Recommendation F174: Candour about harm
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Where death or serious harm has been or may have been caused to a patient by an act or omission of the organisation or its staff, the patient (or any lawfully entitled personal representative or other authorised person) should be informed of the incident, given full disclosure of the surrounding circumstances and be offered an appropriate level of support, whether or not the patient or representative has asked for this information.
In brief (written by this site)
In commentary published in February 2026, the Department of Health and Social Care and NHS England described progress as ongoing, referring to their responses regarding the statutory duty of candour and safety incident frameworks (DHSC and NHS England, Feb 2026). Previously, the Thirlwall Inquiry legal team found in May 2024 that 2014 regulations had established a duty of candour on health service bodies as a requirement for registration with the Care Quality Commission (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.
About this summary
This recommendation applies across many organisations. The record reflects central policy activity; adoption in individual organisations may vary.
Government response
Accepted.
The Secretary of State for Health legally required NHS England to insert a contractual duty of candour into the NHS Standard Contract in 2013–14. This means that NHS Trusts and Foundation Trusts are contractually required to operate a duty of candour. The contract also refers organisations to the Being Open framework that was first produced by the National Patient Safety Agency. This provides guidance on best practice for all healthcare organisations to create an environment where patients, their carers, healthcare professionals and managers all feel supported when things go wrong and have the confidence to act appropriately. The framework gives healthcare organisations guidance on how to develop and embed a being open policy that fits local organisational circumstances. Another key element of the framework is the process on how to communicate with patients, their families and carers following harm.
The Government has also introduced in the Care Bill a new requirement for a statutory duty of candour and will be included as a new registration requirement for health and social care providers registered with the Care Quality Commission. The duty will require providers to be open with patients and service users about failings in care provide an explanation, and where appropriate an apology. As a mark of the Government’s commitment to the duty of candour, the Care Bill puts a requirement on the Secretary of State for Health to establish a requirement for registered with the Care Quality Commission to meet a duty of candour
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 21 regarding the statutory Duty of Candour.
See also recommendation in relation to PSIRF (including 26, 40 and 44) and LFPSE (including recommendation 36,40,99 and 102)
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. 174, PDF page 509.
Department of Health and Social Care says in progress (11 February 2015)
The Government has put in place a new statutory duty of candour as a requirement for registration with the Care Quality Commission which applies to NHS organisations now and all other organisations from April 2015. The threshold for the new duty will be in line with the recommendations of the review led by Professor Sir Norman Williams, President of the Royal College of Surgeons, and Sir David Dalton, Chief Executive at Salford Royal NHS Foundation Trust into enhancing candour in the NHS: Building a culture of candour: A review of the threshold for the duty of candour and of the incentives for care organisations to be candid published on 6 March 2014.
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 the Secretary of State for Health had required NHS England to insert a contractual duty of candour into the NHS Standard Contract in 2013-14. Reg. 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 imposed a duty of candour on health service bodies, which duty became a requirement for registration with the Care Quality Commission.
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 colours its Extent of Implementation cell for this recommendation green, which it uses to mark evidence, identified by the legal team, that a recommendation has been clearly implemented. Table row: section 16.2 No. 174, PDF page 475-476.
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