Patient Safety Watch: Jeremy Hunt’s sobering realisation about bureaucracy and box ticking

Good afternoon, and welcome to this fortnight’s edition of the Patient Safety Watch newsletter, this time from me, Jeremy.

Global State of Patient Safety 2025

Last week was Patient Safety Watch’s biggest of the year with the publication of our new report, The Global State of Patient Safety 2025  – our latest biannual mega-study ranking patient safety across Organization for Economic Cooperation and Development countries, produced by Imperial’s Institute of Global Health Innovation’s highly respected team. Wes Streeting was guest of honour at the launch,  and we had a video message from the World Health Organization director-general, Tedros Ghebreyesus.

While Norway placed top this year, the UK ranked 21st out of 38, unchanged from two years ago. If we matched the patient safety standards of Switzerland, another strong performer, 60 fewer people would die every day.

The results raised a lot of eyebrows because Norway (but not Switzerland) spends a slightly smaller proportion of GDP on health than we do. It’s true that per capita spending is higher (they have a higher GDP per head), but prices are normally higher where GDP per head is high, as salaries go up. And Italy, Spain, Finland, and Japan all achieve better patient safety outcomes than the UK while spending less per capita on health. The findings have prompted wide public and professional debate, including national media coverage.

In my HSJ commentary last week, I argued we must move on from debating funding and staffing to looking at the structures that promote safe healthcare. It’s not that resourcing doesn’t matter – of course it does – but with public finances as they are, there is no likelihood of a big bumping up of NHS funding as happened in the 2000s. Instead, we must ask what else could help. Structural factors – how care is organised, how learning is embedded, how safety is governed, and how patients are involved – play a decisive role in determining outcomes. It’s time we looked at what reforms could improve NHS care’s safety and quality.

Patient safety comes to Westminster

Also last week, the All-Party Parliamentary Group on Patient Safety, which I chair, hosted its first dedicated patient safety symposium in Westminster, bringing together clinicians, patient leaders, policymakers and system leaders. It was a fascinating session attended by luminaries such as NHS England CEO Sir Jim Mackey, patient safety commissioner Henrietta Hughes and Sir Mike.

We focused on systems, staff and patients. We recognised progress – for example, the fall in baby deaths – but also that it was not good enough. I ended up wondering whether too much of my effort to improve patient safety focused on bureaucratic changes, which has led to more box ticking but not necessarily safer care. I have to admit that was sobering.

The event reinforced the importance of sustained parliamentary focus on patient safety, and the value of creating space for honest discussion about what is – and is not – working in our current approach. Dr Hughes published a great summary here.

A special thanks to the APPG secretariat team, especially Dawn Benson and Eleanor Riches, who did such a great job on the programme and organisation.

Other patient safety news this edition…

The rising costs of clinical negligence

The Public Accounts Committee has published a report examining the rapid growth in government liability for clinical negligence. The committee found the cost of medical negligence to the taxpayer has quadrupled over the past 20 years, with provisions for future claims now a staggering £60bn. Annual clinical negligence payments are expected to exceed £4bn by the end of the decade.

The report also highlights that neither the government nor NHSE knows how much cost the NHS incurs treating patients it has harmed each year, meaning the true cost of avoidable harm has not fully been accounted for.

As you know, it has long worried me that the £3.5bn we spend annually settling maternity litigation claims in England is now almost as much as the £4bn annual cost of running all maternity services. But what makes this report especially troubling is not simply the scale of the financial exposure, but the conclusion that this growth reflects a lack of national progress to address the root cause of clinical negligence – unsafe care.

The report reinforces an argument that Patient Safety Watch has made consistently: improving patient safety is not in tension with financial sustainability – it is central to it. Reducing avoidable harm reduces suffering, restores trust, and saves money (are you listening, Wes and Rachel?).

The committee’s recommendations are strong and sensible. I particularly welcome the recommendation to look at how other countries have successfully introduced less adversarial compensation systems that have enabled faster resolutions for those harmed and shifted the focus to quicker learning and change. It is surely time the NHS looked seriously at schemes such as that implemented in Japan for birth injury.

Trusts identified as surgical site infection outliers

HSJ has reported that the UK Health Security Agency has identified five NHS trusts as statistical outliers for higher-than-expected surgical site infection rates in specific orthopaedic procedures in 2024-25. The agency stressed that these largely preventable harms are not a judgement on overall quality, but an early warning designed to prompt closer review and targeted improvement.

Warning over ‘sham investigations’ silencing NHS staff

Former Countess of Chester Hospital Foundation Trust chief executive Susan Gilby has warned that “sham investigations” are increasingly being used across the NHS to silence staff who speak up about concerns.

“Sham investigations appear to be increasingly and frequently used as a way of manipulating somebody out of an organisation or closing down concerns inappropriately,” Dr Gilby told The Guardian. “I think it is a very common problem across the NHS.”

She went on to warn whistleblower protections did not go far enough, potentially risking patient safety as people were afraid to raise concerns.

Government publishes National Cancer Plan

The government has published its National Cancer Plan for England, setting out a 10-year programme to improve cancer outcomes and address long-standing failures in timely diagnosis, treatment, and equity. The plan acknowledges that England continues to lag behind comparable countries, with missed waiting-time standards, late diagnoses and wide variation in performance contributing to avoidable harm.

Key commitments include meeting all cancer waiting-time standards by the end of this Parliament, expanding community diagnostics, tackling pathology backlogs, and using data, digital tools and AI to reduce delays and variation in care. But it is really disappointing that the 2028 target to catch two-thirds of cancers at stages one and two has been pushed back seven years to 2035, as reported by HSJ.

Sharing some good stuff…

HSSIB marks World Cancer Day

To mark World Cancer Day, the Health Services Safety Investigations Body (HSSIB) has published a blog pulling together insights from seven patient safety investigations into cancer care. From missed lung cancer detections on chest X-rays to communication and referral challenges within cancer pathways, the piece highlights systemic issues with clear recommendations to improve early diagnosis, strengthen follow-up of significant findings, and enhance referral systems. Well worth a read.

Baby Lifeline’s National Maternity Safety Conference 2026 – book now!

Baby Lifeline’s National Maternity Safety Conference returns to Birmingham on Wednesday, 16 September 2026. This year’s theme – Next Steps for Safer Care: From Insight to Implementation – will bring together NHS professionals, families, researchers, and key stakeholders. Many fantastic speakers have been announced already, including Marian Knight, Georgia Richards, and Alex Heazell, with more to be announced over the coming months. Find out more and book your place here.

That’s all for this edition. Next one from James in a fortnight.

Jeremy