Improving and assuring accuracy
There is a need for a review by the Department of Health, the Information Centre and the UK Statistics Authority of the patient outcome statistics, including hospital mortality and other outcome indicators. In particular, there could be benefit from consideration of the extent to which these statistics can be published in a form more readily useable by the public.
- NHS England publishes the Summary Hospital-level Mortality Indicator (SHMI) monthly as Accredited Official Statistics, providing a standardised methodology for comparing hospital mortality rates (NHS Digital - SHMI Mortality Data, NHS England, January 2025).
- An academic review in February 2023 found that structural and legislative changes, including the overhaul of the Care Quality Commission and the introduction of revalidation, had been largely delivered (Ten Years After Francis, Academic Review, February 2023).
- The government reported in February 2015 that 19 hospitals had been placed in special measures and that excess avoidable deaths had fallen (Culture Change in the NHS, UK Government, February 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. Patient outcome statistics are publicly available through various platforms, including NHS England's website, the CQC's inspection reports and NHS England's public portals.
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.
Summary Hospital-level Mortality Indicator (SHMI) published monthly as Accredited Official Statistics by NHS England. Provides standardised transparent methodology for comparing hospital mortality rates. Ratio of actual deaths within 30 days of discharge to expected deaths.
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.