Patient-Safety-Learning
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Content Article
At Patient Safety Learning we believe that sharing insights and learning is vital to improving outcomes and reducing harm. That's why we created the hub; providing a space for people to come together and share their experiences, resources and good practice examples. Dementia is an umbrella term for a number of diseases that affect the brain, with Alzheimer’s disease its most common cause. We have picked a range of resources and reflections about keeping people with dementia safe in health and care settings, and when considering medication choices. -
Content ArticleThis update highlights the significant achievements across the strategy’s national patient safety programmes.
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At Patient Safety Learning we believe that sharing insights and learning is vital to improving outcomes and reducing harm. That's why we created the hub; to provide a space for people to come together and share their experiences, resources and good practice examples. Diabetes is a condition that causes the amount of glucose in a person's blood to be too high. When you have type 1 diabetes, your body can’t make any insulin at all, whereas with type 2, you either can’t make enough insulin, or it can’t work properly. There are also other types of diabetes including gestational diabetes, which some women develop during pregnancy, maturity onset diabetes of the young (MODY) and latent autoimmune diabetes in adults (LADA). It is important that people with diabetes are supported to maintain good blood glucose control through diet, insulin and other diabetes medications, to prevent both acute and long-term complications. We’ve selected our top picks of useful resources about diabetes. Self-management is perhaps the most important aspect of treating diabetes effectively, so we've included some resources aimed at helping patients manage their diabetes too. -
Content ArticleThis guidance is for users of the new Learn from Patient Safety Events (LFPSE) service, to provide context and guidance on selection of appropriate categories when recording incidents. It focuses on which Event Type is appropriate for different circumstances, and how to select the most appropriate options for the Levels of Harm categorisation required within Patient Safety Incidents. It covers the following topics: Definitions – event types Definitions – harm grading When are harm grading fields mandatory? Recording guidance questions and answers
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Good hand hygiene in healthcare is essential to reduce the spread of healthcare associated infections (HAIs), which are the most frequent adverse event in healthcare globally. Although progress has been made in improving hand hygiene, there is still a pressing need to give healthcare professionals around the world the necessary knowledge and facilities to achieve effective infection control. The latest World Health Organization (WHO) data shows that globally, half of healthcare facilities do not have basic hand hygiene services, one in five facilities have no water services and one in ten have no sanitation services. -
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At Patient Safety Learning we believe that sharing insights and learning is vital to improving outcomes and reducing harm. That's why we created the hub; providing a space for people to come together and share their experiences, resources and good practice examples. To support. WHO's World Immunisation Week, we have picked 14 resources full of practical advice about vaccination in a range of settings. -
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Parkinson’s is the fastest growing neurological condition in the world. It can affect young or old, and in the UK, around 153,000 people are living with the condition. With population growth and ageing, this figure is estimated to increase by 20%, within the next ten years. At the moment, there is no cure for Parkinson’s, but medication plays a vital role in managing symptoms and preventing deterioration. People with Parkinson’s face a number of specific patient safety issues when accessing healthcare including communication difficulties and risks associated with medication delays. In this blog, Patient Safety Learning has pulled together 14 useful resources about Parkinson’s shared on the hub. They include guidance for patients and their families about hospital stays and medication, and awareness-raising resources for healthcare professionals about the patient safety issues people with Parkinson’s face. -
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Eating Disorders Awareness Week takes place 23 February - 1 March 2026 Eating disorders are complex mental health conditions that affect an estimated 1.25 million people in the UK. There are many unhelpful myths about who eating disorders affect, what the symptoms are and how to support people in recovery. Alongside a current lack of appropriately trained staff and capacity in mental health services, this can make it challenging for people with eating disorders to access the help and support they need. Patient Safety Learning has pulled together 15 useful resources shared on the hub to help healthcare professionals, friends and family support people with eating disorders. They include awareness-raising blogs, practical tips for patients and their loved ones, and clinical guidance for primary, secondary and mental health providers. -
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NHS England has set a target that cervical cancer will be eliminated in England by 2040. Although progress has been made in detecting and treating cervical cancer, there are still many women who are reluctant to go for cervical screening, or who face barriers to accessing screening. These barriers include perceived discrimination, lack of understanding the risk of cervical cancer and unmet access needs. This contributes to persistent health inequalities amongst particular groups. Patient Safety Learning has pulled together 13 useful resources shared on the hub about how to improve access and overcome barriers to cervical screening. -
