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This report sets out how the NHS will resuscitate urgent and emergency care, with a focus on getting patients out of corridors, keeping more ambulances on the road, and enable those ready to leave hospital to do so as soon as possible. Summary of actions and impact for patients and carers Focus as a whole system on achieving improvements that will have the biggest impact on urgent and emergency care services this winter By the year-end, with improvement over winter, we expect to: Reduce ambulance wait times for Category 2 patients – such as those with a stroke, heart attack, sepsis or major trauma – by over 14% (from 35 to 30 minutes). Eradicate last winter’s lengthy ambulance handover delays by meeting the maximum 45-minute ambulance handover time standard, helping get 550,000 more ambulances back on the road for patients. Ensure a minimum of 78% of patients who attend A&E (up from the current 75%) are admitted, transferred or discharged within 4 hours, meaning over 800,000 people a year will receive more timely care. Reduce the number of patients waiting over 12 hours for admission or discharge from an emergency department compared to 2024/25, so this occurs less than 10% of the time. This will improve patient safety for the 1.7 million attendances a year that currently exceed this timeframe. Tackle the delays in patients waiting to be discharged – starting with the nearly 30,000 patients a year staying 21 days over their discharge-ready-date, saving up to half a million bed days annually. Increase the number of children seen within 4 hours, resulting in thousands of children every month receiving more timely care than in 2024/25. Develop and test winter plans, making sure they achieve a significant increase in urgent care services provided outside hospital compared to last winter Improve vaccination rates for frontline staff towards the pre-pandemic uptake level of 2018/19. This means that in 2025/26, we aim to improve uptake by at least 5 percentage points. Increase the number of patients receiving urgent care in primary, community and mental health settings, including the number of people seen by Urgent Community Response teams and cared for in virtual wards. Meet the maximum 45-minute ambulance handover time standard. Improve flow through hospitals, with a particular focus on reducing patients waiting over 12 hours, and making progress on eliminating corridor care. Set local performance targets by pathway to improve patient discharge times, and eliminate internal discharge delays of more than 48 hours in all settings. Reduce length of stay for patients who need an overnight emergency admission. This is currently nearly a day longer than in 2019 (0.9 days) and needs to be reduced by at least 0.4 days . Reduce the number of patients who remain in an emergency department for over 24 hours while awaiting a mental health admission. This will provide faster care for thousands of people in crisis every month. National improvement resource and additional capital investment is simplified and aligned to supporting systems where it can make the biggest difference Allocating over £370 million of capital investment to support: Around 40 new same day emergency care centres and urgent treatment centres. Mental health crisis assessment centres and additional mental health inpatient capacity to reduce the number of mental health patients having to seek treatment in emergency departments. Expansion of the Connected Care Records for ambulance services, giving paramedics access to the patient summary (including recent treatment history) from different NHS services, enabling better patient care and avoiding unnecessary admissions.

Continuing with the JCI Patient Safety Grand Rounds, the next session of the Grand Round is “Diagnostic Safety: From Error to Excellence in Patient Care. This strengthens the global efforts to improve diagnostic safety, building on the World Patient Safety Day theme of 2024. The upcoming session will feature a compelling conversation between internationally recognised leaders in the field. Dr. Hardeep Singh, Professor of Medicine at Baylor College of Medicine, will be joined by Dr. Laura Zwaan, Associate Professor at the Institute of Medical Education Research Rotterdam, Dr. Elizabeth Liz Mort, Vice President and Chief Medical Officer at The Joint Commission, and Dr. Neelam Dhingra, Vice President and Global Chief Patient Safety Officer at Joint Commission International JCI invites you to register now to be part of this important initiative and share this information with your networks and social media channels. The registration is complimentary. Register

Orthopaedic surgeon Sunny Deo has spent three decades diagnosing and treating knee joint issues. In this blog, Sunny argues that the healthcare community needs to take a more nuanced approach to diagnosis and decision making so that it can provide patients with safer, more appropriate treatment options. He reflects on why medicine prefers simple answers and looks at how this affects patient care. He goes on to explore how better data collection and the use of artificial intelligence (AI) could provide a more accurate picture of complexity and allow treatment options to be better tailored to individual patients’ needs. "To know the patient that has the disease is more important than to know the disease that the patient has." William Osler, father of modern medicine, 1849-1919. Diagnosis is the process of identifying the nature of an illness or other problem by examining the symptoms and objective findings from investigations. In modern medicine, it is a key focal point of the assessment and management of all patients. A huge amount of clinical medicine training is focused on the art and science of obtaining a diagnosis, and this focus continues into medical practice. The ease of getting to a diagnosis ranges from the glaringly obvious, the so-called ‘spot diagnosis’, through to cases that are very difficult to solve. In between these extremes there is a range from delayed to missed to incorrect diagnosis. The aim of doctors over the centuries