Skip to content

News

Keep up to date with the latest news, research and activity in patient safety.

We have seen the government’s 10-Year Health Plan: it is a mess

The draft of the government’s 10-Year Health Plan circulated this weekend, which HSJ has seen, is a highly ambitious document. Unfortunately, this is not meant as a compliment
The 150-page document contains many good ideas. However, they are set in a framework that would challenge the logic of the most credulous of policy radicals.
Put crudely – and that is the right word for the plan’s swathe of hi-tech references – the government’s argument is this: the recovery and transformation of the NHS can be achieved by shifting care into the community, applying AI to almost everything and stepping up prevention work.
A new operating model proposed by the government’s 10-Year Health Plan will radically reform the role and governance of foundation trusts and integrated care boards.
HSJ has seen a recent draft of the plan, which states that the strongest foundation trusts will be allowed to become “integrated health organisations”. These will be given the responsibility of managing the budget for the health and care of a designated population.
Meanwhile, the plan says elected mayors will take over from local authority leaders on integrated care boards, and the new role of the boards will often involve shaping the provider market.
‘The draft plan says the Department of Health and Social Care will seek to approve the first “new FTs” in 2026.
The authorisation will be undertaken by a unit within the DHSC, whose work will be overseen by an independent group of experts. There will be no return for Monitor, the standalone FT regulator.
The plan reveals FTs will no longer be required to have governors. The public and staff representatives will be replaced by more “dynamic” ways of reflecting their views.
The highest performing new FTs will be able to manage the entire healthcare budget for a local population. These FTs will become “integrated health organisations” or “IHOs”.
This approach, the plan claims, will avoid the problem in which improving preventative care in one type of provider, such as GP practices, advantages another, for example, a hospital. It is a concept similar to “accountable care organisations” in the USA.
Read full story (paywalled)
Source: HSJ, 23 June 2025
Sam

Four nurses investigated over death of boy, 5, at flagship children’s care home

Four nurses are facing a fitness to practice probe after the death of a five-year-old boy at a flagship care home for disabled children, The Independent can reveal.
The Nursing and Midwifery Council (NMC), the UK’s nursing watchdog, initially found there was no case to answer over the death of Connor Wellsted, who suffocated in his cot in 2017 while being cared for at the Children’s Trust facility in Tadworth, Surrey.
The nurses were referred to the NMC in May 2022, but the watchdog later closed the investigations. It reopened the probe in November 2023 and, this month, after a 19-month-long investigation, decided all four nurses should face fitness to practice tribunals.
No interim conditions have been placed on the nurses, meaning they can continue to work while awaiting the outcome. If the committee finds the nurses are unfit to practice, they could be struck off or suspended. However, the committee can also decide that the nurses’ fitness to practice is not impaired and give no sanction.
It comes after The Independent revealed that Surrey police had reopened a probe into the handling of Connor’s death following a litany of failings over the little boy’s care.
Connor died at Tadworth Children’s Trust (TCT), the UK’s largest brain injury rehabilitation centre for children, which can care for up to 66 young people, having suffocated when a cot bumper became lodged under his chin. He had been there for six weeks, receiving care for neuro-rehabilitation.
He was the first of three disabled children to die while in the care of TCT. Raihana Oluwadamilola Awolaja and Mia Gauci-Lamport died in June and September 2023, respectively.
Read full story
Source: The Independent, 22 June 2025
Patient Safety Learning

Domestic abuse is ‘public health emergency’, experts say after critical NHS report

Domestic abuse is a public health emergency, experts have claimed, after a report concluded that the NHS is failing victims by not training staff to spot and respond to the signs of domestic violence.
About one in four people (21.6%) in England and Wales aged 16 years and over have experienced domestic abuse, affecting 12.6 million people, according to the latest figures from the Office for National Statistics.
Analysis shows that the NHS has more contact with victims and perpetrators than any other public service.
But new research by the charity Standing Together Against Domestic Abuse (Stada) claims the health service is missing vital opportunities to save lives. It examined all the official reviews of domestic abuse-related homicides and suicides published in 2024 and found that about 90% cited safeguarding failings by the NHS.
Lack of domestic abuse training was the most frequent criticism identified. National Institute for Health and Care Excellence guidance advises mandatory training for frontline NHS staff in identifying and properly caring for domestic abuse victims. But Stada’s analysis found that such training was “sporadic and inconsistent”.
The report also highlights repeated failures by the NHS to record risks, share information and get victims help from other specialists such as alcohol and mental health services, and independent domestic violence advisers.
Read full story
Source: The Guardian, 22 June 2025
Patient Safety Learning