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World Hospice and Palliative Care Day takes place on 11 October 2025. Patient safety in hospice and palliative care involves ensuring that every patient is able to access the services, support and pain relief that they need when they reach the end of life. It is also vital that families and carers are given relevant and timely support and information by healthcare services during their loved one’s hospice or palliative care, and following their death. -
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In this podcast interview series, NHS whistleblower Peter Duffy and Patient Safety Learning’s Chief Executive Helen Hughes explore how the healthcare system responds when its staff raise concerns about patient safety. In each episode, Helen and Peter interview someone who has spoken up about patient safety issues in healthcare organisations, or who works to help staff raise concerns where they see unsafe care. In this episode, emergency medicine doctor Chelcie Jewitt describes why and how she co-founded Surviving in Scrubs, a campaign that shares survivor stories of sexism, harassment and sexual assault in the healthcare workforce. She outlines the work the campaign is doing with professional regulators to set clear behavioural standards that will more effectively hold perpetrators to account. She also describes the training and support that Surviving in Scrubs offers healthcare staff and organisations on how to respond to harassment and abuse. Subscribe to our YouTube podcast to keep up to date with the latest episodes. View a transcript of this interview Read a blog from Peter and Helen about the interview series -
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At the beginning of 2025 we launched our video interview series Speaking up for patient safety. The series is hosted by Peter Duffy, NHS whistleblower and Chair of the Healthcare Working Group at WhistleblowersUK, and Helen Hughes, Patient Safety Learning’s Chief Executive. In each interview we hear from someone who has raised concerns about patient safety in healthcare, often at great cost to their own career and personal life. They share their story and their reflections on what needs to be done to improve organisational cultures so that when staff raise patient safety issues, their concerns are responded to appropriately and not dismissed because they are inconvenient to address. Alongside the thread of bravery and tenacity that runs through each contributor, a number of common themes come up time and again as people share their experiences. In this blog, Helen and Peter look at some of these themes and outline their implications for people who speak up or whistleblow. -
Content ArticleIn March 2025, the UK Government announced that it was disbanding NHS England, the arm's length government body that oversees healthcare delivery in England. Although there is public support for change in the NHS, a polling report by UCL Policy Labs and More in Common concluded that the “British people are looking for change, but not chaos, radicalism, not recklessness.” This article looks at where the dissolution of NHS England falls in the current UK context.
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Content ArticleIt’s nearly 30 years since the Food and Drug Administration (FDA) Modernization Act of 1997, when Congress instructed the US Health and Human Services (HHS) secretary to consult with the National Institutes of Health (NIH) director and the pharmaceutical industry to “review and develop guidance, as appropriate, on the inclusion of women and minorities in clinical trials." In this JAMA article, Rita Rubin examines concerns that the Trump administration’s dismantling of diversity, equity, and inclusion (DEI) efforts at the FDA and NIH will result in a reversion back to the days when new treatments were tested mainly in cisgender White men—and not even all shapes and sizes of them.
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In this podcast interview series, NHS whistleblower Peter Duffy and Patient Safety Learning’s Chief Executive Helen Hughes explore how the healthcare system responds when its staff raise concerns about patient safety. In each episode, Helen and Peter interview someone who has spoken up about patient safety issues in healthcare organisations, or who works to help staff raise concerns where they see unsafe care. In this episode, Beatrice Fraenkel, ergonomist and Non Executive Director at Stockport NHS Foundation Trust discusses the importance of understanding the issues that lead to poor culture and harm in healthcare organisations. She describes the Board's radical approach to establishing a Just Culture during her time as Chair of Mersey Care NHS Foundation Trust and the huge investment needed to build trust between healthcare staff and their employers. She also talks with Peter and Helen about the importance of understanding the needs, views and emotions of people in the wider community that each trust serves. They discuss the universal impact of fear and anxiety on human behaviour and the need to ensure lessons are really understood before attempting to put solutions in place to tackle issues, on any scale. Subscribe to our YouTube podcast to keep up to date with the latest episodes. View a transcript of this interview Read a blog from Peter and Helen about the interview series -
Content ArticleOne of the most transformative changes to the US health care system in the last few decades has been the widespread adoption of electronic health record (EHR) systems and online patient portals. The patient portal has improved patient access to medical records and facilitated direct communication between patients and their health care teams, improving patient satisfaction, enhancing health care use and increasing treatment adherence. The implementation of online patient portals has altered clinical practice workflows considerably, allowing the streamlining of interappointment communication. However, direct messaging between patients and their health care team is also having a negative impact on healthcare professionals. Increasing reliance on portal messaging as a primary form of communication and more patients using portals increased the volume of messages being sent. Work associated with portal messaging has fallen primarily on doctors, and many of them end up using time outside of clinical work hours to respond. Limited access to appointments has led to more complex and time-consuming messages. This trend is causing higher levels of staff burnout and female doctors are disproportionately affected. This article looks at the issues and potential solutions.
