The National Health Service (NHS) in England is standing on a burning platform?

By John Tingle

In the introduction to a new report on the state of acute hospitals in the NHS in England, the Chief Inspector of Hospitals, Professor Sir Mike Richards of the Care Quality Commission (CQC) controversially states:

“The NHS stands on a burning platform — the model of acute care that worked well when the NHS was established is no longer capable of delivering the care that today’s population needs. The need for change is clear, but finding the resources and energy to deliver change while simultaneously providing safe patient care can seem near impossible.” (p.4)

This statement raises the fundamental question of whether the current model of the NHS is,’ fit for purpose’? The NHS since its formation has always had both a good and bad press. Since its inception it always been short of resources. Changing times bring with them new demands which can make established health care delivery structures obsolete and no longer capable of delivering optimal performance. One important NHS developing health care trend is the need to keep pace with a growing elderly population with more complex health needs along with other trends.

The NHS model of free care based on need is so interwoven into our social and political culture that the basic NHS model will not change. Hospitals will just have to find better and new ways of service delivery as a number are now doing according to the CQC report.

The report paints a very mixed picture of care quality in hospitals in England. There are both good and bad findings made which has been the case which most of the reports that I have seen over the years which have addressed the issue of NHS care quality. The CQC analysis shows variation both in the quality of care between hospitals and between individual core services within the same hospital.


The safety of hospitals continues to be the area of biggest concern for the CQC with more than four out of five hospital trusts needing to improve in this area. No hospital trust was rated as outstanding overall for safety with some having ‘blind spots’ when it comes to the quality of care they are delivering. The CQC also found that hospital trusts often rely on too few metrics to assure themselves about the quality of their services.

The CQC list the factors that make an outstanding hospital/trust as seen from inspectors reports:

-An open and honest culture

-Genuinely listening to staff about safety concerns

-Monitoring and acting on issues identified

-Sharing the learning from incidents, (p.21)

Other safety concerns

Other CQC patient safety concerns in CQC (2017) include:

  • inconsistent recognition and management of life-threatening conditions such as sepsis and acute kidney injury
  • incomplete, inconsistent and ineffective audits of key safety priorities and quality improvement projects
  • staff not consistently receiving essential safety training, including appropriate safeguarding (p.24).

The report overall is a very mixed one, whilst pointing out major patient safety problems in our hospitals there are also some good areas of care practice identified, all is not doom and gloom. The CQC genuinely acknowledge hospitals efforts against a testing background of increasing calls on finite health resources whilst at the same time meeting budget constraints. However, when the report is read in full a number of age-old patient safety problems emerge which again show that the NHS is poor at learning the patient safety lessons of the past and of implementing necessary changes. The NHS is still a long way off from developing an ingrained patient safety culture.


John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.