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In this blog, hub Topic leader Aurora Todisco shares her new mini-guide - 10 questions every organisation should ask about their PPIE. She explains how and when it can be used to help improve approaches to Patient and Public Involvement and Engagement. A reflective tool for stronger involvement Patient and Public Involvement and Engagement (PPIE) is often well intentioned, but not always well examined. Over time, practices can become habitual, with limited reflection on whether involvement is genuinely inclusive, ethical or impactful. I have developed a new resource, 10 Questions Every Organisation Should Ask About Their PPIE (attached below). It is designed to prompt honest reflection and meaningful improvement. 10_Questions_Every_Organisation_Should_Ask_About_Their_PPIE (1).docx Why questions matter Rather than offering prescriptive answers, this mini guide encourages organisations to pause and ask critical questions such as: Why are we involving people? Are we involving them early enough to influence decisions? Are diverse voices genuinely represented? Do people know how their input has been used? These questions can be uncomfortable – but they are essential if involvement is to move beyond a tick box exercise. Supporting better conversations The questions are suitable for: team discussions and away days governance and quality improvement reviews planning new projects or programmes. They are supported by a clear checklist covering accessibility, feedback, support, recognition and evaluation of impact. Creating accountability Asking these questions regularly helps organisations: identify gaps between values and practice strengthen accountability to lived experience contributors improve the quality and credibility of PPIE activity. Used together with my other resources (links below), this guide helps create a more thoughtful, transparent and respectful approach to involvement. An invitation to reflect Strong PPIE isn’t about having all the answers – it’s about being willing to reflect, listen and change. These ten questions offer a simple but powerful starting point. Related resources How authentic patient stories can shift systems thinking and improve care Being ready for meaningful Patient and Public Involvement and Engagement, and why it matters for patient safety Making meetings inclusive: a practical guide for PPIE Avoiding tokenism: ensuring meaningful Patient and Public Involvement and Engagement (PPIE) The Lived Experience Involvement Toolkit: turning good intentions into practical involvement From consultation to co-production – a beginner’s guide

On the 23 June 2025 the Secretary of State for Health and Social Care (DHSC) announced a rapid, national, independent investigation into NHS maternity and neonatal services. This final report highlights key areas of concern, identifies barriers to delivering change and sets out a robust package of eight recommendations aimed at delivering long-term systemic and cultural transformation in maternity and neonatal care. It builds on an interim report published in February 2026. The report makes eight recommendations aimed to address the systemic problems identified in this report: The Department of Health and Social Care (DHSC) must create a statutory Maternity and Neonatal Commissioner, introducing legislation into the Health Bill at the earliest possible opportunity, and appointing a Commissioner within six months of Royal Assent. DHSC, NHS England (NHSE), Integrated Care Boards (ICBs) and NHS trusts must take action to listen to the voices of women, birthing people and families within 12 months. DHSC, NHSE and CQC must drive improvement, within 12 months, of the quality, transparency, oversight and accountability of investigations and ensure learning is captured and acted upon when things go wrong. DHSC/NHSE must design a Modern Service Framework for maternity and neonatal services within 12 months and begin rollout within 18 months. DHSC, NHSE, ICBs, NHS trusts, the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) must treat racism, discrimination and inequality as a critical maternity safety issue – within 12 months, with work starting immediately. DHSC/NHSE must clarify existing system governance, oversight and accountability structures and improve the effectiveness of regulatory oversight within nine months. DHSC, NHSE, ICBs and NHS trusts must work with colleges, universities, post graduate educators and others to improve culture and teamworking, and strengthen leadership at all levels of the system and across professions within 12 months. DHSC/NHSE must deliver estates and digital systems that are fit for modern maternity and neonatal care with 12-month, five-year and 10-year investment commitments and implementation deadlines.

Dr Zoe Brummell will summarise her research into the Learning from Deaths programme and explore the obstacles to organisational learning as well as the ways it should happen. The session will explore How the Learning from Deaths programme failed to learn. What gets in the way of learning. What learning that leads to improvements looks like. Why partnership with families for organisational learning matters and what it looks like. Register

Families are contacted by a Family Liaison Officer from the NHS at one of the most vulnerable moments people are likely to experience – following an unexpected and traumatic death. Families, often overwhelmed by grief, face arranging the funeral, an NHS investigation, a Coroner’s Inquest – processes that are unfamiliar, confusing and often alarming. Families describing these processes talk about feeling lost, frightened, confused, faced with trying to ask questions to systems they don’t understand. The Family Liaison Officer can offer support, information, understanding, signposting and consensual referrals to other sources of help. But not all Trusts employ them and it is not always clear how their insights help Trusts learn and improve. The session will explore: The role of Family Liaison Officers? – A national perspective The difference between a Family Liaison Officer working in the NHS and in the Police How families experience Family Liaison Officers How we hope this role will develop Register

