Share a patient safety concern

About this form

We would like to hear from everyone who interacts with healthcare, including patients and staff, so that we can understand how different issues affect different groups.

Hearing about these experiences helps us to understand risks and potential areas for improvement across the healthcare system. This information allows us to build a picture of the problems in healthcare, to understand where a Health Services Safety Investigations Body (HSSIB) investigation could provide learning to benefit the whole healthcare system. We are not able to use this information to investigate individual concerns. Please have a look at our Support for patients and families and Support for NHS and healthcare staff pages for a list of organisations who can help with concerns, complaints and support after an event.

Your patient safety concern

About this section

You can tell us about something that has happened or something that might happen.

Something that has happened: this could be a one-off or a series of events where something potentially dangerous has happened, whether or not someone was actually harmed.

Something that might happen: this could be a safety risk or an unsafe condition that, if not corrected, might lead to an incident which could cause harm.

We can consider events or risks that occurred within NHS and independent healthcare in England after 1 April 2017.

Type and frequency
Remember, we can only investigate events or risks that happened after 1 April 2017.
Select all that apply.
Organisation and location

Remember, we can only investigate patient safety concerns that relate to healthcare in England.

Please tell us the organisation that your patient safety concern relates to and the location. For example the name of a hospital, GP practice, or care home.

Details of your patient safety concern

About this section

We’d like you to tell us about your patient safety concern in your own words.

There is the opportunity later in the form to attach supporting files that provide additional information.

When doing this, it’s important that you do not provide any personal identifiable information without permission. If it’s possible to identify an individual from the information you provide – directly or indirectly – this is personal identifiable information.

If you provide information that allows an individual to be identified, you must:

  • be that person
  • or, be telling us about a concern that involves a child under the age of 13 years and be their parent or legal guardian
  • or, be registered with the Office of the Public Guardian to act on the individual’s behalf (a lasting power of attorney).

We cannot use or store personal identifiable information provided without permission. Any personal identifiable information provided without permission will be deleted.

Select all that apply.
Select all that apply.
About you

About this section

When you complete our online form or e-mail us, you will receive an e-mail confirming we have received your information. If we require further information relating to your concerns, we may contact you within 10 working days to request this. Everything you share with us is in the strictest confidence and in line with our privacy notice. We will only share information if we believe there is an urgent risk to individuals. We will always try to contact you to discuss this.

How would you describe yourself?
Contact preference
We need to have a postal or email address, wherever possible, to acknowledge your referral and provide written information to help you. You can advise if there are communication needs we need to take into account.
Our office is open Monday to Friday, 9:00AM to 5:00PM.
24-hour format (HH:MM).e.g. to enter 'quarter past one', type 01:15 for AM or 13:15 for PM.
24-hour format (HH:MM).e.g. to enter 'quarter past one', type 01:15 for AM or 13:15 for PM.
Equality and diversity

About this section

We’d like to collect this information to make sure we give everyone an equal opportunity to access our patient safety investigations. We aim to reflect the diversity of the population in our decision-making.

HSSIB has a duty to pay due regard to avoid unlawful discrimination and to consider how to advance equality. The information you provide is only used for this purpose.

We respect your privacy and are committed to protecting your personal data. You can ask for your information to be updated or removed from our records at any time. Please read the privacy notice on our website for more information.

Supporting files

About this section

Please upload any files that provide additional information that supports your patient safety concern.

You can submit these file types:

  • standard office documents (Word, Excel and PowerPoint)
  • PDFs
  • images (jpg, bmp, png etc)

Only upload personal data:

  • That belongs to you, or another for who you have their consent or you’re acting as their legally appointed representative.
  • If you consent with the way in which HSSIB proposes to process your information.

You can upload a total of 20.0 MB of files at a time using this form.

Please read the privacy notice on our website for more information about our data processing activities.

You can drag and drop files from your computer here or to upload.

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