10 Year Health Plan: Patient Safety Learning’s initial reflections

Summary

This week, the UK Government has published Fit for the Future — its 10 Year Plan for health in England. This sets how it intends to create a modern health service designed to meet the changing needs of the population. In this article, Patient Safety Learning sets out its initial reflections on the Plan.

Content

At Patient Safety Learning, we believe that patient safety is not just another priority; it is a core purpose of health and social care. While patient safety is considered at points in the new 10 Year Health Plan, we are disappointed that it is not recognised as a key theme that should run throughout this.[1] Patient safety is one component of a broader approach to quality, but the risk and impact of avoidable harm to patients should be a strong driver for change.

The Plan acknowledges that “NHS' history is blighted by examples of systematic and avoidable harm”. It also highlights some of the key concerns that arise in patient safety investigations time and time again. However, this is focused specifically in the “A new transparency of quality of care” chapter of the report. The term ‘patient safety’ itself is only mentioned 11 times in the 168 page document.

Despite the awareness of avoidable harm, and the hard work of many people in the health service, this continues to persist at an unacceptable level. Prior to the Covid-19 pandemic, NHS England stated in the NHS Patient Safety Strategy that there were around 11,000 avoidable deaths annually due to safety concerns, with thousands more seriously harmed.[2] In practice, this figure is now likely to be a significant underestimate given the ongoing enormous strain faced by the healthcare system in recent years.

Every avoidable death and disability is an unnecessary tragedy for patients, families and healthcare professionals. As the Government takes forward the implementation of its 10 Year Health Plan, Patient Safety Learning will continue to make the case that the scale of avoidable patient harm needs to be acknowledged and tackled head on.

From hospital to community

At the core of the Plan is the creation of a Neighbourhood Health Service. The Plan sets out an aim that “care should happen as locally as it can digitally by default, in a patient’s home if possible, in a neighbourhood health centre when needed, in a hospital if necessary”.

Moving towards a more community-based model of healthcare is an admirable ambition, and also a significant undertaking. It will require a major investment in the redesigning of healthcare systems and its workforce if it is to meet its aim that the majority of outpatient care will have moved away from hospitals by 2035.

We believe it is important that the new services referred to in this Plan, “single neighbourhood providers” and “multineighbourhood providers”, have a clear focus on patient safety. When introducing these new providers we would expect to see clear plans to ensure they develop and maintain effective systems and processes to respond to and learn from patient safety incidents. This would include using existing NHS initiatives, such as the Patient Safety Incident Response Framework (PSIRF) and the Learn from Patient Safety Events (LFPSE) service, and actively engaging with patients, families and carers for feedback.

From analogue to digital

The 10 Year Health Plan places a strong emphasis on the use of new technologies to improve the performance of the health service, in particular artificial intelligence (AI). We believe it is important to recognise the need to embed patient safety throughout the life cycle of these new digital solutions and products.

Patient safety must be at the heart of the initial procurement, design and configuration of new technologies. As they are subsequently rolled out, appropriate training and support should be provided to staff. Once in place, how they are operating in practice should be monitored, learning and acting on any risk assessments, incidents or near misses relating to this. In each of these stages, there should also be clear steps to involve and engage with both patients and frontline staff.

We were pleased to see the importance of this acknowledged specifically in the Plan when outlining plans for the new My NHS GP tool, with it stating that “safety will be paramount, and it will be designed with clinicians”. We would like to see this principle applied across all these new technologies.

The Plan also refers to a new AI-led early warning system to identify safety concerns across the NHS. We  have set out our reflections on this proposal and how this might work in practice in a separate article this week.[3]

Organisational changes

The Plan also mentions a number of proposed organisational changes in the health service, due to be detailed further in the forthcoming report of Dr Penny Dash’s independent review of the patient safety landscape in England. We will await the publication of this report to see the full detail of this before commenting with a full response. However, we initially would note the following points:

• We welcome proposals to create a new National Director of Patient Experience.
• We have significant reservations about the role of the Patient Safety Commissioner being transferred to the Medicines and Healthcare products Regulatory Agency (MHRA) and the potential for this to undermine the role’s independence and credibility in the eyes of patients and the public.
• We wish to see further detail on proposals to transfer the functions of the Health Services Safety Investigations Body to the Care Quality Commission, to consider the potential implications this will have on its independence and investigation capacity.

Financial sustainability

The final chapter of the 10 Year Health Plan is dedicated to considering how the Government intends to put the NHS on a route to financial sustainability.

We would highlight that the current scale of avoidable harm in the NHS comes at a huge financial cost to the healthcare system. NHS Resolution figures alone make this clear. In their last annual report, they estimate that the cost of harm covered by the Clinical Negligence Scheme for Trusts was £4,778 million in 2023/24.[4]

In 2022, the OECD estimated that the direct cost of treating patients who have been harmed during their care in high-income countries approaches 13% of health spending.[5] Excluding safety lapses that may not be preventable, this figure is 8.7% of health expenditure.[6] In 2024/25, £181.4 billion of the total Department of Health and Social Care budget is being passed on directly to NHS England. Even saving 5% of this expenditure by reducing preventable harm would release £9 billion of funds to reinvest in service improvements and additional capacity.

The above figures do not account for the wider societal costs of avoidable harm, including the loss of productivity in the population as a result of people being economically inactive, either from the direct impact of avoidable harm to patients or indirect impact to families, carers and employers.

There is a financial imperative, as well as a moral one, to focusing on reducing avoidable harm in healthcare. What is clear though is that without improvements, funds that could be spent to proactively improve the volume, quality and safety of care will instead be wastefully spent on dealing with the cost of error and harm.

Concluding comments

As noted earlier, this is just an initial set of reflections on the 10 Year Health Plan and does not cover all aspects of the document or how it relates to patient safety in the NHS. While references to patient safety specifically are limited, we do welcome the ambition of this Plan to tackle some of the key underlying causes of avoidable harm in healthcare, including:

• Healthcare professionals not having the right information at the right time to make decisions on diagnosis and treatment.
• Insufficient incentives for delivering consistent high quality care.
• Not actively engaging patients or capturing patient safety outcome measures to drive change and improvement.

In the coming weeks we will publish a more detailed analysis of the 10 Year Health Plan, along with a response to findings and recommendations of the independent review of the patient safety landscape in England when this is published.

References

1. Department of Health and Social Care. 10 Year Health Plan for England: fit for the future, 3 July 2025.
2. NHS England. The NHS Patient Safety Strategy: Safer culture, safer systems, safer patients, July 2019.
3. Patient Safety Learning. New AI system to identify patient safety issues announced: Patient Safety Learning’s initial reflections, 1 July 2025.
4. NHS Resolution. NHS Resolution annual report and accounts 2023 to 2024, 23 July 2024.
5. OECD and Saudi Patient Safety Center. The Economics of Patient Safety. From analysis to action, 21 October 2020.
6. Helen Hughes. Improving patient safety: a financial imperative, Healthcare Financial Management Association, 17 May 2023.