UK Government

In relation to Recommendation 4c) ii., DHSC agrees that it is important to explore approaches for enhancing the safety of services. In 2023, NHS England established an SMS coordination group with partners from across the healthcare system including providers, patients, regulators, the Health Services Safety Investigations Body (HSSIB), academia and other safety critical industries to explore the potential for SMS principles and processes to be adopted further in the NHS to improve patient safety. The group’s work is ongoing and has not yet reached specific conclusions about the applicability of SMS principles to healthcare but it is likely to report later in 2025.

It is right to ask what more the NHS could learn from other industries and to understand how SMS principles might be appropriately translated into healthcare settings, although we would caution against an approach that seeks to simply adopt a new phrase or framework such as an SMS as the solution to complex patient safety challenges.

In support of the SMS Coordination Group in August 2023, NHS England, in collaboration with the Department of Health and Social Care and the National Institute for Health and Care Research, commissioned the Exeter Health and Social Care Delivery Research Evidence Synthesis Centre to conduct research examining the application of safety management systems to patient safety in terms of effectiveness, implementation and experience. The research included publications from five countries (Australia, Canada, Ireland, New Zealand and the Netherlands). The findings highlight that:
only the Netherlands had introduced a national patient safety programme explicitly based on a high-risk industry SMS approach,
the main components of an SMS were identified, to varying extents, in the patient safety policies and initiatives of other countries included in the review, and
other concepts from wider safety science had influenced patient safety approaches in all countries.

These findings suggest there is no single most effective approach to patient safety, and emphasise the need for any approach to safety to be operationalised and adapted to fit the healthcare context. These findings will inform ongoing discussions undertaken by NHS England’s SMS co-ordination group.

Scottish Government

For recommendation 4c) ii., the Scottish Government and Healthcare Improvement Scotland (HIS) are building knowledge and understanding of what is required to extend and further embed a quality and safety management system across all health and care services. The existing Essentials of Safe Care framework is a Scotland-wide practical package of evidence-based guidance and support that enables the whole health and social care system to deliver safe care. The package includes tools for assessing organisational readiness, prioritising areas for improvement and a measurement framework covering the essential drivers of safe care: person-centred systems and behaviours, safe communication within and between teams, and safe and consistent clinical and care processes, along with leadership to promote a culture of safety at all levels.

The Scottish Government and HIS have mapped the Inquiry’s recommendations against each of the essential drivers of safe care, in order that further actions required are identified in support of the delivery of cross-cutting themes reflected in the Inquiry’s findings.

The Scottish Government will work with their counterparts in the Department of Health and Social Care and other devolved governments to ensure that HIS and the Health Services Safety Investigations Body (HSSIB) are supported to work together effectively to share learning and good practice, and to promote patient safety (including considering the ways in which HSSIB’s work on safety management systems might inform HIS’ work on essentials of safe care and implementation of quality and safety management systems).

Northern Ireland Executive

Further consideration and wider engagement will be required to fully assess the local regulatory picture and how best to give effect to Recommendation 4(c).