Recommendation F131: Development of alternative sources of provision
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Commissioners need, wherever possible, to identify and make available alternative sources of provision. This may mean that commissioning has to be undertaken on behalf of consortia of commissioning groups to provide the negotiating weight necessary to achieve a negotiating balance of power with providers.
In brief (written by this site)
In February 2026, DHSC and NHS England stated that the recommendation had been superseded, explaining that Integrated Care Systems had been established by the Health and Care Act 2022 and Integrated Care Boards had replaced clinical commissioning groups (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted the government's acceptance of the recommendation and recorded earlier progress towards introducing collaborative commissioning arrangements (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.
Commissioners should only decide on models of provision based on the needs and best interests of their patients, in accordance with best practice and with Monitor’s Guidance for commissioners in ensuring the continuity of health services. In doing this, commissioners should prioritise those services for which alternative sources of provision should be made available.
NHS England supports commissioning being undertaken collaboratively, where appropriate. NHS England has provided guidance on collaborative commissioning, to support commissioners who wish to collaborate with one another. It is currently reviewing with clinical commissioning groups whether additional guidance and support would be helpful for 2014–15.
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 state no delivery position (27 February 2026)
Integrated Care Systems (ICSs) were legally established by the Health and Care Act 2022. The 42 ICSs in England are local partnerships that bring health and care organisations together to develop shared plans and joined-up services. They are formed by NHS organisations and upper-tier local councils in that area and also include the voluntary sector, social care providers and other partners with a role in improving local health and wellbeing.
Clinical Commissioning Groups have now replaced by integrated Care system Boards (ICB), who are responsible for planning health services for their local population. Each ICS has an ICB.
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 “Superseded”. Table row: section 18.2 No. 131, PDF page 486-487.
Department of Health and Social Care says in progress (11 February 2015)
NHS England is supporting commissioners to explore new models of commissioning giving patients, local communities and local clinicians greater opportunities to influence how services are delivered. There will be three key changes to the commissioning system for 2015/16, described below.
In May 2014, NHS England announced plans to work with clinical commissioning groups on the development of new models for the co-commissioning of primary care. 196 clinical commissioning groups submitted an expression of interest. Further guidance on co-commissioning has also been produced Next steps towards primary care co -commissioning, This guidance includes detailed overview of the different co-commissioning models and next steps towards implementation. The first delegated co-commissioning arrangements and joint commissioning arrangements involving a pooled budget are planned to be implemented from 1 April 2015.
NHS England has asked a taskforce to analyse current specialised commissioning arrangements to bring about urgent improvements in the way services are commissioned. This move was instigated to address a number of challenges causing significant pressures across the system, gaining financial control but also ensuring that the services delivered to patients across England are planned and delivered safely and efficiently. The outcome is reflected in NHS England’s planning guidance for 2015/16.
In July 2014 NHS England announced plans to pool funding for key groups across local authorities, clinical commissioning groups and specialised commissioning from April 2015. The aims of this approach, to be known as Integrated Personal Commissioning, will be to test new commissioning and funding models and to explore how individuals can have more control over how the funding is used through personalised care and support planning. NHS England also aims to allow people to commission their own care and support through Personal Health Budgets. From October 2014, those in receipt of NHS Continuing Healthcare have the right to a Personal Health Budget, which will allow care and support to be organised that meets their needs. The NHS Mandate sets an ambitious objective that this should also include people with a long-term condition.
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 NHS England supported commissioning being undertaken collaboratively, where appropriate.
In the February 2015 Culture Change report, the Government said that NHS was supporting commissioners to explore new models of commissioning, with plans to work with clinical commissioning groups on the development of new models for the co-commissioning for primary care; plans to pool funding for key groups across local authorities, clinical commissioning groups and specialised commissioning from April 2015; and the announcement of a taskforce to analyse current specialised commissioning arrangements.
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. 131, PDF page 453.
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