Transparency use and sharing of information
Mid Staffs Inquiry · Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · Issued 6 February 2013 · Addressed to: CQC
Government responseDepartment of Health and Social Care: Accepted (Nov 2013)
DeliveryDHSC and NHS England say in progress (Feb 2026)Department of Health and Social Care says completed (Feb 2015)
Recommendation, verbatim from the inquiry
●Inquiry recommendation
The Care Quality Commission should be enabled to exploit the potential of the safety information obtained by the National Patient Safety Agency or its successor to assist it in identifying areas for focusing its attention. There needs to be a better dialogue between the two organisations as to how they can assist each other.
Mid Staffs Inquiry, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry · 6 Feb 2013 Source PDF →
Published evidence summary
AI-generated evidence summary
In September 2024, in commentary published in February 2026, the Department of Health and Social Care and NHS England stated that patient safety incident reports are provided to the Care Quality Commission (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that the recommendation had been accepted and cited earlier updates regarding joint safety work between both organisations (The Thirlwall Inquiry legal team, May 2024). The department had previously reported the recommendation completed in February 2015, stating that the commission had secured free access to incident reporting information collected across national systems (Department of Health, Feb 2015).
Sources
AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 2026.
Report-level response context
Government response
●Department of Health and Social Care · Accepted · 19 Nov 2013
Accepted.
A new start – Consultation on changes to the way Care Quality Commission regulates, inspects and monitors care set out the Care Quality Commission’s intentions to gather information from a range of sources to inform its work. It noted that the Care Quality Commission’s Chief Inspectors will use the expert judgements of their teams of inspectors, together with information and evidence held both by the Care Quality Commission and its partners in the system, to provide a single, authoritative assessment of the quality and safety of care services.
A New Start made clear that the Care Quality Commission would be looking, among other things, at whether a service is safe (i.e. people are protected from physical, psychological or emotional harm) and set out proposals for safety indicators. The consultation closed on 12 August 2013, and responses were considered alongside the recommendations from the Berwick Review, Improving the Safety of Patients in England, which included recommended actions around better streamlining of data requests via the Care Quality Commission acting as the coordinating hub for intelligence about quality and safety of care. On 17 October 2013, the Care Quality Commission published the responses to its consultation in A new start: Responses to our consultation on changes to the way Care Quality Commission regulates, inspects and monitors care services, which showed that there is broad agreement with the new approach.NHS England and the Care Quality Commission are committed to working together to develop a shared and agreed approach to measuring safety in the NHS, both for regulatory and improvement purposes. They are working to develop a set of patient safety measures that are best suited for use the Care Quality Commission in their surveillance model and NHS England is providing patient safety expertise on how patient safety data might be used by the Care Quality Commissions for its surveillance and inspection processes. A joint statement between NHS England and the Care Quality Commission is being published setting out how the two organisations will align their work to support inspection and surveillance work for safety.
The National Clinical Assessment Service, previously a division of the National Patient Safety Agency transferred to the NHS Litigation Authority in April 2013. The NHS Litigation Authority is also putting in place an information sharing agreement with regulators, which will include relevant information relating to the National Clinical Assessment Service.
Delivery
●DHSC and NHS England say in progress · 27 Feb 2026
NHS England patient safety incident reports are provided to the CQC. Please see response to recommendation 35 for information on how NHS England works in partnership with CQC.
●Department of Health and Social Care says completed · 11 Feb 2015
NHS England and the Care Quality Commission have worked jointly to ensure a shared view of patient safety data (and what it means) is developed, and that this is reflected in the new Care Quality Commission’s surveillance model for acute and specialist NHS trusts. The Care Quality Commission now has free and unfettered access to all incident reporting information collected by the National Reporting and Learning System and through the Strategic Executive Information System. The Care Quality Commission and NHS England’s Patient Safety Domain regularly meet to share information, review and co-develop initiatives to improve patient safety. For example, NHS England and the Care Quality Commission have co-developed a new set of indicators that are used in the Care Quality Commission’s Intelligent Monitoring system. In March and July 2014, the Care Quality Commission updated its surveillance model for acute and specialist NHS trusts.
What other bodies have found
●Thirlwall Inquiry legal team · 15 May 2024
This recommendation was accepted by the Government.
In the January 2014 Hard Truths Report, the Government said that NHS England and the Care Quality Commission were working together to develop a set of patient safety measures and were publishing a joint statement between them on how the two organisations would align their work.
In the February 2015 Culture Change Report, the Government said that NHS England and the Care Quality Commission had worked jointly to ensure a shared view of patient safety data, which was reflected in the Care Quality Commission’s new surveillance model. The Government also stated that the Care Quality Commission had free and unfettered access to all incident reporting information collected by the National Reporting and Learning System and through the Strategic Information System.
How this page is built
The recommendation and the government responses are verbatim from primary documents. Delivery statements and other bodies' findings are shown in their own words, each with its source. The summary is written by this site and labelled as such. The Index does not paraphrase sources or characterise intent; it records what has been published.