Recommendation F173: Principles of openness transparency and candour
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Every healthcare organisation and everyone working for them must be honest, open and truthful in all their dealings with patients and the public, and organisational and personal interests must never be allowed to outweigh the duty to be honest, open and truthful.
In brief (written by this site)
The Inquiry asked healthcare organisations and their staff to be honest, open, and truthful. In commentary of September 2024, published in February 2026, the Department of Health and Social Care (DHSC) and National Health Service (NHS) England stated that the values set out in the NHS Constitution are embodied in the NHS Patient Safety Strategy and noted the statutory duty of candour introduced in 2014 (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that the government had accepted the recommendation, pointing to professional codes of practice, Care Quality Commission inspection ratings, and the statutory duty of candour (The Thirlwall Inquiry legal team, May 2024).
AI-generated summary of the record on this page, checked by a second model and automatic checks, 5 Oct 2026. The record below is the sources' own words.
About this summary
This recommendation asks for cultural or behavioural change, which is difficult to verify from published sources alone. The record reflects policy commitments rather than measured outcomes.
Government response
Accepted.
Promoting honesty, openness and transparency, and instilling a culture that values compassion, dignity and the highest quality of care is one the key responsibilities of the Department of Health as part of its role in championing improvement and innovation in health. In Patients First and Foremost, the Government’s initial response to the Inquiry, leaders of health and social care organisations signed up to a Statement of Common Purpose that included reaffirming their commitment to putting patients first before the interest of their organisations and to uphold the value that patients are best served where there is a culture of candour, openness, honesty and acceptance of challenge. In A new start – Consultation on changes to the way Care Quality Commission regulates, inspects and monitors care, the Care Quality Commission proposed a framework for inspection which includes a judgement of organisations based on their ability to promote an open, fair and transparent culture. Openness and honesty is already a requirement in healthcare professionals’ codes of practice and the principles and the NHS Constitution already emphasises the importance of honesty and openness. The Education Outcomes Framework and in turn, the Mandate for Health Education England also identifies recruitment, education, training and development that are consistent with the values and behaviours identified in the NHS Constitution as a key deliverable.
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)
Please see response to recommendation 2 for detail on the values set out in the NHS Constitution. These values are embodied in the NHS Patient Safety Strategy.
A statutory Duty of Candour was introduced in 2014, as set out in our response to recommendation 21.
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. 173, PDF page 508-509.
Department of Health and Social Care says in progress (11 February 2015)
The Department of Health and the wider health and care system remains committed to being transparent and open about the safety and quality of services. The public now has a single authorative view about the quality and safety of healthcare services. From April 2014, the Care Quality Commission began rating hospitals’ quality of care in bands ranging from outstanding to inadequate and the full roll out of ratings for hospitals, and ratings for social care and GPs began to be used from October 2014. The NHS in England is also the first health system in the world to measure its commitment to an ‘open and honest reporting’ on a national scale. And there has been a push to achieve an unprecedented level of transparency. Patient safety information is now on NHS Choices together with information about infection control and cleanliness, whether patients are assessed for risk of blood clots, how trusts perform on whether their staff would recommend the trust, how they respond to patient safety alerts and ward-by-ward level information about nursing and midwifery staff levels. The Consultant Outcomes Publication began with ten national clinical audits in June 2013 and this has now increased to 12 specialties. Over 99 percent of consultants have agreed or not objected to information regarding their practice being published. The statutory duty of candour announced in November 2013 came into force for NHS trusts from November 2014 and will come into force for all other organisations from April 2015.
The latest results of the NHS Staff Survey show that overall, 85% (86% in 2012) of all staff felt encouraged by their organisation to report errors, near misses and incidents. Only 14% of all staff felt that reporting of errors would lead to punishment or blaming of those involved. The Nuffield Trust survey of NHS acute trusts one year post the Francis Report found that many of the themes from the Francis Inquiry Report, including the importance of openness, staffing levels and a patient-centered culture, have resonated with leaders of the hospitals
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 healthcare providers, 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 leaders of health and social care organisations singing up to a Statement of Common Purpose to his effect. The Government also referred to the NHS Constitution as emphasising the importance of honesty and openness, and openness and honesty already being a requirement in healthcare professionals’ codes of practice.
In the February 2015 Culture Change report, the government referred to the Care Quality Commission’s new inspection regime, which include rating hospitals’ quality of care in bands from outstanding to inadequate. The Government also referred to the availability of patient safety information on NHS choices and the introduction of the statutory duty of candour from November 2014.
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. 173, PDF page 475.
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