Failing trusts will pay for new intervention regime

NHS England’s new “provider improvement programme” (PIP) is expected to cover about 15 trusts which will have to pay for NHSE’s interventions themselves, HSJ has learned.
NHSE is also beginning a restructure to cut and overhaul its RSP team into a new PIP team, despite concerns from staff, according to internal documents.
They say the new, renamed regime is generally expected to cover about 15 trusts at a time. They will normally enter when they have the lowest level of performance under NHSE’s new performance regime, and are judged to have a “low” capability to improve. Those which have “suffered a catastrophic failure of governance, either [of] quality or finance” will also be likely to enter the PIP, according to documents seen by HSJ.
According to a document seen by HSJ, as of a month ago, NHSE expected 10 trusts to enter the PIP, but a list is still being finalised based on the overhauled national performance and assessment framework.
Alongside the changes, NHSE has launched a consultation on restructuring its RSP team ahead of other parts of the planned merger of NHSE and the Department of Health and Social Care. The RSP team is expected to see a 27.8 per cent cut in whole-time equivalent posts, from 51 to 37. 
HSJ understands members of the team have raised concerns that the speed of their changes will leave them disadvantaged in the reorganisation, or lead to further disruption.
One source said the changes would mean more cost from external temporary staff and consultancy. The PIP regime will use senior figures from outside NHSE, on a temporary basis, and management consultants, documents suggest.
One states: “A blended support model will be agreed, [with staff ] deployed from across: the NHSE team, including from the PIP team (depending on capacity and capability); from the wider NHS family, including temporary board appointments, buddying or other NHS organisations; and/or consultancy support under a national commissioned framework.”
Read full story (paywalled)
Source: HSJ, 23 June 2025
Patient Safety Learning

NHS plans to DNA test all babies to assess disease risk

Every newborn baby in England will have their DNA mapped to assess their risk of hundreds of diseases, under NHS plans for the next 10 years.
The scheme, first reported by the Daily Telegraph, is part of a government drive towards predicting and preventing illness, which will also see £650m invested in DNA research for all patients by 2030.
Health Secretary Wes Streeting said gene technology would enable the health service to "leapfrog disease, so we're in front of it rather than reacting to it".
It comes after a study analysing the genetic code of up to 100,000 babies was announced in October.
The government's 10-year plan for the NHS, which is set to be revealed over the coming few weeks, is aimed at easing pressure on services.
The Department for Health and Social Care said that genomics - the study of genes - and AI would be used to "revolutionise prevention" and provide faster diagnoses and an "early warning signal for disease".
Screening newborn babies for rare diseases will involve sequencing their complete DNA using blood samples from their umbilical cord, taken shortly after birth.
There are approximately 7,000 single-gene disorders. The NHS study which began in October only looked for gene disorders that develop in early childhood and for which there are effective treatments.
Currently, newborn babies are offered a heelprick blood test that checks for nine serious conditions, including cystic fibrosis.
The health secretary said in a statement: "With the power of this new technology, patients will be able to receive personalised healthcare to prevent ill-health before symptoms begin, reducing the pressure on NHS services and helping people live longer, healthier lives."
Read full story
Source: BBC News, 21 June 2025
Patient Safety Learning

Strict rules as GPs start to prescribe weight loss jab Mounjaro

Prescriptions for Mounjaro jabs, to help people lose weight, will be available at GP surgeries in England from today - but only for those who meet very strict criteria.
NHS England says while the long-term plan is for the jabs to be more widely available, a staggered approach is needed to reach those most at need, manage GPs' workload and NHS resources.
The weekly injection makes you feel full so you eat less, and can help people lose 20% of their body weight.
GPs say they don't have enough doctors to deal with demand for the medicine and are urging people not to approach their local surgery unless they are eligible.
According to NHS England, the first group of patients who will be able to get the jab from their GP or a community clinic, will be those most in need.
This is people with:
a BMI of 40 or over (or 37.5 if from a minority ethnic background) and four out of five of the following conditions: type 2 diabetes, high blood pressure, heart and vascular disease, high cholesterol and obstructive sleep apnoea. People will also get "wrap-around" care - including regular check-ups, support with exercising and advice on eating healthily.
But prescriptions for the drug will not necessarily be available from all local GPs. In some cases, they will come from other primary care services.
Read full story
Source: BBC News, 23 June 2025
Patient Safety Learning

