Recommendation F102: Transparency use and sharing of information
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Data held by the National Patient Safety Agency or its successor should be open to analysis for a particular purpose, or others facilitated in that task.
In brief (written by this site)
In commentary provided in September 2024 and published in February 2026, the Department of Health and Social Care and NHS England stated that incident data held as successor to the National Patient Safety Agency was open to analysis through routes including the Learn from Patient Safety Events service (DHSC and NHS England, Feb 2026). They noted that this service remained in a public-beta stage, with intentions to launch a new public dashboard (DHSC and NHS England, Feb 2026). Earlier, in May 2024, the Thirlwall Inquiry legal team reviewed implementation, noting prior government updates on making incident data available to researchers and regulators (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
Accepted.
In its response to the Caldicott Review, Information: To Share or Not to Share (2013), the Department of Health stated that health and care professionals must make decisions about how information is shared and used in the best interests of people and patients using the five rules of confidentiality set out in new Health and Social Care Information Centre guidance, Guide to Confidentiality in Health and Social Care (2013). This guidance provides a balance between confidentiality and information sharing and states that, ‘People using services deserve a lot more than just information security. Individuals need the teams of professionals who are responsible for their care to share information reliably and effectively. Confidential information about an individual must not leak outside of the care team, but it must be shared within it in order to provide a seamless, integrated service.’
Greater sharing of National Reporting and Learning System information is a stated aim of NHS England, within the bounds of an information governance framework. NHS England publishes patient safety incident data from the National Reporting and Learning System including information on levels and severity of harm to patients. NHS England is exploring the extent to which information on Serious Incidents can be disclosed in more detail without breaching the Data Protection Act. As part of the review of the National Reporting and Learning System, NHS England is considering how greater access can be provided to others for the purposes of analysis of patient safety incident data. Fundamentally NHS England is of the view that improving patient safety is more important than preserving unnecessary confidentiality.
The National Clinical Assessment Service, previously a division of the National Patient Safety Agency, was transferred to the NHS Litigation Authority in April 2013. The release of information relevant to this service is consistent with the NHS Litigation Authority’s approach to making information and data available which is not subject to data protection legislation and regulation, and would not result in breach confidentiality and/or rules of the court or litigation practice.
The Care Quality Commission and NHS England will develop a dedicated hospital safety website for the public which will draw together up to date information on all the factors, for which robust data is available, that impact on the safety of care. This will include information on staffing, pressure ulcers, healthcare associated infections and other key indicators, where appropriate, at ward level. The website will aim to begin publication from June 2014. This will over time become a key source of public information, putting the truth about care at the fingertips of patients. NHS England will begin to publish never events data quarterly before the end 2013, and then monthly by April 2014 to help Trusts, patients and the public drive improvement of services. In addition, new Patient Safety Collaboratives will be created from April 2014, which will bring together expertise on learning from mistakes, encourage open reporting of safety incidents and near misses, and support NHS organisations to take a rigorous approach to transforming patient safety. Initial priorities will include tackling pressure ulcers, hospital associated infections, falls and medication errors. The National Director of Patient Safety, Dr Mike Durkin, will lead the work to develop the collaboratives.
How this response relates to the recommendation
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.
Blanket government agreement does not establish acceptance or delivery by each addressee. Some response passages cover groups of recommendations.
Scope of the government response
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.
Delivery
DHSC and NHS England say in progress (27 February 2026)
Pursuant to section 281 of the Health and Social Care Act 2012, the National Patient Safety Agency no longer exists.
The incident data NHS England holds as successor to the National Patient Safety Agency (NPSA) is open to analysis via a number of routes.
For example, Learn from Patient Safety Events (LFPSE) provides a multi-functional online service to access, review and update previously recorded incidents. The intention is to launch a new public dashboard. The LFPSE service is currently in a public-beta stage and will continue to grow and evolve in response to user feedback.
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 18.2 No. 102, PDF page 473-474.
Department of Health and Social Care says in progress (11 February 2015)
On 24 June 2014, a new NHS Choices microsite was launched which for the first time brings together a range of meaningful patient safety data that can be used by patients and the public to understand more about the safety of services. The data includes information on incident reporting, infection control and cleanliness, staffing levels, patient safety alert compliance, risk assessment for blood clots, data on pressure ulcer and harmful fall prevalence from the NHS Safety Thermometer, the Care Quality Commission’s assessment of compliance with their national standards, and data on the proportion of staff who would recommend the organisation if their family or friends needed treatment. These are now incorporated on My NHS, which alongside other data allows for greater scrutiny and comparison of the performance on similar organisations in terms of quality and safety.
NHS England began the monthly publication of never event data from April 2014.
NHS England makes data on patient safety incidents available to a wide range of patient safety researchers, academics and improvement specialists via the form of Data Sharing agreements. This data is used as the source material for published studies, supports innovation in safer care and tackles key themes and areas of risk identified by professionals outside of NHS England. The Care Quality Commission also has unfettered access to all patient safety incidents reported to the National Reporting and Learning System.
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 NHS England, 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 by the Government.
In the January 2014 Hard Truths report, the Government said that greater sharing of National Reporting and Learning System information was a stated aim of NHS England, with NHS England said to be exploring the extent to which serious untoward incident information could be disclosed in more detail, and considering how greater access can be provided to others for the purposes of analysis of patient safety data.
In the February 2015 Culture Change Report, the Government referred to the launch of NHS Choices microsite in June 2014, bringing together a range of patient safety data. The Government also said that NHS England made data on patient safety incidents available to a wide range of patient safety research, academics and improvement specialists via data sharing agreements. The Care Quality Commission was also said to have unfettered access to all patient safety incidents reported to the National Reporting and learning System.
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. 102, PDF page 439.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding