learn and improve the new approach.
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 completed (27 February 2026)
There was an evaluation of CQC's approach by Keiran Walshe at Manchester Business School in 2014, and in general CQC's whole monitoring and assessment approach was developed in significant part to respond to the Mid Staffs review.
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 – Closed”. Table row: section 18.2 No. 57, PDF page 454.
Department of Health and Social Care says in progress (11 February 2015)
The Care Quality Commission has put in place a system of Intelligent Monitoring to help decide when, where and what to inspect. This draws information and data from a range of sources to identify providers and services where there may be a greater risk of providing poor care. The evidence from the Intelligent Monitoring system is used to prioritise which providers will be inspected and the lines of enquiry during an investigation. The system triggers a response, for example, where there are a statistically significant number of severe harm incidents or avoidable deaths at a provider. “Never events” trigger an automated elevated risk in Intelligent Monitoring which inspectors follow up individually. The data it looks at includes information from:
• Staff
• Patient surveys
• Mortality rates
• Hospital performance information such as waiting times and infection rates In October 2013 the Care Quality Commission began a pilot of its intelligent monitoring programme for acute and specialist NHS Trusts. The pilot looked at more than 150 different sets of data (indicators), which relate to the five key questions the Care Quality Commission asks of all services – are they safe, effective, caring, responsive, and well-led? Using this data, the Care Quality Commission grouped all acute NHS trusts into six priority bands for inspection (The bands are based on the likelihood that people may not be receiving safe, effective, high quality care). The Care Quality Commission completed its latest round of Intelligent Monitoring of trusts in July 2014.
In November 2014, the Care Quality Commission published Mental Health intelligent monitoring reports, which display the results of its analysis of Tier 1 indicators for all Mental Health NHS trusts. Each trust will receive an individual report and banding, similar to those for acute hospitals. The bandings will range from one to four.
In November 2014 the Care Quality Commission published its first round of Intelligent Monitoring for GPs
Draft Intelligent Monitoring models for the Adult Social Care sector have been in place since October 2014, with separate sets of indicators for residential, community and hospice services. the Care Quality Commission will continue to develop these models with providers and stakeholders to develop a more robust Intelligent Monitoring system within Adult Social Care during 2015/16 and beyond
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 the Care Quality Commission carrying out a significant review of how it used information to identify potential failures in quality of care, seeking to define a set of indicators it could use.
In the February 2015 Culture Change report, the Government said that the Care Quality Commission had put in place a system of Intelligent Monitoring to help decide when, where and what to inspect, which would draw information from a range of sources to identify providers and services where there might be a greater risk of providing poor care.
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. 57, PDF page 418-419.
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