. No. Recommendation Hard Truths Government response Progress update
1 It is recommended that:
• 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
• 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
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
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
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 Journey to Putting Patients First 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 3rd Report After Francis – making a
difference, published in September 2013, that it agrees with the 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.
2 The NHS and all who work for it must adopt
and demonstrate a shared culture in which the
patient is the priority in everything done. This
• A common set of shared core values and
standards shared throughout the system.
• Leadership at all levels from ward to the
top of the Department of Health,
committed to and capable of involving
all staff with those values and
Shared core values and standards:
• We will continue to use and promote the core values and expectations for the
NHS set out in the NHS Constitution.
• The development of values based recruitment by Health Education England
will reinforce the importance of values as the driving force of the NHS.
• The Care Quality Commission has conducted a major consultation on a new
set of fundamental standards of care which will set out the inviolable
principles of safe, effective and compassionate care that must underpin all
care in the future.
The Department of Health has put in place a number of measures to address the
elements of this recommendation. The detail of what the Department of Health
have done is set out in the report on progress ‘Culture Change in the NHS -
Applying the Lessons of the Francis Inquiry’ and in the updates we have
provided on progress against other recommendations made by Sir Robert
Among those measures are:
Shared core values and standards
• The Department of Health is consulting on a number of measures in
relation to the NHS Constitution in response to the recommendations
• A system which recognises and applies
the values of transparency, honesty and
• Freely available, useful, reliable and full
information on attainment of the values and
• A tool or methodology such as a cultural
barometer to measure the cultural health
of all parts of the system.
• The introduction of a new and robust inspection regime is an important
shift in the way nationally the system will ensure poor care is identified
Leadership at all levels
• We recognise the importance of leadership at all levels in ensuring that we
prevent terrible failures of care of the kind we saw at Mid Staffordshire NHS
Foundation Trust, and welcome the connection made in this
recommendation between effective leadership and the engagement of staff.
• The NHS Leadership Academy is developing and implementing a wide
ranging programme of leadership support at all levels of the NHS, with
a strong emphasis on values.
Information on the attainment of the values and standards
• We agree that the NHS needs to do much more to put in place a
transparent approach to providing care and to working with patients. The
shift to greater transparency is the foundation for the culture of honesty
and candour that this recommendation calls for.
• We are putting in place legal changes that place a statutory duty of candour
on healthcare providers and which create a new offence of providing false or
Measuring cultural health
• We agree that it is important to ensure there is a clear understanding of the
cultural health of different parts of the NHS. Regular inspection will provide
the basis for a new, clear, transparent system of ratings that will be
accessible to the public. All acute hospitals in England will have been
inspected by the end of 2015.
• The Care Quality Commission is developing a set of indicators for inspecting
all providers of NHS care, and this will permit judgements to be made about
the culture of the organisation in question as well as other elements of its
• In June 2013, the Care Quality Commission issued A new start –
Consultation on changes to the way CQC regulates, inspects and monitors
care. In this, the Care Quality Commission suggested that a ‘well-led’
service is one where there is effective leadership, governance (clinical and
corporate) and clinical involvement at all levels of the organisation, and an
open, fair and transparent culture that listens