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Safer care for all

Solutions from professional regulation and beyond

In our report - Safer care for all - (published in September 2022) we examine the current state of professional health and care regulation in the UK. However we go beyond this in identifying and proposing solutions to some of the huge challenges facing health and social care today.

Our report considers four main themes:

  1. Tackling inequalities
  2. Regulating for new risks
  3. Facing up to the workforce crisis
  4. Accountability, fear and public safety

Next steps for Safer care for all and how it ties in with our strategic direction

We published Safer care for all in September 2022. Since then we have been carrying out extensive engagement with stakeholders (including by consulting on our draft Strategic Plan) to develop our focus for the next three years and plan for 2023-24.

During 2023/24 we intend to focus on the interlinked issues of workforce, inequalities and accountability. A recurring theme in our discussions with stakeholders was that of culture in health and care. We realise that the PSA, alone, cannot tackle poor workplace culture or the problems associated with it, but we hope that with the ambitious aims we've set out in our strategic plan, we can make a start and work with others to to highlight improvements needed to assure better and safer care for all.

  1. Workforce – we know that workforce shortages impact patient safety as well as professionals’ workplace wellbeing. We want to focus on building the evidence base around the regulatory barriers. Working with regulators and wider stakeholders, we want to identify solutions to help create a more agile workforce as well as encourage innovation. We think this work will help us shape a practitioner regulatory strategy. We believe this is needed to support health and care workforce strategies across the four countries of the UK.  
  2. Inequalities – in addition to the work we are doing to revise our expectations of how regulators will meet Standard 3 as part of our performance review process (Standard 3 of our Standards of Good Regulation is focused on regulators understanding the diversity of their registrants, patients and service users and not creating barriers through any of their processes/disadvantage people with protected characteristics), We are also introducing a new EDI standard for the Accredited Registers. Our work in this area will focus on engaging and convening stakeholders on key issues where we can add value and support action. This will include disseminating our consumer research on perceptions of discriminatory behaviour in health and care and looking at barriers to complaints and the role of healthcare professionals in tackling health inequalities.
  3. Accountability – our main focus in this area will be to work with regulators to encourage clear messaging on the role of professional regulators when there have been serious failures of care. We also want to facilitate and encourage stakeholders to look at how to learn from serious patient safety incidents. This will include consideration of the wider issues we are aware of that may impact on professionals’ fear of regulation and wider accountability mechanisms, such as blame culture, barriers to candour and experience of ‘moral injury’ by healthcare professional involved in major failures of care.      
  4. Safety system – work in this area will be primarily focused on building our evidence base on how the functions proposed for the Health and Social Care Safety Commissioner might be delivered in different ways across the four UK countries and engaging with existing bodies fulfilling some or all of these functions across the UK. We want to explore how improvements in the safety system might be achieved. We also intend to engage with stakeholders on the case for a more coordinated approach to public inquiries and reviews (through a Commissioner role or otherwise).     

We will continue having conversations with stakeholders as we take forward this work through the year so watch this space.


Take a closer look at the four issues

Tackling inequalities

There are still unequal and unfair outcomes for protected groups in aspects of professional regulation. There is also a lot we still do not know about how inequalities affect all-important complaints mechanisms when care has gone wrong – or indeed what this could tell us about biases in care itself. Professional regulation must work to address its own issues, and support professionals to help tackle inequalities in the design and delivery of care. But as a sector, we also need to be better at hearing diverse voices, and collecting, analysing and sharing data.

>>Find out more

Facing up to the workforce crisis

Workforce shortages are putting patients and service users at risk across the UK. Engrained attitudes to professional regulation and qualifications aren’t helping. Is it time to rethink the contribution of professional regulation to workforce planning?

>>Find out more

Regulating for new risks

Changes in the way that care is funded and delivered are sometimes made with limited focus on the risks and impacts on patients and service users, and how to manage them. Reforming the regulators gives us an opportunity to address known problems, and may even build in some agility for the future – if we take the opportunity presented to us. But we also need better, more reliable ways to anticipate these changes.

>>Find out more

Accountability, fear and public safety

Just cultures and individual accountability are both essential to better, safer care, and must coexist. Professional regulation should be clearer about its role, to reduce unnecessary anxiety and inappropriate complaints. We need to find ways for these new approaches to safety such as ‘safe spaces’, to incorporate openness with patients, service users and families, and action against individuals where it is needed for public safety.

>>Find out more

Read all recommendations

You can find a table of all our recommendations here. This is not also a case of the 'we say, you do' - we have also committed the Authority to play an active role in tackling these challenges. These commitments are also listed in the table.

What would you like to read?

We have several versions available.  Not got time to read the report in full? You can read through the executive summary here. This encapsulates the four main themes set out in the report as well as the recommendations we have put forward. Even more pressed for time? Then read The essentials - this (very) short section tells you what the report is all about.

You can also download:

There is also a Welsh translation available of front part of the report, including The essentials and the executive summary. You can download it here

We also have a Word version of the full report available. Please get in touch - using the email address below - if you would like a copy.

Please get in touch with us if you would like a Word version of the full report.

Starting the discussion

Safer care for all conference 

When we published Safer care for all in autumn 2022, one of our main aims was to start a debate on the issues highlighted and the recommendations we put forward in the report. To take the next steps we organised a conference. On 9 November 2022, over 250 attendees came together (virtually) to discuss issues highlighted in the report, including:

  • 'Does regulation need to change to deliver the workforce of the future?'
  • 'Do health/care professionals have a duty to tackle inequalities?'
  • 'Is regulation keeping patients safe?'
  • 'Are learning cultures compatible with individual accountability and openness when mistakes are made?'

