• Outpatient transformation – shifting away from traditional outpatient models through a major expansion of Advice and Guidance and a reduction in unnecessary follow‑ups.
• A step‑change in reducing hospital bed‑days for highest‑risk cohorts – with neighbourhoods playing a central role in implementing proactive care models for high‑risk groups.
•  Scheduling and access reform for urgent care – making it easier for patients to book urgent care appointments in GP practices, urgent treatment centres, or other appropriate settings, reducing avoidable ED attendances.
• Technology‑enabled productivity improvements – expanding the deployment of Ambient Voice Technology and a suite of tools to improve theatre utilisation, discharge flow, RTT validation, community waiting lists, Advice and Guidance, electronic prescribing in all trusts, and crisis response.
• The NHS App – accelerating efforts to expand the role of the App as the digital front door into the NHS, supporting more convenient and effective triage and navigation for patients.
• Payment reform – realigning the payment system to the service changes you are seeking to deliver, including new payment models for urgent and emergency care.
• Quality – putting quality back at the heart of everything we do, including the publication of a new quality strategy, the development of modern service frameworks focused on cardiovascular disease, sepsis, serious mental illness, frailty and dementia, children and young people, and palliative and end-of-life care, and testing new delivery models for secondary prevention to tackle variations in the uptake of high-impact CVD and diabetes interventions.
• Capability building and a focus on our people – launching the new Leadership College, which will be the most radical change to leadership development and talent management that the NHS has seen in over a decade. 

LFPSE brings the feature to record patient safety event types beyond incidents. Recorders can now also upload patient safety risks, outcomes and instances of good care. This is to ensure the database contains more instances of care that the healthcare system can learn from instead of only detailing errors involving patients. In this period, 855,535 events were recorded to LFPSE, the majority of which were recorded as patient safety incidents (97.01%).

Count of patient safety incidents by maximum physical harm – based on patient safety incident records from October 2025 to December 2025

Sometimes a problem in care can affect more than one patient, or none at all. To capture this, as a new feature of LFPSE, recorders can submit information for multiple patients per incident, meaning there can be multiple degrees of harm per incident. For the following figure and table NHS England have taken the highest harm level per incident. NHS England identified and removed 66,080 incidents where the number of patients affected was unknown. Preliminary analysis suggests that these records likely represent incidents with no patients involved. NHS England will continue further data quality checks to validate these figures. During this quarter, 763,905 incidents had recorded a degree of harm. The majority of these incidents (94.07%) recorded low or no physical harm to patients.

LFPSE has a new variable for grading of the psychological harm associated with the recorded patient safety incidents. This is an experimental field which seeks to explore if responses to safety incidents need to be different if psychological harm is considered separately from physical harm, rather than rolling them together into one measure, as was done in the National Reporting Learning Service (NRLS). Currently, there is low confidence in the grading of psychological harm, as users familiarise themselves with its use, and as such, it is excluded from this report.

Related reading – previous quarterly data publications

• NHS England: Patient Safety Event Data Quarterly Publication – Quarter 2 2025/26 (July to September 2025)
• NHS England: Patient Safety Event Data Quarterly Publication – Quarter 1 2025/26 (April to June 2025)
• NHS England: Patient Safety Event Data Quarterly Publication – Quarter 4 2024/25 (January to March 2025)
• NHS England: Patient Safety Event Data Quarterly Publication – Quarter 3 2024/25 (October to December 2024)

• Trusts and Integrated Care Boards (ICBs) should work to ensure available supply is focused on higher risk activities (for example urgent care and Trauma provision). Where use of a specific type of products is necessary. Trusts should review and clinically prioritise waiting lists and types of activity to maximise use of available stock, based on patient need, staff preference, training on alternative products and scarcity of supply.
• Trust and ICBs should proactively have conversations with Independent Sector (IS) providers in their area to ensure bone cement resources are prioritised for those patients within the clinical priority list above. ICB colleagues are asked to support and coordinate mutual aid where required.
• Clinicians should determine if the available alternatives are suitable, working closely with procurement colleagues and wider trust leadership. Any decisions to substitute products (as an interim measure or longer term) should be grounded in evidence‑basd practice and patient safety and informed by a documented risk assessment.
• Trusts should consider how to utilise any additional theatre time that is released, if arthroplasty or other elective procedures are not possible given lack of Heraeus products.
• Trust colleagues are asked to share this information with relevant teams in your organisation who may be affected by the supply disruption, for example: theatre leads, anaesthetic leads, surgical teams, and trauma and orthopaedic leads.
• Trusts are also asked to ensure transparent and timely communication with patients, particularly in circumstances where treatment waits may be extended or scheduled surgery requires rearrangement. It is essential that patients are kept fully informed of any changes to their care pathway.

