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  1. Past hour
  2. Content Article
    The long-awaited report into maternity failures at Nottingham University Hospitals NHS trust (NUH), the largest investigation of its kind involving about 2,500 families, is due to be published. Led by the senior midwife Donna Ockenden, the inquiry investigated stillbirths, neonatal deaths, maternal deaths and babies or mothers who suffered brain damage and other injuries between 2012 and 2025. It follows a decade-long campaign for justice and change by the families affected. Some share their stories about what happened to them in Nottingham, and explain why this is such a landmark moment.
  3. News Article
    Most IVF “add-on” treatments sold to people hoping to boost their chances of having children are not backed by reliable evidence, fail to boost fertility and may be a complete waste of money, the largest study of its kind has concluded. There has been a surge in extra procedures, medicines or techniques offered to patients in addition to standard IVF with bold claims they will increase the probability of success. Take-up is widespread, with more than 70% of IVF patients in the UK, Australia and New Zealand paying for one or more add-on during IVF treatment. But the world’s most comprehensive review into their effectiveness – and the evidence behind them – found the majority show no effect on fertility or remain inconclusive due to limited or low-quality data. Unproven add-ons also lead to false hope, greater financial strain and needless medical procedures at what is already a difficult time for patients, experts behind the research said. The findings were published in The Lancet Obstetrics, Gynaecology & Women’s Health journal. “In many countries, infertility care is largely provided by private clinics where IVF is highly commercialised, and some add-ons are extremely expensive,” said Dr Sarah Lensen of the University of Melbourne. “Our review finds a lack of evidence that most of the IVF add-ons we assessed provide any benefit to patients. Unproven add-ons can lead to false hope, greater financial strain and unnecessary medical procedures at what already can be a very difficult time for patients.” Read full story Source: The Guardian, 23 June 2026
  4. News Article
    Mollie Sutton has spent the past seven years waiting for answers. Her son Rupert, aged 7, was born with severe disabilities and is now unable to walk or talk. He also has the mental capability of a four-month-old baby. Ms Sutton, 27, endured a harrowing labour before Rupert’s birth and believes failures by Nottingham University Hospitals (NUH) NHS Trust, both before and during her labour, may have caused his severe physical and mental disabilities. She is one of hundreds of families now seeking answers as to why their babies died or were left with disabilities at Nottingham hospitals. An inquiry by Dame Donna Ockenden, which has looked at thousands of cases of alleged poor care at the hands of the trust, is due to publish a report into its failings on Wednesday as part of what has become the largest ever maternity review in NHS history. Ms Sutton told The Independent: “This can't continue to happen. How many more dead babies, dead mothers, harmed babies, harmed mothers do we have to see until somebody actually finally puts their foot down and does something about it?” It was in September 2018, at 34 weeks pregnant, that Ms Sutton was admitted to the hospital and diagnosed with sepsis. Three weeks later, at 37 weeks, her labour was induced. Ms Sutton, who was aged 19 at the time of the birth, described the intense pain she experienced during her labour. But she believes her begs for help were ignored due to her age. “I was begging for pain relief. But I was told that I'm only two centimetres – I'm being dramatic. ‘I don't know why you're screaming because there are women on this ward with real problems,” she said. At 4am, Ms Sutton, alone with her husband, said the baby suddenly seemed close to arrival so her husband pressed the emergency buzzer. Midwives came running into the ward, Ms Sutton remembers. The curtains had to remain wide open due to the number of people, and Ms Sutton says she was given no dignity at all. Ms Sutton is now waiting to find out whether her son’s disabilities were caused by her care during and after her labour. But, as she awaits a report from the Nottingham inquiry team and a separate one from NUH, she said she wants urgent change. She said: “They [the government, regulators and NHS] knew what was happening and they did nothing to stop it. The [watchdogs] CQC, the GMC, the NMC, and previous secretaries of state, they all knew what was happening. And they should be held accountable in a judge-led inquiry.” Read full story Source: The Independent, 24 June 2026
  5. News Article
