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F65

Quality of care as a pre-condition for foundation trust applications

Mid Staffs Inquiry · Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · Issued 6 February 2013

Government responseDepartment of Health and Social Care: Accepted (Nov 2013)

DeliveryDHSC and NHS England state no delivery position (Feb 2026)Department of Health and Social Care says in progress (Feb 2015)

Recommendation, verbatim from the inquiry

●Inquiry recommendation

The NHS Trust Development Authority should develop a clear policy requiring proof of fitness for purpose in delivering the appropriate quality of care as a pre-condition to consideration for support for a foundation trust application.

Mid Staffs Inquiry, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · 6 Feb 2013 Source PDF →

Published evidence summary

AI-generated evidence summary

In February 2026, the Department of Health and Social Care and NHS England stated that although foundation trust authorisation powers remain following the abolition of Monitor, the "policy position has changed and no more FTs are being authorised" (DHSC and NHS England, Feb 2026). Previously, in May 2024, the Thirlwall Inquiry legal team noted that the recommendation had been accepted and that the NHS Trust Development Authority had published an accountability framework requiring proof of care quality before foundation trust bids could proceed (The Thirlwall Inquiry legal team, May 2024).

AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 2026.

Report-level response context

Government responded via "Hard Truths: The Journey to Putting Patients First" (2014), a single document covering all 290 recommendations with a blanket acceptance. Individual recommendation responses were not broken out.

Government response

●Department of Health and Social Care · Accepted · 19 Nov 2013

Speaker not recorded. Source: Department of Health, Hard Truths: the Journey to Putting Patients First, volume 2 (Cm 8777-II), November 2013

Accepted.
The NHS Trust Development Authority has published its Accountability Framework which sets out how Trusts will be held to account for delivering the appropriate quality of care. Trusts which are failing to meet these standards are subject to a robust and transparent escalation process.
The first priority for all provider organisations and for the bodies that oversee them should be to secure high quality services for patients. NHS Trusts are only able to progress through the Foundation Trust pipeline if they have been consistently delivering high quality care, as assessed against the standards in the Accountability Framework, which include concerns raised by the Care Quality Commission and others, such as commissioners.
The Board of the NHS Trust Development Authority will not support applications to progress to Monitor where there are any doubts about the quality of the services being provided by a Trust. In order to ensure this, future inspections of the quality of services provided by aspirant Foundation Trusts and their quality governance processes will take place earlier in the application process, prior to the NHS Trust Development Authority Board making its decision as to whether an application should be supported. No provider will be put forwards for authorisation as a Foundation Trust unless the Care Quality Commission, through its Chief Inspector of Hospitals, judges that the quality of their services is ‘good’ or ‘outstanding’.

Extract from: Hard Truths: The Journey to Putting Patients First. Volume Two of the Government Response to the Mid Staffordshire NHS Foundation Trust Public Inquiry: Response to the Inquiry's Recommendations

Site note: This is volume two of "Hard Truths: The Journey to Putting Patients First" (Cm 8777-II), the government's response to the Inquiry's 290 recommendations, published by the Department of Health on GOV.UK on 19 November 2013 and dated to that day here. The PDF the row links to is the accessible edition, whose title page reads "January 2014". The Department of Health has been the Department of Health and Social Care since January 2018. The volume says it includes accounts from each of the national organisations the recommendations name, but it does not mark which passage each organisation wrote, so every row is filed under the Department that published it.

Delivery

●DHSC and NHS England state no delivery position · 27 Feb 2026

The provisions for Foundation Trust (FT) authorisation remain, with the power to authorise an NHS trust as an FT vested in NHS England (provided Secretary of State has approved the authorisation and NHS England are satisfied as to the matters set out in section 35 of the NHS Act 2006), following abolition of Monitor and transfer of functions to NHS England. However, policy position has changed and no more FTs are being authorised.

From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025)

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 “Superseded”. Table row: section 18.2 No. 65, PDF page 457-458.

●Department of Health and Social Care says in progress · 11 Feb 2015

Since the decision was made only to support Foundation Trust applications from providers with a Care Quality Commission rating of ‘good’ or ‘outstanding’, the NHS Trust Development Authority has advised the Care Quality Commission on trusts that should be considered as priorities for inspection in order to allow their Foundation Trust bids to progress. 55 NHS Trusts have been inspected under the new arrangements, and of these ten have received NHS Trust Development Authority board approval to be considered by Monitor for Foundation Trust authorisation.

From: Culture Change in the NHS supporting Annex (annex to Culture change in the NHS: applying the lessons of the Francis Inquiries)

Site note: This is the supporting annex published on 11 February 2015 with "Culture change in the NHS: applying the lessons of the Francis Inquiries" (Cm 9009), attached to the GOV.UK page as "Culture change in the NHS supporting annex". The annex has no title page; that title is GOV.UK's and the PDF's own. Its table has four columns (No., Recommendation, Hard Truths Government response, Progress update), and the row carries the Progress update cell. No column says which organisation wrote an update, so the row is filed under the Department of Health (now the Department of Health and Social Care), which published it.

Site note: The Inquiry addressed this recommendation to the NHS Trust Development Authority, not to the Department of Health. The annex gives this update in the Department's publication and does not say who wrote it, so the row is the Department's report of the progress made on it.

What other bodies have found

In their own words. These do not change the delivery statement above.

●Thirlwall Inquiry legal team · 15 May 2024

This recommendation was accepted by the Government.

The NHS Trust Development Authority published an accountability framework which set out the requirement that the achievement of Foundation Trust status would only be possible for trusts delivering the key fundamentals of clinical quality, good patient experience and national and local standards and targets.

From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024)

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 16.2 No. 65, PDF page 422.

How this page is built

The recommendation and the government responses are verbatim from primary documents. Delivery statements and other bodies' findings are shown in their own words, each with its source. The summary is written by this site and labelled as such. The Index does not paraphrase sources or characterise intent; it records what has been published.