Resources for scrutiny
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.
- DHSC and NHS England stated in April 2025 that all NHS commissioners maintain teams to monitor the delivery of contracted services, including quality of care and clinical outcomes (DHSC/NHS England implementation update to the Thirlwall Inquiry, April 2025).
- NHS England mandates the use of the NHS Standard Contract for all commissioners of non-primary care healthcare services (DHSC/NHS England implementation update to the Thirlwall Inquiry, April 2025).
- DHSC and NHS England reported in 2025 that oversight and assurance mechanisms are in place for specialised commissioning services delegated from NHS England to ICBs (DHSC/NHS England implementation update to the Thirlwall Inquiry, April 2025).
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. 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.
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.
Clinical Commissioning Groups replaced by 42 Integrated Care Boards from 1 July 2022 under Health and Care Act 2022. ICBs have broader responsibilities for population health, bringing together NHS organisations, local authorities and partners. Implements some Francis recommendations on commissioning integration.
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.