    A “fundamental failure in quality governance” has led NHS England to take enforcement action against one of England’s largest trusts. NHSE has decided to intervene at Northern Care Alliance Foundation Trust because it believes the provider is “unable to provide assurance” that it has a “clear and consistent quality governance structure across the whole organisation that will ensure no further patients may suffer harm”. A letter to the trust from NHSE North West regional director Louise Shepherd said: “There have been a series of escalating quality concerns over the previous 18 months, for which [the trust] has been unable to respond at the expected pace… The culmination of quality concerns and [the trust’s] response has resulted from a fundamental failure in quality governance.” Greater Manchester Integrated Care Board placed the trust in a “rapid quality review process” in January over concerns that it has made insufficient progress to remedy care failings identified by two independent reviews into its spinal services. The trust then commissioned the Good Governance Institute to undertake a review. It produced 43 recommendations and found NCA lacked a “clear and consistent quality governance structure to ensure patients would not suffer harm”. In September, the Care Quality Commission issued a warning notice to the trust following an inspection of Salford’s surgical services. It said NCA had not ensured surgical wards had sufficient and suitably qualified staff, as well as effective risk-management systems. Read full story (paywalled) Source: HSJ, 23 June 2026
  6. News Article
    The Charity Commission has launched an inquiry into one of the largest private mental health providers over safeguarding and financial concerns. The regulator has confirmed the regulatory compliance case it opened earlier this year into the St Andrew’s charity has been “escalated” to a statutory inquiry. It said the initial case was launched to “assess concerns about the oversight of safeguarding provision by the trustees of the charity, the financial viability of the charity and the wider governance, management and administration of the charity by its trustees”. It also pointed to concerns raised last summer after St Andrew’s submitted a serious incident report, concerning “potential mistreatment of patients” at the charity’s Northampton site. St Andrew’s is one of the biggest independent providers to the NHS and was placed in special measures in December. It was prevented from accepting new patients last summer after revelations of poor care, and an “inadequate” Care Quality Commission rating. The hospital is also the subject of three police investigations, with 15 staff members arrested following abuse and neglect allegations. Read full story (paywalled) Source: HSJ, 23 June 2026
  7. News Article
    Post-market surveillance of AI health tools must be “beefed up” to protect doctors as well as patients, England’s patient safety commissioner says. Henrietta Hughes also told The BMJ it was vital to establish clarity on where clinical liability sits when, not if, AI tools harm patients. Hughes, a GP and a former medical director at NHS England, is deputy chair of the National Commission into the Regulation of AI in Healthcare. The commission was set up by the Medicines and Healthcare Products Regulatory Agency (MHRA) to help guide development of a new regulatory framework for AI medical devices. The commission published interim findings from its consultation and engagement process last week. Hughes said some clear themes had already emerged during the process of engagement with patients, the public, and doctors. Among the most pressing was the need for greater surveillance of AI tools after approval, so the MHRA can act if patients are at risk. Hughes told The BMJ, “It’s really important that real time, real life monitoring happens when a device like AI is deployed in a real life clinical environment, particularly if the population of patients may be different from the population used to feed the model.” Hughes added that while medicines have to pass an “extremely high hurdle” and evidence base to reach the market, AI—where new products are rapidly launched and updated—is different. “We know that AI can change once it’s actually deployed, and so it’s important that the regulations are able to be updated to take account of that and to ensure that all medical devices, and particularly AI, are safe across its whole life cycle,” she said. “Whether we’re using the yellow card system or other kinds of ‘always-on’ postmarket surveillance and postmarket monitoring, that side of things really needs to be significantly beefed up if we’re going to lower the hurdles for products to come onto the market.” Read full story Source: BMJ, 18 June 2026
  8. Today
  9. Content Article
    The NHS is one of the most meaningful places to work, but it can also sometimes leave you stressed, stretched, and struggling. Julia knows these feelings all too well, which is why she developed the SCRIPT Formula. This practical, simple, and no-fluff approach helps you flip the script from being overwhelmed to de-frazzled - in just 15 minutes a day. It focuses on: boosting your wellbeing so you are on top form each day, even on the ones that come at you sideways increasing your productivity so you can focus on what matters and leave work on time working well with others even when relationships or dynamics feel challenging. It was developed through: insights from 30 members of NHS staff, past and present, working in both clinical and non-clinical roles research and guidance from subject matter experts tried and tested tools and techniques that help you make lasting positive change Julia’s own experience of working in or for the NHS for more than 30 years in national, regional, and local organisational roles. The NHS needs you but it needs you at your best. Is it time to de-frazzle your NHS job?
