Recommendation 13: Independent sector provider responsibility
From Report of the Independent Inquiry into the Issues raised by Paterson, published 4 February 2020.
Recommendation
We recommend that the government addresses, as a matter of urgency, this gap in responsibility and liability.
In brief (written by this site)
In June 2026, Baroness Merron, Parliamentary Under-Secretary at the Department of Health and Social Care, stated that the Care Quality Commission expects independent sector providers to meet fundamental standards of care and can take enforcement action if they do not, with principles from the Medical Practitioners Assurance Framework now incorporated into inspections (Baroness Merron, Jun 2026). In February 2026, the Thirlwall Inquiry legal team found that the framework had been refreshed to clarify provider responsibility and that NHS Resolution had issued resources on excluding professionals, noting that issues relating to liability were addressed under another recommendation (The Thirlwall Inquiry legal team, Feb 2026).
AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 2026. The record below is the sources' own words.
Government response
Accept in principle
The government is clear that independent sector providers must take responsibility for the quality of care provided in their facilities, regardless of how the consultants are engaged.
The Medical Practitioners Assurance Framework (MPAF), published in 2019 by the IHPN, was created to improve consistency around effective clinical governance, and to set out provider and medical practitioner responsibilities in the independent sector.
CQC will continue to assess the strength of clinical governance in providers as part of its inspection activity, taking account of relevant guidance such as the MPAF.
As covered in our response to recommendation 10, we have set out a programme of work that will consider the case for reforms to the provision of indemnity cover. We will use this as our initial approach to dealing with the challenges faced by patients of Ian Paterson in accessing compensation.
The government accepts this recommendation in principle and recognises there must be appropriate responsibility taken for the actions of all consultants operating within the independent sector.
Delivery
Department of Health and Social Care says in progress (30 June 2026)
The Care Quality Commission (CQC) expects all health and social care registered providers in England, including those in the independent sector, to meet the fundamental standards of care and quality. The standards include person-centred care, dignity and respect, consent, safety, and safeguarding from abuse. If providers are not meeting these fundamental standards, the CQC can take enforcement action.
The principles in the Medical Practitioners Assurance Framework have been adopted by the CQC into the single assessment framework and sector guidance, and these principles are assessed during inspections of independent healthcare services.
From: Health Services: Private Sector (written question UIN HL963)
Site note: The question asks whether independent sector providers are taking full responsibility for the quality of care in their facilities regardless of how consultants are engaged, the words of the government's December 2021 response to this recommendation.
DHSC and NHS England say partially delivered (27 February 2026)
The Independent Healthcare Providers Network has refreshed the Medical Practitioners Assurance Framework (MPAF) for clinical governance in the independent sector. This framework makes clear that independent sector providers must take responsibility for the quality of care provided in their facilities.
CQC assesses all providers, including independent sector providers, on their mechanisms for ensuring high standards of care, taking into account frameworks such as MPAF as appropriate.
See recommendation 7 in relation to work on clinical indemnity issues.
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 “Partially implemented – Ongoing”. Table row: section 29.2 No. P10 / Action 10.1, PDF page 748-749.
Earlier statement on delivery (1)
Department of Health and Social Care (15 December 2022)
IHPN has refreshed the MPAF for clinical governance in the independent sector. This framework makes clear that independent sector providers must take responsibility for the quality of care provided in their facilities.
CQC assesses all providers, including independent sector providers, on their mechanisms for ensuring high standards of care, taking into account frameworks such as MPAF as appropriate.
Issues relating to liability have been considered together with recommendation 10.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (27 February 2026)
Action 10.1:
Accepted in principle.
There has been a refresh of the Medical Practitioners Assurance Framework (originally published in 2019). The new report, published September 2022, makes clear that independent sector providers must take responsibility for the quality of care provided in their facilities. This framework is taken into account by the Care Quality Commission as appropriate.
In April 2022, NHS Resolution published a suite of resources to support decisions relating to the exclusion of professionals.
Issues relating to liability have been dealt with in Recommendation/Principle 7.
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 dated April 2025, published 27 February 2026). 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 29.2 No. P10 / Action 10.1, PDF page 748-749.
Earlier findings (1)
Thirlwall Inquiry legal team (15 May 2024)
Action 10.1:
Accepted in principle.
There has been a refresh of the Medical Practitioners Assurance Framework (originally published in 2019). The new report, published September 2022, makes clear that independent sector providers must take responsibility for the quality of care provided in their facilities. This framework is taken into account by the Care Quality Commission as appropriate.
In April 2022, NHS Resolution published a suite of resources to support decisions relating to the exclusion of professionals.
Issues relating to liability have been dealt with in Recommendation/Principle 7.
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 26.2 No. P10 / Action 10.1, 10.2, PDF page 749-750.
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