Recommendation F221: Ensuring common standards of competence and compliance
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Consideration should be given to ensuring that there is regulatory oversight of the competence and compliance with appropriate standards by the boards of health service bodies which are not foundation trusts, of equivalent rigour to that applied to foundation trusts.
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 stated that the Care Quality Commission assesses corporate governance through its Well-led Framework, supported by provider licence conditions and a 2023 trust code of governance (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that the government had accepted the recommendation and had tasked the commission alongside the NHS Trust Development Authority with overseeing governance standards across non-foundation trusts (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.
The Care Quality Commission will be responsible for ensuring that all registered providers have appropriate and effective governance arrangements in place as part of its overall assessment of the health of the organisation. This will apply regardless of whether or not an organisation is a Foundation Trust.
One of the key questions that the Chief Inspector of Hospitals, will ask is whether or not an organisation is well-led. In addition, the NHS Trust Development Authority will be responsible for ensuring that NHS Trusts that do not have Foundation Trust status have effective governance arrangements in place. The approach used by the NHS Trust Development Authority is consistent with that used by Monitor, and both of these organisations along with the Care Quality Commission will continue to work closely to ensure that there is effective regulatory scrutiny of governance and compliance with appropriate standards. There will also be checks on quality governance by the NHS Trust Development Authority before referral to Monitor.
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)
Since, 2009 the Care Quality Commission has been the independent regulator for health and adult social care services since 2009. The CQC will assess corporate governance arrangements as part of their Well-led Framework. The NHS Provider licence included a condition covering provider governance (FT4) that required organisations to meet specific standards as set by DHSC, Monitor (prior to its abolition and transfer of functions to NHS England), CQC or NHS England.
NHS England has additionally developed a Code of governance for NHS provider trusts (2023) that sets out the expectation that the board of directors to establish procedures that manage risk.
See response to recommendation 60, above.
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. 221, PDF page 538-539.
Department of Health and Social Care says in progress (11 February 2015)
The Care Act 2014 introduced a new set of fundamental standards, which will apply to all providers from April 2015. Under the Care Quality Commission’s new inspection regime lead by the chief inspectors of hospitals, adult social care, and general practice, every service and provider is ask five questions:
• Are they safe?
• Are they effective?
• Are they caring?
• Are they well led?
• Are they responsive to people’s needs? The Care Quality Commission consulted on its proposals on how organisations can meet the fundamental standards which include the fit and proper person test as part of the ‘well led’ domain. The consultation concluded in October 2014.
Fit and Proper Persons Test Regulations have been passed by Parliament and are in place in November 2014 for NHS organisations and from April 2015 for other organisations. The Care Quality Commission held a consultation between July and October 2014 setting out proposals on how organisations can meet the fit and proper person test.
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 the Care Quality Commission, 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 the Care Quality Commission would be responsible for ensuring that all registered providers and appropriate and effective governance arrangements when assessing the overall health of the organisation, regardless of whether or not it was a foundation trust. One of the questions it would ask during an inspection is whether or not an organisation was well-led. The NHS Trust Development Authority was to be responsible for ensuring that NHS Trusts had effective governance arrangements in place.
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. 221, PDF page 499.
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