Recommendation F132: Monitoring tools
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Commissioners must have the capacity to monitor the performance of every commissioning contract on a continuing basis during the contract period: Such monitoring may include requiring quality information generated by the provider. Commissioners must also have the capacity to undertake their own (or independent) audits, inspections, and investigations. These should, where appropriate, include investigation of individual cases and reviews of groups of cases. The possession of accurate, relevant, and useable information from which the safety and quality of a service can be ascertained is the vital key to effective commissioning, as it is to effective regulation. Monitoring needs to embrace both compliance with the fundamental standards and with any enhanced standards adopted. In the case of the latter, they will be the only source of monitoring, leaving the healthcare regulator to focus on fundamental standards.
In brief (written by this site)
The Department of Health and Social Care and NHS England stated in September 2024 that the NHS Standard Contract allows commissioners to require performance audits and inspect provider premises, while the NHS Oversight Framework uses metrics to prompt further investigation (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team reviewed earlier updates on commissioning support frameworks and recorded the recommendation without assessing implementation as complete (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 exist to provide this resource and expertise. 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).
These functions cover the key elements of this recommendation regarding monitoring quality information, including compliance with fundamental and enhanced standards, and undertaking audits.
NHS England will include this effective contract management and monitoring as an objective in its Commissioning Support Services Strategy and underpinning products, such as quality standards, continuity of service, and procurement vehicles.
NHS England and clinical commissioning groups are developing a Framework for Commissioning for Quality which will set out the steps that commissioners should take to assure themselves and their patients that the services that they are commissioning are safe, clinically effective and result in a positive experience for patients.
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)
The NHS Standard Contract provides for the submission of nationally and locally required information, for commissioners to require an audit of the provider’s performance, and for commissioners and regulatory bodies to enter the provider’s premises to inspect them and to observe service delivery
The NHS Oversight Framework describes how the oversight of NHS trusts, foundation trusts and integrated care boards will operate. It includes oversight metrics used to indicate potential issues and prompt further investigation of support needs.
NHS Provider Licence requires Providers to provide accurate information that is not misleading.
NHS England works alongside the Care Quality Commission (CQC) to ensure these organisations are providing safe and effective care and delivering services in line with the conditions of their provider licence.
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. 132, PDF page 487-488.
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.
NHS England has continued to develop relevant guidance and tools for clinical commissioning groups, to support them in monitoring the quality of service provision and in driving continuous improvement in quality. A framework for commissioning for quality, Commissioning for Quality – Views from Commissioners was published in July 2014
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 services existed to provide this resource and expertise regarding monitoring of quality information, including compliance with fundamental and enhanced standards and undertaking audits.
In the February 2015 Culture Change report, the Government said that NHS England was introducing 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. The Government further referred to NHS England’s framework for commissioning for quality, published in July 2014.
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. 132, PDF page 453-454.
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