Patient Safety Learning

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. 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

A good night’s sleep is essential for healing, yet, for many patients, it can feel almost impossible to be able to sleep or get rest during an inpatient stay. The Noise at night sleep pack project at Nottingham University Hospitals was a finalist at the Picker Experience Network 2025 Awards. In this blog, project lead Kelly Morley tells us why this initiative and a renewed focus on reducing noise at night was so important. Despite the dedication of staff and the comfort measures provided on our wards, night‑time noise remains one of the most common concerns raised through patient feedback and it was quickly identified as one of the top three patient experience priorities within our trust. At Nottingham University Hospitals (NUH), we know that sleep isn’t a luxury it’s a vital part of the fundamentals of patient care. Why night-time noise matters Hospitals are naturally busy environments. Even after lights dim, clinical activity continues as staff carry out observations, respond to emergencies, check medications and support patients who are awake or unwell. For patients, though, these unavoidable sounds can lead to: Interrupted sleep or the inability to fall asleep. Increased anxiety and stress. Decreased mental awareness. Higher pain sensitivity. Slower recovery times. Lower patient satisfaction. Complaints. Decreased uptake in rehabilitation exercises. Deconditioning. Longer patient stays. Many patients tell us that a noise is one of the most challenging aspects of their stay. Sleep is not just a comfort—it’s a critical part of recovery. Even as far back as in 1859, Florence Nightingale published her book 'Notes on Nursing', which contains lots of good advice about sleep in patients and these are still actions we would do well to take into consideration in modern nursing. “Unnecessary noise, then is the most cruel absence of care that can be inflicted on either the sick or well” (Florence Nightingale) What our patients were saying Through patient surveys, ward feedback and conversations with patients and staff, we regularly heard that noise from equipment, conversations, staff, bins, alarms and other patients would significantly affect their sleep. When asked the question: Do you have any suggestions as to how we can improve the quality of sleep for in-patients or any comments you would like to make? Patients responded: “Would be willing to try anything.” “I think the sleep pack should be mandatory and given to inpatients.” “Ask staff to speak quietly and answer the buzzers quicker—it sounded like they were moving furniture last night.” When we asked staff what they thought prevented patients from sleeping they reported: “Noise from other patients.” “Lighting.” “Observations/medications/investigations/turns.” "Noise from staff.” This feedback drove our improvement work. Sleep packs: small items, big impact To help patients rest better, many wards at NUH now offer sleep packs. These typically include: A sleeping well in hospital leaflet—this was designed by clinical staff with an interest in sleep and why it matters. The leaflet pulls together all literature that has been written in the Trust to date in regard to sleep and amalgamates this into one simple evidence-based leaflet. Earplugs—to soften unavoidable environmental noise. These are in singular packs and can be replaced as and when needed. Eye masks—to reduce disruption from lighting on the wards, particularly when nurses tend to other patients. Slipper socks—these ensure patients are not looking around for slippers in the night, opening lockers, looking under beds and, best of all, they are a simple measure that can also reduce slips, trips and falls. Sleep packs may seem like a small intervention, but patients consistently tell us they make a real difference—especially for those who struggle to settle in unfamiliar surroundings. The items are always used with the aid of clinical judgement, and it is reiterated that these items are not always suitable for everyone. Our aim is to ensure these packs are readily available and consistently offered, particularly to patients most likely to benefit. Post implementation, the feedback was very different: “Thank you for supplying the sleep pack. They have definitely made a difference.” “The mask was comfy and helped.” “Sleep packs, very beneficial. Sleep interrupted a lot as observations being taken regularly, but this is to be expected and not a criticism.” How our staff are supporting quieter nights Staff play a crucial role in creating a calmer night‑time environment. Across NUH a quieter hospitals group was formed to work on the problems that were identified during this project, including: Reducing unnecessary noise on wards: Lowering voices during night rounds. Limiting equipment noise where safe to do so. Closing doors softly. Using soft close bins/ doors. Having top tips poster for staff—reiterating the sleep leaflet guidance and making staff more aware. Planning care to avoid multiple disturbances during the night: Grouping non‑urgent tasks together (cluster care). Using soft‑close bins and quieter equipment where possible. Responding to patient needs: Offering sleep packs. Adjusting lighting levels where safe to do so. Addressing concerns quickly. This work is guided by patient experience feedback and in collaboration with ward teams who see first‑hand how important sleep is for recovery. Below is the feedback from the ward manager of one of our pilot wards, and they continue to see the benefits of these packs. “The ward can be noisy at night, and I think we had all just accepted that disturbed sleep is to be expected when you are in hospital, but this trial has changed that outlook. The sleep packs are really simple but very effective, they contain an eye mask, slipper socks, ear plugs and a leaflet with hints and tips of how to get a good night’s rest. Staff have been offering them to patients in the evening, feedback has been great with a few patients claiming ‘it’s the best night’s sleep they have had in years'. We will carry on with them after the study finishes.” (Amy, ward manager on sample ward for pilot – PDSA 2) How the community can help Support from families and visitors also plays a part in creating a restful environment. Simple actions can make a difference: Being mindful of noise during visiting times and remembering people are often sicker than they look and often need more rest. Avoiding phone calls late at night. Encouraging relatives to use call bells instead of raised voices. Bringing in comfort items that help patients relax. Sharing feedback so we can continue improving. Together, we can support better sleep in our hospitals for everyone. So what’s next? Improving sleep in hospital isn’t solved by one intervention alone—it’s a combination of thoughtful design, staff awareness, helpful tools like sleep packs, and ongoing feedback from patients and families. Our commitment at NUH is to continue: Listening to patient experiences. Reacting to feedback. Supporting clinical teams. Introducing practical solutions. Creating calming, quiet environments. Because a quieter night isn’t just about comfort—it’s about better care and better patient outcomes. Noise at night sleep pack presentation: Poster in wards: