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Content Article
Lucy Harding is a Patient Safety Partner at North London NHS Foundation Trust, where she has also been a patient and Peer Support Worker. In this reflective piece, Lucy shares her insights around how design in healthcare can impact patient safety. She draws on her professional background and lived experience of inpatient mental health care as an autistic person, to highlight the critical relationship between design and emotional safety. *Content warning: references to suicidality and self-harm. I have a particular interest in how the physical environment shapes emotional regulation, sensory experience, and feelings of safety. As an autistic person, I also value sensory design and service accessibility, and I’m passionate about creating therapeutic spaces that genuinely support recovery. Design is a core component of patient safety My interest comes from experiencing first-hand how profoundly the built environment can affect emotional state, distress levels, and the ability to feel safe and engage in treatment. Poorly designed wards can feel chaotic, overwhelming, and sometimes frightening. My experience of patient involvement in co‑production projects, from artwork to furniture selection, helped me realise that design isn’t superficial; it’s a core component of patient safety and experience. As an autistic person, sensory design is very important to me, and I’ve experienced how unmet sensory needs can escalate distress. These experiences have made me want to advocate for safer and more therapeutic environments. Seeing the transformative impact of thoughtful design for mental health —such as improved acoustics, better lighting, and more predictable, calming spaces— has shown me how design can actively support or hinder safety. How the environment can impact patient safety Environments that feel like containment: institutional or outdated spaces can make people feel unsafe, watched, or confined. People should have access to outdoor spaces and fresh air, but not every mental health ward provides immediate access (eg. many wards require leave from hospital to be agreed by a care team, as there are not gardens designed into the ward environment). Sensory overload: harsh lighting, echoing voices in corridors, and unpredictable multi‑use spaces can heighten distress, especially for autistic people and those with experiences of trauma. There were times I had no control over sensory input as a patient, and this felt extremely destabilising and made me unsafe. I disengaged with and resisted treatment, and I self-harmed. The National Autistic Society reports that the average length of stay for autistic people in mental health hospital is 4.6 years, which is a considerably long time.[1] The Assuring Transformation dataset can help ICBs to look at where inequalities are for autistic people without LD in comparison to the general population.[2] I am curious about how much building design contributes to this inequity (rather than the clinical care provided). Lack of temperature control: wards that become extremely hot or cold can make rooms unsafe both physically and emotionally. Hot rooms feel stuffy and uninviting to use, both for staff and patients. High temperatures can make me feel more irritable and less rational. Many psychiatric medications also impact body temperature regulation. As temperatures are rising globally, improving ventilation and prioritising resources for this is becoming more essential. Poor acoustic design: noise and echoing make communication difficult, increasing misunderstandings and conflict. Lack of safe respite spaces: without somewhere quiet to withdraw, people may seek unsafe alternatives. I hid on my windowsill often as a patient, escaping observations and noise – but being unseen for two hours was a risk, and I wasn’t always keeping myself safe. Old buildings and shared facilities: shared bathrooms and dormitory bedrooms, and a lack of purpose-use ward spaces can create conflict, distress, and act as a barrier to treatment being therapeutic. Designing ensuite bedrooms, creating dedicated rooms for therapy, group activities, and quiet/sensory rooms can make a difference to how safe a ward feels. When design supports safety An example of a positive design change I experienced was the installation of a sound‑absorbing panel at an inpatient mental health service. It made a noticeable difference- reducing echoing and softening the overall noise level, which helped communication feel calmer and more respectful. This kind of acoustic improvement reduces the intensity and unpredictability of sounds on a ward. Also, seeing our photographs on the wall made me, as a patient, feel safe, heard, and included. Connecting with others through art and design ultimately lifted me out of a state of intense suicidality and depression. That lens has led me to be very passionate about design being directly connected to patient safety. Challenges and barriers Key challenges and barriers to designing healthcare environments in ways that support patient safety: Budget constraints: sensory‑friendly or trauma‑informed design is often seen as optional rather than essential. Legacy buildings: older wards may be structurally unsuitable for modern design standards. Competing priorities: safety is often interpreted narrowly (eg ligature reduction, or a reduction in a particular category of reported incidents) rather than holistically, which can overshadow sensory and emotional safety. Lack of awareness: