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In this free webinar, Senior Consultants Mark Patterson and Matthew Rice will explore what systems leadership is, why it matters, and what it asks of leaders working across health and care. Drawing on their experience of supporting senior leaders through the Top Manager programme (TMP), The King’s Fund’s longest running leadership programme, they will share practical insights into leading across boundaries, working without direct authority, and staying curious in the face of complexity. This session will offer a practical introduction to systems leadership and will encourage you to reflect on your own leadership challenges and opportunities. It’s ideal for senior leaders who want to strengthen their ability to work across organisational boundaries and create change in complex environments. You will learn: what systems leadership looks like in practice in health and care why it matters when challenges span organisations, teams and services how to lead across boundaries when we you don't have direct authority why leadership in complex systems is often a collective endeavour and what that means for how you work with others. Register

In manufacturing a missed signal can cost a product, but in healthcare it can cost a life.  In this blog, Annette Cairns, a leadership development specialist, asks how we can adapt the system-level thinking seen in manufacturing for the unique human complexity, variability and vulnerability that patient care brings. In manufacturing, there was a moment—and you can trace it back through aviation, oil and gas and automotive—when the conversation about safety changed fundamentally. It stopped being about finding the person who made the mistake, and started being about understanding the system that allowed the mistake to happen. That change didn’t come easily or by any means quickly. It required organisations to accept an uncomfortable truth: that in complex, high-pressure environments, human error isn’t primarily a sign of individual failing. It’s a predictable consequence of how systems are designed, how cultures are shaped and how leadership behaves in the moments that really count. The results, where that change has genuinely taken root, have been significant. Aviation is the most cited example—an industry that rebuilt its entire safety culture around the principle that hierarchy, in a cockpit or control tower, cannot be allowed to silence a concern. Crew Resource Management gave co-pilots not just permission but a structured obligation to speak up, regardless of seniority. Near-miss reporting removed the threat of punishment from honesty. Safety culture became something designed into the system, not dependent on the courage of individuals. In manufacturing, parallel principles emerged. James Reason’s Swiss Cheese model gave organisations a language for understanding that failures are almost never caused by one person, but instead they happen when holes in multiple defensive layers happen to align. Toyota’s production system gave every worker on the line the ability to stop everything the moment something didn’t look right. The message was clear and consistent: the system is designed to receive your concern. You don’t need to be brave to raise it. Speaking up is what we do here. Healthcare has borrowed much of this thinking, and rightly so. Just Culture principles, incident reporting frameworks, the language of human factors, all have roots in what manufacturing and aviation learned the hard way over decades. And yet a significant gap remains. It sits not within the clinical team, but between the clinical team and the patient. This is where healthcare faces a layer of complexity that manufacturing simply does not. In manufacturing, the subject of a safety concern, whether it’s the process, the component or the output, has no psychological state. It isn’t frightened. It doesn’t defer to the expertise of the people responsible for it. It has no uncertainty about what ‘normal’ feels like, no anxiety that raising a concern might result in worse treatment, no cultural background or language barrier that makes speaking up feel impossible or unsafe. A patient has all of these things. And they have them at the precise moment they are most vulnerable, most dependent on others and are least certain of their own ground. They are, in the truest sense, inside the system they are being asked to influence. That is a profoundly different position from a worker who can step back from a production line and raise a concern from a position of relative stability. When a patient stays silent about something that concerns them, they are rarely choosing silence because they lack information or awareness. They are making a calculation (often unconsciously) based on the culture they are experiencing: the responsiveness of the people around them, the signals they have received about whether their voice is genuinely welcome, and the very human fear that being perceived as ‘difficult’ might affect the quality of their care. In a system where patients feel they must be compliant to be safe, we have already failed at the most fundamental level. Traditionally, healthcare has tried the route of patient education, but you cannot close this gap just by training patients to be more assertive or by producing better information leaflets about how to raise concerns. It is an organisational and leadership problem—and I believe one that requires the same system-level thinking that transformed safety culture in manufacturing. It requires leaders who understand that psychological safety for patients is not a clinical add-on. It is a core organisational competency. Leaders who ask not just "did we give the patient an opportunity to speak?" but "have we genuinely designed a system in which speaking up is the path of least resistance—and in which our teams have the skills and the capacity to hear what patients say, and act on it?" My extensive work on health and safety behaviour change in manufacturing and technical organisations has consistently shown that the leadership behaviours which create safety: active listening, psychological safety, the reward of raising concerns rather than resolving them quietly, are not industry-specific. They are human. What is industry-specific is the stakes when those behaviours are absent. In manufacturing, a missed signal can cost a product. In healthcare, it can cost a life. The framework for getting this right already exists. Manufacturing and aviation built it over decades of hard-won experience. The question for healthcare is not whether to adopt this system-level thinking, but how to adapt it for the unique human complexity, variability and vulnerability that patient care brings. That work starts with leadership. It always does.