has been to work out diagnoses from patients’ symptoms, presenting features (clinical signs) and, in the past century or so, from the evidence of clinical investigations. Quite often, symptoms, signs and investigations produce consistent patterns, and it is these patterns that are taught to medical and other healthcare professionals. This is how diagnoses and outcomes are portrayed in television series or films—just think back to the last episode of Casualty or Grey’s Anatomy you watched. It's also how things often appear in internet searches and on websites and social media. Seeking simple answers to complex questions However, the reality is different. When a patient is sitting in front of me, what I hear and observe may not exactly be what the textbooks, evidence or research tells me I should be seeing. But because we are wired and trained to recognise patterns, we tend to look for diagnoses and solutions that fit within the well-worn narrative. What if the pattern doesn’t fit the actual diagnosis? There are classic presentations for nearly every condition, and these are what you tend to find at the start of a Google search or when using NHS Choices. The expectation of typical symptoms sometimes means we ignore what we might see as annoying variance, superfluous detail or the patient embellishing the truth. This discordance then causes tension with a very basic trait of humans: when we’re faced with a difficult problem, we still seek the simplest solution. This is an evolutionary feature hardwired into us to optimise survival chances. It means we often believe there is a truth to be found that will provide us with a definite answer. From this answer we will come to the best, and ideally only, ‘correct’ solution. Patients who don’t fit the set patterns of diagnosis may then run into trouble when we offer them what is considered to be the ideal treatment. This is an important problem in clinical thinking, language and practice. As a medical community, we tend to create oversimplified approaches based on research that looks for binary answers to complex questions. This research evidence may be based on a small, highly selective ‘typical’ patient cohort, but its findings and conclusions are then translated on to the entire population. This approach results in poor patient outcomes and experience for a small but significant proportion of patients. Pathways designed for ideal diagnoses can cause harm to patients Over my 30 years as an orthopaedic surgeon, 15 as a knee specialist, I have seen that the assessment and treatment of any given condition isn't quite as predictable as we would like it to be. While many patients fit the pattern we are expecting, some do not. I would empirically put the proportion at 60:40, but some unpublished research we did a decade ago suggested the proportion of truly ‘typical’ case presentations for a common condition is much lower. For example, we found that in the case of suspected meniscal tear, this diagnosis actually applied to only 33% of patients with a variety of other diagnoses accounting for the rest. It gets worse when large organisations start to lump patients into a category by condition in a ‘one diagnosis fits all’ strategy. When this approach is taken, there are winners and losers. The winners are those patients whose condition very closely matches the classic presentation of a given condition in isolation. Let’s take the example of knee osteoarthritis—patients with the ‘right type’ of symptoms, physical signs and x-ray changes are generally more likely to do well. Their recovery is more likely to sit within the knowledge base of treating the condition that has evolved over the past half-century. In contrast, patients whose symptoms and test results fall outside of this category may be less likely to do well or recover in the predicted timeframe. This also applies to patients with additional diagnoses or conditions, often termed comorbidities, which may interact, usually in a bad way, with the condition at hand. Failure to consider other diagnoses, either by over-focus on one condition causing wilful ignorance, inattention or lack of attention, may lead to unexpected poor outcomes from a given treatment. It may also mean that the symptoms from the condition that the patient presents with are worse than expected. This doesn’t mean that they won't gain any benefit from a particular treatment, but the risks and potential outcomes may not be communicated adequately by the patient’s healthcare team, if at all. For example, for patients with painful knee osteoarthritis, the current diagnosis to treatment logic runs like this: Knee osteoarthritis is a painful condition. Total knee replacement surgery is a validated safe procedure with significant improvements in quality of life. Other treatment options do not produce as much positive therapeutic benefit compared to total knee replacement surgery. Therefore, total knee replacement surgery is the only treatment for painful knee osteoarthritis. However, there are patients for whom knee replacement surgery is not a safe or practical option, and these patients may benefit from alternative treatments that are not currently offered as they are seen as providing limited benefit. This may be because the participants in trials undertaken over the years had varying diagnoses, meaning that true comparisons of alternative options may have had additional interacting diagnoses or failed to account for differing severity. Understanding the spectrum of complexity As healthcare professionals, we have a duty to diagnose patients as accurately as possible. In orthopaedics, if treatments go wrong or are poorly undertaken, it may lead to prolonged or permanent pain or disability, and we obviously want to avoid this as much as possible. Incomplete identification and documentation of all relevant symptoms and health conditions can potentially lead to an increased risk of treatment failure and complications. Our priority should be to identify these diagnoses or diagnostic clusters as accurately as possible. I think these are basic principles we need to apply to create better systems and improved care for as many patients as possible. In my view, there are grades of ‘atypical patients’ and I have devoted the past decade to trying to demonstrate this, with surprisingly stiff resistance from peer-reviewed journals and funding organisations. I have tried to move away from lumping all patients into a single category. I have done some research on seemingly straightforward soft tissue problems and osteoarthritis in the knee. My initial analysis suggests that we need to collect more detailed and accurate data, rather than simplifying data into minimum datasets. This is where AI can really come into its own, not as a diagnostic tool initially, but as a powerful aid to unlocking and interpreting some of the diagnostic interactions that create problems for patients. However, the use of AI does need to be undertaken with extreme care and consideration, and this isn’t always happening currently. To offer healthcare that is truly person-centred, we need to look beyond our well-worn simple answers and solutions. By using better data and new machine learning tools to understand the nuances of each person’s condition and how it relates to their wider health, we can offer treatment options that are safer, kinder and more cost-effective. Share your views We would love to hear your views on the issues highlighted in Sunny’s blog Are you a clinician who would like to share your experiences? Do these challenges resonate with you? Or are you a patient who has experienced complications because of poor, missed or inadequate diagnosis? Add your comment below (you will need to be a hub member and signed in) or contact us at [email protected] and we can share your story anonymously. Related content on the hub: Using data to improve decision making and person-centred care in surgery: An interview with Sunny Deo and Matthew Bacon Diagnostic errors and delays: why quality investigations are key

The 7th Global Ministerial Summit for Patient Safety, organised by the Department of Health of the Republic of the Philippines and co-sponsored by the World Health Organization (WHO), takes place on 3-4 April 2025 in Manila. This event focuses on advancing international efforts to improve healthcare quality and safeguard patients worldwide. It brings together global leaders, experts and stakeholders to discuss and shape the future of patient safety.  Global Ministerial Summits on Patient Safety aim to drive forward the global patient safety movement. Beginning in 2016, they have helped to keep patient safety high on policy makers’ agendas and helped the build the momentum needed to create the first World Health Organization (WHO) Global Patient Safety Action Plan, published in August 2021. This year’s Summit in Manilla seeks to support the implementation of the Global Patient Safety Action Plan, embracing the theme "Weaving Strengths for the Future of Patient Safety Throughout the Healthcare Continuum." The event highlights the current implementation progress, showcasing diverse approaches and strategic plans adopted by countries. The Summit will include discussions around: The role of patient engagement in bridging patient safety gaps. Diagnostic safety. Leveraging artificial intelligence (AI) and technology for patient safety. Creating psychologically safe and healthy workplaces. Investing in patient safety for sustainable healthcare. There will be sessions across the two days looking at each of these issues, within the broader context of integrating patient safety in all aspects of healthcare delivery and at all levels of care as a foundation of resilient and sustainable healthcare systems. To support the Global Ministerial Summit, Patient Safety Learning has pulled together some key resources from the hub around these key themes being discussed at the Summit. Patient engagement 1 WHO: Patient safety rights charter The Patient safety rights charter is a key resource intended to support the implementation of the Global Patient Safety Action Plan 2021–2030: Towards eliminating avoidable harm in health care. The Charter aims to outline patients’ rights in the context of safety and promotes the upholding of these rights, as established by international human rights standards, for everyone, everywhere, at all times. 2 Championing the patient voice: a recent discussion with the Patient Safety Commissioner at the Patient Safety Partners Network The role of Patient Safety Commissioner for England was created by the UK Government after a recommendation from the Independent Medicines and Medical Devices Safety Review, chaired by Baroness Julia Cumberlege. The Patient Safety Commissioner acts as a champion for patients, leading a drive to improve the safety of medicines and medical devices. This blog provides an overview of a Patient Safety Partners Network meeting where members were joined by Professor Henrietta Hughes, Patient Safety Commissioner for England. 3 Providing patient-safe care begins with asking and listening... really listening! Dan Cohen is an international consultant in patient safety and clinical risk management, and a Trustee for Patient Safety Learning. In this blog, Dan talks about how patient-safe care is all about collaborating and listening to your patients to find out what really matters to them. He illustrates this in a case study of his own personal experience whilst working as a clinician in the USA. Diagnostic safety 4 The economics of diagnostic safety Diagnosis is complex and iterative, therefore liable to error in accurately and timely identifying underlying health problems, and communicating these to patients. Up to 15% of diagnoses are estimated to be inaccurate, delayed or wrong. Diagnostic errors negatively impact patient outcomes and increase use of healthcare resources. This Health Working Paper from the Organisation for Economic Co-operation and Development (OECD) defines the scope of diagnostic error and illustrates the burden of diagnostic error in commonly diagnosed conditions. It also estimates the direct costs of diagnostic error and provides policy options to improve diagnostic safety. 