designers and decision‑makers may not fully understand sensory needs or lived experience perspectives. Operational pressures: busy wards can deprioritise environmental improvements or require more focus and time than ward staffing allows. Limited co‑production: without meaningful involvement from service users, important design needs can be overlooked. These barriers mean that environments sometimes prioritise containment over comfort, despite evidence that therapeutic design improves safety. Considerations for safer design Co‑production from the start: involve service users, carers, and staff in every stage of design—not just as a consultation step. Sensory‑informed design: consider lighting, acoustics, temperature, predictability, and access to quiet spaces. Flexibility and choice: offer different types of spaces for different needs—calming rooms, social areas, private space, and low‑stimulus zones. Accessibility as standard: such as acoustic design for autistic people, people with hearing impairments, and sensory processing differences. Trauma‑informed principles: prioritise dignity, autonomy, and emotional safety. Feedback loops: continue involving patients after the building opens to refine and improve the environment. Final reflections Feeling safe is not the same as being objectively safe, and both matter equally in mental health settings. Design should never be an afterthought: it is a therapeutic intervention in its own right. When we create environments that respect sensory needs, reduce distress, and promote autonomy, we support recovery and reduce risk. Co‑production with patients isn’t just good practice, it’s essential for designing spaces that truly work for the people who use them. References 1. National Autistic Society. Number of autistic people in mental health hospitals: latest data. June 2025. Accessed online 13/15/26. 2. NHS England. The Assuring Transformation dataset (Table 3, column F&G: average length of stay for autistic patients without a learning disability). March 2026. Accessed online 13/05/26. -
Content ArticleDiverse ethnic groups are under-represented in health research, which can mean healthcare treatments and services are less safe, accessible and effective for these groups. This spoken word video aims to increase the number of people with lived experience from diverse ethnic groups who are actively involved in health research, and ultimately improve health treatments and services. The film focuses on why diversity in patient and public involvement (PPI) and in health research matters for people, families and communities. Related reading “Our message about public involvement is don’t be afraid to start.” Interview with Barbara Molony-Oates from the NHS Health Research Authority
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Content ArticleIn June 2022, General Sir Gordon Messenger and Dame Linda Pollard published their final report on the review of leadership and management in the health and social care sector, as commissioned by the Secretary of State for Health and Social Care in October 2021. This briefing by NHS Providers summarises the key areas covered by the report, grouping recommendations under the following headings: Training Development Equality, diversity and inclusion Challenged trusts, regulation and oversight
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Content ArticleImproving patient safety culture – a practical guide, developed in association with the AHSN Network, brings together existing approaches to shifting safety culture as a resource to support teams to understand their safety culture and how to approach improving it. It is intended to be used across health and social care to support everyone to improve the safety culture in their organisation or area. The guide specifically focuses on: teamwork communication just culture psychological safety promoting diversity and inclusive behaviours civility. Teams should use the guide to find a way to start to improve their culture that is most relevant to their local context. It will support teams to explore different approaches to help them to create windows into their daily work to help them to understand their local safety culture.
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Content ArticleHow can we ensure that health and care staff from all backgrounds feel respected, valued and listened to at work? Siva Anandaciva sits down with Karen Bonner, Chief Nurse at Buckinghamshire Healthcare NHS Trust, to talk about the value of having a diverse workforce, and how we can make the health and care system fairer for staff, patients, and communities from ethnic minority groups.
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Content ArticleThis improvement plan sets out targeted actions to address the prejudice and discrimination – direct and indirect – that exists through behaviour, policies, practices and cultures against certain groups and individuals across the NHS workforce. It has been co-produced through engagement with staff networks and senior leaders.
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Content ArticleIt is essential that the voices of people from diverse communities are heard and acted upon because we will only be effective in improving patient safety for everyone if we include these groups. This blog from the Patient Safety Commissioner Dr Henrietta Hughes outlines the importance of listening to patients and staff from diverse communities to identify and act on patient safety issues – and how to make this happen.