  10. Content Article
    More information about "Patient safety starts with knowing who is in the room"
    In operating theatres and other high pressure clinical environments, clear identification shouldn’t be a nice ‘extra’, it is a patient safety need. When staff cannot quickly recognise names and roles, communication becomes harder, escalation can be delayed and patients are left unsure who is caring for them. Reviews of patient safety repeatedly show that poor teamwork and unclear roles can contribute to avoidable harm. Danielle Checketts, Managing Director of Eco Ninjas, discusses why being able to identify staff by their names and roles is so important not only for the staff themselves but also patients. She explains how a simple idea, reusable hats with detachable name badges that can be removed before laundering, can support safety and teamwork. In theatre, everyone can look the same. Masks, gowns, visors and lead aprons often cover name badges, while lanyards are easily hidden or turned around. Theatre teams include surgeons, anaesthetists, students, agency staff and industry representatives, yet patients and colleagues are still expected to know who is who. When names, roles and seniority are unclear, questions may go to the wrong person, and valuable seconds can be lost. Even when introductions are made during the WHO surgical safety checklist,[1] names and roles can quickly be forgotten once a procedure is underway. In an emergency, it must be immediately clear who is who. This lack of clarity can lead to: Miscommunication at critical moments. Delays in escalation. Reduced patient confidence and psychological safety. Errors due to misunderstood roles or instructions. This isn’t just theoretical. Liz Fitzhugh, net zero lead and former theatre manager at University Hospitals Coventry & Warwickshire (UHCW), put it simply: “If a patient arrests and someone asks for the crash trolley, either everyone goes or no one goes.” In critical moments, teams need to be immediately identifiable so they can act without hesitation. Liz’s team at UHCW were among the first to introduce name and role theatre caps in 2019. It feels fitting that she was also the person who once asked me to write my name on my disposable cap with a marker pen, quietly sparking the idea that grew into this work. For years, poor identification in theatre has become accepted and been treated as normal. But it shouldn’t be. Patients want to know who is caring for them, and staff work more safely when names and roles are clearly visible. That is why the ‘theatre cap challenge’ gained momentum internationally, highlighting a simple idea: if the hat remains visible when wearing sterile attire, it can help make names and roles visible too. Patient perspectives: what matters most Patients consistently say they want to know who is in the room, who is leading their care and who they can turn to for reassurance. Feedback from surgical and maternity care journeys, including caesarean births, shows that visible names and roles help people feel safer, calmer and better able to engage in what is happening around them. Patients describe feeling more reassured when: Staff introduce themselves clearly. Visible names and roles help patients and colleagues remember who is who after introductions, rather than relying on memory alone. There is consistency in communication throughout their care. When identification is unclear, patients can feel anxious and excluded at the point they are most vulnerable. Visible names and roles do more than support courtesy, they strengthen communication, teamwork and reassurance for patients and families. Infection prevention, hygiene and practical constraints Efforts to improve identification must also align with infection prevention standards. Theatre attire cannot simply be adapted without considering contamination risk, laundering processes and the wider pressure to reduce reliance on single use items. The challenge with current approaches The current embroidered theatre caps improve visibility of names and roles, but they are difficult to manage at scale and fail to support consistent identification for all staff. Students, visitors and temporary staff are often excluded, and new starters can wait months before receiving one. They also create ongoing operational challenges, including time-consuming bespoke ordering, poor fit, loss and replacement costs, outdated roles, and complications with laundering. As Alan Dickens, Theatre Manager at MMUH Birmingham, explains: “Bespoke embroidered caps are hard to manage over time. When staff leave or change roles, the hats issued to them often leave with them or need replacing. This creates ongoing cost for the trust and delays in maintaining accurate identification.” Emerging responses across the NHS Several NHS organisations are now testing a more practical approach: reusable hats with detachable name badges that can be removed before laundering. This keeps identification visible while fitting more easily into real hospital systems. In Somerset, a pilot at Musgrove Park showed how a simple change can support safety and teamwork. Mr Andy Stevenson, orthopaedic consultant at Somerset NHS Foundation Trust, said: “In theatre, there can be a really high turnover of colleagues at times, with new people coming and going all the time. This can make it really difficult to know who is who, let alone what jobs they have. Some days, it will be the first time working with half the people in the room. The badge hats have helped to positively transform communication and safety.” A similar message has come from maternity services. Kathryn Harrison, delivery suite manager at Great Western Hospital, said: “Despite staff introducing themselves in the morning, remembering everyone’s name and role throughout the day is challenging, especially when more than 12 people can be in the room at any one time. The badge hats reinforce this critical stage in safe surgery, improve teamwork and communication, and help break down hierarchical barriers. They can be worn by all staff, students, birthing partners and even the patients wear them on our unit”. Building the evidence base There is growing research interest in identification in healthcare.