Recommendation 14: Board apologies
From Report of the Independent Inquiry into the Issues raised by Paterson, published 4 February 2020.
Recommendation
We recommend that when things go wrong, boards should apologise at the earliest stage of investigation and not hold back from doing so for fear of the consequences in relation to their liability.
In brief (written by this site)
In September 2024 commentary published in February 2026, the Department of Health and Social Care and NHS England described implementation as ongoing, noting that Care Quality Commission guidance clarifies that an apology does not amount to an admission of liability (DHSC and NHS England, Feb 2026). The department also highlighted that it had issued a call for evidence in May 2024 as part of a review of the statutory duty of candour (DHSC and NHS England, Feb 2026). In its review published in February 2026, the Thirlwall Inquiry legal team found that the recommendation was accepted in full and that compliance with the candour duty is assessed during regulatory inspections (The Thirlwall Inquiry legal team, Feb 2026).
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 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
Accept
Healthcare organisations have a statutory duty of candour, which sets out specific requirements providers must follow when things go wrong with care and treatment, including providing truthful information and an apology. This duty is regulated by CQC.
NHS Resolution has consistently advised its members to apologise when things go wrong, and to provide a full and frank explanation at the earliest possible stage, irrespective of the possibility of a legal claim. More work is underway to ensure that this NHS Resolution guidance is promoted.
The government accepts this recommendation in full and agrees that patients should receive an apology from boards at the earliest stage of investigation when things go wrong.
Delivery
DHSC and NHS England say in progress (27 February 2026)
Statutory Duty of Candour
In November 2014, the Government introduced a statutory (organisational) duty of candour for NHS trusts and NHS foundation trusts. The duty places a direct obligation upon trusts to be open and honest with patients and service users, and their families, when something goes wrong that appears to have caused or could lead to moderate harm or worse in the future (known as a ‘notifiable safety incident’). From April 2015, the duty extended to all other health and social care providers registered with the CQC including care homes.
The duty of candour is enforced by CQC with consequences for health and care providers who are found to be non-compliant. This can include CQC’s ability to:
• impose conditions
• issue warning notices and fines
• remove a provider’s registration
• bring criminal prosecutions without needing to first serve a warning notice
CQC has produced guidance on the statutory duty of candour which explicitly states that apologising is “a crucial part of the duty of candour” that does not amount to an admission of liability. Compliance with the statutory duty of candour is integral to the CQC’s assessment process. NHSR has launched a new animation on the duty of candour, which underlines that apologising is always the right thing to do. NHSR continues to provide resources and engagement on both the need to provide apologies when appropriate, and on how to do so effectively.
Saying sorry meaningfully when things go wrong is vital for everyone involved in an incident, including the patient, their family, carers, and the staff that care for them. It is part of the duty of candour. NHS Resolution publish supporting guidance.
The Government announced a review of the statutory duty of candour in December 2023. A call for evidence to gather evidence about the operation of the duty of candour was published by DHSC on 22 May 2024.
PSIRF
The NHS England Patient Safety Incident Response Framework confirms that patients, families and carers should receive a meaningful apology as soon as possible. Face-to-face verbal apologies are preferable, and as soon as possible after an incident has occurred. A written apology clearly stating the healthcare organisation is sorry for the suffering and distress resulting from the incident must also be given.
Leadership Framework
The NHS Leadership Competency Framework for board members published in February 2024 sets out six competency domains to support board members to perform at their best which are aligned to the NHS Values as set out in the NHS Constitution. The competency domains are aligned to Our NHS People Promise , Our Leadership Way, and the Seven Principles of Public Life.
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 29.2 No. (blank) / Action 10.2, PDF page 749.
DHSC states no delivery position (15 May 2024)
Action 10.2
This recommendation has been implemented. CQC has produced guidance on the statutory Duty of Candour which explicitly states that apologising is “a crucial part of the duty of candour” that does not amount to an admission of liability. Compliance with the statutory Duty of Candour is integral to the CQC’s assessment process. NHSR has launched a new animation on the Duty of Candour, which underlines that apologising is always the right thing to do. NHSR continues to provide resources and engagement on both the need to provide apologies when appropriate, and on how to do so effectively.
From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024), The Department of Health and Social Care
Site note: DHSC's own comments on progress, supplied to the Thirlwall Inquiry in February 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). They are not a finding of the Inquiry. Table row: section 26.2 No. P10 / Action 10.1, 10.2, PDF page 749-750.
Department of Health and Social Care says in progress (15 December 2022)
CQC has produced guidance on the statutory duty of candour, which explicitly states that apologising is “a crucial part of the duty of candour” that does not amount to an admission of liability.
NHS Resolution has launched a new animation on the duty of candour, which underlines that apologising is always the right thing to do.
NHS Resolution continues to provide resources and engagement on both the need to provide apologies when appropriate, and on how to do so effectively.
Compliance with the statutory duty of candour is assessed as part of the CQC assessment process.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (27 February 2026)
Action 10.2:
Accepted in full.
New Care Quality Commission guidance has been produced on the statutory duty of candour, which explicitly states that apologising is “a crucial part of the duty of candour” that does not amount to an admission of liability. Compliance with this statutory duty is part of the Care Quality Commission assessment process.
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 dated April 2025, published 27 February 2026). 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 29.2 No. (blank) / Action 10.2, PDF page 749.
Earlier findings (1)
Thirlwall Inquiry legal team (15 May 2024)
Action 10.2:
Accepted in full. New Care Quality Commission guidance has been produced on the statutory duty of candour, which explicitly states that apologising is “a crucial part of the duty of candour” that does not amount to an admission of liability. Compliance with this statutory duty is part of the Care Quality Commission assessment process.
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 26.2 No. P10 / Action 10.1, 10.2, PDF page 749-750.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - DHSC
Delivery statement - Thirlwall Inquiry legal team
Finding