Recommendation 1

Accountability for implementation of responses

  • All commissioning, service provision regulatory and ancillary organisations in healthcare should consider the findings and recommendations of this report and decide how to apply them to their own work;
  • Each such organisation should announce at the earliest practicable time its decision on the extent to which it accepts the recommendations and what it intends to do to implement those accepted, and thereafter, on a regular basis but not less than once a year, publish in a report information regarding its progress in relation to its planned actions;
  • In addition to taking such steps for itself, the Department of Health should collate information about the decisions  and actions generally and publish on a regular basis but not less than once a year the progress reported by other organisations;
  • The House of Commons Select Committee on Health should be invited to consider incorporating into its reviews of the performance of organisations accountable to Parliament a review of the decisions and actions they have taken with regard to the recommendations in this report.

The Inquiry made recommendations aimed at national organisations both by name and by implication because of the nature of their responsibilities within the newly reformed system. This document includes a detailed account from each of these organisations on what they have already done to implement  recommendations directed to them and what further action they plan to take. Many organisations have published updates separately on their own websites.

In addition, a number of recommendations were aimed at NHS Trusts and NHS Foundation Trusts.

The Secretary of State wrote to all Trust Chairs in February 2013 asking them to hold listening events with their staff to hear what they have learnt from the inquiry’s findings, and how they best think safe, effective and compassionate care can be delivered in an NHS managing a growing workload within a tight financial context. He followed this up with a letter on 26 March asking them to set out how they intend to respond to the Inquiry’s conclusions before the end of 2013.  Some Trusts have already issued a response.  We would expect these responses to be placed on Trust websites. To maintain momentum, we would encourage all NHS trusts and NHS Foundation Trusts to use the opportunity this further response to the Inquiry presents to continue these local conversations. Leadership teams that put patients first recognise their organisations rely on the skill, motivation and behaviour of the people providing care to patients to drive improvements in safety, quality and compassionate care.

The government’s initial response to the inquiry, Patients First and Foremost published in March 2013, set out a radical programme to prioritise care, improve transparency and ensure that where poor care is detected there is clear action and clear accountability. Informed by the six independent reviews and more detailed work over the summer, Hard Truths: the Government Response to the Mid Staffordshire NHS Foundation Trust Public Inquiry, builds on this to provide a detailed response to each of the 290 recommendations made by the Inquiry. The Department of Health will lead the system in providing an annual report on progress each Autumn.

The Health Select Committee confirmed in its 3rd Report After Francis – making a difference, published in September 2013, that it agrees with inquiry’s recommendation that it should monitor implementation of all his recommendations. Specifically, the Committee proposes to enhance its scrutiny of regulation of healthcare professionals by taking public evidence each year from the Professional Standards Authority for Health and Social Care on the regulatory environment and the performance of each professional regulator, based on the Professional Standards Authority’s own performance reviews. The Government is publishing its response to the Health Select Committee’s report in parallel with Hard Truths.


Hard Truths: the Journey to Putting Patients First published in November 2013 provided an integrated and detailed response to each of the 290 recommendations made by the Inquiry from every part of the health and care system. As part of the Department of Health’s commitment to leading the system in providing an annual progress report, this document sets out what progress has been made towards implementing the actions set out in Hard Truths for each recommendation over the last year.

The Department of Health know that local conversations in NHS Foundation Trusts and NHS trusts on the learning from Francis have continued throughout the year with the focus increasingly shifting towards on driving further improvements in safety, quality and compassionate care across all health and care sectors and settings.