Experience on the front line
Department of Health officials need to connect more to the NHS by visits, and most importantly by personal contact with those who have suffered poor experiences. The Department of Health could also be assisted in its work by involving patient/service user representatives through some form of consultative forum within the Department.
- DHSC officials engage with the NHS through various mechanisms including secondments, visits, and working with arm's-length bodies. The integration of DHSC and NHS England governance structures has brought policy officials closer to operational delivery.
- Healthwatch England, established under the Health and Social Care Act 2012, provides a statutory mechanism for patient and public voice to inform DHSC and NHS England policy. Local Healthwatch organisations gather patient experience data that feeds into national policy discussions.
- However, Francis's specific recommendation was about personal contact between DHSC officials and those who have suffered poor experiences, and the creation of a patient/service user consultative forum within the Department. While DHSC engages with patient groups on specific policy consultations, there is limited evidence of a standing internal consultative forum of patient representatives of the kind Francis described.
- The Patient and Public Voice Assurance Group and patient participation initiatives exist within NHS England, but the direct personal connection between DHSC policy officials and patients who have experienced poor care — as distinct from formal consultation processes — is difficult to evidence systematically.
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.