Inquiries · Recommendations

Recommendations: Mid Staffs Inquiry

1,814 tracked recommendations 35 inquiries 201 match current filters Page 2 of 5

Recommendations issued by UK statutory and non-statutory inquiries, with their tracked government response and supporting evidence.

Recommendations

201 of 1,814 · page 2 of 5

Code	Recommendation	Inquiry	Response
F72	Assessment process for authorisation The assessment for an authorisation of applicant for foundation trust status should include a full physical inspection of its primary clinical areas …	Mid Staffs Inquiry (2013)	Accepted
F73	Need for constructive working with other parts of the system The Department of Health's regular performance reviews of Monitor (and the Care Quality Commission) should include an examination of its relationship with …	Mid Staffs Inquiry (2013)	Accepted
F74	Enhancement of role of governors Monitor and the Care Quality Commission should publish guidance for governors suggesting principles they expect them to follow in recognising their obligation …	Mid Staffs Inquiry (2013)	Accepted
F76	Enhancement of role of governors Arrangements must be made to ensure that governors are accountable not just to the immediate membership but to the public at large …	Mid Staffs Inquiry (2013)	Accepted
F77	Enhancement of role of governors Monitor and the NHS Commissioning Board should review the resources and facilities made available for the training and development of governors to …	Mid Staffs Inquiry (2013)	Accepted
F78	Enhancement of role of governors The Care Quality Commission and Monitor should consider how best to enable governors to have access to a similar advisory facility in …	Mid Staffs Inquiry (2013)	Accepted
F81	Accountability of providers' directors Consideration should be given to including in the criteria for fitness a minimum level of experience and/or training, while giving appropriate latitude …	Mid Staffs Inquiry (2013)	Accepted
F82	Accountability of providers' directors Provision should be made for regulatory intervention to require the removal or suspension from office after due process of a person whom …	Mid Staffs Inquiry (2013)	Accepted
F83	Accountability of providers' directors If a "fit and proper person test" is introduced as recommended, Monitor should issue guidance on the principles on which it would …	Mid Staffs Inquiry (2013)	Accepted
F85	Accountability of providers' directors Monitor and the Care Quality Commission should produce guidance to NHS and foundation trusts on procedures to be followed in the event …	Mid Staffs Inquiry (2013)	Accepted
F86	Requirement of training of directors A requirement should be imposed on foundation trusts to have in place an adequate programme for the training and continued development of …	Mid Staffs Inquiry (2013)	Accepted
F90	Assistance in deciding on prosecutions In order to determine whether a case is so serious, either in terms of the breach of safety requirements or the consequences …	Mid Staffs Inquiry (2013)	Accepted
F92	NHS Litigation Authority Improvement of risk management The financial incentives at levels below level 3 should be adjusted to maximise the motivation to reach level 3.	Mid Staffs Inquiry (2013)	Accepted
F94	Evidence-based assessment As some form of running record of the evidence reviewed must be retained on each claim in order for these reports to …	Mid Staffs Inquiry (2013)	Accepted
F95	Information sharing As the interests of patient safety should prevail over the narrow litigation interest under which confidentiality or even privilege might be claimed …	Mid Staffs Inquiry (2013)	Accepted
F96	Information sharing The NHS Litigation Authority should make more prominent in its publicity an explanation comprehensible to the general public of the limitations of …	Mid Staffs Inquiry (2013)	Accepted
F101	National Patient Safety Agency functions While it may be impracticable for the National Patient Safety Agency or its successor to have its own team of inspectors, it …	Mid Staffs Inquiry (2013)	Accepted
F102	Transparency use and sharing of information Data held by the National Patient Safety Agency or its successor should be open to analysis for a particular purpose, or others …	Mid Staffs Inquiry (2013)	Accepted
F103	Transparency use and sharing of information The National Patient Safety Agency or its successor should regularly share information with Monitor.	Mid Staffs Inquiry (2013)	Accepted
F104	Transparency use and sharing of information The Care Quality Commission should be enabled to exploit the potential of the safety information obtained by the National Patient Safety Agency …	Mid Staffs Inquiry (2013)	Accepted
F105	Transparency use and sharing of information Consideration should be given to whether information from incident reports involving deaths in hospital could enhance consideration of the hospital standardised mortality …	Mid Staffs Inquiry (2013)	Accepted
F106	Health Protection Agency Coordination and publication of providers' information on healthcare associated infections The Health Protection Agency and its successor, should coordinate the collection, analysis and publication of information on each provider's performance in relation …	Mid Staffs Inquiry (2013)	Accepted
F107	Sharing concerns If the Health Protection Agency or its successor, or the relevant local director of public health or equivalent official, becomes concerned that …	Mid Staffs Inquiry (2013)	Accepted
F108	Support for other agencies Public Health England should review the support and training that health protection staff can offer to local authorities and other agencies in …	Mid Staffs Inquiry (2013)	Accepted
F109	Effective complaints handling Methods of registering a comment or complaint must be readily accessible and easily understood. Multiple gateways need to be provided to patients, …	Mid Staffs Inquiry (2013)	Accepted
