The government has this week published its final response to the Francis report accepting all but nine of the 290 recommendations. This follows the government’s initial response in February 2013 which included the introduction of a new hospital inspection regime and legislation for a new duty of candour on NHS organisations.

The government’s response provides for a more transparent NHS with an open and accountable culture designed to improve patient safety and quality of care.

Actions on safety and openness include the introduction of a statutory duty of candour on provider organisations and the professional duty of candour on individuals will be strengthened through changes to professional codes. It also includes a commitment to improve the complaints process, quarterly reporting of complaints data and lessons learned by trusts along with better reporting of safety incidents.

This post looks at the impact for commissioners - for those with an appetite for detail, the HSJ have produced a helpful line-by-line analysis (login required).

What does the government's response mean for commissioners?

  • Commissioners will need to have contingency plans to protect patients who are found to be at risk of substandard or unsafe services. The government accepted the Francis recommendation that “Commissioners must develop plans to ensure that safe and effective services can continue to be provided in the event of provider failure”. The Department of Health in conjunction with the Care Quality Commission, NHS England, Monitor and the NHS Trust Development Authority are working on the development of a single failure regime to provide the much needed clarity on the scope and application of the recommendations made by the Trust Special Administrators when dealing with ‘failed trusts’.
  • Commissioners will not have a role to play in the management of complaints. Francis recommended that commissioners intervene in the complaints process if they are not being dealt with satisfactorily. While the government accepted the “spirit of this recommendation” it is “concerned that it risks creating uncertainty over roles and responsibilities in the management of complaints”.
  • Commissioners will not be able to intervene “where substandard or unsafe services are being provided”. The government rejected the Francis recommendations commenting, “respective roles of commissioners and regulators in their relationships with providers are different and must be distinct” and “to give regulators and commissioners equivalent powers of intervention would blur the distinction of these roles and risk causing confusion in the system, resulting in inaction because of assumptions that another body is intervening to address a problem”.

Managing commissioning risk

With falling budgets and increasing scrutiny of quality and safety following the government’s response to the Francis report, commissioners may find themselves as much in the firing line as providers.