A decade-long drive to improve patient safety across the NHS has led to the creation of dozens of new bodies, billions in spending, and thousands of recommendations—but with limited measurable improvement in care quality, according to Dr Penny Dash’s review.
The report, which examines the evolution of healthcare quality in England over the past 10 years, reveals a fragmented and often inefficient system. Despite a 34% increase in NHS nurses and a 37% rise in doctors since 2013, patient outcomes remain inconsistent, and life expectancy has not recovered to pre-pandemic levels.
Key Findings:
- Over 1,400 recommendations from 30 inquiries in 30 years, yet many lack cost-benefit analysis.
- £100 million+ spent on safety reviews and inquiries, with indirect costs far higher.
- £6 billion annual productivity loss in acute hospitals since 2019.
- 82,000 preventable deaths in 2022 alone, largely due to ineffective care.
- Diabetes care gaps led to 9,500 amputations and 48,000 strokes in one year.
The proliferation of organisations—over 40 with formal roles in care quality—has created confusion and duplication. The report criticises the lack of strategic planning, noting that many recommendations focus on inputs rather than outcomes, and often disempower local NHS boards.
The review has called for:
- A revitalised National Quality Board to lead a unified strategy.
- Streamlining of patient engagement and complaints systems.
- Greater use of AI and data analytics to identify and address care gaps.
- A national strategy for adult social care quality, currently underdeveloped.
Despite multiple organisations advocating for patients, most NHS boards still lack a dedicated executive for user experience—unlike other consumer-focused industries. The report urges a cultural shift to embed patient and staff voices at the heart of care delivery.
Ultimately, the report concludes that only commissioners and providers can drive real change. It recommends clearer governance, stronger leadership, and a renewed focus on outcomes over bureaucracy.
NHS Confederation has welcomed the review, outlining that it is important for patients to be able to report when things go wrong. In response to the publication of the report NHS Confederation’s Chief Executive, Matthew Taylor, said:
“Patient empowerment is crucial to the success of the government’s Ten-Year Health Plan. It is absolutely vital that when things do go wrong there are ways for patients to report it and for NHS organisations to learn from mistakes.
“Our members fully recognise the importance of making sure the voice of patients and their wider communities in how their services and planned and delivered is listened to, and that the feedback they give guides and shapes where improvements need to be made.
“NHS leaders will welcome Dr Penny Dash’s review, which supports the direction of the Ten-Year Health Plan in streamlining the role of the centre and devolving accountability to local leaders, while giving the public the tools to make informed choices about their care.
“The government has already announced plans to reduce costs from within the NHS, so it is understandable that some consolidation may be needed around the way national standards are set too. Any opportunity to reduce duplication should be welcomed, particularly where any money saved can be invested back into frontline care.
“However, NHS leaders would encourage the government to not forget the failings in care that led to these bodies being set up in the first place and tread carefully so as to ensure their vital missions continue in future. Staff and patients will still need safe spaces where they can speak up.
“Given the importance of patient feedback informing the design and delivery of care, and following the abolition of Healthwatch England and local Healthwatches, NHS leaders would encourage the government to ensure ICBs and local authorities taking on these functions are adequately supported and resourced to do so effectively.”
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