Local scrutiny
Commissioners should have contingency plans with regard to the protection of patients from harm, where it is found that they are at risk from substandard or unsafe services.
- National guidance on System Quality Groups was issued in January 2022 to facilitate intelligence-sharing and quality improvement within integrated care systems (System Quality Groups guidance, NHS England, January 2022).
- DHSC and NHS England stated in April 2025 that Continuity of Service conditions in the NHS Provider Licence apply if a provider is designated as "hard to replace" or if removing services would increase health inequalities (DHSC/NHS England implementation update to 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. NHS England published the NHS Oversight Framework to identify where Integrated Care Boards (ICBs) and/or NHS providers may benefit from, or require, support; and provide an objective basis for decisions about when and how NHS England will intervene. These decisions take into account factors including organisational and system context and an assessment of leadership and governance. NHS England discharges its duties in collaboration with ICBs; agreeing together the specific arrangements for each system to ensure effective and proportionate oversight, reflecting local delivery and governance arrangements. National guidance on system quality groups (SQGs), was issued in January 2022. SQGs provide a strategic forum to facilitate engagement, intelligence-sharing, learning and quality improvement between all organisations within an integrated care system. Where the services are such that they would need to remain in their area if a provider were to get into difficulty because: there is no alternative provider close enough and/or removing them would increase health inequalities and/or removing them would make dependent services unviable. Or if the Provider has been designated as a hard to replace provider then the Continuity of Service conditions set out in the NHS Provider Licence will apply.
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.