Of the 290 recommendations in the Francis Report into the Mid-Staffs inquiry, many would have an impact on the role of PCTs. With their abolition now looming, this begs the question of what CCGs should do in response to the Inquiry Report as they take on the commissioning mantle.

The starting point is that although there is no legal obligation on CCGs to even read the report, as Robert Francis QC made clear, the expectation is that any organisation involved in healthcare should consider how it should respond to the recommendations made. The very first recommendation in the report was as follows:

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

The table below sets out the key areas which may impact on CCGs:


Standards in Healthcare

Recommendations 13 – 15:
Proposed introduction of fundamental, enhanced and developmental standards of healthcare to be imposed as part of the contractual arrangements between commissioners and providers

Recommendation 125:
Commissioners should be enabled to promote improvement by requiring compliance with enhanced standards or development towards higher standards. They can incentivise such improvements.

Recommendation 21:
The commissioner is entitled to and should, wherever it is possible to do so, apply a fundamental safety and quality standard in respect of each item of service it is commissioning.


Recommendation 129:
In selecting indicators and means of measuring compliance, the principal focus of commissioners should be on what is reasonably necessary to safeguard patients and to ensure that at least fundamental safety and quality standards are maintained.

Recommendation 131:
Commissioners need, wherever possible, to identify and make available alternative sources of provision.

Recommendation 132:
Commissioners must have the capacity to monitor the performance of evey commissioning contract on a continuing basis during the contract period.


CCGs will be responsible for ensuring that, if introduced, providers will incorporate and implement these standards. The standards proposed are those suggested by the Patient’s Association (see Recommendations 17 & 113).





The extent to which standards are being met by both providers and commissioners should be monitored by CQC. The Report identified a need to enable CCGs to be given the infrastructure to monitor provider services (Recommendation 127-128).

This suggests considerable local discretion for CCGs, but as a step to be taken now, they may consider examining how far they can currently impose and enforce quality standards. Performance management should be a first priority for CCGs under these recommendations and where concerns are raised they would have to ensure that all relevant information was obtained. They would be required to be accountable to the public for the scope and quality of the services commissioned. In so far as PCTS may currently try to restrict their obligations to passive monitoring or simple acceptance of proposals by care co-ordinators or providers, this would not be permissible

Duty of Candour

Recommendations 176 & 182:
Every statement given to a commissioner by a provider must be truthful and honest nor mislead by omission. Failure to do so could be a criminal offence.
Directors of all healthcare organisations will be obliged to be truthful in statements to regulators or commissioners


CCGs will be entitled to expect full and honest accounts of healthcare provision from providers.

While CCGs would have a commissioning function, they would also be healthcare organisations and their directors would be under a similar obligation


Recommendations 120 & 133:
Commissioners should require access to all complaints information as and when complaints are made.
Commissioners should be entitled to intervene in the management of an individual complaint on behalf of the patient where it appears to them it is not being dealt with satisfactorily.


This does not seem to mean that CCGs will have to be kept informed in parallel as complaints are made, but it could lead to difficulties in filtering out which complaints need to be looked into by CCGs, as opposed to all of them. CCGs may have to commission advocacy and support services for patients bringing complaints (Recommendation 134)

The aim of these recommendations is to put patient safety at the heart of all healthcare provision. CCGs, with the support of CSUs, will have a dual role to administer and ensure compliance. This may mean small organisations having to take on experienced and sophisticated providers in negotiations or monitoring, and that may seem an uneven contest. Be that as it may, it will be a basic expectation of them to do so successfully.

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