1. Building on the vision of the 10 Year Health Plan and the three strategic shifts, the Medium-Term Planning Framework outlined the performance targets and requirements for NHS organisations for the three years up to 2028/29, with local leaders empowered to drive accelerated change.

2. The new NHS operating model continues to develop and refine, establishing clearer roles for organisations and systems. We are returning power to the frontline and developing a new smaller centre, creating an environment for locally led improvement and transformation. Improvement is reaffirmed as a core responsibility of providers in the operating model, and the role of regions and the centre needs to shift to support this.

3. To drive transformational change, providers will be encouraged to explore ‘big leap’ improvement initiatives across whole pathways, and in doing so will convene place partners across primary care, social care, and voluntary and independent sectors.

4. During this year, local clinical and operational teams across the NHS have demonstrated how significant improvements and leaps in performance can be achieved. The Shrewsbury and Telford Hospital NHS Trust significantly reduced waiting times for patients in planned care, achieving a 17% improvement in 18-week referral to treatment performance in one year (November 2024 to November 2025). The Trust then used productivity improvements delivered in outpatients and operating theatres to fund expansion in urgent and emergency care capacity. In addition, The Princess Alexandra Hospital NHS Trust have delivered substantial improvements in urgent and emergency care services for patients, and achieved a 23% improvement in 4-hour performance in December 2025, compared to the same month the previous year.

5. Many of the proposals in this paper have been designed by a Task and Finish Group, led by Glen Burley and Sarah-Jane Marsh, and including colleagues from regional and national improvement teams, Trust Chief Executives, and Chief Operating Officers.

See also:

• How improvement will support delivery of NHS medium term priorities (2026/27 – 2028/29)
• The Model Emergency Department: high performing urgent and emergency care pathways

Access

A majority of these clinics have exceptionally long waiting times for NHS services, with patients often waiting for many years to be assessed. This can be distressing for patients, place undue pressure on staff and contribute to patient safety risks.

As the GDCs maintain separate waiting lists, the true size of the waiting list is unclear, as some patients may be referred to 1 or more GDC through self-referral or GP referral.

The current referral process means the majority of GDCs need to manage relationships with GPs and other services outside their region or ICB area. This places additional demands on resources.

Quality (including safety)

The absence of any patient outcomes data, alongside limited and inconsistent quality data reporting, and minimal clinical audit makes it impossible to properly understand patient outcomes and the safety of these services. These gaps place these clinics outside standard NHS quality assurance expectations.

In addition, existing patient demographic data and clinic feedback indicate that there has been a shift in patient demographics in recent years to a younger cohort with reported additional conditions. Yet, this has not always been met with corresponding changes in how some clinics identify and address patients’ potential additional biopsychosocial needs.

Productivity

There is currently a wide variation in service provision across the country. This includes differences in the number of appointments per GDC clinician and consultation length. These variations need to be considered both in terms of improving access and ensuring high-quality services and patient safety.

Additional financial resources have been made available to each GDC to expand its staffing in recent years. However, workforce data has not always reflected an expansion in staff numbers in some GDCs.

Culture, leadership and governance

Some clinics undertake little or no quality improvement work or knowledge-sharing between services. The senior clinical leadership approach at some clinics also limits staff’s clinical curiosity and the opportunities to identify ways to improve patient outcomes. 

The review also found that oversight by some trust boards and by NHS England regional specialised commissioning teams has not consistently identified these concerns, sought any mitigating actions or supported improvements.

This contributes to concerns that these services carry a high level of risk. Commissioners and host organisation oversight, governance and supportive leadership need to be strengthened to manage this risk. This will be critical to delivering improvements.

