Clear lines of responsibility supported by good information flows
For an organisation to be effective in performance management, there must exist unambiguous lines of referral and information flows, so that the performance manager is not in ignorance of the reality.
- NHS England's System Oversight Framework establishes defined information flows from providers to ICBs and from ICBs to NHS England regional teams. SOF metrics are collected routinely through national data submissions, with defined escalation triggers when metrics indicate potential quality concerns. Regional quality teams triangulate multiple data sources including CQC ratings, patient safety incidents, complaints, mortality data, and workforce indicators (NHS System Oversight Framework, NHS England).
- The NHS Standard Contract 2024/25 specifies detailed information requirements that providers must comply with, including submission of quality and performance data at defined intervals, notification of serious incidents, cooperation with information requests from commissioners, and provision of access to premises and records for audit purposes (NHS Standard Contract, NHS England).
- NHS England's Data, Insight and Intelligence programme publishes provider-level performance data across a wide range of metrics through the Model Health System and the National Quality Dashboard, enabling commissioners and NHS England to identify performance concerns through routine data monitoring (NHS England statistical publications).
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
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.