The future of the Health Services Safety Investigations Body: a recent discussion at the Patient Safety Management Network

Summary

This blog provides an overview of a discussion at a Patient Safety Management Network (PSMN) meeting on Friday 29 May 2026. At this session members shared their views on the proposed transfer of the Health Services Safety Investigations Body (HSSIB) functions to the Care Quality Commission (CQC).

The PSMN is an innovative voluntary network for patient safety managers and everyone working in patient safety. It has over 2000 members from more than 650 different organisations. Created by and for people working in patient safety, it provides a weekly drop-in session with guests to talk through issues of importance, offers peer support and creates a safe space for discussion. You can find out more about the network here.

Content

Last summer the Department of Health and Social Care (DHSC) published the findings of its review of patient safety across England, chaired by Dr Penny Dash.[1] This review proposed several changes which sought to coordinate and rationalise patient safety roles and responsibilities. One of those recommendations was that the functions of HSSIB should be transferred to the CQC.

HSSIB investigates patient safety concerns across the NHS in England and in independent healthcare settings where safety learning could help to improve NHS care. It is currently an executive non-departmental public body sponsored by DHSC.

Transferring HSSIB to the CQC

Plans to implement this Dash Review recommendation were included in the new Health Bill, announced in the King’s Speech at the beginning of May.[2] Setting out the rationale for this change, DHSC states:

“Abolishing HSSIB and transferring its functions to CQC will simplify the patient safety landscape. System users will be clearer about who does what in the system and how to effect change. It will increase the effectiveness of patient safety recommendations and lead to more consistent system-wide learning and tangible improvements in patient safety outcomes.

Having CQC undertake investigations (through a discrete function) will mean that the prominence of the investigation recommendations will be increased by virtue of being part of the sector’s regulator. The safety recommendation will therefore be heard clearly by providers across the system.”[3]

In a fact sheet concerning the patient safety aspects of the Health Bill, DHSC advises that as part of these changes:

•  The transfer of investigation functions includes retaining the ‘no blame, safe space’ model, which prohibits the unauthorised disclosure of protected material obtained during investigations.
• The prohibition on sharing protected materials outside of the investigation function will continue when performed by CQC.
• Powers currently held by HSSIB safety investigators will be carried over to CQC, including powers of entry and the ability to demand and secure documents and other evidence.
• HSSIB’s role in education and training in patient safety investigation skills for NHS and healthcare staff will also transfer.

Concerns raised about this transfer

There have been points of concern raised about this proposed change since it was first announced in the Dash Review last year. These have included:

• Concerns highlighted by Professor Carl Macrae that these changes risk setting back progress in the systematic improvement of quality and safety.[4]
• A warning from Sir Bernard Jenkin MP that these changes could undermine public confidence in investigations.[5]
• The All Party Parliamentary Group on Patient Safety calling for these changes to be stopped and HSSIB retained as a separate body.[6]
• Evidence provided by the CQC to the Health and Social Care Select Committee suggesting the changes will create a conflict of interest in protecting the safe space between their proposed investigatory and regulatory arms.[7]

Network discussion

After a brief presentation providing the background context of the Dash Review and the changes proposed in the new Health Bill, PSMN members had an open discussion about this topic.

At the start of the conversation, it was notable that when asked, around one third of the 130 attendees answered that they had not been fully aware of these proposals. This included the implications for NHS organisations of recently announced changes to HSSIB’s education and training programme, discussed in more detail later in this blog.

As the conversation progressed, it touched on the following areas.

Independence

Several network members emphasised the importance of HSSIB’s independence as a national patient safety investigator.

Some of these comments mirrored the points highlighted by the CQC in their response to the Health and Social Care Select Committee mentioned earlier in this blog. There were suggestions that there was an inherent conflict of interest between the roles of investigator and regulator, and that the two needed to remain separate. One attendee said that these could only co-exist in one body if a formal division existed between the functions. They argued that once an inspection culture drifted into the investigation body, much of the value of the latter would be lost.

Attendees also expressed concerns about whether staff could be confident that their disclosures to the investigator would not be shared with other parts of the CQC. Specifically, it was suggested that if investigations were seen as a potential trigger for future inspections, this could deter staff from being open in disclosures to safety investigators.

One network member also queried how the leadership of the CQC in future would be able to appropriately govern the organisation if, to maintain confidentiality, they there were restricted in their oversight of the HSSIB investigations component of this.

