Recommendation F65: Quality of care as a pre-condition for foundation trust applications
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The NHS Trust Development Authority should develop a clear policy requiring proof of fitness for purpose in delivering the appropriate quality of care as a pre-condition to consideration for support for a foundation trust application.
In brief (written by this site)
In February 2026, the Department of Health and Social Care and NHS England stated that although foundation trust authorisation powers remain following the abolition of Monitor, the "policy position has changed and no more FTs are being authorised" (DHSC and NHS England, Feb 2026). Previously, in May 2024, the Thirlwall Inquiry legal team noted that the recommendation had been accepted and that the NHS Trust Development Authority had published an accountability framework requiring proof of care quality before foundation trust bids could proceed (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 NHS Trust Development Authority has published its Accountability Framework which sets out how Trusts will be held to account for delivering the appropriate quality of care. Trusts which are failing to meet these standards are subject to a robust and transparent escalation process.
The first priority for all provider organisations and for the bodies that oversee them should be to secure high quality services for patients. NHS Trusts are only able to progress through the Foundation Trust pipeline if they have been consistently delivering high quality care, as assessed against the standards in the Accountability Framework, which include concerns raised by the Care Quality Commission and others, such as commissioners.
The Board of the NHS Trust Development Authority will not support applications to progress to Monitor where there are any doubts about the quality of the services being provided by a Trust. In order to ensure this, future inspections of the quality of services provided by aspirant Foundation Trusts and their quality governance processes will take place earlier in the application process, prior to the NHS Trust Development Authority Board making its decision as to whether an application should be supported. No provider will be put forwards for authorisation as a Foundation Trust unless the Care Quality Commission, through its Chief Inspector of Hospitals, judges that the quality of their services is ‘good’ or ‘outstanding’.
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 state no delivery position (27 February 2026)
The provisions for Foundation Trust (FT) authorisation remain, with the power to authorise an NHS trust as an FT vested in NHS England (provided Secretary of State has approved the authorisation and NHS England are satisfied as to the matters set out in section 35 of the NHS Act 2006), following abolition of Monitor and transfer of functions to NHS England. However, policy position has changed and no more FTs are being authorised.
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 “Superseded”. Table row: section 18.2 No. 65, PDF page 457-458.
Department of Health and Social Care says in progress (11 February 2015)
Since the decision was made only to support Foundation Trust applications from providers with a Care Quality Commission rating of ‘good’ or ‘outstanding’, the NHS Trust Development Authority has advised the Care Quality Commission on trusts that should be considered as priorities for inspection in order to allow their Foundation Trust bids to progress. 55 NHS Trusts have been inspected under the new arrangements, and of these ten have received NHS Trust Development Authority board approval to be considered by Monitor for Foundation Trust authorisation.
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 NHS Trust Development Authority, 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.
The NHS Trust Development Authority published an accountability framework which set out the requirement that the achievement of Foundation Trust status would only be possible for trusts delivering the key fundamentals of clinical quality, good patient experience and national and local standards and targets.
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. 65, PDF page 422.
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