Inside the NHS quality debate: Key takeaways from Penny Dash’s keynote at the Patient Safety Forum 2026

Summary

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.

A wide-ranging conversation between Penny Dash, Chair of NHS England, and the PPP Chair, the Rt Hon. Stephen Dorrell, offered a rare, candid look at the thinking behind the forthcoming National Quality Strategy and the complex trade-offs shaping it. The session was a live debate on the priorities, pressures and realities of improving care across the NHS.

In this blog, Patient Safety Learning reflects on the key takeaways from this keynote session.

Content

A strategy nearing the finish line

Penny Dash confirmed that the National Quality Strategy is in its final stages, with publication anticipated in April 2026. The process has involved extensive input from across the system, with the National Quality Board—co-chaired with the Care Quality Commission—playing a central role in refining the final draft.

While the timeline reflects urgency, it also highlights the challenge of aligning political, clinical, and operational perspectives in a single framework.

However, there was a concerning lack of focus on the NHS Patient Safety Strategy. Will it be updated or subsumed into the National Quality Strategy? This interview made it clear that while patient safety may have become less of a focus for NHS leadership, for the delegates in the room it was front and centre. During a panel session earlier in the day, Bola Owolabi (CQC Chief Inspector of Primary Care and Community Services) had a clear focus on patient safety, saying that we are all patient safety practitioners and that interfaces between episodes of care are the biggest patient safety risk, with many patients falling between the cracks.

Did we witness a complete difference of opinion and priority between key senior NHS leaders and, if so, what hope is there for coherent strategies that will align to bring safer care and improvements?

No surprises—but a sharper focus

At its core, the strategy reaffirms three familiar pillars of quality:

• Effectiveness (outcomes).
• Safety.
• Patient and user experience.

But what matters is how these are prioritised.

Penny Dash was clear that improving life expectancy and healthy life expectancy is the overarching goal. That means focusing on major drivers of population health, particularly cardiovascular disease and cancer, while aligning with broader NHS reforms around prevention, community care and digital transformation.

The big insight: effectiveness versus safety

One of the most striking moments came when Dash revisited a controversial finding from her earlier review:

• Improving effectiveness could save ~100,000 lives per year.
• Improving safety could save between 1,000 and 10,000.

Her message was clear: this is not a choice, but it does challenge how the system has historically prioritised safety over other aspects of quality and the outcomes from that; aspects of patient safety have not improved over the past 25 years.

Audience members pushed back on this framing, arguing that safety and effectiveness are often intertwined in practice. Penny Dash agreed, acknowledging that quality cannot be meaningfully separated into silos and should instead be addressed as a whole.

A system out of balance

Penny Dash also pointed to a deeper structural issue: how resources have been allocated across the NHS.

Over the past decade:

• Hospital spending has risen significantly.
• Primary care has seen modest growth.
• Community care funding has declined.

At the same time, life expectancy and healthy life expectancy have fallen.

The implication is stark: the system may be investing heavily, but not always in the areas that deliver the greatest long-term health impact, reinforcing the need to prioritise prevention, neighbourhood care and earlier intervention.

The role of Integrated Care Boards

Integrated Care Boards (ICBs) were highlighted as critical to delivering change. Their role is to:

• Plan services for local populations.
• Improve outcomes and reduce inequalities.
• Ensure value for money.

Penny Dash emphasised that ICBs must take responsibility for entire populations, including underserved groups such as prisoners and the homeless, while being supported by national guidance and shared best practice.

As ICBs implement more strategic commissioning, the performance management of the outcomes will fall to the regions. Given the current situation with resource reductions and redundancies, will anyone be focussing on ensuring the right staff are in place with the right skills to understand safety indicators and analyse the data? A lack of appropriate people in place who understand this agenda will leave a void, meaning we will see no progress in how the available data is used to review implementations, learn lessons and make improvements.

Patient experience: leadership without mandates

A major proposal within the strategy is the creation of a National Director of Patient Experience, aimed at strengthening how patient feedback informs decision making.

However, this sparked debate around a broader theme: the approach of not mandating process and practice across the NHS. The perspective from Penny Dash was that too many mandates can stifle innovation and local responsiveness; however, too few can lead to inconsistency and inaction.

Rather than imposing roles or structures from the centre, the strategy will lean towards defining best practice and encouraging adoption locally—a move that drew both support and scepticism from the audience.

Patient Safety Learning has recently highlighted through our blogs the concerns that the patient voice is being dissipated given the structural changes resultant from the implementation of the Dash review. We will look to support initiatives strengthening the patient voice that might come from the new National Director of Patient Experience.

Technology as a game changer

Another key theme from the keynote was the role of technology, particularly through Modern Service Frameworks.  Unlike traditional guidelines, these are envisioned as live, digital tools that will integrate with patient records with the ability to provide real-time prompts to clinicians. 

Early focus areas include cardiovascular disease and sepsis, with ambitions to expand into mental health, frailty and children’s services.

If successful, this could mark a shift from static policy documents to dynamic, data-driven care pathways.

Beyond healthcare: the wider determinants

The discussion also touched on the limits of the NHS alone in improving health outcomes. Penny Dash highlighted the importance of social prescribing, housing and legal support, and community and mental health services.

These 'non-biomedical' interventions are increasingly recognised as essential but require closer collaboration between the NHS, local authorities and public health systems.

The mandate dilemma—still unresolved

Perhaps the most persistent theme throughout the session was the unresolved tension between national consistency and local autonomy. As the chair noted, this is “as old as the health service” itself.

Dash’s position was pragmatic: neither extreme work. The challenge is to find a balance that ensures high standards across the country while allowing local systems the flexibility to innovate and respond to their populations.

Audience Q&A

Members of the audience were given the opportunity to pose questions to Penny. Following a comment from her, that our collective focus should have been on quality rather than patient safety, there was a noticeable edge to delegate’s questions.

People were surprised that patient safety appeared to have been downgraded in importance and others seemed to question whether NHS senior leaders are in tune with the reality of frontline work. Some felt this was not a positive demonstration of leadership in a time of significant change within the NHS.

A system in transition

The conversation made one thing clear: the National Quality Strategy is not just a document, it’s an attempt to reshape how the NHS thinks about quality, signalling a shift from safety alone → to broader outcomes, from central control → to guided collaboration and from static policies → to dynamic, tech-enabled systems.

But it also exposes the scale of the challenge.

Balancing priorities, reallocating resources, integrating services and maintaining public trust all while improving outcomes will require more than strategy alone. It will require sustained alignment across one of the most complex healthcare systems in the world.

And as this session showed, that conversation is only just getting started.

At Patient Safety Learning, we look forward to the publication of the National Quality Strategy. We will reflect and engage with our network members before publishing on the implications for patient safety.

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