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hub topic lead and retired psychotherapist, Risa Mallory, and Karen Padilla, the staff lead of the Women and Heart Network at Global Heart Hub, discuss women’s heart health inequities from both an individual advocate’s and advocacy organisation’s perspective. They explain why the conversation must move beyond awareness alone into actions.This blog is part of a series on noncommunicable diseases, in support of World Patient Safety Day 2026. For decades, heart disease has remained the leading cause of death among women, yet women continue to experience significant inequities in how heart disease is recognised, diagnosed, treated and managed. In addition to well-established risk factors, many women also face sex-specific and other under-recognised risk factors like premature menopause, gestational diabetes and hypertensive disorders of pregnancy, as well as psychosocial and environmental risk factors or socioeconomic deprivation. These inequities are often discussed as healthcare disparities, research gaps or issues of access. However, there is another lens through which we must view them: patient safety. Patient safety is commonly associated with medication errors, hospital-acquired infections or surgical complications. However, patient safety also encompasses harm that results from delayed diagnosis, missed symptoms, inadequate communication, fragmented care and healthcare systems that fail to meet the needs of specific populations. Women living with heart disease encounter these risks every day. Perspectives of an individual patient advocateFrom the perspective of an individual patient advocate, the consequences of these inequities are deeply personal. Many women describe years of unexplained symptoms before receiving an accurate diagnosis. Others recount being told their symptoms were caused by stress, anxiety, menopause or lifestyle factors when they were, in fact, experiencing serious cardiac conditions. Some women leave emergency departments without appropriate investigations. Others receive treatment only after their disease has progressed significantly. These experiences are not isolated incidents. They are recurring patterns that expose women to preventable harm. Women are more likely to experience unrecognised symptoms during a heart attack. Conditions such as spontaneous coronary artery dissection (SCAD), coronary microvascular dysfunction and myocardial infarction with non-obstructive coronary arteries (MINOCA) disproportionately affect women yet remain under-recognised in many clinical settings. When healthcare providers lack awareness of these conditions, the risk of missed or delayed diagnosis increases. For patients, every delay matters. A missed diagnosis is not simply an inconvenience. It can lead to worsening disease, avoidable hospitalisations, increased disability, psychological distress and, in some cases, death. When women are repeatedly required to advocate for themselves in order to be heard, believed or investigated appropriately, the burden of safety shifts from the healthcare system to the patient. No patient should have to become an expert in their health in order to receive safe care. Perspectives of a patient advocacy organisationFrom the perspective of a patient advocacy organisation, these individual experiences reveal broader systemic failures. Patient safety cannot be achieved when the evidence base itself has historically excluded women. For many years, cardiovascular research primarily focused on male participants, creating gaps in our understanding of how heart disease presents, progresses and responds to treatment in women. Women represented less than 39% of cardiovascular disease clinical trial participants between 2010-2017. This underrepresentation limits the potential for developing sex-specific strategies and recommendations. Although progress has been made, these knowledge gaps continue to influence clinical practice today. Healthcare systems also frequently rely on care pathways, educational materials and risk assessment tools that were not designed with women’s experiences in mind. The result is a mismatch between patient needs and the services available to support them. Health inequalities are further compounded by social determinants of health. Perspective of the international communityFrom the perspective of the international community of heart patients, inequalities in healthcare place an enormous social, economic and psychological burden on patients, their families and their caregivers, jeopardising their quality of life and, ultimately, their safety. Women who are racialised, Indigenous, living with disabilities, living in rural communities or experiencing socioeconomic disadvantage often face multiple layers of inequity. They may encounter barriers to specialist care, longer wait times, transportation challenges, financial constraints or communication obstacles that further increase their risk of poor outcomes. These factors do not merely influence health outcomes; they influence patient safety. A healthcare system that does not account for these realities creates conditions in which preventable harm becomes more likely. The transition from hospital to home provides a particularly important example. Many women report feeling unprepared following a cardiac event or hospitalisation. They may receive fragmented information, limited education about symptoms to monitor, unclear medication instructions or inadequate follow-up planning. For instance, registries show that the referral of women to cardiac rehabilitation is significantly lower, despite it being strongly recommended based on the highest quality evidence in the guidelines for the management of acute coronary syndromes. Without effective discharge processes and continuity of care, patients can experience avoidable complications, medication errors, emergency department visits and readmissions. Safe care extends beyond hospital walls. Patient safety depends on ensuring that patients and caregivers have the information, resources and support necessary to manage their health after discharge. When those supports are absent, risk increases. Addressing these inequities requires action at every level of the healthcare system. Healthcare organisations must invest in education that improves awareness of sex- and gender-specific aspects of cardiovascular disease. Research funders must continue to prioritise studies that generate evidence relevant to women. Clinical guidelines must reflect emerging knowledge about conditions that disproportionately affect women. Health systems must strengthen transitions of care and ensure patients receive clear, accessible information throughout their healthcare journey. Patients as partnersEqually important is the inclusion of patients as partners in designing solutions. Women with lived experience bring critical expertise about where systems fail and where opportunities for improvement exist. Their insights can help identify safety risks that may otherwise remain invisible to healthcare professionals and decision makers. Meaningful patient engagement is not a courtesy; it is an essential component of safer care. From both individual advocate’s and advocacy organization’s perspective, we have witnessed the power of patient voices to drive change. We have also witnessed the consequences when those voices are ignored. The conversation about women’s heart health must move beyond awareness alone. Awareness is important, but awareness without action does not prevent harm. We must recognise that health inequities in cardiovascular care are not only matters of fairness and access; they are patient safety issues that affect diagnosis, treatment, recovery, and survival. Every woman deserves to have her symptoms taken seriously. Every woman deserves timely diagnosis and evidence-based care. Every woman deserves a healthcare system designed to keep her safe.