Wes Streeting announces investigation into NHS maternity services

Health Secretary Wes Streeting has announced the launch of a national investigation into NHS maternity services.
The new rapid investigation is intended to provide truth to families suffering harm.
It is also intended to drive urgent improvements to care and safety.
The announcement on Monday came after Mr Streeting met with families who had lost babies and amid the ongoing investigations into poor maternity care at some NHS trusts.
In a statement, the health secretary said: “For the past year, I have been meeting bereaved families from across the country who have lost babies or suffered serious harm during what should have been the most joyful time in their lives.
“What they have experienced is devastating – deeply painful stories of trauma, loss, and a lack of basic compassion – caused by failures in NHS maternity care that should never have happened. Their bravery in speaking out has made it clear: we must act – and we must act now.
“I know nobody wants better for women and babies than the thousands of NHS midwives, obstetricians, maternity and neonatal staff, and that the vast majority of births are safe and without incident, but it’s clear something is going wrong.
“That’s why I’ve ordered a rapid national investigation to make sure these families get the truth and the accountability they deserve, and ensure no parent or baby is ever let down again. I want staff to come with us on this, to improve things for everyone.
“We’re also taking immediate steps to hold failing services to account and give staff the tools they need to deliver the kind, safe, respectful care every family deserves.
“Maternity care should be the litmus test by which this government is judged on patient safety, and I will do everything in my power to ensure no family has to suffer like this again.”
Mr Streeting said the Government was also “taking immediate steps to hold failing services to account”.
“Maternity care should be the litmus test by which this Government is judged on patient safety, and I will do everything in my power to ensure no family has to suffer like this again.”
Officials said that the investigation would examine the entire maternity system, including an urgent review into the worst-performing services.
Read full story
Source: The Independent, 23 June 2025
Patient Safety Learning

Hospital wanted rid of us, Steve James says after daughter’s sepsis death

Five years after her daughter died from an avoidable heart attack at Cardiff’s University Hospital Wales, Jane James was sat in the same chaotic emergency department last month with her elderly mother and saw nothing had changed.
“I sat in that same area, just looking around, thinking, ‘This is not a professional setup’,” she said. “Apart from the horrific feeling of sitting there again and being in that environment, I thought, ‘This has got to change, surely. It is broken’.”
This week a coroner concluded that Bethan James, 21, a promising journalism student, died from sepsis and pneumonia because of multiple failures by paramedics and doctors at University Hospital Wales (UHW) to spot the signs of life-threatening sepsis and follow standard procedures to save her life.
Patricia Morgan, the coroner for South Wales, found Bethan would not have suffered her fatal cardiac arrest if “early recognition and prompt action had occurred”. The inquest heard that Bethan and her concerned parents felt “dismissed” by medics in the two weeks before her death as her health deteriorated.
On the day she died, several paramedics failed to spot the signs of sepsis and did not alert the emergency department about her serious ill health. Once in hospital, nurses and doctors did not identify her life-threatening condition for about an hour, by which time her chance of survival was gone and she suffered a fatal heart attack.
Her father, Steve James, 57, a cricket and rugby writer for The Times, and mother Jane, 59, a physiotherapist for Sport Wales, sat together in Pontypridd coroners’ court this week to hear the vindication of five years of fighting tooth and nail to get an inquest into their daughter’s sudden death.
“They’ve been an absolute disgrace from start to finish and I think it’s a culture of cover-up,” Mr James, a former England and Glamorgan cricketer, said. “From the start, it’s just been covering up and not admitting anything. There’s no culture of trying to get better.”
Read full story (paywalled)
Source: The Times, 19 June 2025
Patient Safety Learning

Simple blood test could provide first reliable diagnosis for ME

Scientists have found biological signatures in the blood of people with myalgic encephalomyelitis (ME), a breakthrough that could lead to the first reliable test for the debilitating condition.
ME, also known as chronic fatigue syndrome (CFS), affects an estimated 400,000 people in the UK. Symptoms can include pain, brain fog and extremely low energy levels that do not improve with rest. These often become dramatically worse after even minor physical effort, a phenomenon known as post-exertional malaise. There is no cure and the cause is unknown.
A diagnosis is typically made by ­ruling out other illnesses, a process that can take years. The new study, led by ­researchers from Edinburgh University, may mark a turning point.
Professor Chris Ponting, of the university’s Institute of Genetics and Cancer, said: “For so long people with ME/CFS have been told it’s all in their head. It’s not. We see [it] in their blood.
“Evidence of a large number of replicated and diverse blood biomarkers that differentiate between ME/CFS cases and controls should dispel any lingering perception it is caused by deconditioning and exercise intolerance.”
Read full story (paywalled)
Source: The Times, 20 June 2025
Related reading on the hub:
Exploring the barriers that impact access to NHS care for people with ME and Long Covid
Patient Safety Learning

