Accountability for quality accounts
Healthcare providers should be required to have their quality accounts independently audited. Auditors should be given a wider remit enabling them to use their professional judgement in examining the reliability of all statements in the accounts.
- NHS foundation trusts were previously required by Monitor to commission external assurance on aspects of their Quality Report in a prescribed format, providing a degree of independent audit. However, this requirement has been withdrawn; NHS foundation trusts no longer produce a separate Quality Report and there is no national requirement for external auditor assurance on Quality Accounts (NHS England, Quality Accounts Requirements).
- Quality Accounts remain a legal requirement under the NHS (Quality Accounts) Regulations 2010, but trusts may choose to locally commission assurance — this is voluntary, not mandatory.
- Integrated Care Boards have assumed responsibilities for review and scrutiny of Quality Accounts, providing a layer of external oversight, but this is not equivalent to the independent professional audit with a wider remit that Francis recommended.
- The Care Act 2014 (Sections 92-94) created a criminal offence for supplying false or misleading information (see F250), which provides a legal deterrent against inaccurate quality reporting. However, the wider auditor remit Francis envisaged — enabling professional judgement in examining the reliability of all statements in the accounts — has not been implemented as a mandatory requirement.
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.
NHS providers required to publish annual quality accounts under Health Act 2009 and NHS (Quality Accounts) Regulations 2010. Strengthened by Health and Social Care Act 2012. Published annually by 30 June. Includes mandatory quality indicators.
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.