Recommendation BRIS-33: Establish a duty of candour for all NHS staff regarding adverse events
From Bristol Heart Inquiry — Final Report, published 18 July 2001.
Recommendation
A duty of candour, meaning a duty to tell a patient if adverse events2 have occurred, must be recognised as owed by all those working in the NHS to patients.
Government response
No government response to this recommendation is on the record yet.
Delivery
DHSC and NHS England state no delivery position (27 February 2026)
The statutory duty of candour was established by regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (SI 2014/2936) and applies to all health and social care providers regulated by the Care Quality Commission (CQC).
The CQC can take enforcement action for breaches of the regulation under section 90 of the Health and Social Care Act 2008.
In addition, a professional duty of candour is owed by healthcare workers.
The GMC and NMC developed joint guidance on the professional duty of candour in 2015 (since been updated) which makes clear that healthcare professionals must be open and honest with their colleagues, employers and regulators, raising concerns where appropriate and taking part in reviews and investigations when requested. It also states that professionals must support and encourage each other to be open and honest, and not stop someone from raising concerns.
In December 2023, the Government announced a review of the statutory duty of candour. The review is ongoing.
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 Their reviewed extent of implementation reads “Superseded (Duty of candour implemented following Mid Staffordshire Inquiry 2013)”. Table row: section 6.2 No. 33, PDF page 86.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
The Government agreed with this recommendation.
In its January 2002 response, the Department of Health referred to the entitlement of patients to a full explanation and apology when something went wrong, whether or not they wished to make a complaint.
No statutory duty of candour was implemented until enactment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 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 6.2 No. 33, PDF page 83.
Themes and tags
Who has spoken
- DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding