Safety recommendation
HSSIB recommends that the Department of Health and Social Care creates a national oversight mechanism that supports co-ordination, prioritisation and oversight of safety recommendations to implementation across the system. This is to ensure that recommendations from public inquiries, independent patient safety investigations and other patient safety investigation reports, as well as prevention of future death reports from inquests, are analysed and monitored and reviewed until their implementation using a continuous quality improvement approach to learning.
Response:
Since 2023, HSSIB, on behalf of the Department of Health and Social Care (DHSC), has worked with relevant stakeholders and ALBs in a Recommendations to Impact Group. This work will be aligned with wider Government plans for effective monitoring and oversight of government-led inquiries. DHSC will draw on both of these activities to take work forward to design an oversight mechanism that supports the effective implementation and learning from safety recommendations. Any mechanism should enable the tracking, prioritisation and oversight of safety recommendations to implementation.
Action planned to deliver safety recommendation:
Design a national oversight mechanism to monitor implementation of safety recommendations drawing on work of HSSIB-led Recommendations to Impact Group, by Autumn 2025. Organisational lead: Department of Health and Social Care. Other dependencies identified: Government plans for oversight of government-led inquiries.
Response received on 19 May 2025.