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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

Public protection at the heart of reform

Dec 19, 2023, 12:43 by Alan Clamp, PSA Chief Executive
In this blog, PSA Chief Executive asks now that legislative reform underway, what are the next steps for professional healthcare regulation?

With legislative reform underway, what are the next steps for professional healthcare regulation? 

This was the theme of the recent Westminster Health Forum Policy Conference, chaired by Lord Hunt of Kings Health (representing the All-Party Parliamentary Health Group), at which I spoke about the need to put public protection at the heart of regulatory reform.

In my presentation I focused on:

  • the necessity of reform;
  • the need to get the legislation right; and
  • our commitment to support implementation of the reforms.

I also discussed how we can promote safer care for all by using reform and by refocusing regulation.

Why do we need reform?

So, why do we need reform? Some might say to improve the efficiency of regulation; to provide up-to-date and more flexible legislation; to have simpler, more coherent and more consistent regulation; or to introduce more proportionate, less adversarial fitness to practise processes. All laudable aims, but secondary to the importance of improving public protection. We need reform to keep us safer – the efficiency, flexibility and proportionality of the processes are important, but not if any of them come at the expense of protecting the public.

For this reason, it is vital we get the legislation right. Along with the obvious desire for the legislation to be fit for purpose, we know that it is the intention of the government to use the forthcoming legislation – which will regulate a few thousand physician and anaesthesia associates – as the blueprint for reform of most of the other regulators. These regulators oversee more than 1.5 million professionals working in health and social care. If it turns out that the legislation isn’t as good as it needs to be to improve public protection, then we must improve it before it is rolled out across the sector.

Reform will replace prescriptive legislation with enabling legislation. We are essentially saying to the regulators, “Here are the powers; it is up to you how to use them”. This additional flexibility brings with it a need for greater accountability and implies that guidance on using the powers will be beneficial.

What is the PSA's position on reform?

The PSA’s position on reform is simple and has not changed: we welcome reform; we will work with others to design legislation that enhances public protection; and we will do everything within our remit, powers and capacity to ensure that reformed regulation is as effective as possible in protecting the public. On this point, we will soon be consulting on our initial guidance documents that will support the implementation of reform.

Driving reform, getting the legislation right, and supporting the implementation of reform will all lead to better regulation. Better regulation can make an even greater contribution to safer care for all. It can help to support effective workforce strategies, respond to new risks, and tackle inequalities – all in the interests of public protection.

This is all good stuff. It is ambitious and forward-looking. The future is bright. But here is the elephant in the room: we don’t yet have large scale reform. The process is slow and clunky, there has been little contribution from the patient voice, the legislation may well need more work before a widescale rollout, and there is a risk that it could all grind to a halt. We can’t let that happen.

If we can keep the momentum going, get the legislation right and support the reforms, then we may just get there one day. But what about the problems we face today, or next week, or next year? Reform is not going to provide the answers to these challenges.

Refocusing regulation

Regulation needs refocusing now to keep us safer. This does not require reform. We need to focus on violations and recklessness, and much less on errors and mistakes. We need to focus on positive and preventative regulation – for example, initial training, continuing fitness to practise, and information, advice and guidance to support professionals to meet high standards of competence and conduct. And we need to focus on a kinder, more compassionate model of regulation.

This does not mean compromising standards, just ensuring that regulation is not excessively draconian in its methods or sanctions. This will reduce fear, promote a just culture, support retention of professionals, and, to quote the Patient Safety Commissioner for England, encourage more “speaking up, listening up and following up”.

Refocused regulation matters – it is better, fairer, more cost-effective and keeps us safer. Refocused regulation is about doing a good job today and an even better job tomorrow. Then, when we get reform, we can use it as an opportunity for a step change in public protection and safer care for all.

Find out more

  • Read through our statement in response to the draft legislation laid before the UK and Scottish Parliaments on Wednesday, 13 December 2023 which will give the General Medical Council the statutory powers it needs to regulate the Anaesthesia Associate and Physician Associate professions in the UK.
  • Or find out more about reforming regulation 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