Recommendation F67: Focus on compliance with fundamental standards
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The NHS Trust Development Authority should develop a rigorous process for the assessment as well as the support of potential applicants for foundation trust status. The assessment must include as a priority focus a review of the standard of service delivered to patients, and the sustainability of a service at the required standard.
In brief (written by this site)
In September 2024 commentary published in February 2026, the Department of Health and Social Care and NHS England reported that the recommendation had been superseded, explaining that statutory authorisation powers remain but the "policy position has changed and no more FTs are being authorised" (DHSC and NHS England, Feb 2026). Earlier, the Thirlwall Inquiry legal team noted in May 2024 that the NHS Trust Development Authority had established an accountability framework requiring applicants to demonstrate fundamental standards of clinical quality and patient experience (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 focus of the NHS Trust Development Authority is to enable NHS Trusts to provide high quality, sustainable services for their local communities. It does this by overseeing all aspects of a Trust Board’s performance on delivering high quality care and supporting them to become sustainable organisations, thereby preparing them to become a Foundation Trust. The Board of the NHS Trust Development Authority will only approve a Trust’s application to be passed to Monitor, when it is satisfied that the Trust has clearly demonstrated both these aspects.
The NHS Trust Development Authority has set out its rigorous process for assessing aspirant Foundation Trusts in its Accountability Framework Delivering High Quality Care For All. There will be a comprehensive inspection by the Care Quality Commission of the quality of services delivered by an aspirant Foundation Trust, as well as the quality governance arrangements within a Trust, prior to any decision by the Board of the NHS Trust Development Authority as to whether a Foundation Trust application will be supported. No provider will go forward for Foundation Trust authorisation 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. 67, PDF page 458-459.
Department of Health and Social Care says in progress (11 February 2015)
NHS Trusts are now required to produce 5-year strategic plans. Trusts will only have their Foundation Trust applications approved by the NHS Trust Development Authority Board if they are able to demonstrate their sustainability in the long-term, as well as achieving a ‘good’ or ‘outstanding’ rating.
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. The process for assessing this would include information from public consultation, the Care Quality Commission, NHS England, the relevant clinical commissioning groups and other national and local system partners.
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. 67, PDF page 423.
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