NHS building

Update on Developing a Culture of Patient Safety in the NHS

By John Tingle

There are no quick fixes to developing an ingrained patient safety culture in health systems — change will not happen overnight. Nevertheless, the National Health Service (NHS) and the government in the U.K. are committed to continuing to improve patient safety.

In 2019, NHS England and NHS Improvement laid down an NHS Patient Safety Strategy roadmap, which continues to hold potential one year later.


The roadmap lays out three strategic aims — insight, involvement, and improvement:

  • improving understanding of safety by drawing intelligence from multiple sources of patient safety information (Insight)
  • equipping patients, staff and partners with the skills and opportunities to improve patient safety throughout the whole system (Involvement)
  • designing and supporting programmes that deliver effective and sustainable change in the most important areas (Improvement)

Two key measures included in the roadmap are developing a national patient safety syllabus for the whole NHS and creating a network of patient safety specialists. There are several other measures outlined as well, such as enhancing learning from litigation.

Update on NHS patient safety strategy progress

NHS England and NHS Improvement recently published their annual progress report for the NHS Patient Safety Strategy: Year One. Despite COVID-19 affecting the pace of strategy implementation there has been progress. This progress includes “increased flexibility; problem-solving at pace; and more collaborative team working in support of colleagues redeployed to the COVID-19 response and clinical services,” per the report.

Mapping progress against objectives

Overall, looking at the report, a promising start has been made in implementing the strategy. In terms of safety culture objectives, the new patient safety measurement unit has been established. A safety culture ’toolkit’ is in development, along with several other measures to meet various objectives set.

Additionally, a new patient safety curriculum and training has been developed, the NHS is preparing for the introduction of patient safety specialists, and has made commitments to patient safety partners.

Clear, detailed, and transparent

The report is a detailed one and lays out the progress made against the objectives in a clear and transparent way. The pandemic itself can also be seen to have had a positive effect on practices in some areas.

A potential negative downside to be kept in mind is that there is always a risk that the NHS could edge forward to becoming too risk tolerant as it tries to cope and adapt to challenging new circumstances brought on by the pandemic.

We have been down this road before

We should also remember that the NHS and successive U.K. governments have been no sloth when it comes down to developing good, well-crafted, researched patient safety policies. We have all been down the NHS patient safety reform road many times before. The NHS has been trying for a long time to develop a patient safety culture, with efforts going back at least 20 years with the seminal patient safety publication Organisation with a memory published in 2000.

A major culture-developing stumbling block, amongst several others, is that patient safety lessons from many previous crises appear to stubbornly go unlearned. This can currently be seen in recently reported maternity adverse health care events.


The efforts to develop an NHS patient safety culture and patient safety system outlined in NHS England and NHS Improvement reports are promising. However, it must not be forgotten that there are still many systemic patient safety hurdles for those that implement the strategy to overcome.

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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