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Content ArticleUnpaid carers provide significant levels of support to family or friends–equivalent to four million paid care workers. Carers often need support with their own health and wellbeing, but they are not always able to access this. Researchers from The King's Fund interviewed commissioners and providers of support to unpaid carers, ran focus groups with unpaid carers in four areas of England, spoke to national stakeholders and reviewed existing literature and national data sets, in order to understand the current picture of local support available for unpaid carers in England. Key findings To better support unpaid carers locally, commissioners and services need to develop and maintain a good understanding of their populations. This can be facilitated by supporting local professionals to identify and point carers to available services, meaningfully measuring the impact of support and engaging with local carers. Local support offers should be built on this understanding. Commissioners and providers of services for unpaid carers need to actively develop awareness of their local support offers among unpaid carers, at the same time ensuring support is appropriate and accessible, as well as inclusive of diverse populations. Carers are a hugely diverse group, both in terms of who they are and who they care for, but policy and services don’t always reflect this diversity. Awareness of carers needs to be embedded in strategic level and commissioning decisions. Professionals who ‘get it’ and advocate consistently are vital. But the work can’t just rely on a few committed individuals—system-level carers’ partnerships and strategies have a key role in advocating and embedding the carers agenda. The impact of wider health and care issues on carers cannot be ignored. The impacts of ongoing funding issues and the health and social care workforce crises on carers and local support services were highlighted multiple times in our research. Workforce shortages in particular are directly impacting on carers health and wellbeing because they are the ones left to fill in the gaps.
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Content ArticleThe latest NHS Workforce Race Equality Standard (WRES) data shows that it is still over twenty times more likely that a White Band 5 nurse will become a Director of Nursing compared to a Band 5 BME nurse. In this letter Roger Kline, Research Fellow at Middlesex University Business School, outlines his concerns about discrimination and bullying taking place within the NHS. Addressed to Secretary of State for Health and Social Care Steve Barclay, the letter recalls the findings of the Messenger report commissioned by Mr Barclay's predecessor Sajid Javid, which found that “acceptance of discrimination, bullying, blame cultures and responsibility avoidance has almost become normalised in certain parts of the system, as evidenced by staff surveys and several publicised examples of poor practice." Referring to recent calls to reduce spending on equality, diversity and inclusion (EDI), he outlines why patient care and frontline services cannot be detached from efforts to improve EDI. He argues that research strongly suggests how staff are treated (including whether they face discrimination) impacts on patient care, staff well-being and organisational effectiveness.
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Content ArticleChairs and non-executives are an important NHS leadership group. As independent board members, they hold the executive to account and in doing so build patient, public and stakeholder confidence in the NHS. This report by the Independent Taskforce on Improving Non-Executive Director Diversity in the NHS explores the steps needed to strengthen the diversity of NHS boards in England. Read a shorter summary of the report Key points A 2019 NHS Confederation report found that there was insufficient diversity in those appointed to these roles in the NHS. A more equal and diverse leadership among chairs and non-executives will mean patients, communities and staff will have leadership that is more reflective and sensitive of the communities the NHS serves. Such a diversification is more likely to transform culture for the benefit of patients and champion patient and staff engagement. An independent taskforce commissioned to review how to strengthen NHS board diversity has found that the NHS appointments process is not independent or transparent; diversity in NHS board roles is often hampered by the rigid candidate criteria; NHS roles are often considered to be unattractive to candidates from underrepresented groups; ‘chemistry and fit’ tend to override diversity, which results in ‘more of the same’; commitments from the top are among important vehicles for change. If NHS organisations are to create a sustainable pipeline of chairs and non-executives that reflect the staff and communities they serve, current non-standard appointment processes need to be refreshed and be independent. The taskforce has put forward a set of recommendations to support a step change in the composition of NHS boards. Measures include establishing an independent appointment process; setting up a confidential feedback mechanism for NED candidates to raise concerns about a recruitment process; publishing data on the protected characteristics of those who applied, are longlisted, shortlisted, interviewed and are appointed; negotiating a compact with executive search firms; and ensuring succession planning arrangements are in place for replacing an organisation’s chair and non-executives. The move to system working and putting integrated care systems on a statutory footing provides an opportunity for the NHS to reset, change the appointments process and appoint diverse leaders. Integrated care systems will have new responsibilities and accountabilities across the system and the NHS organisations that sit within their remit.
