Recommendation F136: Public accountability of commissioners and public engagement
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Commissioners need to be recognisable public bodies, visibly acting on behalf of the public they serve and with a sufficient infrastructure of technical support. Effective local commissioning can only work with effective local monitoring, and that cannot be done without knowledgeable and skilled local personnel engaging with an informed public.
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2024 published in February 2026, the Department of Health and Social Care and NHS England marked the recommendation as superseded, stating that services are commissioned by integrated care boards and NHS England under the NHS Oversight Framework (DHSC and NHS England, Feb 2026). Prior to that, in May 2024, the Thirlwall Inquiry legal team noted that the government had accepted the recommendation and recorded the accountability mechanisms for clinical commissioning groups set out in earlier responses (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.
NHS England will support and assure clinical commissioning groups to be recognisable, visible local bodies.
The National Health Service (Clinical Commissioning Groups) Regulations 2012 already require that clinical commissioning groups’ names reflect their local community, so that they are recognisable and have a clear link to their locality.
Clinical Commissioning Groups demonstrate their accountability to their members, local people, stakeholders and NHS England in a number of ways, including by:
a) publishing their constitution;
b) appointing independent lay members and non GP clinicians to the governing body;
c) holding meetings of the governing body in public;
d) publishing annually a commissioning plan;
e) complying with local authority health overview and scrutiny requirements;
f) meeting annually in public to publish and present its annual report (which must be published);
g) producing annual accounts in respect of each financial year which must be externally audited;
h) having a published and clear complaints process;
i) complying with the Freedom of Information Act 2000;
j) providing information to NHS England as required.
Commissioning support services have been developed to provide the infrastructure of technical support that clinical commissioning groups require. 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 services underpin the effective local monitoring required to support clinical commissioning groups be effective, visible and well engaged local commissioners.
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)
The NHS Constitution provides that the NHS aspires to the highest standards of excellence and professionalism and to provide high quality care that is safe, effective and focused on patient experience. Services are commissioned by Integrated Care Boards (ICBs) and, in certain prescribed cases, NHS England. The NHS Oversight Framework sets out the approach to oversight of ICBs.
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. 136, PDF page 489-490.
Department of Health and Social Care states no delivery position (11 February 2015)
No further update is required. Please see response to the recommendation in Hard Truths
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 would support and assure clinical commissioning groups to be recognisable, visible local bodies. The Government said that clinical commissioning groups did this in a number of ways, including by publishing their constitution, appointing independent lay members, holding meetings in public, and presenting its annual report and annual accounts.
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. 136, PDF page 456.
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