Next steps

Based on these findings, the review panel has set out twenty recommendations to improve patient care which are included in this report. The report calls for a wider healthcare response from national and local commissioning teams, adult gender dysphoria clinics, NHS trusts, ICBs, primary care, and other healthcare constituents. This joint approach will be driven by the proposed National Quality Improvement Programme for Adult Gender Services and a new National GDC Oversight Board.

LFPSE brings the feature to record patient safety event types beyond incidents. Recorders can now also upload patient safety risks, outcomes, and instances of good care. This is to ensure the database contains more instances of care that the healthcare system can learn from instead of only detailing errors involving patients. In the current period, 834,454 events were recorded to LFPSE, the majority of which were recorded as patient safety incidents (96.96%).

Count of patient safety incidents by maximum physical harm – based on patient safety incident records from July 2025 to September 2025

Sometimes a problem in care can affect more than one patient, or none at all. To capture this, as a new feature of LFPSE, recorders can submit information for multiple patients per incident, meaning there can be multiple degrees of harm per incident. The following table we takes the highest harm level per incident. During this quarter, 747,487 incidents had recorded a degree of harm. The majority of these incidents (94.09%) recorded low or no physical harm to patients.

LFPSE has a new variable for grading of the psychological harm associated with the recorded patient safety incidents. This is an experimental field which seeks to explore if responses to safety incidents need to be different if psychological harm is considered separately from physical harm, rather than rolling them together into one measure, as was done in the National Reporting Learning Service (NRLS). Currently, there is low confidence in the grading of psychological harm, as users familiarise themselves with its use, and as such, it is excluded from this report.

It will ensure 85% of people with a cancer diagnosis receive their first treatment within 2 months of a referral – up from 70% today. NHS analysis suggests just over 300,000 cancer patients will get their first treatment within 62 days of receiving a referral in 2028/29, up from 226,939 last year (2024/25). While 96% of patients will begin treatment within one more of a cancer diagnosis by 2028/29.

Meeting these ambitious targets will be achieved by radically transforming how services are delivered – shifting more care out of hospital, freeing up capacity to drive down waiting times – and major improvements in health service productivity.

As part of the biggest shake up of the NHS financial regime in more than a decade, hospitals will be financially incentivised to ensure more patients are treated out of hospital, instead receiving the care they need from local neighbourhood teams and in community diagnostic centres.

This will start with immediate action to improve GP access and tackle unwarranted variation between practices – consulting on a new priority to deliver same day appointments, whether face to face, online or by phone, for all clinically urgent patients.

The Framework also sets an ambitious target for 80% of community health service activity within 18 weeks – tackling long waiting times for community services, which have seen a surge in the number of adults and children waiting for more than 2 years for care.

This will be supported by shifting more resources into community services for people with highest needs – such as frailer older people – reducing unnecessary hospital admissions and helping them manage their health at home.

In line with the ambitions of the 10 Year Plan, the framework sets targets to make sure 95% of appointments after triage are available via the App and ensure all providers are leveraging the full potential of the Federated Data Platform by the end of 2028/29.

Patients will no longer be asked to waste their time at follow-up appointments that aren’t necessary – freeing up clinicians to see the patients that need to see them most. Areas of the country that fail to progress on unnecessary follow ups will be performance managed.

More patients will get appropriate care as part of the ‘Advice and Guidance’ scheme which allows GPs to get specialist clinical advice from leading experts at the touch of a button – rather than sending the patient for a hospital appointment which sometimes isn’t needed.

Radiology departments will no longer be scanning people unnecessarily thanks to the rollout of i-Refer – an online software linked to real time up to date clinical guidance to ensure only those who need a scan are offered one. 

Jess’s Rule asks GP teams to ‘reflect, review and rethink’ if a patient presents three times with the same or escalating symptoms. Below is a poster for displaying in GP consultation rooms in relation to this, which you can also find attached as a PDF at the bottom of this page.

Never Events are defined as patient safety incidents that are “wholly preventable because guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and should have been implemented by all healthcare providers”.

NHS England held a 12 week consultation that ran from February to May 2024 asking, via an online survey, ‘on balance do you think the Never Events framework is an effective mechanism to support patient safety improvement and based on the evidence provided in the supporting consultation document which one of the following options do you prefer for its future?’