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Content ArticleDespite progress in reducing neonatal and child mortality, inequalities in access to age-appropriate medicines remain, particularly in low-income and middle-income countries. The Global Accelerator for Paediatric Formulations (GAP-f), a WHO-hosted network established in 2020, addresses these gaps by uniting 33 partners to promote innovation and access to child-friendly medicine formulations. This article describes phase 2 (2022–24) of GAP-f's work, which focused on: therapeutic areas where innovation and access efforts often did not have stakeholder alignment and coordination of designing and implementing innovative clinical trial methodology. engaging with regulators to address systemic barriers. identifying novel technologies for safe and effective delivery. collaborating across stakeholders for product roll out.
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Content ArticleThis blog describes the approach taken by researchers at the Exeter HSDR Evidence Synthesis Centre when they performed a systematic review on safety management systems in healthcare. They research practice in five English-speaking high-income countries: The Netherlands, Australia, Canada, Ireland and New Zealand. Having started their literature review, the team realised that whilst the components of a safety management system—leadership commitment and safety policy, safety risk management, safety assurance and safety promotion and culture—were present in the patient safety approaches of all of the countries we were looking at, only one of them had actually implemented safety management systems in their healthcare system. This resulted in a change of approach which looked at the differences in how key components of a safety management system were implemented. Read the research study: The implementation of Safety Management Systems in healthcare: a systematic review and international comparison (March 2025)
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Content ArticleThis qualitative study looked at whether oncologists should ask children with cancer and their parents about their communication preferences before telling them about their prognosis. The results suggest that patients, parents and oncologists recommend asking patient and parent communication preferences in advance. Research participants provided advice for achieving this goal, relating to the questions that should be asked, giving multiple options and considering delivery and tone.
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Content ArticleOpioid-responsive cancer pain is a term used to describe cancer pain that can be effectively managed with opioid painkiller medications. This review aimed to explore a paradigm shift in the definition of opioid-responsive cancer pain. The authors argue that looking at the apparently unique properties of opioid-responsive cancer pain allows better understanding of the process by which acute (short term) pain may or may not transition into chronic (long term) pain.
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DeNPRU Exeter is a Policy Research Unit in Dementia and Neurodegeneration based at the University of Exeter. This webinar will share learning from DeNPRU Exeter's policy research project on reducing inequalities for minority ethnic communities living with dementia, Parkinson's disease, motor neurone disease or Huntington's disease. The United Kingdom is composed of diverse range of ethnic and cultural groups. However, people from minority ethnic communities living with dementia or other neurodegenerative conditions often face significant inequalities in accessing healthcare. This can result in delayed diagnoses, poorer health outcomes and a reduced quality of life. This project has: identified and examined community campaigns aimed at raising awareness and/or reducing stigma around neurodegenerative conditions in minority ethnic populations. reviewed existing research on the barriers and facilitators influencing access to care and support for people from minority ethnic communities. learned from people with lived or professional experience about raising awareness of neurodegenerative conditions and addressing barriers to accessing services. Join the DeNPRU Exeter Reducing Ethnic Inequalities Project Team to hear about the findings. Deputy Director of DeNPRU, Professor Jan Oyebode Research Fellow, Dr Maria Caulfield There will be a chance to ask questions of the speakers. Register for the webinar -
Content ArticleIn this piece for the BMJ, Chris Bennett shares her thoughts about the year she and her husband had together after he was found to have a brain tumour. Reflecting on the relative risks, costs and benefits of surgery, she describes the value of her husband being given a little more time to spend with his family. She discusses the importance of healthcare professionals giving of honest explanations of choices and their consequences. This can give patients a valuable feeling of having some personal control over their situation.
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In this blog, Justean Winter shares her experience of working as an agency nurse in the NHS. She describes how she was told not to report patient safety issues she witnessed. After raising concerns about patient care, Justean received several accusations and was eventually blocked from working in the NHS. She outlines why she continues to try and raise awareness of the patient safety and organisational issues she witnessed. -
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This webinar will look at how we can collaboratively and effectively utilise clinical audit to continuously improve patient safety, prevent avoidable harm and work together within our patient safety systems. The Clinical Audit Hero Award for Patient Safety will be announced and there will be the opportunity to hear the winner present their project for wider learning for us all. The event is hosted by the National Quality Improvement (inc. Clinical Audit) Network (N-QI-CAN) and the Healthcare Quality Improvement Partnership (HQIP). Register for the event -
Content ArticleThe provision of high-quality personal protective equipment (PPE) was a critical challenge during the Covid-19 pandemic. This study evaluated an alternative strategy—the mass deployment of a powered air-purifying respirator (PeRSo), in a large university hospital.
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