Recommendation F184: Enforcement by the Care Quality Commission
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Observance of the duty should be policed by the Care Quality Commission, which should have powers in the last resort to prosecute in cases of serial non-compliance or serious and wilful deception. The Care Quality Commission should be supported by monitoring undertaken by commissioners and others.
In brief (written by this site)
In commentary from September 2024, published in February 2026, the Department of Health and Social Care and NHS England stated that the Care Quality Commission had implemented the recommendation and that enforcement remained an ongoing piece of work, alongside a departmental review of the duty of candour held in early 2024 (DHSC and NHS England, Feb 2026). Prior to that, in May 2024, the Thirlwall Inquiry legal team noted that the commission had been granted statutory enforcement powers, including warning and requirement notices, the imposition of conditions, and criminal prosecutions (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.
This is accepted in respect of the statutory duty of candour. This new duty will be a requirement for registration with the Care Quality Commission. In line with other registration requirements, Care Quality Commission will monitor compliance with the duty of candour and has a range of enforcement powers it can use where providers fail to meet the registration requirement.
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)
CQC have implemented this recommendation, and it is an ongoing piece of work. DHSC announced a review of the Duty of Candour and ran a Call for Evidence in the first half of 2024.
See also recommendation 21 for further information regarding the statutory duty of candour.
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. 184, PDF page 515.
Department of Health and Social Care says in progress (11 February 2015)
The duty of candour is a legal requirement and Care Quality Commission will be able to take enforcement action when it finds breaches. The duty of candour has applied to NHS organisations from November 2014 and will apply to all other organisations from April 2015. Where an unintended or unexpected incident appears to have resulted in, or could still result in, significant harm to a specific service user, the regulations prescribe a formal set of notification procedures that the provider must follow when informing the service user (or their representative) of that harm. Providers must notify the service user about incidents where significant harm has occurred or could have occurred, give an apology and follow up the incident in writing. Failure to comply with the duty of candour registration regulation requirement could result in prosecution or, in the worst cases, an organisation could have their Care Quality Commission registration removed and so effectively be shut down.
The Care Quality Commission’s ‘safety’ domain that helps guide its inspections, looks in detail at the quality of reporting, investigating and most importantly learning from things that go wrong, and together with the ‘well-led’ domain will assess how well the new statutory Duty of Candour is being introduced and supported.
Hard Truths proposed that where the NHS Litigation Authority finds that a Trust has breached the statutory duty of candour about a patient safety incident which results in a claim, the NHS Litigation Authority could have the discretion to reduce or remove that Trust’s indemnity cover for that claim. This would serve as a further incentive for organisations to develop a culture of candour, transparency and honesty. The Government plans to consult on how this could be taken forward. The NHS Litigation Authority has also issued guidance to the NHS on Saying Sorry and have reiterated that to support a duty of candour an apology is not an admission of guilt but the right thing to do.
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 the Care Quality Commission, 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 relation to the statutory duty of candour.
The Care Quality Commission was given powers of enforcement of the duty, including warning and requirement notices, imposition of conditions and criminal prosecutions.
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. 184, PDF page 480.
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