As we enter 2025 there is a lot in the NHS patient safety in-tray. Early on in January, Buchanan and Rowles (2025) for the BBC's File on 4 reported on a police investigation into allegations of preventable deaths and injuries. They stated that the claims centre on care and treatment provided by University Hospitals Sussex NHS Trust between 2015 and 2021:
‘Sussex Police started looking in 2023 into an initial 105 cases, but BBC File On 4 Investigates has learned that number is now more than 200.’
The media frequently report on NHS patient safety matters. I would predict, going by previous years, this will be set to continue in 2025.
Government activity
The amount of Government activity in 2024, in terms of volume of patient safety consultations, was exceptional, in my view. The outputs of some of these consultations are now coming through.
I have frequently said in my columns that there is constant stream of excellent reports on patient safety coming into the NHS from various national and international stake holders. The topic of patient safety is a crucial one and will therefore rightly attract attention.
At the same time, however, we must be able to better manage the patient safety information flow into the NHS as it does at times become overwhelming for NHS staff and others. Added to this is the fact that we have a complex and fragmented NHS regulatory and governance structure, which patient safety sits within. This represents, in my view, a ‘perfect storm’ for confusion and inefficiency in patient safety policy making and practice, inhibiting the development of a proper NHS patient safety culture. This will be a hot topic to look out for in 2025 as there are reports commissioned by the government on this issue (Department of Health and Social Care (DHSC), 2024a) that should be published in the near future.
I want to discuss here two key reports that were published towards the end of 2024, and carry important implications for NHS patient safety going forward into 2025 – they will no doubt be revisited in future patient safety policy making and reports.
The current state of patient safety
Illingworth et al (2024) at Imperial College London's Institute of Global Health Innovation have produced a research report on the current state of patient safety in England in 2024. Based on a review of publicly available information, desk research and other sources, this report builds on their previous one (Illingworth et al, 2022) with comparisons.
Drawing on the data
From a data analysis and comparing this with findings from the first report, Illingworth et al (2024) describe a mixed picture for patient safety in England. This mixed picture was also found back in 2022. The report is a detailed one and contains excellent analyses of pressing NHS patient safety issues, which should help inform future NHS patient safety policy making and practice.
A key section, in part 1, is the identification of five broad themes from the data, which the authors argue should sit alongside the patient safety priority areas identified through their other research activities (discussed in part 3 of the report). The themes are:
- Regional variations in safety
- Safety concerns in maternity services
- Staff concerns about safety, particularly in ambulance services
- Risk of slipping in ‘previous safety wins’
- Safety while people wait for their care.
Regional variations
The point about regional variations is an interesting one. Disability-adjusted life years, or DALYs, are discussed, along with the adverse effects of medical treatment – defined here as death or disability caused by a procedure, treatment, or other exposure to the healthcare system:
‘Overall, disability-adjusted life years (DALYs) resulting from this have increased in England since 2005. However, this impact is not evenly spread, for example with rates in the Northeast of England more than twice as high as in Greater London.’
Illingworth et al, 2024: section 1.2.1
Campbell (2024), writing in The Guardian, discussed the report and the point of regional variations, highlighting how:
‘… a stark north/south divide on patient safety has opened up across England, with double the amount of death and disability caused by medical negligence in the north-east than in London.’
There is also a discussion of Summary Hospital-level Mortality Indicator data. The patient safety picture is a mixed one:
‘Analysis of the proportion of trusts with a higher-than-expected number of deaths (up to January 2024) suggests worsening performance in London and some improvement in the Midlands and East of England.’
Illingworth et al, 2024: section 1.2.1
In part 2 of the report there is discussion of developments in policy and practice and part 3 looks at prioritising safety improvement efforts. Part 4 presents the report's conclusion and recommendations.
The NHS must, Illingworth et al argue, ‘finally start to act like a sector’ and focus its limited resources where it counts. Two ambitions for the healthcare sector are set out in the report:
- Local NHS organisations must be supported to adopt evidence-based interventions to tackle the most common safety problems causing significant harm to patients
- National organisations must agree on a focused set of patient safety priorities for the system to rally around.
The second ambition resonates with what I have said in previous columns and what other reports have highlighted: the over-complexity and confusing nature of the NHS patient safety landscape. Illingworth et al (2024) found a crowded landscape of patient safety bodies, an opaque process for national patient safety priority setting, and evidence that the system cannot keep up with the volume of recommendations it receives. These points are well known and ones that I fully subscribe to. It is good to see these important points being made again. Hopefully, the Dash review commissioned by the DHSC (2024a) will also bring recommendations to rationalise and reform the NHS patient safety landscape and the various NHS organisations that have responsibility for it.
The overview by Illingworth et al (2024) is to be welcomed as it shines an important light on where we are with patient safety in the NHS and contributes towards developing an important agenda for change in this area.
Statutory Duty of Candour
The DHSC launched a call for evidence in April 2024 as part of a consultation to consider the statutory duty of candour (DHSC, 2024b). An analysis of the evidence submitted was published on 26 November 2024 (DHSC, 2024c), ahead of the final departmental response in 2025.The main findings of the report will come as no surprise to those who comment on and follow NHS patient safety matters. The DHSC received 261 responses from members of the public including patients, health professionals, providers, regulators, and others.
Putting responses into perspective
It is important to note that this is not a big response cohort. We do need to be careful in not making any profound or substantive changes based on such a small response. The report acknowledges this. However, that said, the report's findings do seem to have a ring of truth to them, when considering the views of expert patient safety stakeholders such as Action against Medical Accidents (AvMA). The chief executive of AvMA, Paul Whiteing, put forward key views on the findings report (DHSC, 2024c) and the need for reform in a blog on the AvMA website:
‘Overall, while it is a disappointing outcome, the evidence is of no real surprise to us at AvMA. But meaningful change takes time, so we must not give up on the Duty of Candour and instead home in on what more can be done to strengthen its application in securing honesty and openness.’
Report findings
Findings drawn from the responses to the call for evidence include (DHSC, 2024c: 4–5):
- Two in five respondents (40%) thought the purpose of the statutory duty of candour is clear and well understood
- Over half of respondents (54%) did not think staff working for health and social care providers know of and understand the duty's requirements
- Less than 1 in 4 respondents said that the duty is correctly complied with when a notifiable safety incident occurs (23%)
- Some patients and service users do not understand their rights.
The report further states:
‘Overall, 3 themes are prominent throughout the survey and have been identified across questions, these are: culture (of the health and care system), inconsistency (in understanding and applying the duty), training (the lack of it, the need for further training)
Reading the DHSC report and AvMA's view, it is clear that the statutory duty of candour must be urgently reformed. There is a lot of definitional ambiguity about certain matters such as the duty's threshold, issues of enforcement and so on. In my view, the report clearly picks up the central issues of contention.
Conclusion
Going forward into 2025 there will be a lot happening on the patient safety front. There are major reports due and ongoing patient safety investigations that will publish their findings. The media will, as always, frequently report on patient safety issues and crises. We have already seen this at the start of the year with Buchanan and Rowles (2025).
Illingworth et al (2024) and the Imperial team have produced another excellent report that provides key research-based insights into the current state of patient safety in England. A mixed picture is revealed, as it was in 2022.
There will be a fuller report on the statutory duty of candour in 2025 but in the meantime the DHSC (2024c) analysis provides some valuable insights that will urgently need to be addressed in order to develop a proper NHS patient safety culture.