Mid Staffordshire NHS Foundation Trust Public Inquiry

There should be a single regulator dealing both with corporate governance, financial competence, viability and compliance with patient safety and quality standards for all trusts.

The Inquiry called for a single regulator overseeing governance, finance, viability, and patient safety. In commentary of September 2024, published in February 2026, the Department of Health and Social Care (DHSC) and NHS England stated that the recommendation was not accepted by the government (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team found in May 2024 that the government had rejected the recommendation, pursuing instead a single regulatory process dividing duties between separate bodies (The Thirlwall Inquiry legal team, May 2024).

A merger of system regulatory functions between Monitor and the Care Quality Commission should be undertaken incrementally and after thorough planning. Such a move should not be used as a justification for reduction of the resources allocated to this area of regulatory activity. It would be vital to retain the corporate memory of both organisations.

In February 2026, the Department of Health and Social Care and NHS England reiterated that this recommendation was not accepted by the government (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that the government did not merge regulatory functions through the development of a single regulator (The Thirlwall Inquiry legal team, May 2024). The department had originally rejected the recommendation in November 2013, explaining that it intended to keep quality inspection separate from improvement functions rather than creating a single regulator (Department of Health response, Nov 2013).

The authorisation process should be conducted by one regulator, which should be equipped with the relevant powers and expertise to undertake this effectively. With due regard to protecting the public from the adverse consequences inherent to any reorganisation, the regulation of the authorisation process and compliance with foundation trust standards should be transferred to the Care Quality Commission, which should incorporate the relevant departments of Monitor.

In commentary from September 2024 published in February 2026, the Department of Health and Social Care and NHS England stated that the government did not accept the recommendation, noting that the latter is responsible for provider licensing, finance, governance, and performance oversight, while the Care Quality Commission handles registration and inspection (DHSC and NHS England, Feb 2026). Previously, in May 2024, the Thirlwall Inquiry legal team found that the government had not accepted the recommendation and did not merge regulatory functions into a single regulator (The Thirlwall Inquiry legal team, May 2024).

Commissioners should have powers of intervention where substandard or unsafe services are being provided, including requiring the substitution of staff or other measures necessary to protect patients from the risk of harm. In the provision of the commissioned services, such powers should be aligned with similar powers of the regulators so that both commissioners and regulators can act jointly, but with the proviso that either can act alone if the other declines to do so. The powers should include the ability to order a provider to stop provision of a service.

In commentary from September 2024 published in February 2026, the Department of Health and Social Care and NHS England confirmed that the recommendation was not accepted, noting that the NHS Standard Contract already provides powers to suspend services, terminate contracts, or agree remedial action plans for unsafe care (DHSC and NHS England, Feb 2026). In its February 2026 review, the Thirlwall Inquiry legal team similarly noted that the government did not accept the proposal (The Thirlwall Inquiry legal team, Feb 2026).

There should be a consistent basic structure for Local Healthwatch throughout the country, in accordance with the principles set out in Chapter 6: Patient and public local involvement and scrutiny.

In commentary of September 2024, published in February 2026, the Department of Health and Social Care and NHS England confirmed that this recommendation was not accepted by the government (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team also recorded that the recommendation had not been accepted, noting the government's view that local Healthwatch organisations should reflect local circumstances rather than adhere to a consistent form (The Thirlwall Inquiry legal team, May 2024).

It should be made a criminal offence for any registered medical practitioner, or nurse, or allied health professional or director of an authorised or registered healthcare organisation: Knowingly to obstruct another in the performance of these statutory duties; To provide information to a patient or nearest relative intending to mislead them about such an incident; Dishonestly to make an untruthful statement to a commissioner or regulator knowing or believing that they are likely to rely on the statement in the performance of their duties.

The Inquiry asked that healthcare professionals face criminal liability for obstructing duties or misleading patients. In commentary of September 2024, published in February 2026, the Department of Health and Social Care (DHSC) and NHS England stated that the recommendation was not accepted by the government (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team noted in May 2024 that the government had rejected the proposal, viewing an individual obstruction offence as unnecessary (The Thirlwall Inquiry legal team, May 2024). The department had stated in November 2013 that it did not intend to criminalise untruthful statements, pointing instead to professional regulation and new provider candour requirements (Department of Health response, Nov 2013).

A registration system should be created under which no unregistered person should be permitted to provide for reward direct physical care to patients currently under the care and treatment of a registered nurse or a registered doctor (or who are dependent on such care by reason of disability and/or infirmity) in a hospital or care home setting. The system should apply to healthcare support workers, whether they are working for the NHS or independent healthcare providers, in the community, for agencies or as independent agents. (Exemptions should be made for persons caring for members of their own family or those with whom they have a genuine social relationship.)

The Inquiry recommended establishing a compulsory registration system for healthcare support workers. The Department of Health and Social Care (DHSC) and NHS England stated in commentary of September 2024, published in February 2026, that this recommendation was not accepted by the Government (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team found in May 2024 that the Government had not accepted the recommendation, noting its reliance on training standards and the Care Certificate rather than compulsory statutory regulation (The Thirlwall Inquiry legal team, May 2024). The department had previously reported in February 2015 that the Care Certificate remained on track for introduction in April 2015 to set out fundamental skills, values, and behaviours for support workers (Department of Health, Feb 2015).

The code of conduct, education and training standards and requirements for registration for healthcare support workers should be prepared and maintained by the Nursing and Midwifery Council after due consultation with all relevant stakeholders, including the Department of Health, other regulators, professional representative organisations and the public.

In commentary published in February 2026, the Department of Health and Social Care and NHS England reiterated that this recommendation was not accepted by the government (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team likewise recorded that the government had rejected the recommendation as a step towards regulation (The Thirlwall Inquiry legal team, May 2024). The department originally explained in November 2013 that it rejected the proposal because the Nursing and Midwifery Council held no remit for healthcare support workers (Department of Health response, Nov 2013).

Until such time as the Nursing and Midwifery Council is charged with the recommended regulatory responsibilities, the Department of Health should institute a nationwide system to protect patients and care receivers from harm. This system should be supported by fair due process in relation to employees in this grade who have been dismissed by employers on the grounds of a serious breach of the code of conduct or otherwise being unfit for such a post.

The Department of Health and Social Care and NHS England stated in September 2024, in commentary published in February 2026, that the recommendation was not accepted by the government (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team similarly found that the government had rejected the recommendation, noting that ministers had instead relied on Care Quality Commission registration standards and guidance on staff appraisal and performance management (The Thirlwall Inquiry legal team, May 2024).