A district nurse cares for an elderly man with a head injury in his living room at home.

Workforce and patient safety


The workforce challenges faced by the NHS in England present a significant risk to patient safety and staff wellbeing.

These challenges include inadequate interoperable IT infrastructure, skills shortages in key areas of the NHS and a mismatch between demand for hospital care and the supply of staff and other resources to meet that demand.

National reports and research have highlighted that these challenges are influenced by a shortage of NHS staff, and that there is a need to focus on recruitment and retention and consider the most appropriate workforce models for health and care in the future. To address these previously identified challenges, we can use our unique system-level perspective to propose ways to improve working conditions for NHS staff. We anticipate this in turn can help to improve patient safety.

Intelligence review

We have reviewed and analysed a range of patient safety intelligence and identified issues that may be limiting the workforce’s ability to deliver safe, efficient and effective care.

Our intelligence sources include:

  • focus groups with NHS staff and representatives from national bodies
  • academic literature
  • national publications
  • incident data
  • patient safety concerns reported to us
  • our previous investigation reports.

We identified a range of issues that may be limiting the workforce’s ability to deliver safe, efficient, and effective care. As a result, we have identified four areas for investigation focused on the conditions in which the workforce is delivering patient care. This aim is for the investigations to identify opportunities for learning and to support improvements in the delivery of safe care.

Investigation criteria

We have considered the risks associated with the issues identified in our intelligence review against our criteria to launch investigations, which include:

  • Outcome impact – what was, or is, the impact of the safety issue on people and services across the healthcare system?
  • Systemic risk – how widespread and how common a safety issue is this across the healthcare system?
  • Learning potential – what is the potential for our investigation to lead to positive changes and improvements to patient safety across the healthcare system?

Outcome impact

Where workforce challenges, including shortages in the workforce, have been identified, patient harm has occurred. This is demonstrated through 19 of our previous investigations and prevention of future death reports. The research literature also describes evidence of where NHS patient and staff harm has been associated with workforce shortages, or shortage of people with the necessary skills.

Systemic risk

Workforce shortages and associated challenges are widely described across multiple healthcare sectors and organisations in England. National publications demonstrate the extent of the risk that remains persistent and affects many parts of the NHS.

Learning potential

Our investigations can provide insight into the factors that contribute to persistent safety risks and make safety recommendations to national bodies to inform improvements. HSIB’s systems-based approach allows consideration of the conditions within which people work to support those caring for patients to deliver safe care.

Summary of investigations

We will undertake four investigations that consider how working conditions in the NHS can be optimised to support patient safety, while maintaining and improving staff wellbeing.

The four investigations are:

  • Workforce and patient safety: the digital environment – considering design of the digital aspects of the work system, such as computer systems, with which staff and patients interact.
  • Workforce and patient safety: prioritising patient care – considering how the ability of the clinical workforce to deliver face to face patient care is affected by undertaking additional tasks, for example administrative roles.
  • Workforce and patient safety: skill mix and staff integration – considering how existing and new roles are implemented as part of the wider multi-disciplinary team to support safe and compassionate patient care.
  • Workforce and patient safety: temporary staff – considering how temporary staff, including agency, bank and locum staff are supported to ensure they have the necessary skills, competencies and understanding to deliver safe patient care.

Our previous investigations have explored challenges faced by the workforce predominantly in the acute healthcare sector. The intelligence reviewed in support of these investigations highlights the need to broaden out to other sectors.

The investigations on the digital environment, prioritising patient care and skill mix will begin their focus in primary care (for example general practice) and community services (for example care delivered at home, in community hospitals, intermediate care facilities, clinics and schools). The scope of the investigations may extend to secondary care (care in hospitals either as an emergency or for planned care) and tertiary care (highly specialised treatment) as the evidence is gathered. The temporary staff investigation will start with a focus on secondary care.

The four investigations will include conversations with relevant integrated care boards and integrated care partnerships within the integrated care systems, to maximise opportunities for learning.

Carrying out the investigations

The investigations will gather evidence from a broad range of healthcare organisations across England.

We are keen to collect a diverse range of views that may also contribute to evidence of where inequalities exist for patients and the workforce. As part of the evidence collection, we intend to undertake observations with multidisciplinary teams and carry out focus groups and interviews with NHS staff, patients and the public.

We want to understand how learning can be used to enhance NHS staff wellbeing, as well as patient safety.

We are also looking for exemplars of good practice.

Summary of outputs

Each individual investigation will produce an investigation report that may make safety recommendations, safety observations or identify local learning to inform improvements in support of patient safety and staff wellbeing.

The findings from all four investigations, and additional intelligence, may then contribute to a future national learning report. This would allow for common themes or issues seen across the investigations to be aggregated and further safety recommendations, safety observations or local learning to be identified.


If you would like to speak to us about these areas of investigation, would be willing to support observational visits by the investigation team, or wish to share any information with us about a specific investigation prior to publication, please email: enquiries@hssib.org.uk.