No person-centred care
Failure to ensure the provision of truly person-centred care that meets individual needs, preferences, and promotes dignity.
128 items
1 source
14 inquiries
Source spread
Where this theme appears
No person-centred care has been flagged across 1 independent accountability source:
128 inquiry recs
This theme has been identified in one data source. As more data is added, cross-references may emerge.
Browse by source
Source-grouped records are useful for tracing where a concern came from. Large sections show the 50 strongest matches for that source; counts still show the full theme total.
Inquiry Recommendations (128) — showing 50 strongest matches
37 — Unrestricted daily visiting
Recommendation: Truly unrestricted daily visiting, which does not exist at present, should be introduced as soon as possible.
Unknown
36 — Information booklet for patients
Recommendation: There should be a simple and attractive information booklet which should be given to each patient and his relatives on arrival specifying, among other things, the procedure for making suggestions and complaints.
Unknown
103 — General health examination alongside abuse examination
Recommendation: Where a child is being examined for evidence of sexual abuse a general examination of the child’s health should be carried out at the same time (17.40).
Unknown
87 — Role of prison Imams
Recommendation: The Muslim Adviser to the Prison Service should consider how the role of prison Imams can be expanded – without in any way compromising their religious role – so as to make them readier to assist with the non-religious needs …
Unknown
13 — Informing prisoners about progress of requests
Recommendation: The guidelines should require officers to keep prisoners informed of the progress of their requests, and if the request is refused, to notify prisoners of the reason for the refusal, unless security considerations or issues of confidentiality make that inappropriate.
Unknown
3 — Bereavement care
Recommendation: The National Bereavement Care Pathway for neonatal death should be implemented nationally and in all Trusts by 31 August 2027.
Words of: Yvette Cooper, Secretary of State for Health and Social Care, oral statement to the House of Commons, 15 September 2026 (text as published on GOV.UK)
Gov response: And I agree with the report that, when the very worst happens and parents face bereavement, they need to be supported to the best of our ability. The report recommends the national bereavement care pathway …
Accepted
In progress
R100 — Person-centred day activities and supported employment
Recommendation: Trusts, private and 3rd sector care providers must ensure that person-centred day activities (including supported employment where appropriate) should be available and offered to all people with learning disabilities and autistic people. This should be monitored through Trust delivery plans.
No response yet
R90 — Regional standing committee of service users and families
Recommendation: A regional standing committee of people with learning disabilities and autistic people and their relatives should be established, to be consulted by the DoH and other bodies on services for learning disabilities and autistic people. This should be funded by …
No response yet
R86 — PCC information on quality of care standards
Recommendation: The PCC should support service users/families and provide information on what constitutes good quality care for people with learning disabilities and autistic people, and how to spot when care is falling short.
No response yet
R59 — CCTV explained in accessible format
Recommendation: All service users and their families should have the CCTV explained to them in easily understood language and with easy access materials, so that they are aware that it is for their protection, and so that they understand when it …
No response yet
R21 — Human rights officer in learning disability services
Recommendation: All providers of learning disability services should appoint a human rights officer, as seen in Sheffield Health Partnership University NHS Foundation Trust and Greater Manchester Mental Health NHS Foundation Trust. This role should support staff and monitor the progress of …
No response yet
R20 — Independent advocacy for service users and families
Recommendation: Properly trained independent advocates should be made available to service users and families to support effective communication with staff and for raising concerns and complaints. DoH/SPPG should specify the level of advocacy services required for people with learning disabilities in …
No response yet
R19 — Amend Quality Standards for shared decision-making
Recommendation: The 2006 Quality Standards for Health and Social Care should be amended to require HSC organisations to provide all people with learning disabilities, and if they lack capacity, their family or advocate, with the opportunity to share in all decision-making …
No response yet
R18 — Co-production processes and clinical audit
Recommendation: Specific processes rather than policies should be designed to ensure there is good communication with families and carers to ensure co-production takes place and is effective. Evidence of co-production should be an element of clinical audit of people’s healthcare records.
