Access for public and patient comments
While there are likely to be many different gateways offered through which patient and public comments can be made, to avoid confusion, it would be helpful for there to be consistency across the country in methods of access, and for the output to be published in a manner allowing fair and informed comparison between organisations.
- The Friends and Family Test (FFT), launched in April 2013 for inpatient and A&E services and subsequently expanded to maternity, GP, mental health, community, and outpatient services, provides one consistent gateway for patient feedback across the country. Approximately 2 million pieces of feedback are submitted monthly. Results are published by NHS England Digital on a monthly basis, enabling comparison between organisations (NHS England, Friends and Family Test).
- The CQC National Patient Survey Programme, established in 2002 and now covering inpatient, maternity, community mental health, urgent and emergency care, and children and young people's services, provides standardised annual patient experience data with results published per trust (CQC, NHS Patient Survey Programme).
- However, Francis's recommendation was about consistency across the many different comment and feedback gateways. In practice, multiple channels exist — FFT, CQC surveys, NHS website reviews, Healthwatch feedback, Patient Advice and Liaison Services (PALS), formal complaints processes, and third-party platforms — without a single unified output enabling fair comparison across all channels.
- The NHS website (nhs.uk) publishes patient ratings and reviews for individual services, providing some consolidation, but the landscape of patient feedback remains fragmented across multiple gateways with different methodologies.
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.
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.