Patient safety at a crossroads: Will reform deliver real change?

Earlier this week, more than 1,000 delegates gathered in Manchester for the 18th HSJ Patient Safety Congress. Across two days, over 150 speakers and hundreds of discussions circled a single shared determination: how to make care safer in a health system under unprecedented strain.

In this blog, Dr Richard Dune reflects on these discussions and their implications for the future of patient safety.

The opening plenary set the tone. Chaired by Shaun Lintern and featuring contributions from leaders such as Dr Penny Dash, Professor Mary Dixon-Woods, Sir Julian Hartley, Dr Aidan Fowler, Professor Nicola Ranger, and patient leader Jono Broad, it was a rare space where senior voices spoke openly, candidly, and without filters.

The insights were sobering - sometimes uncomfortable - but ultimately galvanising.

Key lessons from the patient safety plenary

The opening plenary at the HSJ Patient Safety Congress brought together senior leaders, regulators, clinicians, and patient voices. Their reflections cut through policy jargon and revealed the urgent realities of delivering safe care in today’s complex system. Below are six core lessons that emerged:

1. Patient experience is the core business

Dr Penny Dash reminded the sector that compassion, inclusion, and psychological safety are not “extras” but at the heart of safe care. She warned against sliding into bureaucratic tick-box processes that record activity without improving outcomes.

This resonates with CQC’s expectations under Regulation 17 (Good Governance): providers must demonstrate that policies and procedures, staff training, and governance frameworks deliver measurable improvements to patient outcomes - not just paper-based compliance.

2. Complexity creates risk

Professor Mary Dixon-Woods highlighted the “problems of many eyes and many hands”: multiple regulators, overlapping initiatives, and endless recommendations that fragment accountability. The result is an improvement in waste, as projects often duplicate effort without coherence.

This aligns with what we see in practice: compliance with regulatory frameworks and laws becomes fragmented without centralised systems like Learning Management Systems (LMS), Training Management Systems (TMS), and document repositories to ensure visibility across the organisation.

3. Fragile but real progress

Dr Aidan Fowler pointed to the success of Martha’s Law, enabling patients and families to escalate concerns. Thousands have already used it, and lives have been saved.

Yet embedding patient safety in new contexts - community services stretched to breaking point, or digital health tools like AI - requires caution. Fowler reminded us that safety-by-design is non-negotiable when adopting new digital compliance systems or regulatory technologies.

4. Regulation must rebuild trust

Sir Julian Hartley, Chief Executive of the CQC, spoke frankly about the regulator’s struggles: failed IT platforms, inconsistent inspections, and the controversial rollout of the Single Assessment Framework.

His pledge: CQC must become consistent, compassionate, and improvement-focused. This matters deeply for providers facing inspection under Regulation 13 (Safeguarding) and Regulation 17 (Governance). Effective regulatory compliance will depend on organisations demonstrating robust governance systems, evidence-based training programmes, and secure archiving systems for inspection readiness.

5. Nursing at breaking point

Professor Nicola Ranger painted a stark picture: district nurses with caseloads of 300, junior staff left unsupported at night, and senior nurses leaving in record numbers.

Her message was clear: nursing is not a cost to be cut - it is the backbone of safe care. Workforce shortages not only undermine patient safety but also risk non-compliance with statutory and mandatory training requirements. Providers must invest in workforce development and embed training records into compliance systems to assure both regulators and patients that staff are competent.

6. Patient voice must move centre stage

Patient leader Jono Broad challenged the audience to stop reducing lived experiences to “patient stories”. These are lives, not anecdotes. His refrain - “A bad system will beat a good person every time” - underscored the need for governance systems that support staff and embed patient feedback into policy and practice.

This reflects the rise of I Statements in the CQC framework and the growing expectation that providers not only listen to service users but also demonstrate evidence of change through their governance processes.

Reflections - Where we are now

What struck me most about the plenary was its honesty. Leaders acknowledged the presence of bureaucracy, workforce shortages, failed systems, and the overwhelming complexity.

Yet opportunities are clear:

• Harnessing technology and digital compliance systems to reduce burden, not add to it
• Building learning cultures through reflective supervision, not blame cultures
• Designing policies and procedures that support safe care, not hinder it
• Elevating patient voices into the centre of governance and compliance reporting.

The Congress captured the national mood: the NHS is at a crossroads. A new government promises reform, efficiency, and prevention. NHS England is being dismantled, Integrated Care Boards face pressure, and CQC is in recovery mode. In this turbulence, patient safety risks are being sidelined - buried under bureaucracy or political agendas.

Patient safety in the current reform context

Patient safety cannot be separated from the broader reform agenda shaping health and social care. Shifts in government policy, NHS structures, regulatory expectations, workforce pressures, and digital transformation are redefining how providers must demonstrate safe and compliant care. The following key factors highlight where reform meets risk - and opportunity:

• Government initiatives - Labour’s reform agenda promises a 10-year health plan focused on prevention, community care, and digital innovation. But unless reforms are embedded within compliance frameworks, risk may rise rather than fall
• NHS reorganisation - With NHS England being abolished, ICSs will shoulder greater accountability. Without digital compliance systems and regulatory software, this shift risks deepening fragmentation
• Regulatory trust - CQC’s credibility depends on transparent, consistent inspection. Providers must use policies, procedures, and document repositories to demonstrate compliance with standards
• Workforce development - Safe care requires people, not spreadsheets. Embedding statutory and mandatory training into compliance systems ensures competence is visible and auditable
• Digital health and AI - Technology holds promise, but only if safety-by-design and governance frameworks underpin innovation. Adaptive algorithms need more scrutiny than static compliance tools.

A call to action for providers

For those of us in health and social care governance, compliance, workforce development, or digital innovation, the message is clear:

• Listen to patients and staff. Embed feedback into governance reviews
• Measure what matters, not what’s easiest to record
• Design systems around safety, not bureaucracy
• Invest in workforce development and training, especially nurses and support staff
• Use digital compliance systems to centralise records, monitor CPD, and integrate training into daily practice.

Patient safety is not a destination - it is a continuous compliance obligation.

Strengthen patient safety and compliance with ComplyPlus™

At The Mandatory Training Group, I’ve led the development of ComplyPlus™ regulatory compliance management software, designed to:

• Centralise policies and procedures in a secure document repository
• Track and monitor statutory and mandatory training through an integrated LMS and TMS
• Provide audit-ready dashboards for CQC compliance and regulatory inspections
• Link governance, supervision, and training directly to regulatory compliance frameworks and laws. 

Click here to learn more about how ComplyPlus™ can help your organisation improve governance, compliance, workforce development, and patient safety.

When we embed patient safety into compliance systems, supported by the right tools and workforce training, we move beyond tick-box regulation - and into sustainable, safer, higher-quality care.