Inquiries · Recommendations

Public Inquiry Recommendations

1,814 tracked recommendations 35 inquiries 909 match current filters Page 13 of 19

Recommendations issued by UK statutory and non-statutory inquiries, with their tracked government response and supporting evidence.

Browse by inquiry

35 inquiries with tracked recs

Inquiry	Recs	Accepted
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	95
Fuller Inquiry	92	71
Leveson Inquiry	92	77
Vale of Leven Inquiry	75	75
Baha Mousa Inquiry	73	72
Southport Inquiry	67	—
RHI Inquiry	45	44
COVID-19 Inquiry	44	13
Morecambe Bay Investigation	44	44
Brook House Inquiry	33	28
Bichard Inquiry	31	31
Angiolini Inquiry	30	16
Post Office Horizon Inquiry	27	25
Jermaine Baker Inquiry	26	22
Edinburgh Tram Inquiry	24	21
Daniel Morgan Panel	23	23
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
ICL Inquiry	7	6
Litvinenko Inquiry	5	5
Azelle Rodney Inquiry	3	3
Billy Wright Inquiry	3	3
Penrose Inquiry	1	1

Recommendations

909 of 1,814 · page 13 of 19

Code	Recommendation	Inquiry	Response
F253	Access to quality and risk profile The information behind the quality and risk profile – as well as the ratings and methodology – should be placed in the …	Mid Staffs Inquiry (2013)	Accepted
F254	Access for public and patient comments While there are likely to be many different gateways offered through which patient and public comments can be made, to avoid confusion, …	Mid Staffs Inquiry (2013)	Accepted
F255	Using patient feedback Results and analysis of patient feedback including qualitative information need to be made available to all stakeholders in as near "real time" …	Mid Staffs Inquiry (2013)	Accepted
F256	Follow up of patients A proactive system for following up patients shortly after discharge would not only be good "customer service", it would probably provide a …	Mid Staffs Inquiry (2013)	Accepted
F258	Role of the Health and Social Care Information Centre The Information Centre should continue to develop and maintain learning, standards and consensus with regard to information methodologies, with particular reference to …	Mid Staffs Inquiry (2013)	Accepted
F259	Role of the Health and Social Care Information Centre The Information Centre, in consultation with the Department of Health, the NHS Commissioning Board and the Parliamentary and Health Service Ombudsman, should …	Mid Staffs Inquiry (2013)	Accepted
F261	Information standards The Information Centre should be enabled to undertake more detailed statistical analysis of its own than currently appears to be the case.	Mid Staffs Inquiry (2013)	Accepted
F262	Enhancing the use analysis and dissemination of healthcare information All healthcare provider organisations, in conjunction with their healthcare professionals, should develop and maintain systems which give them: Effective real-time information on …	Mid Staffs Inquiry (2013)	Accepted
F263	Enhancing the use analysis and dissemination of healthcare information It must be recognised to be the professional duty of all healthcare professionals to collaborate in the provision of information required for …	Mid Staffs Inquiry (2013)	Accepted
F264	Enhancing the use analysis and dissemination of healthcare information In the case of each specialty, a programme of development for statistics on the efficacy of treatment should be prepared, published, and …	Mid Staffs Inquiry (2013)	Accepted
F265	Enhancing the use analysis and dissemination of healthcare information The Department of Health, the Information Centre and the Care Quality Commission should engage with each representative specialty organisation in order to …	Mid Staffs Inquiry (2013)	Accepted
F266	Enhancing the use analysis and dissemination of healthcare information In designing the methodology for such statistics and their presentation, the Department of Health, the Information Centre, the Care Quality Commission and …	Mid Staffs Inquiry (2013)	Accepted
F267	Enhancing the use analysis and dissemination of healthcare information All such statistics should be made available online and accessible through provider websites, as well as other gateways such as the Care …	Mid Staffs Inquiry (2013)	Accepted
F268	Resources Resources must be allocated to and by provider organisations to enable the relevant data to be collected and forwarded to the relevant …	Mid Staffs Inquiry (2013)	Accepted
F269	Improving and assuring accuracy The only practical way of ensuring reasonable accuracy is vigilant auditing at local level of the data put into the system. This …	Mid Staffs Inquiry (2013)	Accepted
F270	Improving and assuring accuracy There is a need for a review by the Department of Health, the Information Centre and the UK Statistics Authority of the …	Mid Staffs Inquiry (2013)	Accepted
F271	Improving and assuring accuracy To the extent that summary hospital-level mortality indicators are not already recognised as national or official statistics, the Department of Health and …	Mid Staffs Inquiry (2013)	Accepted
F272	Improving and assuring accuracy There is a demonstrable need for an accreditation system to be available for healthcare-relevant statistical methodologies. The power to create an accreditation …	Mid Staffs Inquiry (2013)	Accepted
F274	Information to coroners There is an urgent need for unequivocal guidance to be given to trusts and their legal advisers and those handling disclosure of …	Mid Staffs Inquiry (2013)	Accepted
F276	Independent medical examiners Sufficient numbers of independent medical examiners need to be appointed and resourced to ensure that they can give proper attention to the …	Mid Staffs Inquiry (2013)	Accepted
F277	Death certification National guidance should set out standard methodologies for approaching the certification of the cause of death to ensure, so far as possible, …	Mid Staffs Inquiry (2013)	Accepted
F278	Death certification It should be a routine part of an independent medical examiners's role to seek out and consider any serious untoward incidents or …	Mid Staffs Inquiry (2013)	Accepted