[2][3][4] We have started to work with medical schools on exploring the impact on training environments, role visibility and communication. This is helping to strengthen the evidence base for scalable, system-wide approaches. Students can be included simply using a badge with their name and role alongside a standard fitted hat. Towards integrated, system-based solutions The challenges across current approaches show the need for solutions that fit existing NHS processes, including laundering and distribution, while also identifying temporary staff, visitors and students. The most effective solutions will improve safety without creating new inefficiencies. A call to action Clear identification in healthcare is not optional. It is a practical safety intervention. When people can immediately see names and roles, communication improves, hierarchy softens, patients feel more reassured and teams are better able to act quickly when it matters most. If the NHS is serious about reducing avoidable harm, improving teamwork and strengthening patient experience, visible identification should be part of the solution. Wearing a detachable badge on a reusable theatre cap sounds very simple but this is a small change that can make a very big difference to the safety of patients. References World Health Organization. WHO Surgical Safety Checklist. Kouba LP, Fabi A, Bayer S, et al. Labeled surgical caps improve perioperative patient safety and interprofessional communication in the operating room: a scoping reviewe. Patient Saf Surg, 2026; 20:(9). Liverpool University Hospitals NHS Foundation Trust (LUHFT) and Warwick Med. Case study – Switching to Reusable Theatre Caps. NHS England. Douglas N, Demeduik S, Conlan K. Surgical caps displaying team members' names and roles improve effective communication in the operating room: a pilot study. Patient Saf Surg 2021;15:27. doi: 10.1186/s13037-021-00301-w.
  11. Yesterday
  12. News Article
    Despite increasing diversity at entry levels in the fields of medicine, this decreases at higher levels. Researchers have discovered that, despite many years of equality policies, advancement in UK surgery still largely depends on who already holds power in the room. Surgeons from underrepresented groups are more likely to leave training and face barriers to promotion, especially in environments dominated by White men in senior positions. This comes from a new study published in the Journal of Management Studies that analysed a decade of NHS career data. The findings suggest that informal networks and professional culture continue to shape careers as much as formal rules. Dr Carol Woodhams, lead author of the study and Professor of Human Resource Management at the University of Surrey, said: ‘Decisions about progression are not purely based on merit but are influenced by who is seen to “fit” the traditional image of a surgeon. In some parts of the NHS system, particularly specialist surgical fields, inequality is more entrenched. ‘In others, especially large teaching hospitals with stronger oversight and clearer procedures, the gap narrows. This suggests that organisational context plays a decisive role in shaping outcomes for staff from underrepresented groups, including their progression, retention, and experience of inequality.’ Despite increasing diversity at entry levels in the fields of medicine, this decreases at higher levels. Researchers have discovered that, despite many years of equality policies, advancement in UK surgery still largely depends on who already holds power in the room. Surgeons from underrepresented groups are more likely to leave training and face barriers to promotion, especially in environments dominated by White men in senior positions. This comes from a new study published in the Journal of Management Studies that analysed a decade of NHS career data. The findings suggest that informal networks and professional culture continue to shape careers as much as formal rules. Dr Carol Woodhams, lead author of the study and Professor of Human Resource Management at the University of Surrey, said: ‘Decisions about progression are not purely based on merit but are influenced by who is seen to “fit” the traditional image of a surgeon. In some parts of the NHS system, particularly specialist surgical fields, inequality is more entrenched. ‘In others, especially large teaching hospitals with stronger oversight and clearer procedures, the gap narrows. This suggests that organisational context plays a decisive role in shaping outcomes for staff from underrepresented groups, including their progression, retention, and experience of inequality.’ Researchers analysed the career paths of 3,402 trainee surgeons across 212 NHS trusts over 10 years, tracking promotion to consultant level and exit from training. They compared outcomes across gender and ethnicity and examined how these varied depending on workforce composition and governance structures. Dr Woodhams said: "People often assume inequality is a thing of the past because the rules have changed. But what we see here is that informal dynamics still carry significant weight. Who is recognised, supported and ultimately promoted is shaped by who already holds power." The study finds that environments with a higher concentration of senior White male surgeons tend to reinforce in-group advantages, while others face steeper barriers. However, stronger governance and transparency can counteract this, particularly in formal promotion decisions. Dr Woodhams added: "This is not about blaming individuals. It is about recognising that systems and cultures matter. The encouraging part is that change is possible. Where organisations take accountability seriously and make processes clearer, inequalities begin to shrink." Read full story Source: Surgery, 17 June 2026
  13. Content Article
    Over the past year, The King’s Fund has been running a project exploring how different groups of men think about their health and how they experience health services. The work was commissioned by the Department of Health and Social Care through the National Institute for Health and Care Research as part of wider work on the Men’s Health Strategy for England, which sets out a vision and a national commitment to address men’s poorer health outcomes and lower engagement with services. Chris Branson, Fellow at The King's Fund, shares six key insights from conversations with men about their health – and how to shape more effective future services.
