The NHS Patient Safety Strategy


This strategy describes how the NHS will continuously improve patient safety, building on the foundations of a safer culture and safer systems.

Due to additional pressures on the NHS at the current time, the development of new programmes introduced in the NHS patient safety strategy are either continuing with amended timescales to be confirmed, or put on hold until further notice. We will look to publish revised timeframes for implementation of the strategy on this page when we are able to.

Publication of the requirements document for Patient Safety Specialists is currently on hold and providers will not be required to identify their patient safety specialist to the national team until further notice.

Further updates will be published on specific strategy initiatives:

Patient safety is about maximising the things that go right and minimising the things that go wrong. It is integral to the NHS’ definition of quality in healthcare, alongside effectiveness and patient experience. 

This strategy sets out what the NHS will do to achieve its vision to continuously improve patient safety. 

Annex 1: NHS Patient Safety Strategy consultation results PDF, 1.6 MB

A summary of the results of the consultation held December 2018 to February 2019 on proposals for a patient safety strategy.

Annex 2: NHS Patient Safety Strategy equality impact assessment PDF, 234.6 KB

Under the Equality Act 2010 (the public sector equality duty) we have analysed the potential impact of the NHS Patient Safety Strategy on health equality and on groups with protected characteristics.

It is human to make mistakes so we, the NHS, need to continuously reduce the potential for error by learning and acting when things go wrong. In this spirit, we will report progress against this strategy annually and update it as needed.

Easy read version

Strategy implementation updates

We are working with our partners to develop the new patient safety initiatives the strategy introduced. We will provide brief updates below to show progress:

  • Patient Safety Incident Response Framework (PSIRF) - 10 March 2020, we have published a new Patient Safety Incident Response Framework (PSIRF) webpage, including details of our work with a small number of early adopters who are testing an introductory version of the framework. The PSIRF is being developed to replace the current Serious Incident Framework with updated guidance on how NHS organisations should respond to patient safety incidents, and how and when a patient safety investigation should be conducted. This testing phase will be used to inform the creation of a final version of the PSIRF which we anticipate will be published in Spring 2021.
  • Patient safety partners - 10 March 2020, we have launched a consultation on our draft 'Framework for involving patients in patient safety'. Following the consultation, a final version of the framework will be published providing guidance on how the NHS can involve patients and their carers in their own safety; as well as being partners, alongside staff, in improving patient safety in NHS organisations. You can view the draft framework on the consultation webpage and access the consultation questions. Consultation closes 5 May 2020.
  • Patient Safety Specialists - 30 January 2020, we have launched a consultation on the patient safety specialists initiative that will see all providers identifying at least one member of staff to the role of their patient safety specialist, to oversee and support patient safety activities across their organisation. The consultation is on a draft requirements document outlining our proposals for what the patient safety specialist role will entail, and the skills and responsibilities required. You can view the draft requirements document on the consultation webpage, and access the consultation questions. Consultation closes 12 March 2020.
  • Patient Safety Syllabus - 24 January 2020, Academy of Medical Royal Colleges (AoMRC), in collaboration with NHS England and NHS Improvement, and Health Education England published the first iteration of the first National patient safety syllabus. The syllabus will underpin the development of patient safety curricula for all NHS staff. AoMRC are now considering revisions based on the comments it receives from its call for feedback. You can view the current iteration of the syllabus on the AoMRC website.
  • National Patient Safety Alerts - 5 November 2019, the first National Patient Safety Alert was issued by the NHS England and NHS Improvement national patient safety team following its accreditation to issue the new types of alerts. All national bodies that issue alerts are going through a process of accreditation to issue National Patient Safety Alerts to ensure they meet a set criteria to improve their effectiveness and support providers to better implement the required actions.

Key components of the strategy

Aidan Fowler, National Director of Patient Safety, introduces the NHS Patient Safety Strategy.

A key principle of the NHS Patient Safety Strategy is continuous improvement. Hugh McCaughey, National Director of Improvement, discusses the relationship between Quality Improvement and patient safety.

Dr Suzette Woodward, director of the Sign up to Safety Campaign that ran from 2014 to 2019, describes the equally important behaviours of kindness and civility that support patient safety.

There is a clear interest in widening patient safety thinking beyond things that go wrong. Dr Suzette Woodward, describes the concept of Safety II and the importance of also looking at why things routinely go right in healthcare.

The National Reporting and Learning System (NRLS) has been at the heart of NHS patient safety insight since 2004, but it uses outdated technology, Lucie Musset, product owner for a new digital system to replace the NRLS describes what it will do and how it will benefit patient safety.

Developing the strategy

Between December 2018 and February 2019 we held a consultation on our original set of ideas for a national patient safety strategy for the NHS.

We received 527 contributions from organisations and individuals (staff, patients and carers), and attended stakeholder meetings and engagement events. We also held workshops with staff, patients and senior leaders across the country and hosted online discussions. See Annex 1 above for a summary of the results of the consultation.

You can also view our original proposals and the online consultation questions in our consultation discussion document.  

NHS patient safety strategy oversight committee

Contact us

If you would like further information about the NHS Patient Safety Strategy, or have any questions, please email

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