• Option 1: no change; continue with the current framework
• Option 2: abolish the Never Events framework and list
• Option 3: revise the list of Never Events to only include those with current barriers that are ‘strong, systemic, protective’
• Option 4: revise the definition of and process for Never Events to create a new system that does not require all relevant incidents to be ‘wholly preventable’

Key findings

• There were 854 responses to the online survey, 86% (744) from individuals and 14% (120) on behalf of an organisation
• Only 8% of consultation respondents felt the current Never Event framework was effective
• 66% of consultation respondents considered the current framework unfit for purpose
• 48% of respondents advocated for an alternative approach
• Feedback highlighted the ‘Never Event’ terminology creates unintended negative effects on staff morale and blame culture
• The majority of respondents shared the view that the current framework has limited impact on driving safety improvements

Future direction and next steps

NHS England state that as a result of these findings Option 4 is the preferred way forward, revise the definition of and process for Never Events to create a new system that does not require all relevant incidents to be ‘wholly preventable’. Reflecting the consultation's findings, they state that a new framework should:

• Focus on learning rather than meeting a definition based on strength of barriers
• Reflect the patient safety events that are of significant concern to patients and the NHS
• Be better at including patient safety events across sectors and settings, including mental health and primary care
• Align with Patient Safety Incident Response Framework (PSIRF) principles of proportionate learning and response
• Support a just culture where staff feel confident to report and learn
• Direct resources toward activities that have the greatest potential for improvement
• Better recognises the complexity of healthcare delivery

To take this forward, NHS England had said they have launched a ‘discovery phase’ to explore and test alternatives to the Never Events framework. This will be done in collaboration with stakeholders, including patients and NHS staff. They state that they will aim to complete this next phase within six months and will then set out further plans after that.

While an alternative process is in development, the existing Never Events framework will remain active.

Related reading

• NHS England, Detailed findings from the 2024 consultation on the Never Events framework, 16 September 2025.
• Dr Aiden Fowler, Evolving our approach to patient safety: the future of Never Events, 16 September 2025.
• Patient Safety Learning, Never Events: The Big Debate, 2 May 2024.

Accessible text: 

Figure 1 above sets out the self-assessment process which will take a number of stages across the year:

1. NHS trust boards carry out an annual self-assessment against the 6 domains in The insightful provider board and:

• highlight any areas for which they consider they do not meet the criteria, the reasons why and the actions being taken or planned then, within 2 months
• submit the completed self-assessment template to their regional oversight team with supporting evidence

2. Oversight teams review the self-assessment and:

• triangulate this with other information including the trust’s recent operational history and track record of delivery and third-party intelligence (see below) as necessary to develop a holistic view of capability
• assign a capability rating to the trust

Oversight teams will discuss the capability rating with the NHS trust and consider, in the round, the principal challenges the organisation faces, prioritising issues and the actions needed – for example, monitor something more closely, request follow-up action(s) and/or refresh the capability rating to reflect concerns if necessary.

3. Oversight teams will, across the financial year, use the capability assessment to inform oversight, for example where:

• risks flagged in the self-assessment are a concern (for example, inability to make 1 or more certifications), or
• annual self-assessments do not tally with oversight team’s views or information from third parties, or

subsequent performance/events at the trust or third-party information are a cause for concern such that elements of the self-assessment are no longer valid and, in order to assess ‘grip’, teams may wish trusts to review the basis on which they made the initial assessment.

• strategy, leadership and planning
• quality of care
• people and culture
• access and delivery of services
• productivity and value for money
• financial performance and oversight

Trusts must return this completed self-assessment and associated evidence underpinning it (for example, a board paper) to their regions. Regions will then use this self-assessment along with the trust’s historic track record of delivery and any relevant third-party assessment to arrive at a view of provider capability, which will be shared with the trust. As the year progresses, oversight teams will monitor the trust’s track record against these self-assessments, taking account of any relevant information as it emerges in order to maintain a real-time view of provider capability to inform the relationship with the organisation.

See also: Assessing provider capability: guidance for NHS trust boards

LFPSE brings the feature to record patient safety event types beyond incidents. Recorders can now also upload patient safety risks, outcomes, and instances of good care. This is to ensure the database contains more instances of care that the healthcare system can learn from instead of only detailing errors involving patients. In the current period, 833,136 events were recorded to LFPSE, the majority of which were recorded as patient safety incidents (96.81%).