The conference provided an opportunity to hear experts’ views as well as consider and contest the themes raised in the report. Speakers and delegates came from both professional and system regulators as well as patient organisations, the ombudsman, the NHS, health and care sector organisations and Chairs from major healthcare inquiries. You can find a summary of the main themes that came out of the discussions here.

Safer care for all guest blogs

We are also publishing a series of guest blogs written by stakeholders from across the sector. You can find all our guest blogs published to date below:

Read our blogs

Who isn't complaining? Learning from those who do not complain

Dec 16, 2022, 13:26 by Jacob Lant, Head of Policy, Public Affairs, Research and Insight, Healthwatch England
In this blog, Jacob Lant, Head of Policy, Public Affairs, Research and Insight at Healthwatch England, explains how the healthcare system can use complaint processes to address inequalities in healthcare and how this can help us understand the demographic of those who are not complaining to learn about those who are receiving poorer outcomes.

Our report Safer care for all launched at a Parliamentary reception on 6 September. It highlights some of the biggest challenges affecting the quality and safety of health and social care across the UK today.

We want Safer care for all to start a debate on the issues highlighted and recommendations we have put forward in the report. As part of this debate, we are planning to publish a series of guest blogs written by stakeholders from across the sector. This guest blog is from Jacob Lant, Head of Policy, Public Affairs, Research and Insight at Healthwatch England.

Complaints and feedback from patients and the public are vital sources of knowledge for the health service. Understanding who is complaining, and proactively seeking out feedback from those who do not, is vital to ensuring the NHS learns from the experiences of women, ethnic minorities, and other groups who experience poorer health outcomes overall. Yet official data about NHS complaints collected by NHS Digital currently tracks only the age of complainants and no other demographic characteristics.

At Healthwatch England, we know that most people who make a complaint don’t do it in search of compensation or retribution. They are motivated by a desire to improve care for others in the future. Seeing evidence of how past complaints have led to change and improvement makes people more likely to speak up for themselves in the future.

We also know that not everyone wants to make a formal complaint – a focus on encouraging and acting on informal feedback can empower patients to speak up through informal routes, avoiding the complexity of a formal process while giving services the same opportunity to learn and improve.

Research we conducted in 2019 found that while most trusts report publicly on the number of complaints they receive, only a minority make public any information on the changes they’ve made in response to complaints. Since then, there have been important national initiatives aimed at improving how the NHS approaches learning from complaints.

The Parliamentary and Health Service Ombudsman (PHSO) has led on development of a Complaints Standards Framework, which sets out a single national set of standards on how services should approach learning from complaints, and what feedback patients can expect to see. NHS England’s regional complaints teams have also been doing important work to compare complaints data across regions and support thematic learning on a national level.

We know that many people would like to share feedback with services on how they could improve, but only a small proportion do. The most common reason for this is that people don’t know how to share concerns.

When it comes to formal complaints, the barriers to navigating an often complex and lengthy process are even higher. Through feedback collected as part of our accessible information campaign, we know that people with sensory impairments and disabilities, as well as those who speak little or no English, often find complaints processes inaccessible.

These are also people who are already more likely to be experiencing barriers to accessing services or to receive worse quality of care. Out of 139 hospital trusts who responded to our Freedom of Information requests, only 53% reported that they always ask patients about accessible information needs at the point of first contact, and only a third (35%) told us they are fully compliant with all parts of the legally binding Accessible Information Standard.

The pandemic has also thrown up additional challenges for managing and learning from complaints, including delayed timescales for processing complaints, as well as the transition of complaints management responsibility from NHS England to Integrated Care Systems (ICSs) in some cases.

The first step to improving the accessibility of complaints processes, and ensuring that health services are proactively seeking out feedback from all patients, especially those less likely to speak up, is understanding who is complaining and who is not. To use complaints processes to address health inequalities, services need to collect more robust demographic data, including age – as currently mandated - plus gender, ethnicity, and disability at a minimum.

Our 2020 report on hospital complaints suggested several ways this demographic collection could be mandated nationally, including through an NHS Digital submission requirement, or by amending statutory complaints regulations. Services can also take the initiative to collect this data locally, although a common national taxonomy would be beneficial for regional comparisons. 

Services and ICSs should use this data to compare with demographics of patients across the service or region, to understand whether certain groups are more or less likely to complain. This would serve two purposes: allowing services to investigate whether certain groups are complaining more because they are experiencing worse care, as well as allowing services to understand which groups may be experiencing barriers to complaining and working to address these.

It’s also important to look at any complaints that have been made about the accessibility of services, to proactively address any barriers to complaining. But we know that complaints categories are not always helpful to looking at themes across a service: responding to our FoI requests, most hospital trusts told us they could not be sure how many complaints they had received around accessible information, as they had no standard way of coding these.

Lived experience groups could help services review their complaints categorisation approach to ensure there is a consistent way of logging complaints around accessibility or access for disadvantaged groups. Local Healthwatch and our partner organisations in local communities stand ready to support services in making their complaints processes more accessible, including by convening lived experience groups to feed into improving the complaints process. As part of this process, people with lived experience should be compensated for their time and input.

We’ve come a long way in recent years on shifting the mindset around complaints away from a culture of blame to a culture of learning. But there is still more to do to ensure that everyone feels equally empowered to share their experiences. Collecting the right information about who is complaining is the first step to understanding who is more or less likely to speak up and levelling the playing field. 

Related material

In the first chapter of our report Safer care for all, one of our main recommendations is to call for 'Regulators and registers work with other health and care bodies to gain a better understanding of the demographic profile of complainants and reduce barriers to raising complaints for particular groups.' Find out more in the chapter on Tackling inequalities, the full report or a list of recommendations and commitments.

Get in touch

Contact us if you would like to join the discussion about how we can work together to make health and social care safer for all. You can get in touch by emailing