Mental health services have developed Experts by Experience work to involve patients/service users in services, but the engagement of family and friends carers has progressed much more slowly. It’s complicated by complex family relationships and potential disagreements and estrangements, yet family and friends know their loved one best of all and hold information that can assist with safety planning, understanding risk and supporting recovery. This session will explore: What co-production is – and what it is not. How co-production with patients/service users can work well. How can we improve co-production with family and friends carers. What best practice looks like. Register

In February, Public Policy Projects (PPP) hosted their annual Patient Safety Forum in partnership with Patient Safety Learning. Held at the Royal College of Surgeons of England in London, it was attended by senior healthcare leaders, patient safety experts, representatives from the HealthTech industry, frontline healthcare professionals and patients. In this article, Patient Safety Learning reflects on one of the panels discussions—Aligning patient safety with productivity. Against a backdrop of long waiting lists and increasing financial pressures, improving productivity is a priority for healthcare leaders, commissioners and providers. The 10 Year Health Plan for England identifies this as a key issue of the NHS, setting a target to deliver a 2% year on year gain in productivity over the next three years. Productivity gains can sometimes be seen as running contrary to patient safety—a push to deliver more activity while cutting resources. However, at Patient Safety Learning we believe that creating a safer health system can be a key driver of productivity. Unsafe care and its consequences are inherently inefficient: it leads to longer stays, readmissions, litigation, staff turnover and reputational damage. At the Patient Safety Forum 2026 an expert panel was convened to discuss this topic, with the following members: Andi Orlowski, Director, NHS Health Economics Unit Professor Sanjiv Sharma, Group Medical Officer, Barts Health NHS Trust Stephen Rocks, Head of Secretariat for NHS Productivity Commission, The Health Foundation Gayathri Kumar, Lead Health Economist, NHS Health Economics Unit Panellists had a thought-provoking discussion about this topic. In this blog we reflect on the key takeaways from this panel. Scale of the challenge Andi Orlowski noted that while there had been many positive discussions at the Forum about improving patient safety, outcomes and experiences, the financial backdrop faced by the health service remains stark. He pointed to wider pressures on the Government to increase expenditure in areas outside of healthcare, such as defence, and the likely need for the NHS to do more work with the same money or less going forward. Panellists reflected on the scale of the productivity challenge faced by the health system. It was noted that since the onset of the Covid-19 pandemic, the NHS has grown in terms of staffing but productivity has fallen considerably in official measures. This is obviously not in itself a direct relationship, with the latter being associated with a range of issues varying from higher waiting list burdens to increased patient complexity. Stephen Rocks spoke about the work of The Health Foundation’s NHS Productivity Commission. This was established to provide evidence and solutions to boost productivity over the next decade. He was clear that patient safety should be seen as being aligned to productivity, with reductions in avoidable harm ultimately improving patient outcomes and by definition improving productivity. As part of its work, the NHS Productivity Commission held a public call for evidence this year. This invited a wide range of stakeholders to share their insights, ideas and expertise on the productivity challenge and how it could be tackled. Since the Patient Safety Forum took place a summary of its activities to date has now been published. Keeping sight of value A recurring discussion theme was that in looking to improve productivity in healthcare, we should not lose sight of value. By value, we mean whether patients achieve outcomes that matter to them, relative to the resources that have been used. What is meant by value in this context, however, can differ depending on perspective. Reflecting on this point, an audience member noted the importance of ensuring productivity discussions included the views of patients and frontline staff members. Gayathri Kumar concurred with this view, emphasising the importance of having deliberative conversations that include everybody who has a stake in decision making. Speaking about a practical example of this, she referred to the Health Economics Unit using the STAR (Socio-Technical Allocation of Resources) method to support Integrated Care Boards (ICBs). Taught through the Smarter Spending in Population Health programme, this is intended to help decision-makers to effectively assess their resources to see how they can create more value. This involves: Bringing together key stakeholders at decision conferences. Asking them to identify the criteria that matters to them and map the different interventions in a pathway. Subsequently working out what the value for money is, on both the financial side of things and in value terms. By coming together in this way, the aim is that decisions are not simply making assessments based on statistics divorced from patient and healthcare professional experience. It provides a way of identifying higher value interventions and services, crucial when there are only finite budgets available. Not just a financial focus Not simply focusing on financial improvements when thinking about productivity was also a key topic of discussion amongst the panel. Sanjiv Sharma from Barts Health Trust spoke about the importance of recognising the interrelationship of finance, quality and safety in healthcare, rather than framing them in oppositional terms. Avoidable harm in healthcare is not just a tragedy for those involved but comes at a huge financial cost. Sanjiv noted the Organisation for Economic Co-operation and Development (OECD) estimate that the direct cost of treating patients who have been harmed during their care in high-income countries approaches 13% of health spending. Reflecting on their work at Barts Health Trust, Sanjiv said that when they spoke about productivity they used a simple definition: using their resources to treat the highest number of patients in the safety way through the delivery of