F110	Lowering barriers Actual or intended litigation should not be a barrier to the processing or investigation of a complaint at any level. It may …	Mid Staffs Inquiry (2013)	Accepted
F111	Lowering barriers Provider organisations must constantly promote to the public their desire to receive and learn from comments and complaints; constant encouragement should be …	Mid Staffs Inquiry (2013)	Accepted
F112	Lowering barriers Patient feedback which is not in the form of a complaint but which suggests cause for concern should be the subject of …	Mid Staffs Inquiry (2013)	Accepted
F113	Complaints handling The recommendations and standards suggested in the Patients Association's peer review into complaints at the Mid Staffordshire NHS Foundation Trust should be …	Mid Staffs Inquiry (2013)	Accepted
F114	Complaints handling Comments or complaints which describe events amounting to an adverse or serious untoward incident should trigger an investigation.	Mid Staffs Inquiry (2013)	Accepted
F116	Support for complainants Where meetings are held between complainants and trust representatives or investigators as part of the complaints process, advocates and advice should be …	Mid Staffs Inquiry (2013)	Accepted
F119	Learning and information from complaints Overview and scrutiny committees and Local Healthwatch should have access to detailed information about complaints, although respect needs to be paid in …	Mid Staffs Inquiry (2013)	Accepted
F121	Learning and information from complaints The Care Quality Commission should have a means of ready access to information about the most serious complaints. Their local inspectors should …	Mid Staffs Inquiry (2013)	Accepted
F123	Responsibility for monitoring delivery of standards and quality GPs need to undertake a monitoring role on behalf of their patients who receive acute hospital and other specialist services. They should …	Mid Staffs Inquiry (2013)	Accepted
F125	Responsibility for requiring and monitoring delivery of enhanced standards In addition to their duties with regard to the fundamental standards, commissioners should be enabled to promote improvement by requiring compliance with …	Mid Staffs Inquiry (2013)	Accepted
F126	Preserving corporate memory The NHS Commissioning Board and local commissioners should develop and oversee a code of practice for managing organisational transitions, to ensure the …	Mid Staffs Inquiry (2013)	Accepted
F127	Resources for scrutiny The NHS Commissioning Board and local commissioners must be provided with the infrastructure and the support necessary to enable a proper scrutiny …	Mid Staffs Inquiry (2013)	Accepted
F128	Expert support Commissioners must have access to the wide range of experience and resources necessary to undertake a highly complex and technical task, including …	Mid Staffs Inquiry (2013)	Accepted
F129	Ensuring assessment and enforcement of fundamental standards through contracts In selecting indicators and means of measuring compliance, the principal focus of commissioners should be on what is reasonably necessary to safeguard …	Mid Staffs Inquiry (2013)	Accepted
F130	Relative position of commissioner and provider Commissioners – not providers – should decide what they want to be provided. They need to take into account what can be …	Mid Staffs Inquiry (2013)	Accepted
F131	Development of alternative sources of provision Commissioners need, wherever possible, to identify and make available alternative sources of provision. This may mean that commissioning has to be undertaken …	Mid Staffs Inquiry (2013)	Accepted
F132	Monitoring tools Commissioners must have the capacity to monitor the performance of every commissioning contract on a continuing basis during the contract period: Such …	Mid Staffs Inquiry (2013)	Accepted
F134	Role of commissioners in provision of support for complainants Consideration should be given to whether commissioners should be given responsibility for commissioning patients' advocates and support services for complaints against providers.	Mid Staffs Inquiry (2013)	Accepted
F136	Public accountability of commissioners and public engagement Commissioners need to be recognisable public bodies, visibly acting on behalf of the public they serve and with a sufficient infrastructure of …	Mid Staffs Inquiry (2013)	Accepted
F138	Local scrutiny Commissioners should have contingency plans with regard to the protection of patients from harm, where it is found that they are at …	Mid Staffs Inquiry (2013)	Accepted
F139	The need to put patients first at all times The first priority for any organisation charged with responsibility for performance management of a healthcare provider should be ensuring that fundamental patient …	Mid Staffs Inquiry (2013)	Accepted
F140	Performance managers working constructively with regulators Where concerns are raised that such standards are not being complied with, a performance management organisation should share, wherever possible, all relevant …	Mid Staffs Inquiry (2013)	Accepted
F142	Clear lines of responsibility supported by good information flows For an organisation to be effective in performance management, there must exist unambiguous lines of referral and information flows, so that the …	Mid Staffs Inquiry (2013)	Accepted
F143	Clear metrics on quality Metrics need to be established which are relevant to the quality of care and patient safety across the service, to allow norms …	Mid Staffs Inquiry (2013)	Accepted
F144	Need for ownership of quality metrics at a strategic level The NHS Commissioning Board should ensure the development of metrics on quality and outcomes of care for use by commissioners in managing …	Mid Staffs Inquiry (2013)	Accepted

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