Craig Russo outlines the Core Needs School Pilot, a needs-led, school-based early intervention model for young people with neurodevelopmental needs. He describes how embedding clinicians in schools enables rapid, functional assessment and support without waiting for diagnosis, improving outcomes while significantly reducing costs and demand on specialist services. It demonstrates impact and support expansion, highlighting strong value for money, improved access and alignment with national SEND reform principles. The Core Needs provides a clear, practical example of how a needs‑led model can be operationalised at scale within mainstream education, moving beyond theory into delivery. It demonstrates how embedding clinical expertise directly into schools transforms access, shifting support closer to children and young people and enabling real-time assessment, observation and intervention in their everyday environment. This approach not only improves timeliness but strengthens relationships between health, education and families, creating a more joined-up system that is easier to navigate. A key learning point is the power of intervening early with functional, strengths-based support rather than relying on diagnostic thresholds. The model shows that many young people can be effectively supported through a single, well-structured intervention, supported by a period of watchful waiting and clear step-up pathways when required. This has important implications for demand management, demonstrating a credible route to reducing pressure on specialist services while maintaining safe and appropriate escalation. The pilot also highlights the importance of building capability within schools. By working alongside SENCOs and staff, clinicians are not only supporting individual children but leaving a lasting legacy of increased confidence, skills and consistency within the wider workforce. This creates a multiplier effect, where impact extends beyond the initial intervention and contributes to longer-term system resilience. From an operational perspective, the pilot identifies critical enablers of success, including strong multi-agency partnership working, clear referral processes, dedicated workforce capacity and a structured delivery model. It also makes clear the risks of not investing, particularly around increasing demand, widening inequity of access and continued reliance on costly statutory pathways. For decision-makers, the key action is to consider how this model can be embedded as part of the core local offer, rather than as a time-limited pilot. The evidence presented supports scaling through a phased approach, ensuring quality and consistency are maintained while expanding reach. It also prompts a wider reflection on how services can redesign pathways to prioritise early intervention, improve flow and ensure that resources are directed where they have the greatest impact. Overall, this pilot offers a compelling, evidence-informed case for system change, showing not just what should be done differently, but how it can be delivered in practice in a way that is sustainable, equitable and centred on the needs of children and young people. More blogs on the hub from Craig Russo: Partnership working between A&E, the police and custody healthcare

As one of the three shifts set out in the 10 Year Health Plan, technology and the digitisation of health and care is expected to change the way people access and interact with services, reduce administrative tasks to free up staff time, and even prevent ill health occurring in the first place. While the technology landscape is evolving rapidly, the NHS itself is also undergoing significant structural change, including the planned abolition of NHS England and substantial cuts across integrated care boards. These changes have direct implications for the entire workforce, and the patients and communities they support. This free King's Fund online event, will explore what health and care leaders need to truly shift from analogue to digital; recognising that transformation, innovation and partnership working demands good leadership, the right infrastructure and capacity and capability development. The event will discuss: the current state of digital leadership across systems and organisations with different levels of digital maturity examples where structural changes and budget cuts are having an impact on digital priorities outlined in the 10 Year Health Plan emerging approaches to deliver digital priorities that better care for patients. Register

