F249

Accountability for quality accounts

Mid Staffs Inquiry · Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · Issued 6 February 2013 · Addressed to: Healthcare providers

Government responseDepartment of Health and Social Care: Accepted in part (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

Each quality account should be accompanied by a declaration signed by all directors in office at the date of the account certifying that they believe the contents of the account to be true, or alternatively a statement of explanation as to the reason any such director is unable or has refused to sign such a declaration.

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 commentary from September 2024 published in February 2026, the Department of Health and Social Care and NHS England marked the recommendation as superseded, stating that although it was accepted in part, the government later concluded that accountability was better served by enabling Healthwatch to challenge quality accounts locally (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that the government had only partially accepted the proposal because existing regulations required an authorised statement on behalf of the provider rather than separate signatures from every director (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.

About this summary
This recommendation applies across many organisations. The record above reflects central policy activity; adoption in individual organisations may vary.

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 in part · 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 in part.
The National Health Service (Quality Accounts Regulations) 2010 state that Quality Accounts must include a ‘…written statement… signed by the responsible person for the provider that to the best of that person’s knowledge the information in the document is accurate…’ While this does not include a separate signature from each director, the Quality Account is signed as an accurate and reliable record on their behalf.
2012–13 Detailed Guidance for External Assurance on Quality Reports (Monitor, March 2013) states that for 2012–13 Foundation Trusts will be required to sign a Statement of Directors’ Responsibilities in respect to the Quality Report that states that performance information reported in the Quality Report is reliable and accurate. This is signed by order of the Board by the Chairman and the Chief Executive.
Quality Accounts: 2011–12 audit guidance (Department of Health, April 2012) states that Trusts must sign a statement of Directors’ responsibilities in respect of the content of their quality accounts. This includes a statement that, ‘…the performance information in the Quality Account is reliable and accurate’. This is signed by order of the Board by the Chairman and the Chief Executive.
We will review Quality Accounts before the 2014–15 cycle to ensure that they give patients appropriate information regarding the services they use, and that they add value to the quality assurance infrastructure used by trusts, local and national organisations. While the review is yet to complete, we anticipate that NHS England will implement this recommendation and include it within guidance that it intends to issue by the end of March 2014. NHS England will advise Trusts of expected changes in early 2014 to support them to plan for the 2014–15 cycle.

Response document: 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

This recommendation was accepted only in part.

The recommendation was implemented at the time, but the Government subsequently set out that the review of quality accounts had considered this recommendation, and felt its aims could be better achieved by enabling Healthwatch to challenge quality accounts locally.

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. 249, PDF page 558.

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

The review of Quality Accounts has considered this recommendation. The review felt strongly about accountability and was clear that this could be better achieved by enabling Healthwatch to challenge Quality Accounts locally, given the existing requirements set out above. We will work with Healthwatch to develop guidance. We also intend for Quality Accounts to fall within the scope of the ‘false and misleading information offence’ and for the offence to apply for them. This should come into effect by winter 2014.

The review also felt it was important for Quality Accounts to be made accessible to the public in a more patient friendly format. NHS England plan to issue guidance to support this in 2014/15.

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 healthcare providers, 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 in part by the Government.

In the January 2014 Hard Truths report, the Government said that the National Health Service (Quality Accounts Regulations) 2010 required quality accounts to include a written statement signed by the responsible person for the provider that to the best of their knowledge the information in the document is accurate. They did not have to include a separate signature from each director.

In the February 2015 Culture Change report, the Government said the review of quality accounts had considered this recommendation, and felt its aims could be better achieved by enabling Healthwatch to challenge quality accounts locally.

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. 249, PDF page 514.

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.