Public Inquiry Recommendations

1,832 tracked recommendations across 36 inquiries (search by inquiry name to find 1,056 historic recs) — page 37 of 37

What these recommendations are about

Most prevalent topics across all 36 inquiries: Staff training and development (527) · Quality and safety oversight (440) · Patient safety governance (293) · Weak Government Accountability & Scrutiny (290) · Care safeguarding systems (282) .
The same issues recur across multiple inquiries — Staff training and development (Workforce & Staffing) is the single most common theme, with 527 tagged recommendations. Explore →
Browse by inquiry
Inquiry Recs Accepted
All inquiries (1,832)
Mid Staffs Inquiry 290 281
Manchester Arena Inquiry 169 169
IICSA 107 96
Muckamore Abbey Inquiry 106 —
Grenfell Tower Inquiry 104 104
Infected Blood Inquiry 103 102
Hyponatraemia Inquiry 96 96
Fuller Inquiry 92 71
Leveson Inquiry 92 77
Vale of Leven Inquiry 75 75
Baha Mousa Inquiry 73 72
Southport Inquiry 67 67
COVID-19 Inquiry 55 24
RHI Inquiry 45 44
Morecambe Bay Investigation 44 44
Brook House Inquiry 33 28
Bichard Inquiry 31 31
Angiolini Inquiry 29 16
Post Office Horizon Inquiry 27 25
Jermaine Baker Inquiry 26 22
Edinburgh Tram Inquiry 24 21
Daniel Morgan Panel 23 21
Cranston Inquiry 18 —
Paterson Inquiry 17 15
HIA Inquiry 12 12
Scottish Hospitals Inquiry 11 11
Anthony Grainger Inquiry 9 9
Al-Sweady Inquiry 9 9
Hillsborough Panel 9 5
Fingerprint Inquiry 9 9
Urology Services Inquiry 8 —
ICL Inquiry 7 6
Litvinenko Inquiry 5 5
Azelle Rodney Inquiry 3 3
Billy Wright Inquiry 3 3
Penrose Inquiry 1 1
SP36 Accepted
Southport Inquiry (2026)
Sharing information about closed Prevent referrals
Counter Terrorism Policing Headquarters and the Home Office should assess and issue clear guidance on best practice for sharing appropriate information about closed Prevent referrals. This guidance should ensure that …
- The government response states Counter Terrorism Policing are scoping the legal implications of sharing information about closed Prevent referrals, that the Home Office and …
SP37 Accepted
Southport Inquiry (2026)
Prevent Supervisor training on closure decisions
Prevent Supervisors should receive improved role specific training, including training on supervising decisions to close Prevent referrals and ensuring that all outstanding actions have been completed. This may be achieved …
- The government response states this recommendation requires delivery by an organisation outside central government, that the government has written to the responsible organisations to …
SP38 Accepted
Southport Inquiry (2026)
Prevent referral training for organisations
Building on the Key Principles of Prevent issued on 23 February 2026, the Home Office should ensure that accessible information and appropriate training materials should be made available to organisations …
- The Home Office published the Key principles of Prevent, setting out how Prevent operates and the basis on which referrals should be made (Key …
SP39 Accepted
Southport Inquiry (2026)
Working Together guidance on risks to others
The Department for Education should update Working Together to Safeguard Children and the Children’s Social Care National Framework. These documents should highlight that safeguarding and child protection assessments, when considering …
- The government agreed the recommendation and stated the Department for Education is consulting on the 2027 update to the statutory framework for help, support …
SP40 Accepted
Southport Inquiry (2026)
LCC frontline staff Prevent training
Lancashire County Council should ensure that by 13 October 2026 all its frontline staff have received suitable training, or refresher training, on Prevent.
- The government agreed the recommendation and noted it requires delivery by an organisation outside central government, stating it has written to the responsible organisations …
SP41 Accepted
Southport Inquiry (2026)
Social worker supervision for Level 3 cases
Lancashire County Council should ensure that its arrangements for social workers provide appropriate support and supervision for family support workers handling Level 3 cases on the Continuum of Need.
- The government agreed the recommendation and noted it requires delivery by an organisation outside central government, stating it has written to the responsible organisations …
SP42 Accepted
Southport Inquiry (2026)
Decisions based on assessed need not inflexible criteria
Lancashire County Council should review its processes and training to ensure decisions regarding children and families are made on the basis of assessed need rather than inflexible criteria such as …
- The government agreed the recommendation and noted it requires delivery by an organisation outside central government, stating it has written to the responsible organisations …
SP43 Accepted
Southport Inquiry (2026)
Significance of multiple referrals
Lancashire County Council should ensure that its policies and training emphasise the significance of multiple referrals when considering the relevant risks relating to a child (including the risk to others).