On the 14 May 2026 the UK Government introduced the Health Bill in the House of Commons, also known as the NHS Modernisation Bill. This new legislation is intended to introduce two significant changes, joining up health information and abolishing NHS England. This article pulls together a number of different reflections shared on this bill as it proceeds through Parliament. The Health Bill 2026-27 is a new piece of Government legislation which aims to: Improve patient safety and experience through a new single patient record, enabling joined-up, proactive care and empowering patients. Put power and resources in the hands of frontline NHS organisations by abolishing NHS England and stripping back national bureaucracy. Clarify the role of local health bodies, giving them real flexibility to design and deliver health services to best meet the needs of their local populations. Department of Health and Social Care The UK Government has published a collection of resources about the Health Bill, including fact sheets on the following topics: Single Patient Record Role and functions of the restructured Department of Health and Social Care Data and digital functions Oversight of the health system Integrated Care Boards as strategic commissioners Providers Patient safety Patient voice Patient Safety Learning Following the announcement of the NHS Modernisation Bill in the King’s Speech 2026, Patient Safey Learning published an article highlighting six key takeaways from this speech from a patient safety perspective. This includes reflections on specific provisions in the Bill including: Transferring the Health Services Safety Investigations Body functions to the Care Quality Commission. Creating a new single patient record. Transferring the functions of Healthwatch England to the Department of Health and Social Care and creating a new Patient Experience Directorate in the Department of Health and Social Care. Abolish NHS England and making several changes to the role of Integated Care Boards. The King’s Fund The health and care charity and think tank, The King’s Fund, have created a new area on their website where they are sharing all their latest analysis, commentary and responses on the Health Bill as this legislation developments. This includes an article by their Chief Executive Sarah Woolnough setting out five tests for the NHS Modernisation Bill. Nuffield Health In this article, Becks Fisher, Director of Research and Policy at the Nuffield Trust, discusses key issues raised by the NHS Modernisation Bill. He considers this in the context of the departure of Wes Streeting MP as Secretary of State for Health and Social Care, and his replacement with James Murray MP. Health Service Journal In this episode of the Health Service Journal Health Check Podcast, Annabelle Collins and Dave West are joined by Hugh Alderwick, Health Foundation director of policy and research, to help unpick the 200-page legislation and what it will mean for the service. House of Commons This article provides a brief overview of patient safety issues raised in a debate in the House of Commons on Monday 1 June 2026, during the second reading of the Health Bill 2026-27. The second reading is the stage of the UK legislative process where Members of Parliament (MPs) debate the general principles and main purpose of a proposed piece of legislation. Carnall Farrar (CF) In a helpful infographic, CF’s snapshot of the NHS Modernisation Bill focuses on the provisions most relevant to NHS leaders and executives: what is changing, when, and what it may mean in practice.