  14. Content Article
    High-volume low-complexity elective hubs have been central to NHS England’s strategy to reduce waiting times for planned surgery. By concentrating activity in dedicated units, separating elective from emergency care and applying operational management principles, they are expected to deliver high levels of productivity and throughput, benefitting patients, populations and the system. The aim of this study was to identify features of hubs that contribute to strong performance in optimising care delivery, with a view to offering practical insights for those leading new and existing surgical hubs. Findings For those designing, delivering and overseeing surgical hubs, this study has several implications. First (and most prominently), work to ensure the implementation of standards relating to hub delivery, such as those set out by accreditation criteria, need to be accompanied by efforts to secure continuous improvement, for example through collection and regular review of process data to identify challenges to productivity, quality and patient experience as they arise. Active work to learn from the views of patients and staff appears to be an essential component of this since their experience of care as delivered will help to identify opportunities for improvement that may not be apparent from activity data alone. Second, since not all influences on productivity are within the scope of control of hub leads, a strong relationship with host organisations is vital, both in providing hubs with the latitude to implement staffing models and work routines that are appropriate to their distinctive needs, and in ensuring that emerging challenges to service delivery are dealt with promptly. Finally, efforts to foster strong relationships across a coherent set of clinical and non-clinical staff appear crucial. Besides ensuring that insights were transmitted from frontline staff to service managers in the hubs we studied, familiarity between staff groups also oiled the perioperative pathways, and created an environment that was receptive to the continuous adjustments needed to maintain productivity, quality and patient experience.
  15. Content Article
    While a growing body of evidence suggests that healthcare workers in low and middle-income countries often provide poor quality of care, the reasons behind such low performance remain unclear. The literature on medical decision-making suggests that cognitive biases, or failures related to the way healthcare providers think, explain many diagnostic errors. This study investigates whether one cognitive bias, overconfidence, defined as the tendency to overestimate one's performance relative to others, is associated with the low quality of care provided in Senegal. It links survey data on the overconfidence of health workers to objective measures of the quality of care they provide to standardised patients – enumerators who pose as real patients and record details of the consultation. We find that about a third of providers are overconfident – meaning that they overestimate their own abilities relative to their peers. It shows that overconfident providers are 26% less likely to manage patients correctly and exert less effort in clinical practice. These results suggest that the low levels of quality of care observed in some settings could be partly explained by the cognitive biases of providers, such as overconfidence. Policies that encourage adequate supervision and feedback to healthcare workers might reduce such failures in clinical decision-making.
  16. News Article
    As artificial intelligence (AI) becomes deeply embedded in triage and clinical workflows, experts are raising concerns about a growing “blind trust” where clinicians and patients alike defer to algorithmic confidence over independent medical judgment. Speaking at the HLTH Europe 2026 conference, panellists stressed that a person’s information ecosystem —who they follow on social media, the podcasts they listen to, and how they interact with AI — is becoming a dominant determinant of health outcomes. Speaking at the event, Patient Safety Learning’s Chief Digital Officer Clive Flashman defined blind trust in this new era as the moment a “clinician stops being able to think independently, independently judging what they see, feel, or hear, because the algorithm has told them something that they should believe or do.” Read full article. Source: Medscape, 21 June 2026
  17. Content Article
    Ted Baker, Chair of the Health Services Safety Investigations Body (HSSIB), is a key speaker during Clinical Audit Awareness Week 2026. In this blog, Ted explains why structural change must come before cultural change in patient safety, and the lessons that can be learned from regulatory and safety bodies in using audit data for improvement.
