Training and training establishments as a source of safety information
The General Medical Council should amend its standards for undergraduate medical education to include a requirement that providers actively seek feedback from students and tutors on compliance by placement providers with minimum standards of patient safety and quality of care, and should generally place the highest priority on the safety of patients.
- The Health Services Safety Investigations Body (HSSIB) was established as an independent statutory body on 1 October 2023 (Health and Care Act 2022, July 2022).
- The Learn from Patient Safety Events (LFPSE) service, which uses machine learning for trend identification, was fully implemented by June 2024 (Learn from Patient Safety Events, NHS England, June 2024).
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Progress Timeline
DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Implemented - Ongoing. The GMC sets out requirements for the management and delivery of undergraduate and postgraduate medical education and training in its standards (Promoting excellence). The standards sit alongside its Outcomes for graduates and Outcomes for provisionally registered doctors, which set out what the GMC expects doctors to learn and to be able to demonstrate. Its last review of Promoting excellence highlighted a theme of 'learning environment and culture' and focuses on ensuring that educational environments are safe for patients and leaners. The theme, now built into the standards, encourages the notion that an effective learning environment should ensure that learning is part of the culture, and that safe and effective care can be provided to patients. The standards outline the responsibilities of education providers in creating a learning environment and culture and the requirements the GMC set. The standards say that '[Local education providers] are responsible for taking action when concerns are raised that impact on patient safety' [and] 'Postgraduate deaneries, LETBs and medical schools make sure that medical education and training takes place in an environment and culture that meets these standards, within their own organisation and through effective quality management of contracts, agreements and local quality control mechanisms. They work together to respond when patient safety and training concerns are associated.' (Promoting excellence pages 8-10). The GMC engaged with its stakeholders as part of the review to help shape the standards and there has been wide support for defining what a learning environment would look like. The standards were published in 2016 and the GMC is beginning work to consider its Education Framework which will include a review of its standards and how it can build on lessons from previous reviews to ensure its approach remains fit for the future.
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Learn from Patient Safety Events (LFPSE) service replaced the National Reporting and Learning System (NRLS). NRLS fully decommissioned 30 June 2024. LFPSE has broader coverage including primary care, uses machine learning for analysis and improved trend identification.
HSSIB formally launched 1 October 2023 as independent statutory body under Health and Care Act 2022. Replaced HSIB (non-statutory, established 2016). Has statutory "safe space" protections, powers of entry, inspection and seizure. Conducts system-focused patient safety investigations.
Patient Safety Incident Response Framework (PSIRF) replaced the Serious Incident Framework from Autumn 2023. Shifts from individual blame to system-based learning approaches. Mandatory for all NHS-funded secondary care providers. Part of NHS Patient Safety Strategy (July 2019).
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
First Patient Safety Commissioner Dr Henrietta Hughes OBE appointed 12 September 2022 under Medicines and Medical Devices Act 2021. Independent champion for patient safety regarding medicines and medical devices.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.
GMC medical revalidation launched December 2012. All licensed doctors must demonstrate fitness to practise every five years through appraisal and evidence. Francis Report endorsed and recommended strengthening revalidation.