This strategy, published on behalf of the National Quality Board, provides a new structured approach to making quality the organising principle for all NHS activity in England over the next decade. Its purpose is to ensure people receive high‑quality care consistently across all NHS-funded services. By doing so, it aims to: improve health outcomes improve patient satisfaction with NHS services reduce health inequalities. It applies system-wide, guiding national bodies, NHS leaders, the wider healthcare workforce and partners whose actions influence the quality of care in local communities. The Strategy uses a definition of high-quality care based on the three core domains of quality: Safety: reducing the risk of unintended or unexpected harm to patients arising from the provision of healthcare. Effectiveness : delivering evidence-based care that optimises the outcomes that matter to people using services. Experience: co-ordinated, compassionate and responsive care, delivered by staff who are skilled, supported and able to do their job well. It focuses on improving performance across all three of these domains. Key priorities identified by the strategy The Strategy sets initial focus on where clear standards and the application of proven approaches will deliver the greatest improvements in outcomes, equity and value, based on current evidence. It notes that these priorities are not static, stating that as progress is made and as risks, outcomes and population needs change, priorities will be reviewed and updated. Improving outcomes and reducing variation. Making sustained improvements in maternity and neonatal services. Maintaining patient safety across all settings. Improving experience of care and restoring trust. Reducing inequalities across all three quality domains. Monitoring clinical and population health outcomes, Drawing on the 10‑Year Health Plan and the Dash Review, this strategy sets out ten enablers that support quality improvement across the whole healthcare system: Clarifying who is responsible and accountable for quality at every level of the healthcare system. Setting clear priorities to improve the quality of care while adopting a transparent, co-ordinated and value-based approach. Strengthening leadership and management capability to create the right culture and conditions for improvement. Listening to and working with people and communities on what matters to them. Using data to manage quality, inform decisions and support accountability at all levels. Increasing transparency, making the NHS the world’s leading healthcare system for public access to information on care quality. Developing and embedding technology to underpin quality management and improvement. Aligning incentives and rewards with accessible, high-quality and productive care. Promoting innovation and research to support continuous improvement in both clinical care and how the NHS operates. Creating a more co-ordinated and improvement-focused approach to regulation.

Healthcare Quality Improvement Partnership (HQIP) Clinical Audit Awareness Week ran from 22-26 June 2026. Designed to celebrate the critical role of clinical audit and data-driven healthcare improvement, the campaign explored how insight becomes action across five themed days. Through a packed programme of events and awards, it showcased practical examples, innovation and collaborative projects. Find out more about what took place, with event recordings and slides on HQIP's website.

From 1 July 2026, following a recommendation by the Dash review of patient safety across health and care, NHS England will deliver some activities previously undertaken by the National Guardian’s Office (NGO). Trusts, primary care organisations, integrated care boards (ICBs) and independent providers will be taking on greater responsibility and accountability for embedding effective Freedom to Speak Up (FTSU) arrangements. More information is available in The future of Freedom to Speak Up publication. Guidance and support: Creating a safe speaking up environment: the role and responsibilities of healthcare leaders and commissioners Information for healthcare leaders to support their Freedom to Speak Up (FTSU) responsibilities Integrated care board and primary care FTSU arrangements Support for healthcare leaders, non-executive directors and trustees Information for FTSU guardians Information for FTSU stakeholders Information for independent healthcare providers (including hospices) Accessing the National Guardian’s Office website Privacy notice

In a LinkedIn article, Roger Kline highlights the significance of the EHRC’s 2024 Sexual harassment and harassment at work: technical guidance. It rightly emphasises the proactive, preventative duty on employers to prevent sexual harassment. But it goes further and sets out how legislation now applies (with one exception) to any form of harassment linked to most protected characteristics. Its emphasis is in sharp contrast to the emphasis on supporting individuals to make that characterise much work on equality. The NHS England policy rightly states at para 1.2. “The new Worker Protection (Amendment of Equality Act 2010) Act 2023 creates a duty on employers to take reasonable steps to prevent sexual harassment in the workplace”. However, in Roger's view, it does not sufficiently emphasise the central importance of the anticipatory requirement on employers.

In this King's Fund article, Danielle Jefferies explores the link between delayed discharges and corridor care, the growing financial cost of both and why action beyond hospital walls will be essential if we are serious about reducing pressure on hospitals. Further reading on the hub: The crisis of corridor care in the NHS: patient safety concerns and incident reporting Corridor care guidance needs to move beyond what “should” happen and grapple honestly with why it isn’t Corridor care: are the health and safety risks being addressed?

A new paper from NIHR RSET, in collaboration with Sands, describes the experiences of different families of advocacy support in maternity and neonatal services. Based on conversations with 34 families, the findings suggest that independent advocacy could help ensure that families are listened to, heard and supported following an adverse outcome.