Lowering barriers
Provider organisations must constantly promote to the public their desire to receive and learn from comments and complaints; constant encouragement should be given to patients and other service users, individually and collectively, to share their comments and criticisms with the organisation.
- The Care Quality Commission publishes national patient experience surveys for secondary care to measure views on care and services (National Patient Survey Programme, CQC, 2024).
- The Department of Health and Social Care and NHS England stated in April 2025 that Patient Advice and Liaison Services (PALS) operate within provider organisations to offer confidential support and information (DHSC/NHS England implementation update to the Thirlwall Inquiry, April 2025).
- The NHS Complaint Standards require organisations to actively promote how people can provide feedback and make complaints (NHS Complaint Standards, PHSO, April 2022).
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Progress Timeline
DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Implemented - Ongoing. Please see response to recommendation 109. Patient feedback CQC publishes patient experience surveys in secondary care under their National Patient Survey Programme. On the same day that CQC publish the national survey results, NHS England publishes the Overall Patient Experience Scores. These are a statistical series measuring overall patient views of care and services provided by the NHS. The Friends and Family Test (FFT) is an important feedback tool that Provider Trusts use that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. Patients and their carers should also have access to a Patient Advice and Liaison Service operated within the provider organisation. This is intended to offer confidential advice, support and information on health related matters and should be available as a point of contact.
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
PHSO developed NHS Complaint Standards framework providing consistent approach to complaint handling across NHS. Piloted 2021-2022, introduced across NHS from 2022. Applies to all NHS organisations and independent healthcare providers delivering NHS-funded care.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.
Ann Clwyd MP and Professor Tricia Hart published review of NHS hospital complaints handling on 28 October 2013. Key recommendations: Chief Executives must sign off complaint responses; Trust Boards must scrutinise complaints; trusts must publish annual complaints reports in plain English.