  18. News Article
    A ‘landmark moment’ is being celebrated in the NHS as a first-of-its-kind therapy that can delay the onset of type 1 diabetes for up to three years will be made available. The National Institute for Health and Care Excellence (Nice) has approved teplizumab, which the charity Diabetes UK said “marks the start of a new age of type 1 diabetes treatment”. Teplizumab, also known as Tzield and made by Sanofi, is approved for children aged eight and over and adults who have type 1 diabetes in its early stage before symptoms appear. It is given as a one-off course and trains the immune system to stop attacking pancreatic cells. Evidence shows the drug can delay the onset of type 1, meaning people can live a fuller life and children can have longer before having to aggressively manage their diabetes. Nice estimates that around 1,100 people could be eligible for teplizumab in the first year, dropping to around 820 patients in the coming years. Read full story Source: The Independent, 23 June 2026
  19. News Article
    A trial examining the risks or benefits of drugs that can delay puberty for gender-questioning children will help reduce harm, according to the author of a landmark review. Dr Hilary Cass said she was "absolutely convinced that more children will be harmed if we don't do the trial than if we do." Her comments follow pressure from campaigners and some politicians to have the research programme scrapped after it was announced children as young as 11 could be recruited onto the trial. The Pathways clinical trial will be run by researchers at Kings College, London (KCL). In addition to setting a minimum age, they have also increased the safeguards for participants. The puberty blockers research was recommended by Dr Cass after her 2024 review of gender medicine for children pointed to weak evidence behind their use. Speaking to the BBC, Dr Cass said she believes since then "some of the hype about risks have been exaggerated in that we genuinely don't know if there are harms." And she said the trial was "essential" to answer the question about "whether these drugs are helpful or not". She added that young people will be "closely monitored in every respect" and the drugs stopped if concerns emerge. The researchers will examine the impact of the drugs on the physical, social and emotional wellbeing of participants. This will include checks on bone density, brain function and fertility. Cass believes without a trial young people will continue to get drugs from "unregulated and dangerous routes." Read full story Source: BBC News, 22 June 2026
  20. News Article
    Oversight of advanced AI systems capable of making autonomous decisions should “mirror” the assessment of healthcare professionals, a government commission has proposed. The National Commission into the Regulation of AI in Healthcare has proposed that agentic AI systems, which can autonomously plan and execute tasks with limited human supervision, should be required to demonstrate capability over time before being allowed to undertake more complex work. The minutes to the commission’s latest meeting, seen by HSJ, stated: “Commissioners advised that approaches to deploying AI systems should mirror that of human professional style progression.” This would involve AI agents needing “to demonstrate capability over time before being exposed to higher risk activities”. The commissioners were responding to a discussion paper on agentic AI systems, “which explored regulatory approaches to oversee AI systems that are capable of autonomously planning and taking actions with limited human supervision”. The paper proposed “a tiered regulatory framework, which uses levels of agent autonomy as a basis to determine what regulation and risk controls are required”. The commissioners “welcomed the proposal for a tiered regulatory framework”, but suggested, “further work should be undertaken to identify other potential factors relevant to determine the appropriate level of regulation”. Read full story (paywalled) Source: HSJ, 22 June 2026
  21. News Article
    Serious concerns have been raised that the delayed NHS “quality strategy” does not “prioritise patient safety”, HSJ has discovered. The government’s 2025 10-Year Health Plan stated “we will revitalise the National Quality Board (NQB) and task it with developing a new quality strategy”. The plan said the strategy would be published by March 2026, but this goal was missed, as was a second scheduled publication date soon after the May local elections. Minutes from the meeting obtained by HSJ reveal that NQB members “raised concerns” about the strategy’s lack of focus on patient safety and mental health. They also expressed a desire for the strategy to set “clearer expectations for providers”. Read full article (paywalled). Source: Health Service Journal, 23 June 2026 Related reading In this blog, Patient Safety Learning and the Advancing Quality Alliance (Aqua) set out the need for safety to serve as a golden thread woven throughout the Strategy.
