Recommendation 27: Professional duty to report concerns
From Report of the Morecambe Bay Investigation, published 3 March 2015.
Recommendation
Professional regulatory bodies should clarify and reinforce the duty of professional staff to report concerns about clinical services, particularly where these relate to patient safety, and the mechanism to do so. Failure to report concerns should be regarded as a lapse from professional standards. Action: the General Medical Council, the Nursing and Midwifery Council, the Professional Standards Authority for Health and Social Care.
In brief (written by this site)
In commentary published in February 2026, the Department of Health and Social Care and NHS England reported that implementation was ongoing, noting that joint duty of candour guidance was updated in 2019 and the General Medical Council updated its Good Medical Practice standards in January 2024 to require doctors to report concerns promptly (DHSC and NHS England, Feb 2026). Previously, in May 2024, the Thirlwall Inquiry legal team found that although online records showed an update letter sent to the Secretary of State, a complete report of Sir Bruce Keogh's review of professional codes could not be found (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. The record below is the sources' own words.
Government response
53. We accept this recommendation. A review of professional codes is under way. 54. Dr Kirkup found that many staff did not raise any concerns about standards of care in the maternity units across Morecambe Bay, but perhaps even more troubling is that where concerns were raised there was no evidence that they were properly addressed or followed up. 55. The Professional codes of conduct for both the General Medical Council13 and the Nursing and Midwifery Council14 require registrants to raise concerns and take action where patient safety is at risk. 56. In addition, Professor Sir Bruce Keogh has been asked to review the professional codes of practice of doctors, nurses and midwives and to ensure that the right incentives are in place to prevent people from covering up, instead of reporting and learning from mistakes. This work is being conducted in collaboration with key stakeholders, including the Professional Standards Authority, the General Medical Council, the Nursing and Midwifery Council and Health Education England. The final report is expected later this year.
How this response relates to the recommendation
Site note: This is the Department of Health's response, "Learning not blaming" (Cm 9113, July 2015), to the Morecambe Bay Investigation and two other reports. The department has been the Department of Health and Social Care since January 2018, and the rows are filed under that name. Every word is the department's, including where it reports what another body has done or will do.
Site note: The recommendation is addressed to the General Medical Council; the passage is the Department of Health's account, not that body's.
Delivery
DHSC and NHS England say in progress (27 February 2026)
In March 2015, the former Secretary of State for Health asked Sir Bruce Keogh to review the professional codes of doctors and nurses, and to ensure that the right incentives are in place to prevent health care professionals from covering up mistakes. On 16 July 2015, Sir Bruce confirmed that the professional codes of conduct for doctors (Good Medical Practice) and nurses (The Code) are both fit for purpose.
The GMC and NMC developed joint guidance on the professional duty of candour in 2015 (updated in 2019) which makes clear that healthcare professionals must be open and honest with their colleagues, employers and regulators, raising concerns where appropriate and taking part in reviews and investigations when requested. It also states that professionals must support and encourage each other to be open and honest, and not stop someone from raising concerns. The GMC developed a ‘Speaking Up Hub’ for doctors. This contains advice and tools to help doctors follow GMC guidance and be more confident in raising concerns effectively, and case studies showing the positive impact of raising concerns on patient safety.
The GMC updated Good Medical Practice guidance in January 2024. The guidance states that doctors must raise concerns promptly and includes a duty which says that doctors in management roles must encourage and support their colleagues to raise concerns. All professional regulators are overseen by the Professional Standards Authority for health and social care. The Professional Standards Authority annually reviews each professional regulator’s performance against the following four core functions: Guidance and standards, Education and training, registration, and fitness to practice.
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 “Implemented – Ongoing”. Table row: section 23.2 No. 27, PDF page 647-648.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
Department of Health response (July 2015):
“We accept this recommendation. A review of professional codes is under way … Professor Sir Bruce Keogh has been asked to review the professional codes.” (p. 78)
Whilst there is information online which shows that Sir Bruce Keogh sent a letter to the Secretary of State updating on his review, a complete report of his assessment of the professional codes could not be found.
The Department of Health also mentioned that there is existing guidance for both the General Medical Council and the Nursing and Midwifery Council to require registrants to raise concerns and act where patient safety is at risk.
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 20.2 No. 27, PDF page 609-610.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding