Sam

This is the second of two investigation reports into crisis care in emergency departments (EDs). An interim report was published in April 2026 following early identification of a significant legal, policy and safety gap in the care of people in mental health crisis in EDs. This report is part of the Health Services Safety Investigations Body (HSSIB)’s wider work on safety issues for people experiencing a mental health crisis who come into contact with urgent and emergency care services. A related investigation is examining the 999 and 111 response to mental health crisis and will report its findings in spring 2027. The two investigations consider different points in the same pathway. Wider health and care system issues are included where they directly affect ED care, and further themes may be brought together in a separate, final report drawing on evidence from both investigations. Around 3% of ED attendances are mental health-related. However, people experiencing mental health problems are twice as likely as other patients to remain in the ED for more than 12 hours.

The NHS chief executive is set to have equal rank in government to the health department’s permanent secretary when NHS England is abolished – meaning a proposal to downgrade their status has been rejected by ministers. The decision was made by health and social care secretary Yvette Cooper last week, after several weeks of deliberation over the choices she needs to make ahead of NHSE being scrapped, officials have been told. Ms Cooper had decided the NHS CEO post will sit “alongside the permanent secretary” of the Department of Health and Social Care and with “equal rank” in government, the current NHSE CEO Sir Jim Mackey said at a staff meeting last week. She wants a return to a departmental structure very close to that immediately before the creation of NHS England in 2012, Sir Jim said. This would include a distinct “NHS executive” group within the department, to run NHS-focused national work, led by the NHS CEO. The decision means the NHS CEO will report directly to the health and social care secretary and, in central government, to the cabinet secretary, after NHSE is abolished, which is due to take place at the end of March.

Transformative Simulation considers how simulation can be intentionally used beyond education to understand and contribute to change within healthcare systems. The Identification Simulation-Based Intention focuses on using simulation to uncover risks, vulnerabilities, unmet needs and other aspects of healthcare systems that may otherwise remain difficult to see. This resource from hub topic lead Sharon Weldon brings together a short Transformative Simulation thought piece, visual explainer and selected examples from the literature demonstrating how simulation has been used to identify patient safety and system challenges in practice. Further resources from Sharon on Transformative Simulation: Using simulation to improve patient safety and healthcare systems: The Improvement Intention Using simulation to strengthen workforce participation, belonging and wellbeing: The Inclusion Intention Using simulation to involve patients and communities in shaping safer care: The Involvement Intention

AI is increasingly becoming part of how health care is delivered. This comes with both potential, for example to reduce administrative burden, and risks, such as widening inequalities. It also raises complex questions about how AI tools should be regulated, and challenges around how to assess, monitor and oversee its safety and effectiveness. Commissioned as the research partner to the MHRA's independent National Commission into the Regulation of AI in Healthcare, this report brings together findings from the Health Foundation's polling of public attitudes towards AI with new findings from a UK-wide public deliberative exercise exploring what the public thinks regulators should prioritise and what is needed to build and maintain public trust in AI regulation.  The findings underscore the importance of public trust, safety and accountability in the regulation of AI. Overall, it found that participants largely support the use of AI in health care, but that support is conditional on strong safeguards where accuracy and human oversight are essential. The report presents the findings of the research, including the public’s awareness of and attitudes to AI use in health care, priorities for regulation and potential approaches, and principles for regulating AI. The final section sets out the implications of these findings for policy.

One of the aims of the Healthcare Financial Management Association (HFMA) Four Nations Group is to share learning and insights across the United Kingdom. At its June meeting, the group focused on productivity. The meeting opened with an update on the position in England, followed by a discussion with members from all four nations on differences in measurement, priorities and improvement strategies. This discussion paper summarises the conversation and is intended to inform members’ thinking and support wider shared learning.

The NHS faces unprecedented financial pressure, requiring the identification of cash-releasing interventions (CRIs). To support evaluation of this, the authors of this study established five criteria based on relevant frameworks. They conducted an evidence review of published and grey literature (2019–2025), identifying and evaluating CRIs aligned with NHS England’s ʻthree shifts’.

The Health Economics Unit (HEU) has developed a framework for the ethical and effective decommissioning and disinvestment in clinical services, in partnership with the Healthcare Financial Management Association (HFMA).

Do NHS organisations have enough staff, with the right skills and expertise, to vet new digital technologies before they are deployed on the shop floor? A report from the Health Services Safety Investigations Body on advice and guidance unearthed some uncomfortable truths about digital clinical safety assurance. Among its findings was that providers deploying the electronic referral service (e-RS), which hosts A&G, could not evidence compliance with a key digital clinical risk management stanardard. Dean Mawson, founder of DPM Digital Health and national CSO training lead, told The Download that with the average trust running upwards of 200 digital health systems, a single full-time CSO would struggle to do their job properly.  One of the reasons for this is that most CSOs hold the title in addition to a clinical day job. Sometimes, senior figures like chief clinical or nursing information officers are expected to become CSOs too. Youssof Oskrochi, one of the paper’s authors and a CSO himself, told The Download that this part-time, bolted-on approach underappreciates what work goes into digital clinical safety assurance. He said: “AI is a black box, EPRs are complex, a lot of the technology now has generative AI or large language models in. You need at least some expertise to understand the technical features of this product. “If you’re expecting someone to put [a safety case] out on half a day a week, you either have to expect that’s going to take a long time, or you’re

People sexually abused as children who seek help in later life for mental health problems are being failed by the NHS, senior doctors have told the BBC. The Royal College of Psychiatrists is issuing a public apology for what it says is decades of mismanagement and misdiagnosis in the UK. For some, it has worsened their traumas, it said. The college said mental health staff have been too focussed on treating symptoms rather than exploring how past traumatic experiences can still affect patients. Support is improving, it said, but there must be better training and more investment - something NHS bosses have said is being introduced. Immediate past president of the college, Dr Lade Smith, said she was "sorry" that, too often, victims have suffered "avoidable harm when seeking help". The report details how treatment has sometimes been inappropriate, while people have been re-traumatised by the experience of repeated assessments and history-taking and not always being believed. Dr Smith told the BBC it was clear people were not getting the support they needed, and that this was not just a failing of psychiatrists, but the whole mental health system. "Services are so fragmented. The system is set up to provide short, discrete episodes of care. Psychiatrists do not get the time to build up a relationship with patients so they can be properly supported. "They are lucky if they get eight sessions of therapy, when it could take eight sessions for a person just to disclose the abuse. "And these are just the people who get support – many don't even get seen by mental health services because services are so stretched," she said. Read full story Source: BBC News, 26 August 2026

Complaints about autism and attention deficit hyperactivity disorder (ADHD) services in England have more than tripled in five years, official figures show, with the NHS ombudsman warning of years-long waits and patients paying thousands of pounds for private care. One woman was removed from an ADHD medication waiting list without warning after almost four years, leaving her without the support she needed for about six months. Another patient was given an autism assessment lasting just 50 minutes that failed to follow guidance from the National Institute for Health and Care Excellence, while a man referred to an ADHD service that was not yet operational ended up paying almost £4,000 for private treatment. Complaints rose from 410 in 2021-22 to 1,257 in 2025-26, an increase of more than 200%, as referrals and the number of people waiting for assessment, treatment and support also increased. The parliamentary and health service ombudsman, Paula Sussex, said ADHD and autism services were “under significant pressure, with demand outstripping capacity”, adding: “While commissioning cannot solve these supply constraints, the way services are designed, commissioned and delivered can compound the pressure people experience and make it harder to make the best use of available resources.” She said: “Right now, the system is too complex and inconsistent, leaving too many patients falling through the gaps.” A report, called Improving ADHD and Autism Services: Commissioning With Confidence, shares the ombudsman’s findings based on 3,000 complaints. It found recurring issues, including uncertainty around patients’ right to choose a provider. Under right to choose, patients in England can choose from eligible NHS-funded providers for certain services, including some independent providers. However, the ombudsman found uncertainty around how this right applied, with patients sometimes being told wrongly that they could not exercise it. Read full story Source: The Guardian, 26 August 2026