No response yet
R12 — Person-centred care plans with family involvement
Recommendation: Care plans must be live, person-centred documents. This requires joint ownership with people with learning disabilities and their families rather than simply professional records. While professionals necessarily lead assessments, families should be actively involved in identifying needs. Resulting care plans …
No response yet
R11 — Meaningful daily activities
Recommendation: Like anyone else, people with learning disabilities and autistic people require a variety of meaningful activities on a daily basis to enhance their quality of life. Every person should have an individualised activity schedule, including leisure activities and skill-building activities, …
No response yet
BRIS-9 — Develop kitemarking system for reliable internet health information guidance for public
Recommendation: The public should receive guidance on those sources of information about health and healthcare on the Internet which are reliable and of good quality: a kitemarking system should be developed.
Unknown
In progress
BRIS-8 — NHS Modernisation Agency to prioritise patient information quality and establish accreditation system
Recommendation: The NHS Modernisation Agency should make the improvement of the quality of information for patients a priority. In relation to the content and the dissemination of information for patients, the Agency should identify and promote good practice throughout the NHS. …
Unknown
BRIS-7 — Regularly update and pilot patient information materials with active patient involvement
Recommendation: Various modes of conveying information, whether leaflets, tapes, videos or CDs, should be regularly updated, and developed and piloted with the help of patients.
Unknown
In progress
BRIS-6 — Provide evidence-based patient information in a comprehensible summary format
Recommendation: Information should be based on the current available evidence and include a summary of the evidence and data, in a form which is comprehensible to patients.
Unknown
In progress
30 — Stop admissions from outside the inner catchment area
Recommendation: Admission of patients from outside Preston and its surrounding district (the inner catchment area) should cease as soon as possible.
Unknown
150 — Parents' presence and child's interests
Recommendation: The right of parents to be present throughout a Children’s Hearing should give way to the interests of the child when the child’s interests so require (18.32).
Unknown
149 — Inform parties of business meetings
Recommendation: The child and the child’s parent or guardian should be informed of any ‘business meeting’ of the Children’s Hearing and their position presented orally or in writing at that meeting (18.31).
Unknown
133 — Initial interview series not above four
Recommendation: An initial series of investigative interviews should usually not exceed four (17.75).
Unknown
131 — Maximum two interviews per child per week
Recommendation: In general a maximum of two investigative interviews per child per week should be appropriate and the frequency of interviews is a matter for regular review (17.73).
Unknown
106 — Child's choice of doctor's sex
Recommendation: A child should be able to choose whether the examination is conducted by a female or a male doctor (17.44).
Unknown
77 — Measures for mentally disordered prisoners on wings
Recommendation: The measures which should be taken to minimise the risk which a mentally disordered prisoner on ordinary location poses to staff and other inmates includes: • not placing such a prisoner in a shared cell • if such a prisoner …
Unknown
66 — Assigning personal officers to prisoners
Recommendation: Personal officers should be assigned to individual prisoners, not to a group of cells. They should be members of a small team, so that when a prisoner’s personal officer is not on duty, the prisoner can approach another member of …
Unknown
65 — Mandatory personal officer schemes
Recommendation: It should be mandatory for all establishments to have a personal officer scheme. That includes busy local prisons, although if time for personal officer work is limited, it should be used constructively.
Unknown
R52 — CCTV policies agreed with staff residents and families
Recommendation: Policies governing the use of CCTV should be agreed only after consultation with staff, residents and their families using the service.
No response yet
R51 — CCTV in non-public areas only in best interests
Recommendation: The installation of CCTV in non-public areas should be considered only where this will be in the best interests of the individual service user and following full consultation taking the views of relevant carers, service users (where possible) and relatives …
No response yet
R46 — Lived experience feedback via external agency
Recommendation: Where people with learning disabilities can participate, the provider should actively seek their lived experience feedback in relation to staff attitudes and behaviours on a quarterly basis through an external and independent agency (perhaps to be undertaken by the PCC), …
No response yet
R39 — Guidance on recording and presenting concerns
Recommendation: People with learning disabilities and autistic people and their families should be provided with a short description of how best to record and present concerns so as to be effective.
No response yet
R38 — Clear pathways for raising concerns
Recommendation: People with learning disabilities and autistic people and their families should be provided with clear, written information outlining the available pathways for raising concerns. This information should clearly distinguish between an enquiry, a concern and a complaint. Individuals should then …
No response yet
R37 — Human rights-based restrictive practices training
Recommendation: Education and training on the use of restrictive practices should be grounded in human rights principles and the dedicated human rights specialist appointed in accordance with Recommendation 21 (R21) should work with staff on this approach.