Education and training

There were a lot of reflections about the role that HSSIB has played to date in providing patient safety training for NHS staff. As a result of recently confirmed changes following on from its new strategy, Building investigation excellence, HSSIB has announced the conclusion of its previous education programme. This had provided a range of training courses for NHS staff, which have had more than 40,000 participants since 2023.[8]

There were many positive reflections about HSSIB’s previous programme of education and training. Comments included:

•  Multiple attendees stating that they had heavily relied on HSSIB for providing training to support their staff in implementing and supporting their use of Patient Safety Incident Response Framework (PSIRF) tools and methods in their organisations.
• HSSIB courses were seen as high quality. Some members expressed concerns about the quality of alternative options from external private providers in comparison to this.
• Courses from HSSIB being free for NHS staff was particularly beneficial. Some attendees suggested that their withdrawal raised questions about whether there would be adequate funding available in future for staff to be trained in the same way by external providers.
• HSSIB courses were not only a helpful training resource but a useful opportunity to meet and collaborate with peers in other NHS organisations.
• An attendee from a private provider noted this would have less impact on them as HSSIB courses had not been open to them, so they had relied on in-house support.

It was also noted that HSSIB’s new approach to education services intends to build on its previous programme through a new operating model, focused on targeted capability building and creating a greater range of accessible training resources.

Investigation reports

During the discussion, several meeting participants highlighted the value of HSSIB’s patient safety investigation reports. Members shared how they had used the findings and recommendations from these reports to inform safety improvement work in their organisations.

One point of debate was whether this proposed change could potentially strengthen the value of these reports in future. Some attendees suggested that CQC branded reports might be perceived as more authoritative by decision makers, prompting greater action in response to their recommendations.

The wider question was also raised of how patient safety recommendations are approached in healthcare—namely, the number of recommendations made and the difficulties translating these into practical improvements. It was noted this was likely to remain an issue, irrespective of this organisational change.

‘Safe space’ provisions

Existing legislation concerning how HSSIB operates means that under its ‘safe space’ provisions, its investigation evidence and findings is subject to special protections. They cannot be disclosed without the HSSIB chief investigator’s consent, or without a High Court order that has assessed the public benefit of that disclosure.

The intention of this is to ensure staff feel they can speak to investigators without fear that their evidence could be used against them in some way. A similar approach is used in other safety critical industries—for example, in the UK’s transport investigation branches.

As noted earlier, DHSC has stated that, as part of these changes, ‘safe space’ provisions will be carried over as HSSIB’s functions move into the CQC as part of the Health Bill. However, network members still expressed significant concerns about this.

For some, the questions were how fixed this would be, and whether the ‘safe space’ provisions in practice may simply be removed by the Government later once this transition was complete. Others reflected on the importance of these changes not simply being protected but being seen as protected. One suggestion was that retaining an independent identity and infrastructure for HSSIB as it moves to within CQC could be important in maintaining the perception of this.

Patient Safety Learning perspective

In our response to the Dash Review last year, Patient Safety Learning stated our belief that HSSIB has an important independent role in the health system which should be retained.

We do not think, to date, the concerns shared by PSMN members in this discussion have been effectively addressed by those in decision-making roles when considering the future of the independent patient safety investigation capacity in the NHS.

Fundamentally, if confidence in the independence and confidentiality of HSSIB’s investigations is undermined, whether in reality or perception, this could compromise understanding of what is really happening on the ground. HSSIB’s ability to do this is an essential prerequisite to understanding what the risks to patient safety are and the actions needed to address these.

We will be raising these issues directly with DHSC, the Health and Social Care Select Committee, and Members of Parliament more broadly as the Health Bill progresses through Parliament.

How to get involved

Are you working in patient safety and interested in joining the PSMN? You can join by signing up to the hub today When putting in your details, please tick ‘Patient Safety Management Network’ in the ‘Join a private group’ section. If you are already a member of the hub, please email [email protected].

References 

1. DHSC. Review of patient safety across the health and care landscape. 7 July 2025.
2. Patient Safety Learning. The King’s Speech 2026: Six key takeaways for patient safety. 15 May 2026.
3. DHSC. Health Bill: patient safety – fact sheet. 19 May 2026.
4. Macrae C. Failing to learn? The NHS is losing its capacity for system-wide safety investigation. Journal of the Royal Society of Medicine, 2025; 118(10).
5. Health Service Journal. Merging watchdog into CQC will ‘destroy’ independence. 26 February 2026.
6. Moore A. Patient safety: MPs urge Streeting to stop “forced merger” of agencies. BMJ, 3 March 2026.
7. CQC. CQC written evidence to the Health and Social Care Select Committee on Health Services Safety Investigations Body transfer to CQC. 2 June 2026.
8. HSSIB. Building investigation excellence: our strategy for strengthening the capability of healthcare investigations. 27 February 2026