The King’s Speech 2026 sets out the programme of legislation that the UK Government intends to pursue in its next parliamentary session. This blog highlights six key takeaways from this speech from a patient safety perspective. On Wednesday 13 May 2026, Kings Charles III delivered his annual speech in the Lords Chamber at the State Opening of Parliament.[1] Written by the Government and delivered by the Monarch, the speech presents opportunity at the start of a new parliamentary session for a government to set out its plans for the year ahead. This year’s speech includes two pieces of proposed legislation that have, potentially, significant implications for patient safety: NHS Modernisation Bill Public Office (Accountability) Bill In this blog, we highlight six takeaways from these proposed bills from a patient safety perspective. 1. Future of the Health Services Safety Investigations Body The NHS Modernisation Bill includes several changes to the patient safety landscape in England. These involve the implementation of several key recommendations put forward in Dr Penny Dash’s Review of patient safety across the health and care landscape last year.[2] This includes the recommendation to transfer the Health Services Safety Investigations Body (HSSIB) functions to the Care Quality Commission (CQC). In our response to the Dash Review, we stated our belief that HSSIB has an important independent role in the health system which should be retained.[3] There are understandable concerns about the potential for its independence to be compromised by its functions being transferred to the CQC.[4] [5] More broadly, we know that many staff working in healthcare do not feel confident raising concerns. As NHS Staff Survey results continue to illustrate, nearly two-fifths of staff say they do not feel safe to speak up about concerns.[6] Recognising the importance of staff feeling able to speak freely in investigations, HSSIB currently conducts these using a ‘safe space’ approach. This prohibits, on a legal basis, the unauthorised disclosure of protected material. Even if this legal assurance is maintained under these proposed changes, there still may be concerns that moving HSSIB into the CQC could potentially undermine staff confidence that confidentiality will be maintained. If confidence in the independence and confidentiality of HSSIB’s investigations is undermined, whether in reality or perception, this could compromise understanding of what is really happening on the ground. HSSIB’s ability to do this is an essential prerequisite to understand what the risks to patient safety are and the action needed to address these. We await further detail in the NHS Modernisation Bill on how these challenges will be addressed. 2. Embedding patient voice in national decision making Other notable recommendations from Dr Penny Dash’s review expected to feature in the NHS Modernisation Bill include: Transferring the functions of Healthwatch England to the Department of Health and Social Care. Developing a new Patient Experience Directorate in the Department. In our response to the Dash Review, we welcomed the proposal to create a new National Director of Patient Experience, alongside a Patient Experience Directorate. A new central body offers potential benefits for pooling expertise and resources. However, questions remain as to whether these changes could risk making the routes through which patient experience and concerns influence decision making less visible and more diffuse.[7] [8] [9] [10] It is vital that these changes improve the health systems capacity to listen and respond to patient experiences. We believe that an important element of this will be ensuring this new Patient Experience Directorate can benefit from regional and local experience and expertise. We would expect to see further detail setting this out in due course, considering how this will connect with local models for engaging with patients, families and carers. Specifically, we would also seek clarity on how this Directorate will work with local and national Patient Safety Partners, whose roles were not mentioned in the Dash Review. 3. Creating a new single patient record Another key strand of the NHS Modernisation Bill will be plans to create a new Single Patient Record. This is intended to “enable people to see their own health records securely on the NHS App, empowering them to make informed decisions about their own health”.[11] In our response to the 10 Year Health Plan for England, we stated our support for this initiative.[12] It is broadly acknowledged that if implemented effectively, this could make a real difference in improving joined-up communication in the NHS.[13] Patients not only need easy access to their records, but simple mechanisms to flag concerns and address any inaccuracies in a timely manner. Mistakes in records can create significant patient safety risks, and as illustrated by patient experiences shared with us on our patient safety platform the hub, amending these is often not a simple process.[14] 4. Introducing the Hillsborough Law The proposed Public Office (Accountability) Bill would put in place a new professional and legal Duty of Candour—meaning public officials must act with honesty and integrity at all times. This was previously announced in September 2025 and the Bill itself has already been tabled in Parliament.