Recommendation F138: Local scrutiny
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
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.
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 reported that work was ongoing, stating that the NHS Oversight Framework and 2022 system quality group guidance govern interventions and maintain service continuity when providers face difficulties (DHSC and NHS England, Feb 2026). Previously, the Thirlwall Inquiry legal team found in May 2024 that the recommendation had been clearly implemented, pointing to earlier government reports on provider failure planning (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 must develop plans to ensure that safe and effective services can continue to be provided in the event of a provider failure.
NHS England is supporting commissioners to develop plans for responding to a serious provider failure, in line with Monitor’s guidance and rules on service continuity.
The Department of Health, the Care Quality Commission, NHS England, Monitor and the NHS Trust Development Authority are working together to develop a single failure regime (outlined in the response to recommendation 19), which will ensure that financial and quality failures are handled in a consistent way and can be enacted where risks to quality and patient safety are identified. As part of that regime, the Care Quality Commission, NHS Trust Development Authority and Monitor will work together, with the trust and its commissioners, to ensure that where concerns are raised, the trust acts swiftly to resolve them. This will provide external support and assurance that appropriate action has been taken or may indicate that further action is needed.
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)
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.
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. 138, PDF page 490-491.
Department of Health and Social Care says in progress (11 February 2015)
With support from NHS England, many commissioners have developed plans for responding to a serious provider failure, in line with Monitor’s service continuity guidance. All clinical commissioning groups will be required to have these plans in place by 2015/16.
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 was support commissioners in developing plans for responding to serious provider failure.
In the February 2015 Culture Change report, the Government said that many commissioners had developed plans for responding to a serious provider failure, with all clinical commissioning groups
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 colours its Extent of Implementation cell for this recommendation green, which it uses to mark evidence, identified by the legal team, that a recommendation has been clearly implemented. Table row: section 16.2 No. 138, PDF page 457.
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