5 Improving diagnostic safety in surgery: A blog by Anna Paisley Good outcomes for surgical patients require accurate, timely and well-communicated diagnoses. In this blog, Anna Paisley, a Consultant Upper GI Surgeon, talks about the challenges to safe surgical diagnosis and shares some of the strategies available to mitigate these challenges and aid safer, more timely diagnosis. 6 How early diagnosis saves lives: case study on aortic dissection In this blog, The Aortic Dissection Charitable Trust explains why timely and accurate diagnosis of aortic dissection is critical for saving lives. By sharing Martin’s recovery story, they illustrate the positive impact of prompt testing and treatment. The blog highlights the need to improve patient safety relating to aortic dissection, calling for increased education and awareness among healthcare professionals; improved clinical guidelines and protocols; and heightened vigilance in recognising and responding to the symptoms of aortic dissection. Artificial intelligence (AI) and technology 7 Patient Safety and Artificial Intelligence: Opportunities and Challenges for Care Delivery (IHI Lucian Leape Institute) In January 2024, the Institute for Healthcare Improvement (IHI) Lucian Leape Institute convened an expert panel to explore the promise and potential risks for patient safety from generative artificial intelligence (genAI). The report that followed summarises three user cases that highlight areas where genAI could significantly impact patient safety: in documentation support, clinical decision support and patient-facing chatbots. 8 AI in healthcare translation: balancing risk with opportunity In an increasingly global healthcare environment, with patients and professionals from many different cultural and linguistic backgrounds, precision in medical document translation is key. In this blog, Melanie Cole, Translations Coordinator at EIDO Systems International, talks about the challenges, risks and opportunities for using AI in healthcare translation. 9 Integrated human-centred AI in clinical practice: A guide for health and social care professionals This is a guide for designers, developers and users of AI in healthcare. It outlines general principles health and social care professionals should consider, a case study drawn from clinical practice and a directory of resources to find out more. It includes key questions that clinicians and AI developers need to answer together to ensure the best possible outcomes. It follows on from the CIEHF's White Paper, Human Factors in Healthcare AI, which sets out a human factors perspective on the use of AI applications in healthcare. Psychological safety 10 Speak up for Safety: A new workshop for healthcare staff about the importance of Just Culture The culture of a healthcare organisation can determine how safe its staff members feel to raise concerns about patient safety. Bella Knaapen, Surgical Support Governance & Risk Management Facilitator and Sarah Leeks, Senior Health & Wellbeing Practitioner at Norfolk and Norwich University Hospitals NHS Foundation Trust, have developed ‘Speak Up For Safety’, a Just Culture training workshop that aims to help staff, at all levels, understand the importance of creating an environment that encourages people to share concerns and feedback. 11 Balancing care: The psychological impact of ensuring patient safety In this blog, Leah Bowden, a patient safety specialist, reflects on the impact her job has on her mental health and family life. She discusses why there needs to be specialised clinical supervision for staff involved in reviewing patient safety incidents and how organisations need to come together to identify ways we can support our patient safety teams. 12 Amy Edmonson: The importance of psychological safety As a leader how can you foster a work environment where people feel safe to speak up, share new ideas and work in innovative ways? In this video from the Kings Fund, Amy Edmondson, Novartis Professor of Leadership and Management at the Harvard Business School, talks about the importance of psychological safety in health and care and what leaders can do to create it. Sustainability 13 The Royal College of Surgeons of Edinburgh: Green Theatre Checklist Healthcare services globally have a large carbon footprint, accounting for 4-5% of total carbon emissions. Surgery is particularly carbon intensive, with a typical single operation estimated to generate between 150-170kgCO2e, equivalent to driving 450 miles in an average petrol car. The UK and Ireland surgical colleges have recognised that it is imperative for us to act collectively and urgently to address this issue. The Royal College of Surgeons of Edinburgh have collated a compendium of peer-reviewed evidence, guidelines and policies that inform the interventions included in the Intercollegiate Green Theatre Checklist. This compendium should support members of the surgical team to introduce changes in their own operating departments. 14 Communicating on climate change and health: Toolkit for health professionals Communicating the health risks of climate change and the health benefits of climate solutions is both necessary and helpful. Health professionals are well-placed to play a unique role in helping their communities understand climate change, protect themselves, and realize the health benefits of climate solutions. This toolkit from WHO aims to help health professionals effectively communicate about climate change and health. 15 Climate change: why it needs to be on every Trust's agenda The NHS has declared climate change a health emergency, but are trust leaders and healthcare staff talking and acting on this? Angela Hayes, Clinical Lead Sustainability at the Christie Foundation Trust and a hub Topic leader, discusses climate change and the impact it has on all of our lives and health. She believes healthcare professionals have a moral duty to act, to protect and improve public health, and should demand stronger action in tackling climate change. If you would like to write a blog or have a resource to share on any of the themes highlighted in this blog, please get in touch. Contact the hub team at [email protected] to discuss further.