[15] We welcome this legislation. Patient Safety Learning believes it should be a requirement to be honest and transparent with patients and their families when something goes wrong, and this should be fundamental for all staff. The proposals in this new legislation have greater scope than the existing statutory Duty of Candour in the NHS, with a focus on systemic institutional behaviour. It is also notable that these provisions of the Bill will apply to the whole of the UK, not just England and Wales. 5. Abolition of NHS England The NHS Modernisation Bill will legislate to integrate NHS England’s functions into the Department of Health and Social Care, as first announced last year.[16] While we are still waiting further detail of what this will look like in practice, the existing National Patient Safety Team at NHS England is likely to be impacted by these changes. This Team is currently responsible for owning various patient safety programmes and policies and issuing safety warnings and recommendations. As stated in our response to the 10 Year Health Plan for England, an area of concern for us remains the lack of significant capacity to intervene if necessary for the purposes of improvement at a national level. Alongside this, there is also currently no national body able to commission or develop solutions that all organisations can use and adapt to improve patient safety. If healthcare providers identify a systemic issue that needs to be addressed because it affects other organisations, there is no national organisation that has the role or capacity to act on this. Instead, providers are left to find local solutions to system-wide concerns without a vehicle for widespread dissemination and evaluation. We believe this gap places a serious limitation on the healthcare system’s ability to reduce avoidable harm. It does little to address the inconsistencies in care across the country, with multiple different responses and workarounds to system-wide problems with varying levels of success. It is also a significant missed opportunity if we fail to take learning gained from provider organisations and apply this nationally for improvement in a meaningful way. This is an issue we think should be considered and addressed in the future merger of NHS England and the Department of Health and Social Care. 6. Changes to Integrated Care Boards Finally, the NHS Modernisation Bill will also include several changes for Integrated Care Boards (ICBs), including: Refine the membership of ICBs. Placing new requirements for mayoral nominees to be on ICBs. Confirming their role as strategic commissioners, by transferring responsibilities for all but the most specialised commissioning functions to ICBs. In a joint blog with the Advancing Quality Alliance (Aqua) earlier this year, we noted that there is huge opportunity for ICBs to drive a systemic approach to patient safety through their strategic commissioning responsibilities.[17] [18] [19] However, there is currently significant variation in ICBs involvement in safety management activities.[13] With the right support ICBs have the potential to develop an integrated and coordinated approach to safety, reflecting patient care pathways across systems and ensuring consistency and collaboration. We would hope to see this included in these changes considered in the provisions of the NHS Modernisation Bill, and in the forthcoming new NHS Quality Strategy. References Prime Minister’s Office. 10 Downing Street. Oral statement to Parliament: The King’s Speech 2026. 13 May 2026. Department of Health and Social Care. Review of patient safety across the health and care landscape. 7 July 2025. Patient Safety Learning. Review of patient safety across the health and care landscape: Patient Safety Learning‘s response. 15 July 2025. Macrae C. Failing to learn? The NHS is losing its capacity for system-wide safety investigation. Journal of the Royal Society of Medicine, 2025; 118(10). Health Service Journal. Merging watchdog into CQC will ‘destroy’ independence. 26 February 2026. Patient Safety Learning. Patient Safety Learning’s response to the NHS Staff Survey Results 2025. 13 March 2026. Martin G, O’Hara J. Hope over experience? Patient and staff voice in the NHS after the Dash review. 1 2025;390:r1514. Cox C. Is the patient voice fading? Reflections on patient safety in a changing NHS. Patient Safety Learning. 28 January 2026. Morris L, et al. The Kings Fund. The future of patient voice: learning from the Healthwatch model. 18 March 2026. Patient Safety Learning. Patient voice, safety and the NHS 10 Year Plan: Reflections from the Patient Safety Forum 2026. 23 March 2026. Prime Minister’s Office. 10 Downing Street. King’s Speech 2026: background briefing notes. 13 May 2026. Patient Safety Learning. 10 Year Health Plan: Patient Safety Learning’s response. 14 August 2025. The Kings Fund. The King’s Fund responds to the King’s Speech and the introduction of the NHS Modernisation Bill. 13 May 2026. Anonymous. The digitalising of patient records – why patients MUST be involved. Patient Safety Learning. 16 April 2024. House of Commons. Public Office (Accountability Bill), Session 2024-26. Last updated 5 May 2026. Department of Health and Social Care. World’s largest quango scrapped under reforms to put patients first. 13 March 2025. Patient Safety Learning and Aqua. Patient safety and the new NHS Quality Strategy. 25 February 2026. Aqua. What Should Safety Look Like at a System Level. 6 April 2023. Patient Safety Learning. The elephant in the room: Patient safety and integrated carer systems. 11 July 2023. Health Services Safety Investigations Body. Safety management: accountability across organisational boundaries. 13 February 2025.