Patient Safety Learning’s initial response to the Quality strategy for NHS-funded care in England

Summary

This week the new Quality strategy for NHS-funded care in England has been issued. This has been published by NHS England on behalf of the National Quality Board (NQB), the principle national forum for quality across the healthcare system in England. The NQB brings together leaders from NHS England, the Department of Health and Social Care (DHSC), arm’s length bodies and clinical leadership.

In this article, Patient Safety Learning sets out its initial reflections on the new Quality Strategy.

Content

On Tuesday 14 July 2026 a new Quality Strategy was published by the NQB. This document is intended to provide a structured approach to making quality the organising principle for all NHS activity over the next 10 years. At Patient Safety Learning, we believe that improving patient safety in inextricably linked to this aim.

The new Strategy builds on last year’s Review of patient safety across the health and care landscape in England. We agreed with the Review’s recognition of the need to coordinate and rationalise the patient safety landscape. However, we have also expressed concerns about some of its content.

In particular, we contested its argument that patient safety has been significantly over prioritised in recent years at the expense of other aspects of quality. As noted in our response to the review, we do not believe the examples it gave provided compelling evidence of this. Furthermore, we strongly believe that you cannot build an effective, efficient and responsive NHS on an unsafe system.

In the coming weeks we will publish a more detailed analysis of this new Quality Strategy; however, in this article we will share our early reflections on the direction and content.

Where we agree and welcome its approach

We welcome the publication of the new Quality Strategy and the opportunity that it presents to improve patient care, experiences and outcomes.

Priorities

We are supportive of the six priorities identified by the new Strategy, and particularly the inclusion of a specific reference to patient safety. The priorities it includes are as follows:

1. Improving outcomes and reducing unwarranted variation across major conditions and priority groups through implementation of the National Cancer Plan and modern service frameworks.
2. Making sustained improvements in maternity and neonatal services.
3. Strengthening patient safety across all settings.
4. Improving experience of care and restoring trust in NHS services.
5. Reducing inequalities across safety, effectiveness and experience.
6. Monitoring clinical and population health outcomes.

Clarifying who is responsible and accountable for quality

Given the number of organisational changes in recent years, we are pleased to see the Strategy provides a clear outline of roles and responsibilities for quality management among different parts of the health system.

Identifying patient safety risks

We welcome proposals to explore how artificial intelligence and other advanced digital technologies can help the NHS learn more quickly when things go wrong and identify emerging risks earlier.

Updating the Patient Safety Strategy

We await with interest the publication a reviewed and refreshed NHS Patient Safety Strategy. Looking ahead to this:

• It is positive that there is a recognition of the need to integrate digital safety considerations into the updated document.
• We would echo comments made in by the Health Services Safety Investigations Body (HSSIB) about reviewing the Patient Safety Strategy with a view to bringing together quality management and safety management. The Quality Strategy rightly acknowledges these as different but connected approaches. We believe these should be brought together, as part of an integrated quality and safety management system.

Where we have concerns

Recognition and prevention of avoidable harm

We are disappointed that in setting the context for this Strategy, the scale and persistence of avoidable harm is not mentioned. Given the findings of numerous public inquiries and rising clinical negligence costs, the omission of avoidable harm as a factor for consideration is a significant oversight in our view.

We are also disappointed that there is also no explicit ambition to reduce avoidable harm, beyond the following statement:

“Improving safety in healthcare involves reducing the risk of unintended and unexpected harm to patients, while recognising that all care carries some level of risk. It does not mean eliminating all risk or pursuing zero harm.”

We have concerns that this could, understandably, be considered alarming by many, including those patients and families where harm is preventable but is not being prioritised. We also have concerns about how this approach sits along the statutory obligations of providers to provide safe care and treatment (set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014).

National learning and improvement

Patient Safety Learning believes that there needs to be structured systematic approaches to learning about the cause and contributory factors of avoidable harm. We need to better understand the action that is needed to develop solutions and improvement action in the NHS. Accompanying this, there should be capacity at a national level to:

• Share widely learning from investigations and learning responses to patient safety incidents.
• Intervene if necessary for the purposes of improvement.
• Develop solutions to improve safety and share these systematically.

The Strategy does not appear currently to envision any such role for either the DHSC, NHS England or the NQB. The absence of this national capacity is a gap we also highlighted in our responses to Penny Dash’s patient safety review and the 10 Year Health Plan last year.

Culture

We believe there needs to be a transformative effort and commitment to creating a safety culture in the health service. We are disappointed that this has not been given greater consideration in the Quality Strategy, despite the ambition being explicit in the NHS Patient Safety Strategy.

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. Organisations need to actively foster a patient safety culture, tackle blame and fear and promote a culture of safety improvement.

Areas we believe need further consideration

Involving and engaging with patients and families

We believe there is room to develop in this Strategy to include greater detail on how patients and families can be supported and involved in improving quality and safety.

The Quality Strategy tends to focus on the role of the new Directorate of Patient Experience in DHSC, and better use of patient feedback mechanisms. We believe there should also be a greater emphasis on listening to patients, families, including  bereaved relatives. Their concerns can often highlight risks that organisations have not identified or before they are aware of them.

The Strategy puts on a welcome emphasis on increasing transparency. We believe this should be accompanied by stronger commitments to ensure openness and transparency when harm occurs. This includes honest communication with patients and families following safety incidents, an ambition often stated but not delivered.

Coordination and improvement

We would welcome further information about the roles of:

• Regional teams “co-ordinating involvement and intervention where necessary”.
• System Quality Groups supporting the management of quality across organisational boundaries by identifying early warning signs and “co-ordinating system action required to improve quality”.

If these bodies are to take important  roles in these areas we would expect to see plans to ensure they have the appropriate capacity and support to function in this way. This is particularly important in the context of the changing roles and reduced resources with the current NHS organisational changes

Monitoring recommendations

There remain significant questions around how the NQB will undertake its new role maintaining and monitoring national recommendations arising from reports, reviews, inquiries and investigations.

We understand the development of a new “recommendations hub”, mentioned in the Strategy, is already underway, and we await to see what this will look like in practice. There remain unanswered questions about how this will work in practice and what level of transparency there will be around which recommendations are prioritised for implementation. This will be important given concerns which have been raised about how the transfer of HSSIB’s functions to the Care Quality Commission may impact the independence of future investigations.

Questions about implementation

The new Quality Strategy contains a detailed list of requirements, opportunities, imperatives and suggestions. However, many questions remain about what its implementation will look like and the impact this will have on patient and staff safety.

At Patient Safety Learning, we recognise challenges organisations face in implementing changes in quality and patient safety. We have been engaging with organisations through our “What Good Looks Like” for patient safety, drawing on our report A Blueprint for Action. We believe this framework could help to potentially underpin significant elements of the implementation of the broad commitments in the new Quality Strategy.

While the existing Strategy does include some specific activities are accompanied with broad timescales, we would expect to see more developed plans subsequently setting out how this will be delivered. This should be accompanied with details on the initial areas that will be prioritised and what key success criteria will be for delivering quality and safety improvements.