- The government agreed the recommendation and noted it requires delivery by an organisation outside central government, stating it has written to the responsible organisations …
SP44 Accepted
Southport Inquiry (2026)
Frontline staff access to full case information
1. Lancashire County Council should ensure that frontline staff are required to familiarise themselves with full case information, with this being embedded through training and performance review. 2. Lancashire County …
- The government agreed the recommendation and noted it requires delivery by an organisation outside central government, stating it has written to the responsible organisations …
SP45 Accepted
Southport Inquiry (2026)
Autism training for frontline social care staff
Lancashire County Council should ensure frontline staff receive appropriate training on autism spectrum disorder, emphasising that autism does not necessarily explain or excuse behaviour. The Department for Education should ensure …
- The government stated the recommendation will be led by Lancashire County Council, that the Department for Education will consider Lancashire's approach and how training …
SP46 Accepted
Southport Inquiry (2026)
Addressing parental consent manipulation
1. Lancashire County Council should consider how to address repeated lack of consent or manipulation of consent within existing legislation. 2. Phase 2 should consider whether legal reforms are needed …
- The government agreed the recommendation and noted the Chair identified it for further consideration by the Inquiry in Phase 2 (Government Response to Phase …
SP47 Accepted
Southport Inquiry (2026)
Audit of LCC Child and Youth Justice Service
Lancashire County Council, in consultation with the Youth Justice Board, should arrange for a comprehensive and independent audit to be undertaken of the Lancashire County Council Child and Youth Justice …
- The Ministry of Justice stated that it supports the Chair's recommendation 47, calling for an independent audit of the Lancashire County Council Child and …
SP48 Accepted
Southport Inquiry (2026)
Training on Child and Youth Justice Service
1. Lancashire County Council should ensure that staff within Children and Family Wellbeing Service, and Children’s Social Care receive training on the services available through the Child and Youth Justice …
- The government agreed the recommendation and noted it requires delivery by an organisation outside central government, stating it has written to the responsible organisations …
SP49 Accepted
Southport Inquiry (2026)
Audit of Young Adults Team transition assessments
Lancashire County Council, with the Care Quality Commission, should commission an independent audit of the Young Adults Team to ensure assessments for transition to adult care are timely, properly reasoned …
- The government agreed the recommendation and noted it requires delivery by an organisation outside central government, stating it has written to the responsible organisations …
SP50 Accepted
Southport Inquiry (2026)
Healthcare trust risk information visibility
The Department of Health and Social Care / NHS England should ensure that all healthcare trusts involved in the care of children and young people who are at risk of …
- The 10 Year Health Plan for England committed the NHS to introducing a single patient record bringing an individual's records together in one authoritative …
SP51 Accepted
Southport Inquiry (2026)
GMMH local structured risk assessment responsibility
At the local level, Greater Manchester Mental Health NHS Foundation Trust should liaise with all of the relevant community healthcare organisations (including Child and Adolescent Mental Health Services and Criminal …
- The Department of Health and Social Care stated that it has limited powers to direct NHS Foundation Trusts to implement recommendations 51 and 53, …
SP52 Accepted
Southport Inquiry (2026)
National guidance on structured risk assessments
Nationally, the Department of Health and Social Care and NHS England should review: 1. Whether there is a need for further development and guidance including on the thresholds for when …
- The government stated the Department of Health and Social Care and NHS England expect to complete a review of the need for further guidance …
SP53 Accepted
Southport Inquiry (2026)
GMMH and Alder Hey joint SMART audit
At the local level, Greater Manchester Mental Health NHS Foundation Trust and Alder Hey Children’s NHS Foundation Trust should by no later than 13 October 2026 carry out and report …
- The Department of Health and Social Care stated that the Secretary of State for Health and Social Care has written to Greater Manchester Mental …
SP54 Accepted
Southport Inquiry (2026)
National guidance on SMART action points
Nationally, the Department of Health and Social Care and NHS England should consider whether nationwide guidance should be issued on the importance of action points from all relevant meetings involving …
- The government stated the Department of Health and Social Care and NHS England expect to complete consideration of national guidance on SMART-compliant recording of …
SP55 Accepted
Southport Inquiry (2026)
Community mental health services for violence-fixated children
Phase 2 should consider the ability of community and forensic mental health services to deliver clinical interventions to mitigate the risk from violence fixated children and young people.
