Recommendation F127: Resources for scrutiny
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The NHS Commissioning Board and local commissioners must be provided with the infrastructure and the support necessary to enable a proper scrutiny of its providers' services, based on sound commissioning contracts, while ensuring providers remain responsible and accountable for the services they provide.
In brief (written by this site)
In commentary from September 2024 published in February 2026, the Department of Health and Social Care and NHS England stated that all NHS commissioners have teams to monitor contracted service delivery, clinical outcomes, and quality, and that the NHS Standard Contract is mandated to provide a sound basis for local contracts (DHSC and NHS England, Feb 2026). Earlier, in May 2024, the Thirlwall Inquiry legal team reported that the recommendation had been accepted and noted earlier government updates regarding the contract and commissioning support services (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 Standard Contract, NHS England’s assurance of clinical commissioning groups, and the development of commissioning support services, together provide a new infrastructure to ensure that commissioners have the capacity and capability to scrutinise providers’ services.
The NHS Standard Contract provides a clear framework through which commissioners can hold providers to account for service quality and safety, and NHS England will continue to develop this further for 2014–15.
Commissioning comprises some activities for which the statutory commissioning body must retain ultimate responsibility, but there is also a range of other, key support functions which it may be more effective and efficient to be secured externally. These are known as ‘commissioning support services’. Commissioning support services typically include:
• Health Needs Assessment;
• business intelligence;
• support for redesign;
• communications and patient and public engagement;
• procurement and market management (agreeing contracts);
• provider management (monitoring contracts).
Provision of commissioning support services is currently dominated by 19 commissioning support units, created from Primary Care Trusts and hosted by NHS England and the NHS Business Services Authority until 2016.
Work has already been done through NHS England’s clinical commissioning groups assurance programme and through the development of commissioning support services to assure the quality of infrastructure and support within, and available to, commissioning organisations. NHS England will continue to develop this as an objective in its Commissioning Support Services Strategy.
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)
All NHS Commissioners have teams whose role it is to monitor the delivery of contracted services, including levels of access, quality of care purchased and clinical outcomes.
There are robust oversight and assurance mechanisms in place for delegated specialised commissioning services, including in respect of quality relation to services delegated by NHS England to ICBs.
The NHS Standard Contract is published and mandated for use by NHS England to commissioners of non-primary care healthcare services as the basis for sound and robust local contracts.
See answer to Recommendation 17 above for a selection of quality and oversight-related requirements in the contract
See response to recommendation 18 and 31 on the Quality Boards and Groups currently in place.
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. 127, PDF page 485.
Department of Health and Social Care says in progress (11 February 2015)
The NHS Standard Contract continues to provide a clear framework through which commissioners can hold providers to account for quality and safety. Revised provisions, particularly relating to commissioner’s rights to suspend the provision of services, were published in December 2013 as part of the NHS Standard Contract for 2014-15.
NHS England has developed a new framework agreement for commissioning support services – the Lead Provider Framework – that from January 2015 will give clinical commissioning groups, NHS England and other customers a choice of supplier for some or all of their commissioning support needs, ranging from transactional back office support services to more bespoke services that support local and large scale transformational change projects. The Framework will be available to any organization, within or outside the NHS that wishes to procure some or all of its health and social care support services from a variety of accredited providers. It is anticipated that between £3bn and £5bn of services will be procured through it over the next four years. Use of the framework is optional for clinical commissioning groups.
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 NHS England, 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 said that the NHS Standard Contract, NHS England’s assurance of clinical commissioning groups and the development of commissioning support services provided an infrastructure to ensure that commissioners had the capacity and capability to scrutinise providers’ services. In the February 2015 Culture Change report, the Government said the NHS Standard Contract continued to provide this framework, with revised provisions relating to commissioner’s rights to suspend the provision of services being included in the NHS Standard Contract for 2014-15.
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. 127, PDF page 451-452.
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