No response yet
R32 — Balanced performance measures including restrictive practices
Recommendation: HSCTs should implement a comprehensive set of balanced performance measures across all services for people with learning disabilities, including those commissioned from third-party providers. These measures should include: Trends in the use of restrictive practices; Trends of aggressive behaviour incidents, …
No response yet
R29 — Psychology input to reduce restrictive practices
Recommendation: All facilities providing residential services for people with learning disabilities and autistic people should provide sufficient psychology input for each patient, to obviate the need for restrictive practices in all but the most exceptional circumstances.
No response yet
R28 — Restraint Reduction Network principles
Recommendation: The Restraint Reduction Network identifies six principles to avoid the use of restrictive practice. While there is evidence that some Trusts have adopted these principles, further action is needed to ensure the principles are fully embedded. These principles must be …
No response yet
R26 — Six-monthly financial accounts to families
Recommendation: Information about the use of cash and other property and six-monthly accounts (or such period as appropriate upon discharge of the person) should be available to the service user concerned where possible and to the family where appropriate. Where appropriate …
No response yet
R25 — Accessible financial records
Recommendation: The records kept must be easy to manage by staff and easily comprehensible to others, including people with learning disabilities and autistic people, carers and relatives.
No response yet
R22 — Easy Read documents
Recommendation: All documents relevant to the service user’s experience and intended for their information must be made available in Easy Read format.
No response yet
R17 — Co-production training
Recommendation: Creating a co-produced care environment, where people with learning disabilities, families and professionals work collaboratively, requires a fundamental shift in practice. As well as organisational commitments, staff will need education and facilitation to transition to this way of working. Specific …
No response yet
R7 — Independent living skills focus
Recommendation: While patients remain in hospital pending resettlement, there should be a focus on enhancing their independent living skills, tailored to their physical and mental capacity.
No response yet
R5 — Named person for care plans
Recommendation: Any service user with a learning disability should have a named person (a key individual) responsible for their care plans and this person should be involved in and record the discussion with the family and the discussion with any relevant …
No response yet
R4 — Consultation before patient transfers
Recommendation: Prior to the decision to move a service user to a different facility there must be discussion with the staff regularly caring for them, the relevant multidisciplinary team (MDT), the person's family where practicable and the person themselves where possible, …
No response yet
BRIS-59 — Make communication skills education essential for all healthcare professionals
Recommendation: Education in communication skills must be an essential part of the education of all healthcare professionals. Communication skills include the ability to engage with patients on an emotional level, to listen, to assess how much information a patient wants to …
Unknown
In progress
BRIS-5 — Tailor patient information to individual needs, circumstances, and wishes
Recommendation: Information should be tailored to the needs, circumstances and wishes of the individual.
Unknown
In progress
BRIS-3 — Adopt patient-professional partnership model across all NHS healthcare settings
Recommendation: The notion of partnership between the healthcare professional and the patient, whereby the patient and the professional meet as equals with different expertise, must be adopted by healthcare professionals in all parts of the NHS, including healthcare professionals in hospitals.
Unknown
In progress
R11 — CDI severity awareness
Recommendation: Health Boards should ensure that patients, and relatives where appropriate, are made aware that CDI is a condition that can be life-threatening, particularly in the elderly. The consultant in charge of a patient’s care should ensure that the patient and, …
Words of: Scottish Government, The Scottish Government's Response to the Vale of Leven Hospital Inquiry Report, section 1.3, 18 June 2015
Gov response: The Scottish Government accepts its responsibility for the failings identified in the report and we apologise unreservedly for the suffering and loss caused. We accept in full all of the report's recommendations.
Accepted
4 — Reflection period for consent
Recommendation: We recommend that there should be a short period introduced into the process of patients giving consent for surgical procedures, to allow them time to reflect on their diagnosis and treatment options. The GMC should monitor this as part of …
Words of: Department of Health and Social Care, Government response to the independent inquiry report into the issues raised by former surgeon Ian Paterson, 16 December 2021
Gov response: Accept in principle Many key organisations, including the GMC, have taken steps to update their guidance, and to confirm that doctors should give patients sufficient time to consider their options before making a decision about …
Accepted in part
In progress