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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

Race inequality in health and care. Who’s responsible?

Jan 25, 2023, 16:59 by Sam Rodger, Assistant Director, Policy and Strategy, NHS Race and Health Observatory
In the latest in our series of guest blogs to discuss issues raised in our report Safer care for all, Sam Rodger from the NHS Race and Health Observatory discusses how making race equity everybody's job risks it being nobody's job, but we can all have a shared ambition to create a culture of equity

Our report Safer care for all  launched at a Parliamentary reception on 6 September 2022. It highlights some of the biggest challenges affecting the quality and safety of health and social care across the UK today.

With the publication of Safer care for all, we started a debate on the issues highlighted in the report and the recommendations we put forward. As part of this debate, we are publishing a series of guest blogs written by stakeholders from across the sector. This blog is from Sam Rodger, Assistant Director, Policy and Strategy at the NHS Race and Health Observatory.

The NHS is for everyone, we are told. This is the promise of our most treasured national institution. The very first principle of the NHS constitution sets out a commitment to provide a comprehensive service, available to all, irrespective of a person’s protected characteristics. More than that, the NHS constitution outlines a “wider social duty to promote equality” through the services it provides. So, whose job is it to make this a reality?


Everybody’s job

The answer we often hear is that it’s everyone’s job. We’re told that considerations about racial and ethnic equality should be a ‘golden thread’ embedded in all discussions about healthcare. We are told that every policy decision should be underwritten by an Equality Impact Assessment. We are told that every member of staff in the NHS, from the CEO to each and every clinician, should be mindful of potential health inequalities, and should work to eliminate them where they find them.

This means each GP and practice manager should be thinking about ethnic health inequalities in their local population, and that individual nurses, receptionists, allied health professionals, and other members of staff should be culturally competent. It means that commissioners should be allocating funds according to the needs of our most marginalised communities, ensuring that nobody is left out of the great promise of an NHS for all.

More recently, we are told that the newly established Integrated Care Boards will have responsibility for taking a place-based population health approach to delivering services in an equitable way. The hope is that, by joining up the NHS with Local Authorities and other providers of essential services, we will make it impossible for the needs of marginalised communities to fall through the cracks, as has so often been the case in the past.

Nobody’s job

But what is happening on the ground? Is it realistic to expect NHS leaders to give their limited time and resources to race equity when they are under significantly more pressure to cut costs and reduce waiting times? Is it reasonable to expect members of staff – usually from ethnic minority communities themselves – to give their free time to the cause of achieving race equity?

As the old saying goes, when it’s everybody’s job, it’s nobody’s job. Across the system, we see a phenomenon whereby everyone thinks someone else should be responsible for making a difference. There’s not enough money, our leaders might say, to fund the extra community engagement required to properly cater services to our most vulnerable marginalised communities. I recently met a GP who claimed they would love to spend more time out in their local community fostering trust, but that they were already struggling to keep on top of the rising demand for consultations. And perhaps there wouldn’t be such a need to build this trust at a local level if cultural competence were considered at the outset of public health campaigns.

Part of the issue is accountability. Is anyone really held to account for delivering on race equity in the NHS? It is currently possible for a trust with among the lowest scores on the NHS Workforce Race Equality Standard (WRES) to still be rated ‘Outstanding’ by the Care Quality Commission (CQC). What message does this send to Black, Asian and ethnic minority members of NHS staff? What message does it send to members of the public when leaders are not held to account for the continued poorer outcomes experienced by these communities?

In a similar fashion, the NHS announced in 2020 that each provider organisation in the NHS (including both trusts and ICSs) was required to appoint a board-level accountable lead for health inequalities. In our research on these appointments, we found a huge variation in the levels of support available to these leads, and in the amount of power they felt they had to effect change. Moreover, at a national level, it remains unclear who is responsible for ensuring that these appointments have been made, or who is responsible for holding them to account. This is particularly concerning given the lack of representation among ICS Chairs and Chief Executives.

Most concerningly of all, we have recently seen that the NHS has dropped targets in its planning guidance aimed at ensuring an organisation’s leadership reflected the racial diversity of its workforce.

Moving towards an equity culture

As we have seen repeatedly in the past, we are reaching a point where the NHS is under such significant strain that considerations about equity are becoming an afterthought. When targets around equity are forgotten, so too is the dream of an NHS that serves everyone equally and with dignity.  Exacerbating this is an increasing tendency for efforts to promote equity to be dismissed as ‘wokery’ by some media outlets and politicians.

In truth, equity should be everyone’s responsibility. It should be a fundamental tenet of every job description, policy document and target that the health sector produces. But if equity is ever to be more than a tick-box exercise, it must be embedded in a holistic framework of accountability.

For regulators, this likely means considering their internal processes first – ensuring that their fitness to practise procedures and their role in clinical education are free of bias. Then, it means considering how members of the health and care workforce are encouraged and supported to champion equity in their work, but also how they are held accountable for doing so. What, for example, is the role of revalidation and appraisal in making a difference?

Most importantly of all, we must all look beyond our individual roles and consider how each of us can contribute to a culture of equity. A culture is not just carefully chosen words, or a list of generic ‘values’ on a corporate website. A culture is formed of human interactions and behaviours. A culture is formed when people ask questions, when they listen to the views of others, when they speak out in a meeting, when they recognise their lived experience – privileged or not – may be at polar opposites from others in the room.

Accountability is the start of a journey towards health equity. But an equity culture must be the shared ambition of everyone in our health and care sector if we are to move forward.

Find out more

Read our full report Safer care for all - solutions from professional regulation and beyond  or through chapter 1 -  No more excuses - tackling inequalities. There are also shorter versions available, including the executive summary, you can download these versions here.

Find out more about the NHS Race and Health Observatory here

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