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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

Looking back to help us look forward

Jan 10, 2024, 11:53 by Caroline Corby, PSA Chair
PSA Chair, Caroline Corby, shares her thoughts on the coming year - with 2023 being a busy year for us, it's looking like 2024 is shaping up to be just as busy

With talk of New Year’s resolutions still in the air, I thought it timely to reflect on a busy year and predict some key areas that the PSA will need to focus on as we settle into 2024.

Though I don’t have a crystal ball to hand, I may not need one as in the world of professional regulation, change happens at a measured pace. This means that as one year ends and another starts, what we focus on will not be dramatically different in 2024 from the work we were doing in 2023. We will still be very much focused on our role of protecting the public and making sure that this is a key consideration for both government and regulators during the upcoming reforms to regulators.

Reforming regulation

The end of 2023 saw a real milestone in efforts to reform professional regulation with the laying of the draft legislation to enable the General Medical Council (GMC) to regulate the Anaesthesia Associate and Physician Associate roles in the UK. This happened on 13 December and was almost a year in the making with the Government’s initial consultation on this launching in February 2023.  

The intention is for this order to become the blueprint for full scale reform of other healthcare professional regulators (impacting more than 1.5 million professionals working in healthcare).

Reform is essential to make regulation of these professionals more flexible, efficient, consistent and proportionate. We support reform and all the things we hope it will achieve, but we don’t want it to come at the cost of public protection. Protecting the public throughout the reform process remains a key consideration for us. We encapsulated these views in our consultation response and the briefing we prepared for stakeholders. We have also worked intensely with the Department for Health and Social Care (DHSC) on the detail of the draft Order, highlighting areas where we felt that public protection could be better served.  

In 2024, we expect we’ll need to increase our activities to support regulators as they get ready to exercise their new powers and ensure they continue to be as effective as possible in protecting the public. We are developing guidance for reformed regulators and will be consulting on this shortly. We expect to be continuing the conversation with the DHSC throughout the year on legislation to reform the other regulators. 


A clear point emerging from our Safer care for all report published in 2022, was the need to collaborate across the health and social care sector if we are to have any chance of tackling the complex challenges identified in the report. The five themes of health inequalities, new risks, workforce crisis, accountability and fear and a flawed safety framework are too big for any one part of the system to address on its own. That’s why in June we held a symposium to bring together professional regulators, registers, professional bodies, system regulators, patient organisations, academics and others around the topic of how we can collaborate towards safer care for all. This timely event was well-received, promises to give birth to new working partnerships and in 2024 we will continue to convene a range of stakeholders to work towards solutions to the knotty issues identified and emerging ones. Collaborating is key but just as important is cooperation and communication.

Non-surgical cosmetics

2023 saw many stories of botched cosmetic treatments highlighting the popularity of procedures such as Botox and fillers and the lack of regulation around them.

The prevalence of these stories caused us to speak out about our concerns in July. We highlighted the great risk of harm to people and urged the Government to speed up their plans to put a new licensing scheme in place. We encouraged people to use a practitioner on an accredited register when getting such services, to help steer them towards safer practices. We were pleased to see the Government consultation on a new licensing scheme launched in September and we provided our views on the proposals. We expressed our support for setting a minimum age of 18 for access to all non-surgical cosmetic procedures, placing high-risk procedures under additional regulatory oversight, establishing a simple and transparent licensing system and taking a consistent approach across the four UK countries to avoid ‘cosmetic tourism’. We look forward in 2024, to the next steps the Government will take on this work and are ready to do all we can to support the speedy implementation of the new scheme so that people are better protected.

Regulation of NHS Managers

In August, the sad and shocking case of Lucy Letby and the baby deaths at the Countess of Chester Hospital brought the issue of regulation of non-clinical NHS Managers to the fore. It is an issue that had been raised previously and is now being reconsidered. We contacted NHS England to offer our expertise in exploring options for the way forward. With our oversight of statutory regulators and management of the Accredited Registers programme for voluntary registers, our understanding of the broad spectrum of regulatory options means we can bring valuable insights to the debate. Initial discussions have been positive and we remain keen to support collaborative efforts to address risks to patient safety in 2024 by helping to work towards appropriate solutions.

Scotland Patient Safety Commissioner Bill

A focus of Safer care for all was the gaps in the safety system. Our report highlighted the need for a coordinating function which could take an overarching view of where adjustments are needed to improve safety across the system. The establishment of a Patient Safety Commissioner in Scotland provided an opportunity to shape a role which could help to address some of the gaps we’ve identified, by making it a role with broad responsibility for identifying, monitoring, reporting, and advising on ways of addressing patient and service-user risks. We felt it was important to encourage a role that would be broader than the current English equivalent, which we would like to see expanded.

We expressed our views on this and submitted evidence to the Health, Social Care and Sport Committee in Scotland to inform the legislative process related to the Patient Safety Commissioner Bill. The Bill received Royal Assent in November and we are pleased that Scotland is going to have a commissioner that looks at the whole system to spot problems and recommend solutions. This is a vital step forward in ensuring that the system is capable of learning from its failings, as well as identifying and acting on risks before they lead to harm. In 2024, we look forward to the role and office being set up and building effective links with the Commissioner around areas where our work aligns.

Artificial Intelligence

Only the most determined of people will have been able to avoid talk of artificial intelligence (AI) over the past year. It seemed that ChatGPT entered our general lexicon and AI found its way into all sorts of areas from academia to courtrooms; and healthcare was no exception. 

In the Safer care for all chapter on regulating for new risks, we mentioned the increasing use of technology in the delivery of health and care which can bring efficiencies and other advantages but also has the potential to blur lines of accountability and put professionals in uncertain positions. Last year we recognised the need for greater understanding of how AI will impact professional regulation. We made links with experts, joined relevant groups and networks and have been working to build up our knowledge in this area. And we are sharing this knowledge with others. As part of our role supporting regulators and registers on emerging issues, we are hosting a session between government officials from the Department of Science, Innovation and Technology and regulators/registers this month to map out areas where further knowledge-building and action may be needed in 2024 and beyond. We anticipate that this is an area we will need to keep exploring for some time to come.

And all that is in addition to our core work of reviewing the performance of regulators, accrediting registers and reviewing fitness to practise panel decisions. 2023 was a busy year for the PSA. With the need to keep supporting the areas we worked on last year and taking on the new issues which will emerge this year, 2024 promises to be just as busy as we continue to strive to better protect the public.

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