Count of patient safety incidents by maximum physical harm – based on patient safety incident records from April 2025 to June 2025

Grading the degree of harm to a patient resulting from a patient safety incident can be a challenge for recorders, but by grading patient safety incidents according to the harm they cause patients, local organisations can ensure consistency and comparability of data. This consistent approach locally will enable LFPSE to compare, analyse and learn from data nationally. This grading can also be used to “triage” incidents for review both locally and nationally, ensuring the most serious events are looked at first.

LFPSE has a new variable for grading of the psychological harm associated with the recorded patient safety incidents. This is an experimental field which seeks to explore if responses to safety incidents need to be different if psychological harm is considered separately from physical harm, rather than rolling them together into one measure, as was done in the National Reporting Learning Service (NRLS). Currently, there is low confidence in the grading of psychological harm, as users familiarise themselves with its use, and as such, it is excluded from this report.

LFPSE brings the feature to record patient safety event types beyond incidents. Recorders can now also upload patient safety risks, outcomes, and instances of good care. This is to ensure the database contains more instances of care that the healthcare system can learn from instead of only detailing errors involving patients. In the current period, 832,301 events were recorded to LFPSE, the majority of which were recorded as patient safety incidents (96.73%).

Count of patient safety incidents by maximum physical harm – based on patient safety incident records from January 2025 to March 2025

Grading the degree of harm to a patient resulting from a patient safety incident can be a challenge for recorders, but by grading patient safety incidents according to the harm they cause patients, local organisations can ensure consistency and comparability of data. This consistent approach locally will enable LFPSE to compare, analyse and learn from data nationally. This grading can also be used to “triage” incidents for review both locally and nationally, ensuring the most serious events are looked at first.

LFPSE also allows for grading of the psychological harm associated with the recorded patient safety incidents. This is an experimental field which seeks to explore if responses to safety incidents need to be different if psychological harm is considered separately from physical harm, rather than rolling them together into one measure, as was done in the previous National Reporting Learning Service (NRLS). Currently, NHS England states that there is low confidence in the grading of psychological harm, as users familiarise themselves with its use, and as such, it is excluded from this report.

Summary of actions and impact for patients and carers

Focus as a whole system on achieving improvements that will have the biggest impact on urgent and emergency care services this winter

By the year-end, with improvement over winter, we expect to:

• Reduce ambulance wait times for Category 2 patients – such as those with a stroke, heart attack, sepsis or major trauma – by over 14% (from 35 to 30 minutes).
• Eradicate last winter’s lengthy ambulance handover delays by meeting the maximum 45-minute ambulance handover time standard, helping get 550,000 more ambulances back on the road for patients.
• Ensure a minimum of 78% of patients who attend A&E (up from the current 75%) are admitted, transferred or discharged within 4 hours, meaning over 800,000 people a year will receive more timely care.
• Reduce the number of patients waiting over 12 hours for admission or discharge from an emergency department compared to 2024/25, so this occurs less than 10% of the time. This will improve patient safety for the 1.7 million attendances a year that currently exceed this timeframe.
• Tackle the delays in patients waiting to be discharged – starting with the nearly 30,000 patients a year staying 21 days over their discharge-ready-date, saving up to half a million bed days annually.
• Increase the number of children seen within 4 hours, resulting in thousands of children every month receiving more timely care than in 2024/25.

Develop and test winter plans, making sure they achieve a significant increase in urgent care services provided outside hospital compared to last winter

• Improve vaccination rates for frontline staff towards the pre-pandemic uptake level of 2018/19. This means that in 2025/26, we aim to improve uptake by at least 5 percentage points.
• Increase the number of patients receiving urgent care in primary, community and mental health settings, including the number of people seen by Urgent Community Response teams and cared for in virtual wards.
• Meet the maximum 45-minute ambulance handover time standard.
• Improve flow through hospitals, with a particular focus on reducing patients waiting over 12 hours, and making progress on eliminating corridor care.
• Set local performance targets by pathway to improve patient discharge times, and eliminate internal discharge delays of more than 48 hours in all settings.
• Reduce length of stay for patients who need an overnight emergency admission. This is currently nearly a day longer than in 2019 (0.9 days) and needs to be reduced by at least 0.4 days .
• Reduce the number of patients who remain in an emergency department for over 24 hours while awaiting a mental health admission. This will provide faster care for thousands of people in crisis every month.