- The government stated the Chair identified this recommendation for further consideration by the Inquiry in Phase 2 (Government Response to Phase 1 of the …
SP56 Accepted
Southport Inquiry (2026)
Mental health assessment powers for isolated children
Phase 2 should consider whether further legislative change is required to allow mental health clinicians to assess children and young people who are isolated from professional support and may pose …
- The government stated the Chair identified this recommendation for further consideration by the Inquiry in Phase 2 (Government Response to Phase 1 of the …
SP57 Accepted
Southport Inquiry (2026)
Agencies to respect school insight on risk
The Home Office (for police forces nationwide) Counter Terrorism Police Headquarters (for Prevent), Department of Health and Social Care (for all healthcare providers) and Ministry of Housing, Communities and Local …
- The Children's Wellbeing and Schools Act 2026 received Royal Assent on 29 April 2026, amending safeguarding arrangements so that designated childcare or education agencies …
SP58 Accepted
Southport Inquiry (2026)
KCSIE 2026 safeguarding information transfer
The Department for Education, in finalising the Keeping Children Safe in Education guidance 2026, and in any necessary amendments to other policy and guidance, should ensure that: 1. In cases …
- The Department for Education ran a consultation on proposed revisions to Keeping Children Safe in Education from 12 February 2026 to 22 April 2026, …
SP59 Accepted
Southport Inquiry (2026)
Audit of safeguarding information transfer between schools
The Department for Education should carry out an audit to ensure that safeguarding information is reliably being passed between schools and should consider what further role Ofsted may play to …
- The government stated the Department for Education expects to complete a sample audit of schools to assess the reliability of safeguarding information transfer by …
SP60 Accepted
Southport Inquiry (2026)
School safeguarding recording systems
The Department for Education should ensure (either by direct guidance or through Ofsted) that all schools are required to record safeguarding information in a system that is fit for purpose.
- Keeping Children Safe in Education, the Department for Education's statutory safeguarding guidance for schools and colleges, requires settings to record safeguarding concerns and referrals, …
SP61 Accepted
Southport Inquiry (2026)
LCC education provision and attendance audit
Lancashire County Council should, by no later than 13 October 2026, carry out and report on an audit (preferably involving an experienced independent external member) to review: 1. The speed …
- The government response records that this recommendation requires delivery by an organisation outside central government (Lancashire County Council), that the government has written to …
SP62 Accepted
Southport Inquiry (2026)
Guidance on LEA and police visits to absent children
The Department for Education and the Home Office should review whether further guidance and/or minimum guidance is required in relation to local education authority and police visits to children not …
- The Post-16 education and skills white paper sets out initiatives to help young people at risk of becoming NEET into education, training and work, …
SP63 Accepted
Southport Inquiry (2026)
Improved school Prevent training
The Department for Education should ensure that (i) its own policy guidance for teachers and schools (outside the Statutory Guidance for which the Home Office is responsible) is strengthened; and …
- The Keeping children safe in education: proposed revisions 2026 consultation ran from 12 February 2026 to 22 April 2026 (Keeping children safe in education: …
SP64 Accepted
Southport Inquiry (2026)
Review of school attendance monitoring guidance
The Department for Education should undertake a targeted review, engaging with a representative sample of local authorities, to check both that the current (improved) guidance is now sufficient and understood …
- The government response states the Department for Education is the lead department and expects to complete implementation by late 2026, with regional workshops with …
SP65 Accepted
Southport Inquiry (2026)
Remedial steps for failing education authorities
The Department for Education should consider what remedial steps can be put in place to assist in circumstances where, whether through underfunding or underperformance, local education authorities are failing to …
- The SEND reform: putting children and young people first consultation ran from 23 February 2026 to 18 May 2026, set out an intention to …
SP66 Accepted
Southport Inquiry (2026)
Guidance for parents of children found with weapons
The Youth Justice Board should ensure that a form of clear practical written guidance is drafted which relevant professionals (social care, healthcare, police, education) can provide to parents of children …
- The Ministry of Justice stated that it supports the Chair's recommendation 66 for the Youth Justice Board to issue written guidance for parents of …
SP67 Accepted
Southport Inquiry (2026)
Law Commission review of duty to warn/report
The Law Commission should be asked to review the merits of legal reform concerning whether specified categories of persons ought to be under a legal duty to warn about, or …
- The government response states the Ministry of Justice is the sponsoring department for the Law Commission, that the Law Commission is engaging with the …