Although public inquiries can reveal institutional errors and propose sweeping changes, guaranteeing that those suggestions are carried out continues to be a difficult problem.
Reports from bodies like the Grenfell Tower Inquiry, the Infected Blood Inquiry, and the Thirlwall Inquiry contain many proposals intended to spark change and rebuild trust. Their conclusions have drawn significant media coverage. However, less focus has been placed on the tougher issue of who is in charge of making sure these suggestions are actually put into practice.
This issue lies at the center of a rising difficulty within the inquiry system. While these inquiries excel at assigning blame for past mistakes, they frequently lack the power to enforce accountability for future actions.
It is vital to distinguish between conclusions and advice. An inquiry can determine what failed, explain the causes, and suggest steps to prevent recurrence. However, it cannot force compliance. The duty to act on these suggestions falls on governments, regulators, public agencies, and private companies.
Read Also: Cyprus Diverges from Europe in Russian Extradition Case
From a constitutional standpoint, this makes sense. Inquiries are not parliaments, and their chairs are not policy makers. The downside is that the ultimate success of an inquiry relies on entities that had no hand in creating the report. The legal power of the inquiry frequently terminates just as the practical work begins.
This creates a disconcerting paradox. While an inquiry’s conclusions may face years of intense scrutiny, the actual execution of its recommendations often receives minimal attention once the public spotlight moves on.
A notable feature of the Thirlwall Inquiry is its review of advice from prior NHS investigations. When looking at reviews from the last 30 years, the Inquiry discovered many instances where suggestions were never fully applied, were only partially enacted, or were lost over time. This observation should prompt reflection across many industries, not just healthcare.
Most large organizations do not lack for advice. Public sector bodies, local councils, medical providers, and businesses constantly receive suggestions from inquiries, regulators, inspectors, auditors, coroners, and internal audits. The true obstacle is rarely finding areas for improvement. The real hurdle is prioritizing, executing, and demonstrating change while managing competing operational and regulatory pressures.
