This year will mark the publication of the first comprehensive Quality Strategy for the NHS in over fifteen years. In this blog, the Advancing Quality Alliance (Aqua) and Patient Safety Learning set out the need for safety to serve as a golden thread woven throughout the Strategy.
The 10-Year Health Plan for England presents a significant opportunity to improve patient care, experiences, and outcomes. It is expected that the forthcoming NHS Quality Strategy will seek to deliver these improvements by placing a system wide focus on quality. We believe that improving patient safety is inextricably linked to this aim.
Level of avoidable harm
Prior to the Covid-19 pandemic, NHS England stated in its Patient Safety Strategy that there were around 11,000 avoidable deaths annually due to safety concerns, with thousands more patients seriously harmed.[1] Separately, a 2026 report from the Institute of Global Health Innovation has suggested that 22,789 lives could be saved if the UK matched the rate of treatable mortality of Switzerland.[2]
In practice, both these sets of figures are likely to significantly underestimate the scale of harm given the ongoing enormous strain faced by the healthcare system in recent years. Particularly when also considering the pressures in service provision in primary care, emergency and urgent care and discharge planning with social care.
This is an unnecessary tragedy for patients, families, and healthcare professionals.
Cost of unsafe care
This level of avoidable harm is also accompanied by a huge financial cost.
The Organisation for Economic Co-Operation and Development (OECD) has estimated that the direct cost of treating patients who have been harmed during their care in high-income countries approaches 13% of health spending.[3] Excluding cases of avoidable harm that may not be preventable, this figure is 8.7% of health expenditure. NHS Resolution estimated that the “annual cost of harm” of clinical negligence claims alone in England in 2024/25 was £4.6 billion.[4]
The problems created by unsafe care also undermine efforts to improve quality by increasing productivity. Avoidable harm and its consequences are inherently inefficient, leading to longer inpatient stays, higher staff turnover, reputational damage and reduced trust by patients and the public in the NHS.
Improving safety to deliver improvement
Patient Safety Learning and Aqua believe that improving patient safety should be a key cornerstone for creating a more effective and productive health system.
This means that we should be designing for safety, to ensure safe outcomes, processes, and behaviours. We should know ‘what good looks like’ for safe care and apply this knowledge rigorously and transparently.[5] This should include:
- Improving the quality of patient safety reviews and investigations.
- Sharing learning widely and translating this into tangible improvements.
- Nurturing an open and restorative culture in the NHS.
- Listening to patients, families, and staff, to better understand risk, take action to prevent harm and give redress and support to people harmed.
- Board level oversight and reporting of safety incidents, reviews and learning applied.
- Greater use of technology, data and analytics to significantly improve the safety, effectiveness and responsiveness of care delivery.[6]
We also believe it is important to embrace safety science and not oversimplify complex issues. We must respond to delivering safer ‘work as done’ and not be comforted by revising unrealistic and unachievable ‘work as imagined’.[7]
Moving towards a safer healthcare system
Leadership will be essential to driving these safety improvements. The creation of a new Quality Strategy presents a valuable opportunity for organisational and system leaders to embrace an integrated approach to patient safety. They should encourage a culture of openness and transparency among staff and patients regarding safety issues and related recommendations, while ensuring that safety and quality remain balanced priorities.
We need to find better ways of working within organisations and across patient pathways and systems to design and deliver safer outcomes. We too often remain siloed in our response to avoidable harm and must share and work together to design system-wide solutions.
There is a huge opportunity for Integrated Care Boards (ICBs) to drive a systemic approach to patient safety through their strategic commissioning responsibilities.[8] [9] There is however currently significant variation in ICBs involvement in safety management activities.[10] We believe they could take on a clear leadership role for system safety. This could have the potential to develop an integrated and coordinated approach to safety, reflecting patient care pathways across systems and ensuring consistency and collaboration.
Aqua and Patient Safety Learning look forward to reviewing the Quality Strategy and contributing to its implementation, ensuring that patient safety is integral to how we design and deliver a transformed health care system.
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References
[1] NHS England. The NHS Patient Safety Strategy: Safer culture, safer systems, safer patients, July 2019. https://www.england.nhs.uk/patient-safety/the-nhs-patient-safety%20strategy/
[2] Institute of Global Health Innovation & Patient Safety Watch. National State of Patient Safety 2025: Prioritising improvement efforts in a system under stress, 29 January 2026. https://www.imperial.ac.uk/Stories/global-state-patient-safety-2025/
[3] OECD and Saudi Patient Safety Centre. The Economics of Patient Safety. From analysis to action, 21 October 2020. https://www.oecd.org/en/publications/the-economics-of-patient-safety_761f2da8-en.html
[4] NHS Resolution. NHS Resolution annual report and accounts 2024 to 2025, 17 July 2025. https://www.gov.uk/government/publications/nhs-resolution-annual-report-and-accounts-2024-to-2025
[5] Patient Safety Learning, ‘What Good Looks Like’ in patient safety, Last accessed 23 February 2026. https://www.patientsafetylearning.org/standards/how-the-standards-can-work-for-you
[6] Alex Kafetz, Why data on quality of care is now more important than ever, 17 February 2026. https://integratedcarejournal.com/why-data-on-quality-of-care-is-now-more-important-than-ever/
[7] Claire Cox, Putting the writing on the wall: Explaining work as imagined vs work as done, 1 August 2023. https://www.pslhub.org/learn/improving-patient-safety/human-factors-improving-human-performance-in-care-delivery/process-improvement/putting-the-writing-on-the-wall-explaining-work-as-imagined-vs-work-as-done-by-claire-cox-r9873/
[8] Aqua, What Should Safety Look Like at a System Level, 6 April 2023. https://aqua.nhs.uk/wp-content/uploads/2023/04/What-Should-Safety-Look-Like-at-a-System-Level.pdf
[9] Patient Safety Learning, The elephant in the room: Patient safety and integrated care systems, 11 July 2023. https://www.patientsafetylearning.org/blog/the-elephant-in-the-room-patient-safety-and-integrated-care-systems
[10] Health Services Safety Investigations Body, Safety management: accountability across organisational boundaries, 13 February 2025. https://www.hssib.org.uk/patient-safety-investigations/safety-management/investigation-report/