Overseas-trained doctors ‘put off UK due to cost of living and low salaries’

Doctors are choosing not to come and work in the UK because they are put off by low salaries, the high cost of living and poor quality of life.
Research by the General Medical Council (GMC) shows that doctors who shun the UK are opting to move instead to the United States, Australia and Canada to earn more and have a better life.
Overall, 84% of doctors trained abroad surveyed by the GMC said that other countries were better than Britain at paying good salaries and only 5% felt the opposite was true.
The UK was also seen as being very poor for the cost of living and quality of life, attracting scores of minus 44 and minus 43.
Among doctors considering where to further their careers, the UK scored worse than competitor countries on 14 of the 15 issues the GMC asked them about.
It also recorded negative ratings for being an advanced healthcare system (minus 26), doctors being treated with respect by patients and the public (minus 20), quality of patient care (minus 17) and having enough appropriately qualified staff (minus 17).
Read full story
Source: The Guardian, 20 June 2025
Patient Safety Learning

NHSE orders trusts to halt ‘safety risk’ AI projects

NHS England has been forced to warn trusts and GPs against adopting “non-compliant” AI technology which “risks clinical safety, data protection breaches [and] financial exposure”.
A letter from the national chief clinical information officer, seen by HSJ, ordered NHS bodies to immediately “pause, reject or stop engagement” with suppliers offering audio transcription software, if they did not comply with its standards (see box below).
“Ambient voice technology” software aims to save clinicians time they would otherwise spend writing up consultation notes and inputting them into medical records. Government is poised to accelerate the rollout of the systems in its 10-Year Health Plan.
But in the letter last week, Alec Price-Forbes told tech leaders: “Proceeding with non-compliant solutions risks clinical safety, data protection breaches, financial exposure, and fragmentation of broader NHS digital strategy.”
NHS England warned: “Liability for the use of non-compliant AVT solutions will be held by the local NHS trust, primary care practice or individual clinicians.”
Read full story (paywalled)
Source: HSJ, 19 June 2025
Patient Safety Learning

Two Leeds hospitals’ maternity services rated inadequate over safety risks

The care of women and babies at two Leeds hospitals presents a significant risk to their safety, the NHS regulator has said, after the preventable deaths of dozens of newborns.
The Care Quality Commission (CQC) demanded urgent improvements to maternity services at Leeds general infirmary and St James’s hospital as it downgraded them to “inadequate”.
A BBC investigation this year found that the deaths of at least 56 babies and two mothers may have been preventable at the two hospitals between January 2019 and July 2024.
The hospitals, run by Leeds teaching hospitals NHS trust, are the latest to be engulfed by a maternity scandal that has revealed catastrophic failings in Nottingham, Shrewsbury and Telford, Morecambe Bay, east Kent and others.
The downgrading of maternity and neonatal services in Leeds follows unannounced inspections by the CQC in December and January.
Ann Ford, a director of operations at the CQC, said it had received concerns from staff, patients and families about safety and staffing levels at the two hospitals.
She said: “During the inspection the concerns were substantiated, and this posed a significant risk to the safety of women, people using these services, and their babies as the staff shortages impacted on the timeliness of the care and support they received.”
Inspectors found dirty areas on the maternity wards of both hospitals, unsafe storage of medicines, a “blame culture” that left staff unwilling to raise concerns, and short-staffed units.
On the neonatal wards, which care for the most vulnerable newborns, the CQC found they were understaffed and infants needing special care were being transported unsafely from one hospital to another.
Read full story
Source: The Guardian, 20 June 2025
Patient Safety Learning

Hackers took down high-secure hospital’s security system

A cyber attack disabled alarm systems used by staff at a high-security psychiatric hospital, HSJ can reveal.
West London Trust, which runs Broadmoor hospital in Crowthorne, Berkshire, is still trying to fix the system after an attack which it says took place in January.
The facility was forced to use extra alarms, radios and staff “in order to respond to incidents in a timely fashion”, a trust board report from April said.
High-secure hospitals are used for patients who have been detained under mental health legislation or present an immediate risk of harm to others, and have the same security arrangements as category B prisons.
Staff have access to alarms for their safety and that of their patients.
In a board report last week, West London Trust said clinical and operational services continued to operate with “minimal” disruption to patients. It said the organisation’s “cyber posture” would be enhanced to “limit the impact of future incidents”.
Read full story (paywalled)
Source: HSJ, 19 June 2025
Patient Safety Learning