National improvement resource and additional capital investment is simplified and aligned to supporting systems where it can make the biggest difference  

Allocating over £370 million of capital investment to support:

• Around 40 new same day emergency care centres and urgent treatment centres.
• Mental health crisis assessment centres and additional mental health inpatient capacity to reduce the number of mental health patients having to seek treatment in emergency departments.
• Expansion of the Connected Care Records for ambulance services, giving paramedics access to the patient summary (including recent treatment history) from different NHS services, enabling better patient care and avoiding unnecessary admissions.

National actions:

• Publish a framework for community language, translation and interpretation.

Opportunities for local implementation:

• Improve every interaction between patients and healthcare staff.
• Make communication at all levels culturally and linguistically appropriate.
• Make information clear and accessible.
• Minimise the risk of digital exclusion.
• Reduce communication barriers.

Principle 2 – All healthcare staff receive undergraduate patient safety training, ongoing training, and accessible resources that improve their awareness and understanding of healthcare inequalities related to patient safety risks. 

National actions:

• Co-develop and publish a patient safety healthcare inequalities reduction handbook to provide guidance and ‘top tips’ for use by individual clinicians, organisations, patients and communities.

Opportunities for local implementation:

• Improve training.
• Develop a repository of accessible resources.

Principle 3 – Accurate and complete diversity data are collected for protected characteristics and inclusion health groups on digital platforms. This work includes making disaggregated data available so evaluation can drive improvements in patient safety and healthcare inequalities.

National actions:

• Clarify the requirements for reducing healthcare inequalities related to patient safety at the provider, ICB, regional, and national levels through the delivery of quality functions in the ICSs document on the ICS Quality Hub FutureNHS Collaboration Platform.
• Develop the LFPSE service to record the protected characteristics of those involved in patient safety events to identify when patient harm is more common in specific groups of patients, and whether there is case selection bias in patient safety incident investigations (PSIIs).

Opportunities for local implementation:

• Use data on health inequalities to improve safe care.

Principle 4 – Representatives of diverse communities are involved in the design and delivery of improvements aimed at reducing patient safety healthcare inequalities. This co-production involves drawing on the knowledge and experience of patients, service users, carers, families, communities and staff.

National actions:

• Promote the recruitment of diverse Patient safety partners (PSPs) and their value in co-production in all areas of patient safety improvement work by providing information, guidance, surveys and tools for support.

Opportunities for local implementation:

• Involve patients and diverse communities in developing patient safety improvements.

Principle 5 – Improve the understanding of patient safety healthcare inequalities and drive improvement through identifying priority areas for research.

National actions:

• Submit proposed patient safety healthcare inequalities reduction research questions to the next round of NIHR funding opportunities.

Opportunities for local implementation:

• Identify and enable research.

LFPSE brings the feature to record patient safety event types beyond incidents. Recorders can now also upload patient safety risks, outcomes, and instances of good care. This is to ensure the database contains more instances of care that the healthcare system can learn from instead of only detailing errors involving patients. In this period, 814,560 events were recorded to LFPSE, the majority of which were recorded as patient safety incidents (96.46%).

Count of patient safety incidents by maximum physical harm – based on patient safety records from October 2024 to December 2024

Grading the degree of harm to a patient resulting from a patient safety incident can be a challenge for recorders, but by grading patient safety incidents according to the harm they cause patients, local organisations can ensure consistency and comparability of data. This consistent approach locally will enable LFPSE to compare, analyse and learn from data nationally. This grading can also be used to “triage” incidents for review both locally and nationally, ensuring the most serious events are looked at first.

LFPSE also allows for grading of the psychological harm associated with the recorded patient safety incidents. This is an experimental field which seeks to explore if responses to safety incidents need to be different if psychological harm is considered separately from physical harm, rather than rolling them together into one measure, as was done in the previous National Reporting Learning Service (NRLS). Currently, NHS England states that there is low confidence in the grading of psychological harm, as users familiarise themselves with its use, and as such, it is excluded from this report.