Of the 727 local reviews which contained sufficient information for an assessment of care, over one-fifth – 150 (21%) – contained no actions or recommendations.
Of the 542 local reviews which contained clear actions or recommendations, 126 (23%) had actions or recommendations which were aimed solely at individual members of staff (for example, a requirement to attend further training). The remaining 418 reviews (77% of reviews with clear actions or recommendations) contained actions or recommendations which took a systemic approach (Figure 8).

Figure 8. Recommendations and actions from the local reviews (N=542)