Trust accused of ‘highly inappropriate’ physician associates policy

A union has criticised a hospital trust for “jeopardising patient safety” by issuing “highly inappropriate” instructions for resident doctors to approve prescription requests from physician associates.
The British Medical Association has written to University Hospitals Plymouth Trust to raise “serious concerns about the apparent unsafe and unprofessional working arrangements” between resident doctors and physician associates at the trust.
The letter comes after a leak on social media appeared to show resident doctors at one of UHP’s departments being instructed to set up a rota to sign off requests for prescriptions and imaging investigations made by a physician associate. The BMA has called for these instructions to be “urgently rescinded”.
Guidance from the General Medical Council states that physician associates cannot prescribe medication, even if they held prescribing rights in a previous role.
The letter to UHP’s interim chief executive Mark Hackett, from BMA council chair Phil Banfield, said the instructions “contain highly inappropriate directions to resident doctors which, if acted upon, would cause them to breach professional standards set by their regulator, risk their professional indemnity, and jeopardise patient safety.
“The rules on prescribing are clear, physician associates are not qualified or legally entitled to prescribe. This is not ‘due to a number of issues’ (as claimed in the instructions) that can somehow be circumvented by the trust – it is a necessary legal restriction put in place to protect patient safety.
“Our guidance (and that of the GMC) is clear that no resident doctor should automatically prescribe medications or request ionising radiation on behalf of another practitioner…. That resident doctors have been asked to organise a rota implementing such unsafe practices speaks volumes about the way they are viewed by their employer”.
Read full story (paywalled)
Source: HSJ, 19 June 2025
Sam

Under-fire NHS trust recorded patient ate breakfast three days after he died

An NHS mental health trust, recently found guilty of serious failings in the care of a young patient who took her own life, has had serious concerns raised over the deaths of 20 other patients over the last 10 years, the BBC has found.
Coroners have repeatedly highlighted issues about the North East London NHS Foundation Trust (NELFT), including about the quality of risk assessments and record-keeping.
In two cases patient notes were found to have been falsified. Including one man who was recorded as eating breakfast three days after he had died.
An Old Bailey jury last week found the trust guilty of health and safety breaches in the care of 22-year-old Alice Figueiredo who was an inpatient at NELFT's Goodmayes hospital.
The BBC can now reveal in the decade since Alice's death, NELFT has been repeatedly criticised by coroners for failures in patient care.
In the last decade, nearly 30 prevention of future deaths (PFD) reports from coroners have mentioned NELFT. Of these, the BBC has analysed 20 which raise the most serious concerns.
In two cases where patients took their own lives inquests concluded records had been altered after their deaths.
The most common criticism found the assessment of the risk patients posed to themselves was poor or incomplete.
Cases also highlighted poor record-keeping, a lack of communication between teams, staff shortages and high caseloads.
Two patients who died of overdoses were said to have been on short-term medication for 18 years and 20 years, with no record of that having been reviewed.
Read full story
Source: BBC News, 18 June 2025
Patient Safety Learning

Police maternity investigation to interview staff

A police investigation into maternity services at two hospitals has started interviewing current and former members of staff.
West Mercia Police began the inquiry in June 2020, while a review by senior midwife Donna Ockenden was ongoing - Ockenden would eventually find there had been catastrophic failings at the Shrewsbury and Telford Hospital Trust.
The police investigation was set up to explore whether there was evidence to support a criminal case against the trust or any individuals involved.
The hospital trust said it recognised it was important people get "the answers they have waited for" and that it was fully cooperating with police.
The Ockenden inquiry examined maternity practices at Shrewsbury and Telford NHS Trust over a period of 20 years.
Initially set up to examine 23 cases, it was widened to include almost 1,600 cases where there were concerns over maternity care.
It found the failures may have led to the deaths of more than 200 babies, nine mothers and left other infants with life-changing injuries.
Hundreds of the cases have been examined by police officers involved in Operation Lincoln.
The senior officer in the police investigation, Supt Carl Moore, said the start of staff interviews represented a new phase.
"We are committed to ensuring that the families involved are fully informed at each stage of our enquiries," he said.
Read full story
Source: BBC News, 19 June 2025
Patient Safety Learning
Registered address: Patient Safety Learning, China Works SB203, 100 Black Prince Road Vauxhall, London, SE1 7SJ

Account

Navigation

Search

Search

Configure browser push notifications
Chrome (Android)
  1. Tap the lock icon next to the address bar.
  2. Tap Permissions → Notifications.
  3. Adjust your preference.
Chrome (Desktop)
  1. Click the padlock icon in the address bar.
  2. Select Site settings.
  3. Find Notifications and adjust your preference.