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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

Five priorities to address health inequalities

May 16, 2024, 15:09 by Christine Braithwaite, PSA Director of Standards and Policy
In this blog we outline five priorities we identified at our event in December to address healthcare inequalities - actions that could be taken by regulators, and could make a real difference towards addressing, and solving, the problem of healthcare inequality
In the 21st century, you would be forgiven for thinking that health inequalities were a thing of the past. Sadly, incidences of inequality remain both widespread and shocking, the statistics depressingly stark. Black women are four times more likely to die in childbirth than white women. Two thirds of healthcare workers who died from Covid-19 came from ethnic minority backgrounds. And Black and ethnic minority doctors are consistently over-represented in all stages of the ‘fitness to practise’ process.

In September 2022, we published our report, Safer care for all, which looked at some of the biggest challenges affecting the quality and safety of health and social care across the UK. One of the report’s central themes was the major and persistent inequalities affecting patients, service users and healthcare professionals.

Patients and service users sharing one or more protected characteristics may be more likely to experience a poorer outcome and may be more vulnerable to major failings of care – for example, four of the most recent major patient safety scandals have affected women. And while we are building an increasingly clearer picture of healthcare disparities, surprisingly little is known about those who make complaints about poor care or misconduct by health and care professionals, or the barriers preventing particular groups from complaining.

Professionals are also affected. Research has shown that certain groups of healthcare professionals are affected disproportionately by professional regulation processes, such as referrals into fitness to practise processes. For example, Black and minority ethnic professionals are twice as likely to be referred to their regulator, the General Medical Council (GMC), by employers compared to white doctors. There are also differing levels of academic and career attainment between certain groups, particularly women and those from ethnic minority backgrounds.

To try to tackle the insidious problem of healthcare inequality, we made several recommendations in Safer care for all, calling for action by other bodies (including regulators and governments), and committing ourselves to helping bring about solutions. We called for regulators and registers to work collaboratively to improve the diversity of fitness to practise panels and other decision-makers to ensure they reflect the diversity of their communities. 

We also said the system as a whole needs to improve the way it collects data about the protected characteristics of people who make complaints about their care, so we can begin to identify differences in how care is delivered and how complaints are handled.

Since publishing Safer care for all, we have undertaken research into public perceptions of discriminatory behaviours in health and care and facilitated a session with health and care regulators on barriers to complaints.

In December 2023, we sought to shine a spotlight on this important topic again by hosting an event to examine the role of healthcare professionals in tackling health inequalities.

Over 90 people came together to be part of the conversation. The discussion revealed five priorities – in particular, actions that could be taken by regulators – that could make a real difference towards addressing, and solving, the problem of healthcare inequality.

1. Listen to patients and service users

It’s clear that patients and service users are best placed to report on their experiences and suggest solutions. So why do they, so often, have to shout to be heard? We need to be better at listening to those who raise complaints.

Unfortunately, the system does not make it easy to complain. We have a complicated complaints landscape that is difficult to navigate. This issue is exacerbated by a lack of data on who is complaining and why. Regulators need more and better data to help them understand experiences of care across diverse groups.

2. Education, education, education

Education shapes culture for generations to come. With the right education, we can teach professionals – right from the start of their careers – the importance of addressing health inequalities. There must be consideration of health inequalities not just in the curricula, but in the language, codes and standards that underpin it.

Regulators must work with others to shape education and training for healthcare professionals. And as improved cultures start to take root, it is up to regulators across the system to reinforce expectations throughout a professional’s career. 

3. Balance the carrot with the stick

Sometimes, change happens with the gentlest of encouragement; sometimes a firmer stance is required. Regulators need to find the right balance when dealing with professionals – between incentives (the carrot) and enforcement measures (the stick) – so that they can promote compliance without creating undue burden or stifling growth.

Improvements in practice can be encouraged with Continuing Professional Development and guidance to help professionals better serve the populations they care for. Regulators must also demonstrate courageous leadership and have mechanisms in place to hold healthcare professionals and organisations to account. 

Despite a plethora of legislation (the Equality Act, Workforce Race Equality Standard, the Disability Standard and the Accessible Information Standards), health inequalities are still widening. This needs to change, and enforcing existing requirements is an important part of this.

4. Regulation should set a good example

Inequalities exist within regulation, such as disproportionate fitness to practise referrals, inconsistent fitness to practise decisions, and differential attainment in education, training and career progression. Add harassment, bullying and discrimination faced by many NHS staff into the mix and we have a culture where some professionals don’t feel valued and, in some cases, are forced out of the profession. This needs to change. It is inherently wrong that anyone faces discrimination and inequality. It is also important to have a healthcare workforce that represents the diversity of our communities.

Regulators should act in the areas where they have influence. They can support action to tackle systemic racism and discrimination, such as in curriculum design. Compassionate regulation can also make a real difference in supporting healthcare professionals to contribute to tackling inequalities involving patients. The process of building health equity must be equitable itself.

5. Speak with one voice

No one organisation can tackle health inequality alone. To give professionals the confidence and support to do the right thing at work, healthcare organisations must speak out and make it clear that the provision of equitable care is non-negotiable. Collaborating across organisations, professions, systems and UK countries can achieve this. 

The PSA has commissioned research to look at whether a common code of conduct across professions might help to support a unified approach. We will also be reviewing our Standards of Good Regulation to make sure the expectations we have of regulators are sufficiently high where health inequality is concerned.  

Ultimately, we need a collective response to reverse the tide on health inequalities. Regulators and those with influence in this area must establish where their contribution lies and make sure we are all pulling in the same direction so that safer care for all really does mean ‘all’. 

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