  22. Last week
  23. News Article
    The Ebola outbreak in eastern Congo has now surpassed 1,000 confirmed cases, with officials reporting 254 deaths as of Sunday evening. Congo’s Ministry of Health confirmed 1,003 cases and 100 recoveries since the epidemic was declared on 15 May in Ituri province. Caused by the rare Bundibugyo virus, for which no vaccines or treatments exist, this outbreak was the worst ever in its initial month. Officials admit more cases are likely unknown, and the peak is still ahead. Contact tracing remains a key issue, with local authorities achieving only 55 per cent coverage. The outbreak’s patient zero is yet to be identified, and over 35,000 contacts still require tracing, authorities confirmed. Read full article. Source: The Independent, 22 June 2026
  24. News Article
    The health minister has once again apologised for what he described as the "evil" perpetrated at Muckamore Abbey Hospital in County Antrim. Speaking in the assembly, Mike Nesbitt said what happened was a " true scandal". On Thursday, a long-awaited report into abuse at the hospital said a number of patients suffered physical abuse, including black eyes, broken bones, bruising and excessive restraint. Nesbitt said the weight of evidence had provided a "watershed" moment for the treatment and care of the most vulnerable in society. The Police Service of Northern Ireland has said its Muckamore investigation is the biggest criminal adult safeguarding case of its kind in the UK. In the assembly on Monday, Nesbitt said the report "helps us understand the failings of the past, and provides a road map for the work needed to address those issues". But, he said, it was "vital that we now move forward as a health and social care system, and importantly as a society, into a safer, more inclusive and accepting future for those most vulnerable in our society". Read full article. Source: BBC News, 22 July 2026
  25. Content Article
    The long-awaited report into maternity failures at Nottingham University Hospitals NHS trust, the largest investigation of its kind in the UK, involving about 2,500 families, will be published shortly. Led by the senior midwife Donna Ockenden, the inquiry investigated stillbirths, neonatal deaths, maternal deaths and babies or mothers who suffered brain damage and other injuries between 2012 and 2025. In this article some of the families affected share their stories about what happened to them in Nottingham, and explain why this is such a landmark moment.
  26. Community Post
    Thanks @Jules I've used AI to summarise this. Will watch the full presnetation too! “Can improvement and innovation save the NHS?” by Professor Mary Dixon-Woods Below is an AI generated concise summary report of the video “Can improvement and innovation save the NHS?”, a keynote by Professor Mary Dixon-Woods published by THIS Institute in May 2026. The lecture argues that improvement and innovation can help the NHS, but only when they are evidence-based, realistically implemented, attentive to inequality, and supported by well-functioning organisations rather than treated as universal solutions in themselves.[1][2] Executive summary The lecture presents a sober assessment of current NHS performance across access, timeliness, quality, effectiveness, and equity, using examples such as elective delays, cancer treatment delays, unwarranted variation in diabetes and breast cancer care, and persistent inequities in maternity outcomes. Professor Dixon-Woods argues that these problems are not simply deficits of effort or goodwill, but symptoms of deeper organisational, policy, and system design failures that limit the impact of improvement work.[2] Her central message is that innovation and improvement are necessary but insufficient unless they are grounded in evidence, matched to context, and protected from hype, overclaiming, and poorly designed large-scale programmes. She cautions that the NHS has often adopted interventions with excessive optimism, weak evaluation, and inadequate attention to implementation, creating cycles of enthusiasm followed by disappointment.[2] Main arguments The lecture identifies several core challenges facing the NHS: care is not consistently accessible, timely, high quality, effective, or equitable, and these deficits vary substantially by geography, deprivation, ethnicity, and sex. Examples cited include falling public satisfaction, persistent elective backlogs, non-compliance with guidance in some diagnostic testing, and marked disparities in maternal mortality and severe morbidity.[2] A major theme is that variation should not be dismissed as inevitable background noise, because it often indicates remediable organisational weakness, uneven capability, or failure to apply existing knowledge reliably. The lecture also highlights the continued use of some low-value activity alongside failures to deliver proven beneficial care, showing that both underuse and overuse coexist in the NHS.[2] Improvement lessons Professor Dixon-Woods argues that improvement succeeds least when it is treated as a slogan, a centrally imposed programme, or an assumption that any change is inherently beneficial. She emphasizes that large-scale initiatives often fail when they are oversold, under-specified, weakly evaluated, and inattentive to frontline realities, staffing pressures, and competing operational demands.