Recommendation F128: Expert support
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Commissioners must have access to the wide range of experience and resources necessary to undertake a highly complex and technical task, including specialist clinical advice and procurement expertise. When groups are too small to acquire such support, they should collaborate with others to do so.
In brief (written by this site)
In commentary provided in September 2024 and published in February 2026, the Department of Health and Social Care and NHS England stated that Integrated Care Boards can enter joint working arrangements and obtain specialist commissioning support from four Commissioning Support Units (DHSC and NHS England, Feb 2026). Earlier, the Thirlwall Inquiry legal team noted in May 2024 that the government had accepted the recommendation and had previously reported developing commissioning support services and a Lead Provider Framework agreement (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.
Commissioning support services have been developed to provide commissioners with the range of capacity and expertise required to commission effectively.
Commissioning comprises some activities for which the statutory commissioning body must retain ultimate responsibility, but there is also a range of key support functions which the statutory body not only does not have to undertake itself, but for which it may be more effective and efficient to secure externally. These are known as ‘commissioning support services’. Commissioning support services typically include:
• Health Needs Assessment;
• business intelligence;
• support for redesign;
• communications and public and patient 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.
NHS England will prioritise the further development of the expertise and resources required in its Commissioning Support Services Strategy, and in underpinning products such as quality standards, continuity of service, and procurement vehicles.
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)
In addition to entering joint working arrangements with other ICBs, Integrated Care Boards can secure specialist commissioning support from one of four Commissioning Support Units:
• NHS South, Central and West
• Arden and GEM CSU
• Midlands and Lancs CSU
• North East CSU In 2015, NHS England introduced Lead Provider Framework agreements.
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. 128, PDF page 485-486.
Department of Health and Social Care says in progress (11 February 2015)
NHS England is introducing a Lead Provider Framework agreement for commissioning support services to ensure that clinical commissioning groups and other commissioners have a choice of the best and most efficient commissioning support suppliers. For further information on the Framework see recommendation 127
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 said that commissioning support had as being developed to provide commissioners with the range of capacity and expertise needed to commission effectively.
In the February 2015 Hard Truths report, the Government said that NHS England had introduced a Lead Provider Framework agreement for commissioning support services, to ensure that clinical commissioning groups and other commissioners had a choice of commissioning support suppliers.
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. 128, PDF page 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