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.

Summary of investigations

We’re undertaking four investigations that consider how working conditions in the NHS can be optimised to support patient safety, while maintaining and improving staff wellbeing:

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. So far, we have published one of four investigation reports, with the rest to follow during 2024.

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.

Carrying out the investigations

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.

Investigation criteria

We have considered the risks associated with the issues identified in our intelligence review against our criteria to launch investigations.

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. HSSIB’s systems-based approach allows consideration of the conditions within which people work to support those caring for patients to deliver safe care.

Evidence collection

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

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

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.

Investigation report