[2] The lecture supports a more disciplined model of improvement: test interventions properly, understand mechanisms, use robust evidence, and distinguish genuinely effective innovation from attractive but weakly evidenced ideas. In practice, this means improvement should be designed as serious applied inquiry rather than as advocacy, branding, or policy theatre.[2] Governance implications For board and governance audiences, the lecture implies that oversight should focus not only on performance outcomes but on the organisational conditions that make safe and effective improvement possible. These conditions include the ability to identify risk early, hear uncomfortable information, respond to variation, evaluate change honestly, and sustain attention on inequity as well as aggregate performance.[2] The talk is particularly relevant to patient safety governance because it links poor outcomes to structural and cultural issues rather than isolated individual failings. It therefore supports governance approaches that emphasise system surveillance, speaking up, learning capability, and critical scrutiny of improvement claims before scale-up.[2] Actions for leaders A practical reading of the lecture suggests five priorities for NHS leaders and boards: · Treat major improvement claims as propositions requiring evidence, not as self-validating solutions.[2] · Target unwarranted variation as a governance signal of uneven quality and possible safety risk.[2] · Examine inequity explicitly, especially where deprivation, ethnicity, sex, or geography are linked to worse outcomes.[2] · Avoid adopting innovations at scale without credible implementation planning and evaluation.[2] · Strengthen organisational conditions for learning, challenge, and candour so that weak signals are detected earlier.[2] An example of the lecture’s practical relevance is its treatment of maternity inequity: disparities in mortality and morbidity are presented not as unfortunate externalities but as evidence that service design and care delivery are failing some groups more than others. That framing is directly applicable to board assurance, quality committees, and patient safety improvement programmes.[2] Would you like this converted into a more formal board paper style with headings such as background, key issues, implications, and recommendations? 1. https://www.youtube.com/watch?v=E_iCWIazGtU 2. https://support.google.com/youtube/answer/15930243?hl=en-GB
  27. News Article
    NHS England is being warned that the planned rollout of a new “portal” for all NHS primary dental work could lead to widespread disruption. The NHS Dental Services Portal is proposed as a new digital system for managing all NHS dental contract administration, including how dental activity is recorded, validated and paid. It is being rolled out to modernise an old, fragmented process, with the aim of improving efficiency, transparency, and consistency. In an open letter sent to NHS Business Services Authority and NHSE, and shared with HSJ, the Dental Software Suppliers Association raised concerns about the speed of implementation being imposed. Read full article (paywalled). Source: Health Service Journal, 22 June 2026
  28. News Article
    NHS England has taken enforcement action against a major health trust over multiple safety concerns, warning that it cannot be sure more patients won’t be harmed. The sanction means Northern Care Alliance NHS Foundation Trust, in Greater Manchester, could be fined or lose its license to provide care if it does not improve. It comes after a string of serious concerns were raised about patient safety, including in its gynaecological services, after an audit of hundreds of cases at Salford Royal Hospital in 2024 found dozens of women, including cancer patients, were “harmed” after their diagnosis and treatment were delayed due to admin failures. Now, a damning document, seen by The Independent, reveals NHS England found the trust has been “unable to provide assurance” that it has a clear and consistent structure “that will ensure no further patients may suffer harm”. Read full article. Source: The Independent, 19 June 2026
  29. News Article
    The report of the inquiry into the biggest maternity scandal in NHS history will outline “horrendous” failings in the care provided to women in Nottingham. A catalogue of appalling behaviour over many years by staff at the city’s two hospitals – Queen’s Medical Centre and Nottingham City hospital – included racism towards mothers, it will say. The NHS is bracing itself for the publication on Wednesday of a report by Donna Ockenden on 2,500 cases involving babies and mothers dying or being injured, and babies being stillborn, while under the care of Nottingham university hospitals NHS trust between 1 April 2012 and 31 May 2025. The document will stretch to more than 350 pages. Ockenden, a senior midwife and expert in maternity care failings, began her inquiry into Nottingham more than four years ago, in May 2022. About 2,505 families – more than in any previous maternity scandal – and approximately 850 staff and ex-staff of the NHS trust have given evidence to it. Read full article. Source: The Guardian, 22 June 2026
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