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EventuntilPrimary care services are the front door to the NHS – they are the first port of call when we feel unwell and the main coordinator of care when we are living with ill health. The primary care team have an important role in making people feel welcomed, listened to and taken seriously. At National Voices we often hear stories from groups of people who struggle to have their communication needs met within primary care. As just one example, five years after the launch of the Accessible Information Standard, 67 per cent of Deaf people reported that still no accessible method of contacting their GP has been made available to them (Signhealth, 2022). This issue also affects other groups with specific communication needs - people who don't speak English fluently, people with learning disabilities, autistic people, people with dementia, people with low or no literacy, people who are digitally excluded, people living nomadically, people experiencing homelessness and more. We know that these experiences happen within the context of a primary care team under exceptional pressures. This workshop will bring together people with lived experience from all the groups mentioned above, as well as voluntary sector organisations, members of the primary care workforce, primary care policy leads, as well as commissioners and providers to discuss the challenges and co-produce solutions. At the workshop, we hope to build and improve understanding of: The experiences of people with diverse communication needs within primary care. The barriers primary care teams experience in meeting diverse communication needs, especially under existing pressures. Practical ways that we can embed and improve inclusive communications within the primary care setting. Register for the webinar. If you have any questions, please contact [email protected]
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EventuntilJoin the National Academies of Sciences, Engineering, and Medicine’s Committee on Improving the Representation of Women and Underrepresented Minorities in Clinical Trials and Research as it discusses its newly released report Improving Representation in Clinical Trials and Research: Building Research Equity for Women and Underrepresented Groups. This new report makes a compelling case for why we need more equitable participation in clinical trials and clinical research, including an economic analysis on the cost of health disparities in the United States. It provides a review of the barriers to having more equitable participation in clinical trials, describes strategies to overcome those barriers, and provides actionable recommendations to drive lasting change on this issue. The webinar will take place at 11:00-13:00 EST (16:00-18:00 GMT+1) Register for the webinar
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EventuntilIn this online event, the Chartered Institute of Ergonomics & Human Factors will be launching their new guidance packed with information on how human factors as a discipline can help address Equality, Diversity and Inclusion (EDI) issues. You’ll learn: How human factors can support the different protected characteristics under the Equality Act 2010. How human factors techniques and approaches contribute to EDI by increasing buy-in and engagement. How storytelling of lived experiences helps build a stronger sense of empathy. Who will this be of interest to? Are you an EDI or human factors professional eager to learn more about the relationship between these two areas? Are you a policy maker? Are you involved in dealing with human resources, UX and workplace issues that touch on EDI? If so, this webinar will be of interest to you. About the presenters Courtney Grant is a Senior Human Factors Engineer with twenty years’ experience across industry, consultancy and public service. Amanda Widdowson is Head of Human Factors Capability, Thales UK and Past President of the CIEHF. Abigal Wooldridge is Diversity lead at the US Human Factors & Ergonomics Society. How to book Register for your free place
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EventThe NHS is the biggest UK employer of Black and Minority Ethnic staff. More action needs to be taken to tackle disparities and prejudice to make our NHS more equitable for staff and patients alike. Dr Anu Obaro has recently shared her experiences through a BOB impact story, in which she has reflected on how she presented the subject to her peers at a roundtable event. Join Dr Anu Obaro and guests for a one-hour webinar as they discuss how you can take action to instil anti-racism where you work. In this webinar, you will learn: How racism can be institutionalised. How you can spread and scale the learnings from Dr Obaro’s write-up on BOB. How you can gather data to demonstrate outcomes in your workplace. Register
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EventuntilThe purpose of this online event is to demonstrate how human factors as a discipline can help address Equality, Diversity and Inclusion (EDI) issues. This webinar will explore the different situations that give rise to EDI issues, including the impact of equipment positioning on wheelchair users, the impact of open plan offices on neurodiverse people, and the impact of user interface language and terminology on people with communication difficulties. It will discuss the implications of these EDI issues, including the impact on the people directly experiencing them, as well as the wider impact on society. It will uncover how human factors can make a difference in addressing these issues, including adopting a systems approach, using a participatory design process and applying specific human factors methods to enhance EDI delivery. Register
