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Toward a Safer NHS in 2020

By John Tingle

As the New Year begins its important to reflect on the previous year’s National Health Service (NHS) patient safety milestones in England. We should ask also whether the NHS patient safety agenda will make major advances in 2020.

The year 2019 was another bumper year for NHS patient safety policy developments and crises. Some major patient safety publications were produced, and stories of NHS patient safety crisis continued to regularly hit the headlines. The NHS is no sloth when it comes to patient safety policy report writing and the number patient safety adverse incidents happening.

NHS Patient Safety Plan

The new NHS Patient Safety Plan was launched in July 2019 by NHS Improvement and NHS England.The plan contains promising patient safety improvement measures, but it will be an uphill struggle to fully implement. The plan includes proposals to create the first NHS system-wide, consistent patient safety syllabus, education and training framework. Measures also include the establishment of patient safety specialists to lead safety improvement across the system.

Policy documents by themselves don’t affect change immediately and this will take some time.

NRLS National Patient Safety Incident Reports: Commentary

It is possible to obtain from data produced by the National Reporting and Learning System (NRLS) a sense of the level of adverse patient safety events in the NHS in England. NHS England and NHS Improvement produced a report in September 2019.

Adverse health event reporting to the NRLS is largely voluntary, “to encourage openness and continual increases in reporting.” An analysis of the NRLS reports can reveal important trends at trust and national levels.

The report does state the caveat that the NRLS is not designed to count the actual number of incidents occurring in the NHS; it is a learning support tool.

The report also looks at incidents reported as occurring from April 2018 to March 2019. From April 2018 to March 2019, English NHS organizations reported 2,036,681 incidents. This is 4.9% more than from April 2017 to March 2018 (1,942,179).

The report states that nationally, the top four reported incident categories were: “implementation of care and ongoing monitoring/review” (14.9%; 302,566/2,036,681); “patient accident” (14.1%; 286,991); “access, admission, transfer, discharge (including missing patient)” (11.9%; 242,773); and “medication” (10.6%; 216,177), see table 3.

Reported Degree of Harm

Nationally most incidents are reported as causing no or low harm. About three quarters were reported as causing no harm (74.0%; 1,508,124/2,036,657) and 23.0% (467,429) as causing low harm. The report states that 2.5% incidents (51,110) were reported as causing moderate harm, 0.3% (5,426) as causing severe harm and 0.2% (4,568) as causing death. This pattern is consistent with data for April 2017 to March 2018, see table 5.


However, you look at the data there were 4,568 reported patient safety adverse events which caused the death of the patient in the NHS in England during the reporting period. To my mind that is a very stark and disturbing finding.


Several other major patient safety reports and incidents occurred during 2019 and hit the media headlines. Sadly, the NHS is never short of patient safety incidents to report. The NHS patient safety policy development activity in 2019 has set the scene for a promising patient safety cultural change and development though it will not be an easy task. Through the NRLS the NHS has a sense of where the patient safety problems are.

History however has not served NHS patient safety policy developments well. Progress has been slow over the years in making positive sustainable changes to a largely defensive NHS culture. The year 2020 may well be the year for positive change and with hopefully less adverse health care events to report.



John Tingle

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.

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