Patients have died or have been harmed because of care failures at an under-fire NHS trust which staff fear could become the next major health scandal, whistleblowers have claimed. An investigation by The Independent and Channel 4 into Northern Care Alliance NHS Foundation Trust, which treats more than a million patients across Greater Manchester, has uncovered allegations that patients have died in surgery without adequate investigation, while others had their cancer diagnosis delayed. Some patients are alleged to have been left dying or in pain in overcrowded A&E corridors or have been forced to undergo invasive treatments that might have been avoided if their care had not been delayed. And some staff claim they have been encouraged not to submit reports to managers when safety issues arise, while others say their accounts of serious harm and death are shut down or not investigated properly. Retired consultant, Dr Glyn Smurthwaite, who blew the whistle over rogue spinal surgeon John Bradley Williamson, found to have harmed dozens of patients at the trust between 2009 and 2014, including some who had misplaced screws causing chronic pain, warned that the deterioration in patient care and the trust’s attitude to harm was not a recent development. “I believe this is potentially bigger than the Mid Staffs scandal in terms of the magnitude of harm. For decades, Salford Royal [before the creation of the NCA] had seemingly executive-led and failing governance processes,” he said. “The organisation has a malevolent intent to defocus from the true problem and just tick a box. We’ll do an investigation because the system forces us to generate an investigation… but they’ll close it, investigate it, file it, and no one will ever see it, and there’s probably no meaningful outcome from it.” Read full story Source: The Independent, 19 August 2026 Further reading on the hub: Ensuring patients feel informed, listened to and supported long after the headlines disappear

Despite a 30% increase in frontline staff since 2019, the NHS has failed to achieve their equivalent productivity gains. In this HSJ article, Steve Black uses the simple metaphor, “a chain is only as strong as its weakest link", to explain why. He argue that by making just one link in a complex chain stronger not only doesn’t strengthen the chain. It may also make it weaker, as every link adds extra weight the other links must support in addition to whatever object the complete chain is supposed to hold. This helps explain why simply adding so many more frontline staff does not lead to the expected huge increases in activity. The other links are the limiting factors.

A senior doctor has blamed NHS chiefs for numerous problems within transplant services in England and called for an overhaul in a leaked letter seen by the BBC. Professor Derek Manas, the medical director of NHS Blood and Transplant, admonished NHS England for creating a system with a burnt-out workforce, "few consequences for poor performance" and operations cancelled "last-minute". The number of heart and lung transplants the NHS carries out each year has not increased in 30 years. NHS England, the national management body for the health service in England, said it was "working hard to improve these life-saving services". While NHS Blood and Transplant manages organ donations and supports transplant centres, services are commissioned and paid for by NHS England. But in a letter to NHS England and a small group of patient advocates, Manas said the central body had created a "fragmented" system "with poor accountability". There is a "mismatch", he said, between each hospital's waiting lists, organ availability, capacity to carry out surgeries and the availability of operating theatres. This is "leading to last-minute cancellations [and] unpredictable utilisation of donated organs," he warned. Read full story Source: BBC News, 13 August 2026

Nurses are collapsing during shifts amid “inhumane and impossible” conditions caused by extreme heat, their union has warned, as Andy Burnham promised to grapple with “the bigger questions” of climate adaptation. With the number of days of 30C-plus heat in the UK already at a new record of 35, the Royal College of Nursing (RCN) became the latest union to warn of unsafe working conditions for many members in hospital wards and care homes. The RCN, which runs an advice hotline, said some staff had collapsed. Others were left dizzy, nauseous or at risk of fainting while dripping with sweat “from head to toe”. They also faced pressure to keep elderly and vulnerable patients safe alongside keeping medications cool. Working within a critical care unit in an NHS hospital in the south-west of England, a 37-year-old nurse told the Guardian her ward had reached temperatures of more than 30C and staff were struggling in the conditions. “Our ward doesn’t have air conditioning, and so we’re all really struggling. We’ve had hot summers before, but I can’t remember ever working in conditions like these back to back,” she said. Another nurse, working in a community health centre in England, said: “It gets to the point you dread going to work, especially when wearing PPE and providing patient care. We drip with sweat from head to toe.” Read full story Source: The Guardian, 13 August 2026