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Event
Diversity is a fact, inclusion is a choice
Patient Safety Learning posted an event in Community Calendar
Diversity is a matter of makeup and composition. Inclusion is a matter of belief and behaviour. Diversity benefits no one unless we can unleash its power; simply putting diverse people together doesn't tap their creative potential. Inclusion does that. Inclusion releases talent and activates a cooperative system to harvest that talent. Without inclusion, we stall, sputter, and break down. Yet many organizations declare victory after becoming more diverse. That's a premature and uncritical celebration. Becoming more diverse is just the first step in a two-step transformation. This webinar will discuss the socialisation of exclusionary bias and how to accelerate its removal. We will also discuss the difference between bonding and bridging behaviours and conduct a global brainstorming session to identify specific bridging behaviors that organisations can implement to create sanctuaries of inclusion. Findings will be gathered, designed, and shared following the event. Agenda: What is diversity? (Make up and composition vs. Belief and behaviour) What is inclusion? (Being seen, heard, and appreciated) What is exclusionary bias? (Individual vs. systemic) How to accelerate the removal of exclusionary bias Biased behaviour brainstorm: Starting and Stopping Bonding vs. bridging behaviours: What’s the difference? Bridging behavior brainstorm: Starting and Stopping Register -
News Article
Confed chair: Trusts lacking senior diversity should not get top CQC ratings
Patient Safety Learning posted a news article in News
Trusts underperforming on leadership diversity should not be rated “good” or “outstanding” by the Care Quality Commission (CQC), the NHS Confederation chair has told HSJ. Victor Adebowale said he did not understand how organisations can achieve the top CQC ratings if they do not demonstrate sufficient diversity at senior levels. Lord Adebowale was speaking to HSJ alongside Marie Gabriel, following Ms Gabriel being appointed last month to chair the new NHS Race and Health Observatory, which is being hosted by the confederation. The influential peer’s comments also follow the new People Plan tightened criteria around equality, diversity and inclusion in the “well-led” aspect of the care quality regulator’s inspections. He said: “I struggle to see [how] any NHS trust that performs badly, [on] racial equality and leadership, can be considered to be good and outstanding. I don’t get it. “It seems to me there is enough regulation to take into account the requirement to lead all the people, all the time. But, obviously, if you’re not, then you shouldn’t be [getting] slaps on the back, and [be rated] outstanding or good in anything else.” Read full story (paywalled) Source: HSJ, 28 August 2020 -
News Article
The medical school trying to become anti-racist
Patient Safety Learning posted a news article in News
A major British medical school is leading the drive to eliminate what it calls "inherent racism" in the way doctors are trained in the UK. The University of Bristol Medical School says urgent action is needed to examine why teaching predominantly focuses on how illnesses affect white people above all other sections of the population. It comes after students pushed for reform, saying gaps in their training left them ill-prepared to treat ethnic minority patients – potentially compromising patient safety. Hundreds of other UK medical students have signed petitions demanding teaching that better reflects the diversity of the country. The Medical School Council (led by the heads of UK medical schools) and the regulator, the General Medical Council, say they are putting plans in place to improve the situation. A number of diseases manifest differently depending on skin tone, but too little attention is given to this in training, according to Dr Joseph Hartland, who is helping to lead changes at the University of Bristol Medical School. "Historically medical education was designed and written by white middle-class men, and so there is an inherent racism in medicine that means it exists to serve white patients above all others," he said . "When patients are short of breath, for example, students are often taught to look out for a constellation of signs – including a blue tinge to the lips or fingertips – to help judge how severely ill someone is, but these signs can look different on darker skin." "Essentially we are teaching students how to recognise a life-or-death clinical sign largely in white people, and not acknowledging these differences may be dangerous," said Dr Hartland. Read full story Source: BBC News, 17 August 2020 -
News Article
Fifth of GP partners remove BAME staff from patient-facing work in pandemic
Clive Flashman posted a news article in News
More than one in five GP partners said they removed practice staff away from face-to-face care due to ethnicity during the pandemic, a Pulse survey has revealed. The survey in June revealed that 84 of the 378 respondents said that ‘ethnicity was a crucial factor in removing anyone in your practice away from face-to-face assessments’. Around 70% of respondents said they had been counting ethnicity as a factor when risk assessing staff. See full article here -
Content ArticleThis article from the King's Fund examines the differences in health outcomes for ethnic minority groups, highlighting the variation across groups and conditions, and considers what’s needed to reduce health inequalities.
