Education And Debate

The use and impact of inquiries in the NHS

BMJ 2002; 325 doi: http://dx.doi.org/10.1136/bmj.325.7369.895 (Published 19 October 2002) Cite this as: BMJ 2002;325:895
  1. Kieran Walshe, reader in public management and director of research (kieran.walshe@man.ac.uk),
  2. Joan Higgins, professor of health policy and director
  1. Manchester Centre for Healthcare Management, University of Manchester, Manchester M13 9PL
  1. Correspondence to: Dr Walshe
  • Accepted 20 May 2002

When things go wrong in the NHS an inquiry is often set up to find how what happened and what can be learnt. Kieran Walshe and Joan Higgins show that since the 1970s inquiries have been resorted to increasingly often to investigate service failures. Such inquiries take various forms, but the pressures seem to be increasing for them to be set up as independent external investigations with full inquisitorial powers

In the past few years the NHS has been subject to several major inquiries. Such inquiries have been established to investigate poor clinical performance, major service failure, or even criminal misconduct, and they seem to have become an increasingly common political and managerial response to any major problem in the NHS. As a result, the costs, methods and effects of inquiries have begun to be questioned.1

This paper explores the use and impact of inquiries in the NHS. It presents an overview of their history and development; describes their purposes and how and why they are set up; discusses the models, methods, and processes that inquiries use; and reviews how their findings and recommendations are used. We conclude with some lessons for policy makers and other stakeholders in the NHS, which might inform the design and conduct of future inquiries.

Summary points

  • NHS inquiries take various forms, from small internal inquiries to statutory ones set up by parliament

  • Many inquiry reports highlight similar sorts of failures, suggesting that lessons are not always learnt

  • Often these failures are organisational and cultural, and the necessary changes are not likely to happen simply because they are prescribed in a report

  • Inquiries should conform to the standards of any primarily qualitative method: their biases and generalisability should be more carefully considered

The development of NHS inquiries

We define an inquiry as a retrospective examination of events or circumstances surrounding a …

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