Teamwork
There needs to be effective teamwork between all the different disciplines and services that together provide the collective care often required by an elderly patient; the contribution of cleaners, maintenance staff, and catering staff also needs to be recognised and valued.
- The Care Quality Commission implemented a Single Assessment Framework where multi-disciplinary working is assessed under the 'Effective Quality Statement' (DHSC and NHS England implementation update provided to the Thirlwall Inquiry, April 2025).
- Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires providers to work in partnership with service users (The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, SI 2014/2936).
- NICE published guidance in September 2015 on delivering personal care and practical support to older people in their homes (Home care: delivering personal care and practical support to older people, NICE, September 2015).
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. Multi-disciplinary team working Changing health needs, a complex health and social care system, a growth in multiple co-morbidities and staff shortages mean the NHS must think differently about how it supports new ways of working across teams. The NHS Long Term workforce plan contains a specific focus on optimising MDTs, building on earlier toolkit resources published by Health Education England (now part of NHS England), including self-assessment material. Person-centred care CQC Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities)(Regulations) 2014 (Person-centred care) requires that providers must work in partnership with people using a service, make any reasonable adjustments and provide support to help them understand and make informed decisions about their care and treatment options themselves. NICE have published a guideline in September 2015 Home care: delivering personal care and practical support to older people living in their own homes which provides guidance on delivering personal care and practical support to old people living in their own homes CQC CQC looks at MDT working when it assesses services, and in its previous inspection approach, prompts about MDT working were added to the relevant inspection frameworks CQC have now implemented and started assessing against the new Single Assessment Framework (SAF), where MDT working is assessed under the Effective Quality Statement for how staff, teams and services work together.
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.
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.