high-quality care. This moves slightly beyond a pure definition of productivity, also bringing in issues of quality, safety and access. Considering an example of an improvement made without a pure financial focus, he cited the introduction of digital push notifications at Barts Health Trust to improve attendance at outpatient appointments. He said that by using these over a 12-month period they had managed to reduce non-attendance from 12.3% to 10.3%. While this may sound like quite a small percentage, the gain from this was not simply an improvement in attendance. Fewer wasted appointments had enabled them to create a significant number of new appointments, effectively delivering more care while expending a similar resources. This activity links to national proposals around improvements to the NHS App, with plans to use push notifications more widely to remind patients about upcoming appointments and relay important messages. Sanjiv also shared an example from a clinical productivity programme at Barts Health Trust looking at how outpatient clinics operate in the context of breaking down long waiting lists. In particular, looking at how the clinics can be organised more efficiently to better use the time of the most highly remunerated part of the workforce (consultants) so that more patients can be seen in normal working time. He noted this not only can save money on additional working hours, but also reduces the risk of consultants becoming overworked or burned out. More broadly, Sanjiv noted that when considering how healthcare can increase productivity, it is also important to recognise that there are limits to this. He spoke about the need for more honest conversations in wider society about what we can expect from healthcare, with our ageing population in the UK driving ever increasing demand on the system. 10 Year Health Plan As noted earlier, the 10 Year Health Plan for England sets specific goals for productivity improvements in the NHS. But how will this be measured and assessed? Gayathri noted that the answer to this was complex, as it depends on the perspective you take. She noted that if you were planning to take a societal perspective or NHS and broader perspective, you would consider the system impacts. Wider than this, she emphasised the importance of bringing together stakeholders from across different parts of care pathways so they can make things better—delivering both cost savings and improved patient outcomes. Andi reflected positively on the work Gayatri and her colleagues had done in this area. He noted that their work around the three shifts in the 10 Year Health Plan had involved reviewing over 6,000 papers to find which were cash-releasing by seeking the evidence base in the published literature and the grey literature. He noted that in many cases, performing these interventions would not achieve savings as often it results in moving pressures around the system. For example, increasing activity in an acute organisation saves money there, but transfers in activity in primary care which increases costs there. The importance of looking at the system as a whole was emphasised. Digital developments Panellists also discussed how digital advances can unlock productivity gains in the NHS. An example provided was switching to digital communications in full; for instance, stopping the use of paper letters. It was noted that this is quite a simple change, but can potentially unlock huge cost savings, while in turn reducing or enabling the re-direction of administrative resources in other areas. However, how this is delivered in practice requires considerably effort to change how healthcare organisations work, with far more complexity sitting behind such proposals than may first be apparent. The example of using artificial intelligence (AI) more was also highlighted, which is another key element of the 10 Year Health Plan. It was noted that while currently our approach to the application of AI in the NHS is a little uneven, it could potentially unlock significant improvements in processes if applied correctly in future. Role of Integrated Care Boards Whether ICBs could play an important role in improving productivity was also discussed by the panel. With a renewed focus on their strategic commissioning role, there is significant potential for ICBs to drive forward NHS productivity. Stephen Rocks suggested that they could potentially help look at improving productivity through the lens of their role in maximising population health management. He said he would welcome seeing more work at an ICB level that could help us to understand how well their areas are doing in terms of outcomes, and considering going forward if there is potentially more of a role for outcomes-based contracting rather than paying through block contracts or for activity targets. Importance of leadership One final key area of reflection from panellists was how leadership relates to improving productivity in healthcare. Stephen Rocks said that The Health Foundation had recently held a event with people sharing their success stories in other sectors which bore out the importance of this. They noted that this stressed the importance not only of those at the top of the organisation, but also the vital role of middle management. He reflected that the people at the top set the vision, at the bottom are the ground people doing things, and in the middle you're having to respond to people and understand their concerns as well as trying to carry out that vision. Investment was needed across all these levels. Sanjiv Sharma also noted the need to balance this focus on helping those in leadership roles be the best they can be. Sanjiv emphasised the importance of having proper support mechanisms in place as too often we create environments in the healthcare system where people are faced with a “just get on and do it attitude”. Share your insights What are your views on how best to align patient safety and productivity? Share your thoughts on this article and the issues raised by commenting below (sign up first for free). Find out more about the Patient Safety Forum 2026 You can read more about different discussions and panel sessions at this year’s event in the below: Safe systems, safe cultures: reflections from the Patient Safety Forum 2026 Patient voice, safety and the NHS 10 Year Plan: Reflections from the Patient Safety Forum 2026 Designing AI with patient safety at its core: Reflections from the Patient Safety Forum 2026 Inside the NHS quality debate: Key takeaways from Penny Dash’s keynote at the Patient Safety Forum 2026