Recommendation F71: Role of Secretary of State
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The Secretary of State's support for an application should not be given unless he is satisfied that the proposed applicant provides a service to patients which is, at the time of his consideration, safe, effective and compliant with all relevant standards, and that in his opinion it is reasonable to conclude that the proposed applicant will continue to be able to do so for the foreseeable future. In deciding whether he can be so satisfied, the Secretary of State should have regard to the required public consultation and should consult with the healthcare regulator.
In brief (written by this site)
In commentary from September 2024, the Department of Health and Social Care and NHS England stated that while statutory powers to authorise foundation trusts remain, the "policy position has changed and no more FTs are being authorised" (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team noted in February 2026 that the government had accepted the recommendation and previously delegated applicant assessments to the NHS Trust Development Authority (The Thirlwall Inquiry legal team, Feb 2026).
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’s role is to ensure, on behalf of the Secretary of State for Health, that aspirant Foundation Trusts are ready to proceed for assessment by Monitor. This role is discharged on behalf of the Secretary of State by the Board of the NHS Trust Development Authority, which will not refer to Monitor any Trust where there are concerns relating to the compliance with any of the relevant standards either now or in the future. The decision of the Board is made with regard to the public consultation and after consulting with the Care Quality Commission, NHS England and other national and local system partners.
No provider should be authorised as a Foundation Trusts 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. 71, PDF page 460.
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.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (27 February 2026)
This recommendation was accepted by the Government.
In the January 2014 Hard Truths report, the Government said that this role would be carried out by the Board of the NHS Trust Development Authority on behalf of the Secretary of State, which would not refer to Monitor any trust where there are concerns relating to compliance with any of the relevant standards now or in the future. The decision of the Board would be made with regard to the public consultation and after consulting the Care Quality Commission, NHS England and other partners. In the February 2015 Culture Change report, the Government also referred to the requirement for trusts to produce 5- year strategic plans.
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 dated April 2025, published 27 February 2026). 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 18.2 No. 71, PDF page 460.
Earlier findings (1)
Thirlwall Inquiry legal team (15 May 2024)
This recommendation was accepted by the Government.
In the January 2014 Hard Truths report, the Government said that this role would be carried out by the Board of the NHS Trust Development Authority on behalf of the Secretary of State, which would not refer to Monitor any trust where there are concerns relating to compliance with any of the relevant standards now or in the future. The decision of the Board would be made with regard to the public consultation and after consulting the Care Quality Commission, NHS England and other partners. In the February 2015 Culture Change report, the Government also referred to the requirement for trusts to produce 5-year strategic plans.
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. 71, PDF page 425.
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