Recommendation F243: Recording of routine observations
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The recording of routine observations on the ward should, where possible, be done automatically as they are taken, with results being immediately accessible to all staff electronically in a form enabling progress to be monitored and interpreted. If this cannot be done, there needs to be a system whereby ward leaders and named nurses are responsible for ensuring that the observations are carried out and recorded.
In brief (written by this site)
The Inquiry recommended that healthcare providers record routine ward observations automatically and electronically. In commentary of September 2024, published in February 2026, the Department of Health and Social Care (DHSC) and NHS England stated that most trusts have electronic patient record (EPR) systems bringing together patient information, though automatic recording of ward observations was not mentioned (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team noted in May 2024 that the government accepted the recommendation and had pointed to the Nursing Technology Fund (The Thirlwall Inquiry legal team, May 2024). In February 2015, the department reported that the first round of that fund awarded funding to 74 trusts, with a quarter of projects involving vital signs monitoring solutions (Department of Health, Feb 2015).
Sources
AI-generated summary of the record on this page, checked by a second model and automatic checks, 1 Oct 2026. The record below is the sources' own words.
About this summary
This recommendation applies across many organisations. The record reflects central policy activity; adoption in individual organisations may vary.
Government response
Accepted.
In the initial Government response to The Inquiry, Patients First and Foremost, the Department of Health gave strong support to supervisory roles for Ward Managers (including Sister, Charge Nurse and Team Leader) in delivering oversight to all aspects of care on a ward and in a community, from cleanliness to allocation of staff. Nurse leadership at ward level provided by a Ward Manager is also important to the delivery of safe, high-quality care to patients. However, we wish to allow for local flexibility in delivering nursing care and so the Government is not mandating that ward nurse managers must operate in a supervisory capacity.
Having sufficient nurses trained and with the capacity to respond to ensure the delivery of safe, patient focused care is currently a core standard requirement of the Care Quality Commission. Compassion in Practice commits to ensuring we have the right staff, with the right skills in the right place. This includes supporting leaders to be supervisory, giving them time to lead action plans by December 2013.
The Government’s Information Strategy, published in May 2012, https://www.gov.uk/ government/uploads/system/uploads/attachment_data/file/213689/dh_134205.pdf outlines the use of routine observations in improving the quality of data saying: ‘Connected information can support safer, more integrated care for us and for the professionals providing our care – for example, through online access to GP records in hospitals, electronic prescriptions, barcode-scanning in care homes and hospitals to reduce medication errors, and electronic access to results, X-rays and scans. Many benefits and efficiencies can be achieved through information being recorded once, at first contact, and shared securely between those providing our care.’
In October 2012 the Prime Minister announced the Nursing Technology Fund, an investment fund of £100 milliion spread over 2013–14 and 2014–15. Three key technology types have been identified: digital pens, mobile technology and, of relevance to this recommendation, end of bed monitoring technologies. Full details of how NHS providers will be able apply for funding are to be announced shortly. The Nursing Technology Fund is available to support nurse or midwife led activity in all NHS Trusts and Foundation Trusts in England, including acute, community, mental health and ambulance trusts.
Local Healthwatch organisations are using their ‘enter and view’ powers to get a clear picture of how health and care services are meeting the needs of the public, and their place on every local health and wellbeing board will ensure that voices of people using services is at the heart of local planning and decision-making. Local Healthwatch will also enhance the new inspection regimes. They will make sure inspection teams get a comprehensive picture of local people’s opinions and concerns, and will maintain a focus on service quality issues after the inspection team has moved on.
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)
Patient records must be clear, accurate and legible. This is a requirement set out by professional bodies including the General Medical Council and the Nursing and Midwifery Council. In accordance with the Data Protection Act 2018, organisations must ensure the information they hold is accurate and where necessary, kept up to date.
Most Trusts have electronic patient records (EPR) systems providing a digital platform that brings together all patient information, from medical history to results of investigations and medications prescribed. EPR also has alert features that can help clinicians quickly identify immediate risks to patients and enables audit logs that contain data on clinician interaction with the system.
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. 243, PDF page 553.
Department of Health and Social Care says in progress (11 February 2015)
In the first round of the Nursing Technology Fund, 74 Trusts were awarded funding totalling almost £30m for 85 projects.
The funded projects represent a good geographical spread and a range of care settings. The highest award to an individual project was £1 million, and to an individual organisation was £1.46 million (for two separate projects). All projects projected a Value For Money return greater than 2:1, with almost half projecting a return of at least 4:1. Of the successful projects, 90% will provide solutions for nurses, 23% for midwives, and 10% for health visitors. The majority of projects involve mobile technology, a quarter involve vital signs monitoring solutions, and eight projects involve digital pens.
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 healthcare providers, 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.
The Government referred to the Prime Minister announcing the Nursing Technology Fund, an investment fund of £100m spread over 2013-2015.
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. 243, PDF page 510.
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