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 three 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 three investigation reports, with the rest to follow during 2024.

The findings from all three 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.

Closure notice

Update on the Prioritising Patient Care (PPC) investigation

The Workforce and Patient Safety: Prioritising Patient Care (PPC) investigation, which is part of the wider programme of work on the theme of workforce and patient safety, has been closed.

The purpose of PPC investigation was to establish how the workforce in primary and community care deliver person centred and safe care, is prioritised. This was a legacy investigation being completed by HSSIB under the NHS England Healthcare Safety Investigation Branch Directions 2022. Under these directions, it is important to ensure there is evidence of a qualifying incident/s, meaning there is demonstrable harm to patients. Limited reporting of harm to people in primary care has resulted in difficulty in identifying qualifying events.

In addition, the investigation has identified ongoing work at a national level to address access to primary care which includes the NHS England delivery plan for recovering access to primary care and work by the Academy of Medical Royal Colleges on how bureaucracy and workload can be cut by improving the interface between primary and secondary care. Given the current national focus in this area, there is limited scope for HSSIB to add value at this time. The areas whereby HSSIB can add value are included within the digital workstream and the care coordination for people with complex disease workstream. This includes the lack of integration and therefore system interoperability and how this hinders effective communication.

A workforce and patient safety theme report will be published with learning from all investigations, and this will include information gathered as part of the prioritising patient care investigation.

Investigation report