Recommendation 124

Commissioners applying fundamental safety and quality standard

Accepted in principle
The commissioner is entitled to and should, wherever it is possible to do so, apply a fundamental safety and quality standard in respect of each item of service it is commissioning. In relation to each such standard, it should agree a method of measuring compliance and redress for non-compliance. Commissioners should consider whether it would incentivise compliance by requiring redress for individual patients who have received substandard service to be offered by the provider. These must be consistent with fundamental standards enforceable by the Care Quality Commission.

Fundamental standards of care will be a key part of Care Quality Commission registration requirements and so commissioners will only contract with providers that are meeting these standards.

Commissioners must have regard to any fundamental standard that relates to a service they commission, and they should apply it where they can. They can set safety and quality standards for all services they commission, through clear specification.  The NHS Standard Contract allows for agreement at local level of the method of measuring compliance with such standards, and any appropriate sanctions.

We have considered whether commissioners should consider incentivising compliance through redress for individual patients, which has been tested with providers and commissioners, and the overwhelming response was that this would not be practicable. Potential difficulties would be:

  • a drain of funds from the local health community, where funds may be most needed
  • the potential for perverse incentives to claim compensation
  • duplication with existing rights for patients to be recompensed through litigation, and
  • methodological challenges in assessing the appropriate level of recompense.


Revised provisions, particularly relating to commissioner’s rights to suspend the provision of services, were published in December 2013 as part of the NHS Standard Contract for 2014–15. NHS England will continue to keep the provisions in the NHS Standard Contract under review.