Recommendation F125: Responsibility for requiring and monitoring delivery of enhanced standards
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
In addition to their duties with regard to the fundamental standards, commissioners should be enabled to promote improvement by requiring compliance with enhanced standards or development towards higher standards. They can incentivise such improvements either financially or by other means designed to enhance the reputation and standing of clinicians and the organisations for which they work.
In brief (written by this site)
In September 2024, in commentary published in February 2026, the Department of Health and Social Care and NHS England noted that the recommendation remained in progress, referring to their response on a preceding recommendation (DHSC and NHS England, Feb 2026). Earlier, in May 2024, the Thirlwall Inquiry legal team recorded that the government had accepted the recommendation and planned to use contractual indicators and dedicated funding to encourage higher standards (The Thirlwall Inquiry legal team, May 2024). The department had previously reported in February 2015 that quality frameworks and incentive schemes had been established to reward service improvements under provider contracts (Department of Health, Feb 2015).
Sources
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 Standard Contract allows for agreement on a range of quality standards or development towards higher standards. Incentives should thus contribute to improved outcomes through improvement in the quality of health services for patients, their families and carers, and through reducing health inequalities. NHS England will be setting and incentivising enhanced standards through a ‘pick-list’ of evidence based indicators for improvement, against which it and clinical commissioning groups can set improvement trajectories and a number of non-mandated best practice service specifications to use with providers. NHS England will continue to make significant funding available (up to 2% of provider contract value) for commissioners to use in setting local improvement goals.
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 in progress (27 February 2026)
Please see response to recommendation 124 above.
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 – Ongoing”. Table row: section 18.2 No. 125, PDF page 484.
Department of Health and Social Care says in progress (11 February 2015)
NHS England has set and incentivised enhanced standards for 2014/15 through a ‘pick-list’ of evidence based indicators for improvement. The Commissioning for Quality and Innovation scheme for 2014/15 provides a national framework through which organisations providing healthcare services under the NHS Standard Contract can earn incentive payments of up to 2.5% of their contract value by achieving agreed national and local goals for service quality improvement. NHS England will continue to keep the provisions in the NHS Standard Contract under review.
The quality premium rewards Clinical Commissioning Groups for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities.
The quality premium paid to Clinical Commissioning Groups in 2015/16 – to reflect the quality of the health services commissioned by them in 2014/15 – will be based on six measures that cover a combination of national and local priorities. These are:
• reducing potential years of lives lost through causes considered amenable to healthcare and addressing locally agreed priorities for reducing premature mortality (15 % of quality premium);
• improving access to psychological therapies (15 % of quality premium);
• reducing avoidable emergency admissions (25 % of quality premium);
• addressing issues identified in the 2013/14 Friends and Family Test, supporting roll out of Friends and Family Test in 2014/15 and showing improvement in a locally selected patient experience indicator (15 % of quality premium);
• improving the reporting of medication-related safety incidents based on a locally selected measure (15 % of quality premium);
• a further local measure that should be based on local priorities such as those identified in joint health and wellbeing strategies (15 % of quality premium).
The quality premium will be further developed to confirm the combination of national and local priorities that will determine the amount to be paid to Clinical Commissioning Groups in 2016/17 to reflect the quality of health services commissioned in 2015/16. Details will be published alongside the NHS Standard Contract for 2015/16, and details of other incentives to improve quality.
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 commissioners, 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 NHS Standard Contract as allowing for agreement on a range of quality standards or development towards higher standards. The Government also said that NHS England would set and incentivise enhanced standards through evidence-based indicators for improvement, against which it and clinical commissioning groups could set improvement trajectories. NHS England would make funding available to commissioners to use in setting local improvement goals.
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. 125, PDF page 450-451.
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