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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

How can regulation support the healthcare workforce in Wales – now, and in the future?

May 3, 2023, 08:09 by Professor Marcus Longley
In this blog, our Board member, Marcus Longley, gives a brief overview of discussions as part of our joint seminar looking at the current regulatory context in Wales

In late March, in partnership with the Welsh Government, we held our sixth annual seminar exploring recent healthcare regulatory policy developments in Wales and across the UK. Delegates from across the sector joined us and together we discussed the current issues and challenges which are influencing Welsh Government policy.

As noted in the opening remarks by the Welsh Government’s Chief Nursing Officer Gillian Knight, there is a clear commitment from the Welsh Government and those in the sector to work towards shared goals of maintaining staff and patient safety despite some differing approaches across the UK. There is also a firm commitment to provide the NHS and care sector with the skilled workforce it needs.

There needs to be close collaboration underpinning a UK-wide commitment to considering issues of regulation. Differences in professional regulation do exist for a variety of reasons; nonetheless, equitable and balanced regulation is crucial, particularly as we move towards a multidisciplinary way of working which creates new challenges for workforce planning.

Ensuring our workforce can deliver safe and quality care

In our first session, we asked the question: ‘What skills do the health and care workforce need and what do services need from regulators to provide safe and quality care?’

We heard from a range of speakers from the General Medical Council Wales, Health Education & Improvement Wales, Social Care Wales and Cardiff & Vale University Health Board. All agreed that legislative reform is now essential to ensure regulation can be effective and support multi-disciplinary team working. As the health and social care system continues to evolve in Wales, regulators must continue to learn, adapt and collaborate with others – and regulation must be seen as a fundamental element of the strategy, not something separate.

Initially, discussions focused on the critical need for reform for the medical profession, amplified by the growing dependence on international medical graduates (IMG). While work is ongoing to improve Equality, Diversity and Inclusion outcomes for doctors, there is still a disproportionate number of IMG and ethnically-diverse doctors being referred for fitness to practise investigations.

More broadly across the healthcare system, stress and burnout issues are a significant challenge. It was observed that workforce data could be better used to support the system, including identifying areas with high burnout rates and addressing staffing shortages which lead to poorer quality of patient care. Lack of education and training opportunities can also exacerbate workforce pressures.

So what can be done to support the workforce? All agreed that prioritising staff wellbeing was essential, so that they can provide the best possible care to patients. Promoting an inclusive and fair working environment and addressing systemic issues through a learning culture will lead to improved outcomes.

And it’s crucial for professionals to have access to ongoing CPD and leadership support so that they can adapt to new ways of working and new models of care, such as providing more care closer to home. Graduates must be supported via agile curricula to ensure they have the right skills for a modern working environment. Regulators also play an important role in supporting professionals: in taking risks, developing new skills and working across boundaries.

When discussing how to embed compassionate leadership in healthcare, the speakers all agreed that regulators should not only talk about it, but also ‘live it’ and set examples for others to follow to ensure a more cohesive and effective system.

At the same time, it is important that regulators do not diverge too much under their new legislation following reform as this may well cause more fragmentation and confusion.

Ensuring public needs are met and their voices are heard

In the second session, we asked the question: ‘What do the public need from the workforce and how can their voices be heard effectively?’

We heard from the representative from LLAIS, a new independent statutory body set up by the Welsh Government, which will replace the Board of Community Health Councils. Their vision is to give the people of Wales more say in the planning and delivery of their health and social care services – locally, regionally and nationally. LLAIS will do this by engaging with community representatives and groups via evidence-based approaches, sharing with the NHS, local authorities, and other decision-makers to ensure that people's views and experiences directly contribute to, and improve, health and social care services.

LLAIS will work in partnership with NHS bodies and local authorities to promote their activities and make arrangements to co-operate in the exercise of functions, including sharing information when asked. It wants to foster clear communication and ensure the empowerment of patients, and its success will be measured by how well it works with the NHS and local authorities. The hope for the future is that, through LLAIS, patients’ voices will be better heard, and mutual communication between the health and social care sector, and the public, improved.

Providing support for a post-pandemic recovery

In the final session, we heard from speakers from Aneurin Bevan Health Board, Royal College of Nursing Wales as well as Unite the union, who discussed what support the workforce needs to help them deliver a post-pandemic recovery.

A series of surveys totalling over 16,000 individual respondents by Aneurin Bevan Health Board found that nearly 60% of their staff reported suffering from fatigue; 61% reported to be struggling to cope with the pressure of increased service demands; and 55% felt pressurised due to staff shortages. On average staff absences due to anxiety and depression account for at least 31% of total absences, an increase of just over 2% from 2022, and 11% since before the pandemic. Data also indicated that nearly a quarter of staff were unsure if current working levels in response to increased demand were sustainable. Most staff who leave do so in their first five years of employment; many of them report feeling undervalued, and unable to settle in environments with high numbers of temporary or agency staff.

Despite these obvious challenges, the Board was focused on staff retention and has increased staff engagement activities, the established Employee Well-being Service has been invested in, and is placing a strong focus on leadership development and healthy working culture. Post-Covid, there has been a change of approach to staff entry points and ensuring training for internal development and progression is in place.

In the discussion, it was recognised that career progression for healthcare professionals is important; there is a need for more career pathway planning, career progression rewards and dealing with middle management bureaucracy that can push staff towards agency roles. If we worked towards a goal of having at least 80% of staff in substantive positions, the current over-reliance on agencies would reduce. Contingency plans in the short, medium, and long term are needed, so that the profession can be improved, and practitioners can receive the support and recognition they deserve.

Closing thoughts and common threads

All our speakers called for a more compassionate and meaningful collaboration within the healthcare system and agreed that effective communication and partnership-building are essential to address the challenges we face and to deliver better outcomes for patients and healthcare professionals alike. Collaboration with system regulators is needed, and regulators should work with each other, and with employers, to break down the perceived professional barriers which can get in the way of creating the roles that are needed.

As always with these seminars, it was great to hear a wide variety of different views from various parts of the health and social care system. It is still quite rare for service providers and patient and staff representatives to talk directly with regulators about shared issues. It was really useful, too, to think about the specific circumstances and ambitions of Wales in this context. 

There could be no doubt at all about the scale of the challenges facing health and social care.  Equally, the energy, enthusiasm and creativity around a shared purpose was really powerful. The Professional Standards Authority is committed to support action it can on the back on the recommendations we made on workforce in our Safer care for all report. Let’s hope it bears fruit soon. 

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