F279	Death certification So far as is practicable, the responsibility for certifying the cause of death should be undertaken and fulfilled by the consultant, or …	Mid Staffs Inquiry (2013)	Accepted
F280	Appropriate and sensitive contact with bereaved families Both the bereaved family and the certifying doctor should be asked whether they have any concerns about the death or the circumstances …	Mid Staffs Inquiry (2013)	Accepted
F281	Appropriate and sensitive contact with bereaved families It is important that independent medical examiners and any others having to approach families for this purpose have careful training in how …	Mid Staffs Inquiry (2013)	Accepted
F282	Information for and from inquests Coroners should send copies of relevant Rule 43 reports to the Care Quality Commission.	Mid Staffs Inquiry (2013)	Accepted
F283	Information for and from inquests Guidance should be developed for coroners' offices about whom to approach in gathering information about whether to hold an inquest into the …	Mid Staffs Inquiry (2013)	Accepted
F284	Appointment of assistant deputy coroners The Lord Chancellor should issue guidance as to the criteria to be adopted in the appointment of assistant deputy coroners.	Mid Staffs Inquiry (2013)	Accepted
F285	Appointment of assistant deputy coroners The Chief Coroner should issue guidance on how to avoid the appearance of bias when assistant deputy coroners are associated with a …	Mid Staffs Inquiry (2013)	Accepted
F286	Impact assessments before structural change Impact and risk assessments should be made public, and debated publicly, before a proposal for any major structural change to the healthcare …	Mid Staffs Inquiry (2013)	Accepted
F287	Impact assessments before structural change The Department of Health should together with healthcare systems regulators take the lead in developing through obtaining consensus between the public and …	Mid Staffs Inquiry (2013)	Accepted
F288	Clinical input The Department of Health should ensure that there is senior clinical involvement in all policy decisions which may impact on patient safety …	Mid Staffs Inquiry (2013)	Accepted
F289	Experience on the front line Department of Health officials need to connect more to the NHS by visits, and most importantly by personal contact with those who …	Mid Staffs Inquiry (2013)	Accepted
F290	Experience on the front line The Department of Health should promote a shared positive culture by setting an example in its statements by being open about deficiencies, …	Mid Staffs Inquiry (2013)	Accepted
1	Chief Coroner guidance on coroners' records We recommend that the Lord Chancellor and Secretary of State for Justice invite the Chief Coroner to prepare guidance for all coroners …	Hillsborough Panel (2012)	Accepted
3	Central government documents to National Archives We recommend that relevant central government documents - particularly those of the Cabinet Office and No 10 - be transferred to the …	Hillsborough Panel (2012)	Accepted
4	Distributed Permanent Archive at Sheffield/Liverpool/Kew We recommend that a Distributed Permanent Archive be established across the Central Library in Sheffield, the Liverpool Record Office and the National …	Hillsborough Panel (2012)	Accepted
8	Digital archive accessible with professional support We recommend that the Digital Archive be permanently accessible at the Liverpool Record Office, the Central Library, Sheffield and other appropriate local …	Hillsborough Panel (2012)	Accepted
9	Digital archive permanently archived at National Archives We recommend that the Digital Archive be permanently archived at the National Archives at Kew (or its successor). Regardless of any developments …	Hillsborough Panel (2012)	Accepted
LIT-1	Closed Recommendation One recommendation contained within the closed section of the report (classified).	Litvinenko Inquiry (2016)	Accepted
LIT-2	Asset Freezes on Suspects Asset freezes should be implemented against the suspects Andrey Lugovoy and Dmitri Kovtun.	Litvinenko Inquiry (2016)	Accepted
LIT-3	Maintain Arrest Warrants Interpol notices and European Arrest Warrants should remain in place for the suspects.	Litvinenko Inquiry (2016)	Accepted
LIT-4	Diplomatic Representations to Russia Senior diplomatic representations should be made to Russia regarding its failure to cooperate with justice.	Litvinenko Inquiry (2016)	Accepted
LIT-5	Review Further Legal Actions The Director of Public Prosecutions should consider whether further action can be taken on extradition and asset freezing.	Litvinenko Inquiry (2016)	Accepted
AS-1	Document Retention and Storage Policy Consideration should be given to the establishment of a policy by the Ministry of Defence to ensure that all documents or other …	Al-Sweady Inquiry (2014)	Accepted
AS-2	Recording of Interrogation and Tactical Questioning Digital video and audio recordings should be made of both interrogation and tactical questioning sessions. Such recordings should be retrieved from theatre, …	Al-Sweady Inquiry (2014)	Accepted
AS-3	Training Material Dating and Archiving All training material should be dated, appropriately retained and archived in such a way that it can easily be established when the …	Al-Sweady Inquiry (2014)	Accepted
AS-4	Shooting Incident Policy A Shooting Incident Policy should be drafted which is achievable in practice in Theatre, which is compliant with Article 2 of the …	Al-Sweady Inquiry (2014)	Accepted
AS-5	Detainee Capture and Condition Records Appropriate procedures should be introduced to ensure that there is an accurate and detailed contemporaneous record of the circumstances relating to the …	Al-Sweady Inquiry (2014)	Accepted
AS-6	Informing Detainees of Rights All detainees should be clearly informed of their rights and obligations as soon as is practicable upon arrival at any detention facility. …	Al-Sweady Inquiry (2014)	Accepted

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