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Content ArticlePeople in Place highlights the fundamental skills and people issues which will determine the future of health and care in the UK. The Covid-19 pandemic has made these issues clearer and more pressing, but it has also revealed an appetite for change and resulted in innovative ways of working. This report argues that building effective collective leadership into systems and places is vital to overcome staffing and governance issues in the NHS. Focusing on building long-term frameworks for change rather than responding to immediate pressures, it suggests practical tools and resources that could be used to bring about transformation within the system.
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Content ArticleThis report by Roger Kline brings together a range of research evidence to suggest practical steps NHS employers can take to reduce inequalities in staff recruitment and career progression. It specifically focuses on the treatment of female, disabled and BAME staff. Written for practitioners, it summarises some of the research evidence on fair recruitment and career progression. It highlights principles drawn from research that underpin the suggestions made for improving each stage of recruitment and career progression.
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News Article
Messenger at odds with Javid over NHS diversity jobs
Patient Safety Learning posted a news article in News
Sajid Javid’s claim that the number of NHS roles dedicated to promoting equality and diversity should be cut is incorrect and not what the government-commissioned review into NHS management recommended, according to its author. The review by General Sir Gordon Messenger and Leeds Teaching Hospital chair Dame Linda Pollard was published Wednesday. Speaking to the Daily Telegraph on Tuesday evening, the health secretary said: “In my view, there are already too many working in roles focused solely on diversity and inclusion, and at a time when our constituents are facing real pressures around cost of living, we must spend every penny on patients’ priorities. “As this report sets out, it should be the responsibility of everyone to encourage fairness and equality of opportunity which is why we must reduce the number of these roles.” Speaking later to HSJ, Mr Javid was asked if there was any area of NHS management cuts should be made. He said: “I would like to see fewer managers in terms of diversity managers and things, because I think it should actually be done by all management and all leadership, and not contracted out as some kind of tick-box exercise.” However, when HSJ spoke to General Messenger he said: “The report does not recommend the reduction of EDI (equality, diversity and inclusion) professionals. “What it does say though, is that if one successfully inculcates equality, diversity and inclusion to every leadership’s responsibilities then that becomes an accepted, instinctive, understood part of being a leader and a manager at every level then the requirement for dedicated EDI professionals should reduce over time." Read full story (paywalled) Source: HSJ, 8 June 2022 -
News Article
Duty of all NHS staff in England to fight discrimination, review says
Patient Safety Learning posted a news article in News
All the NHS’s 1.5m staff in England should tackle discrimination against disadvantaged groups, not just bosses and specialist diversity teams, a major review has concluded. NHS trusts will need fewer equality, diversity and inclusion (EDI) teams if action against discrimination does become “the responsibility of all”, according to the report. The review of NHS leadership said the health service should adopt a different approach to equality issues in order to overcome the widely recognised disadvantages faced by certain groups of its own staff, which include lower pay and chances of promotion among Black and ethnic minority doctors compared with white medics and low BAME representation in senior managerial ranks. The inquiry, undertaken by Genl Sir Gordon Messenger and Dame Linda Pollard, was commissioned last year by Sajid Javid, the health secretary. The report concluded that: “Most critically, we advocate a step-change in the way the principles of equality, diversity and inclusion are embedded as the personal responsibility of every leader and every member of staff. “Although good practice is by no means rare, there is widespread evidence of considerable inequity in experience and opportunity for those with protected characteristics, of which we would call out race and disability as the most starkly disadvantaged. “The only way to tackle this effectively is to mainstream it as the responsibility of all, to demand from everyone awareness of its realities and to sanction those that don’t meet expectations.” Read full story Source: The Guardian, 8 June 2022 -
Content ArticleMore Inclusive Healthcare (MIH) works to positively impact disparities, providing customisable solutions to help teams measure and improve outcomes, enhance cultural responsiveness and strengthen the fault lines. MIH is based in the USA.
