Perspectives on the Dash Review (29 August 2025)

Summary

On the 7 July 2025, the Department of Health and Social Care (DHSC) published the findings of its review of patient safety across the health and care landscape in England. Chaired by Dr Penny Dash, Chair of NHS England, the review looked at six specific organisations that were established to either assure—or contribute to improving—the safety of care. It also looked at the wider landscape of organisations influencing care. In this article, we pull together a number of different reflections that have been shared in response to the review’s findings.

Content

Dash Review recommendations

The Review of patient safety across the health and care landscape set out nine recommendations seeking to streamline and consolidate patient safety functions in England:

1. Revamp, revitalise and significantly enhance the role of the National Quality Board.
2. Continue to rebuild the Care Quality Commission (CQC) with a clear remit and responsibility.
3. Continue the Health Services Safety Investigations Body’s (HSSIB) role as a centre of excellence for investigations and clarify the remit of any future investigations (while transferring HSSIB’s functions to the CQC, operating as a discrete branch within the regulator).
4. Transfer the hosting arrangement of the Patient Safety Commissioner to the Medicines and Healthcare products Regulatory Agency (MHRA), and broader patient safety work to a new directorate for patient experience within NHS England, transferring to the new proposed structure within DHSC.
5. Bring together the work of Local Healthwatch, and the engagement functions of integrated care boards (ICBs) and providers, to ensure patient and wider community input into the planning and design of services (with the strategic functions of Healthwatch England transferred to the new Patient Experience Directorate at DHSC).
6. Streamline functions relating to staff voice (abolishing the role of the National Guardian for Freedom to Speak Up in the NHS and National Guardian’s Office).
7. Reinforce the responsibility for and accountability of commissioners and providers in the delivery and assurance of high-quality care.
8. Technology, data and analytics should be playing a far more significant role in supporting the quality of health and social care.
9. There should be a national strategy for quality in adult social care, underpinned by clear evidence.

Perspectives on the Dash Review’s findings and recommendations

Below are five different perspectives to the Dash Review that we have added to the hub:

Patient Safety Learning

In our response to the Dash Review, we set out that while we agree with its overarching recognition of the need to coordinate and rationalise the patient safety landscape in England we strongly contest its assertion that patient safety has been significantly over prioritised in the past 5 to 10 years at the expense of other aspects of quality. Our response also notes:

• The need for further detail on how the operational independence of HSSIB will be maintained as it transitions to the CQC.
• Reservations about the role of Patient Safety Commissioner being transferred to the MHRA and the impact of this on the role’s credibility and independence.
• The absence of consideration of the future role of NHS England/DHSC on patient safety, in particular the lack of structure systematic approaches to learning and solution development at a national level.
• Disappointment that culture has not been a key issue considered by this review. There are significant changes needed to ensure that there is an open and fair culture with a focus on learning and improvement that does not blame healthcare staff for systemic failings.
• The existing network of Freedom to Speak Up Guardians working with individual healthcare providers is identified by the review as being able to contribute to a strengthened safety culture. However, this is not in itself sufficient. Organisations need to actively foster a patient safety culture, tackle blame and fear, and promote a culture of safety improvement.

Read more here.

Graham Martin and Jane O’Hara

In a BMJ opinion piece, Graham Martin and Jane O’Hara from The Healthcare Improvement Studies (THIS) Institute, share their views on the proposals in the Dash Review. They argue that while few would disagree with the Dash Review's assessment of the current patient safety environment, the review’s recommendations raise a number of questions. Specifically, how effective ICBs and a new national Patient Experience Directorate will be at incorporating patient voice functions into their roles.

Read more here.

Suzette Woodward

In two articles, Suzette Woodward, visiting Professor for the Institute of Global Health Innovation at Imperial College University London, sets out her reflections on the Dash Review. In her first article she expresses concerns that the review feels too often the ‘world of safety as imagined’ rather than the ‘world of safety as done’, not necessarily engaging with the difficult systemic issues that underpin avoidable harm in healthcare. 

Read more here.

In her second piece she talks about the lack of substantive commentary about the review from those working in patent safety, and the factors that may explain this. She also provides a detailed commentary on the review, considering is findings and recommendations.

Read more here.

Carl Macrae

In this article, Carl Macrae, Professor of Organizational Behaviour and Psychology at the University of Nottingham, reflects specifically on the review’s recommendations to transfer the functions of HSSIB into the CQC. He argues strongly that this change potentially risks setting back progress in the systematic improvement of quality and safety, removing the health system’s nascent capacity for independent system-wide safety investigation.

Read more here.

The Pharmaceutical Journal

In this article, journalist Emma Wilkinson reflects on the Dash Review's proposals to streamline oversight and reduce duplication around the patient voice, specifically plans to abolish Healthwatch England and bring its functions in-house with a new Patient Experience Directorate in DHSC.

Read more here.

Share your views with us

What is your opinion on the findings and recommendations of the Review of patient safety across the health and care landscape? We would welcome your thoughts on the review. You can comment below (sign up to the hub first for free) or email the team directly at [email protected] to share your views.