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

Investigation finds patients suffer harm as electronic communications fail to support their safe discharge from hospital

10 July 2025

Patients are coming to harm due to failures in the way critical clinical information is electronically communicated when they are discharged from hospital.
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News

10 year plan recognises importance of HSSIB for the future of patient safety

3 July 2025

We welcome the publication today of the NHS 10 Year Health Plan. It recognises the importance of our work and gives us clear direction for the future. We will continue to address systemic patient saf…
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News

HSSIB’s work to address patient safety concerns continues as usual

30 June 2025

Our work to address systemic patient safety concerns continues as usual, whilst we await the publication of the NHS 10 Year Health Plan and the Dash review of patient safety organisations.
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News

HSSIB’s work to address patient safety concerns continues as usual

30 June 2025

Our work to address systemic patient safety concerns continues as usual, whilst we await the publication of the NHS 10 Year Health Plan and the Dash review of patient safety organisations.
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Focus on the hand of a hospital patient laying on a bed. An IV cannula is inserted in a vein on the top of their hand.
News

Investigation reports highlight ongoing challenges in early diagnosis of sepsis

26 June 2025

Despite extensive national work and awareness campaigns, the recognition of sepsis remains an urgent and persistent safety risk, according to three reports published today.
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A brightly lit corridor on a hospital paediatric ward. The space is clear, clean and predominantly white, with a colourful mural running along one wall.
Blog

Designing paediatric wards to support mental health

20 May 2025

Saskia Fursland, Senior Safety Investigator, blogs about her visit to a newly opened paediatric ward where its design has carefully considered children and young people with mental health needs. Sask…
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Events

Webinar: mental health care in inpatient settings

14 May 2025

A webinar to discuss our series of patient safety investigations looking at mental health inpatient care, directed by the Secretary of State for Health.
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A female clinician crouches to reassure and help a male patient who sits on the floor with his head in his hands.
News

More must be done to stop reoccurring harm in mental health

13 May 2025

Critical recommendations to improve mental health inpatient services are too often not implemented, which leads to missed opportunities to learn, improve and prevent harm to patients and NHS staff, a…
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Sophie Hide, Senior Investigation Science Educator, stands next to her poster presentation in a conference hall.
News

Education team present safety investigator competencies work at annual human factors conference

7 May 2025

Sophie Hide, Senior Investigation Science Educator, represented HSSIB at ‘Ergonomics & Human Factors 2025’ which took place over three days in Burton upon Trent in April.
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News

Stephen Carruthers appointed as Finance and Resources Director

30 April 2025

Following a successful recruitment process we have appointed Stephen Carruthers to the role of Finance and Resources Director. He will take up the position on 1 June 2025.
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Portrait of a male paramedic wearing a bright yellow jacket.
News

HSSIB responds to growing number of violent assaults against ambulance staff

25 April 2025

The Association of Ambulance Chief Executives (AACE) has this week published data that shows the number of violent incidents against UK ambulance staff has reached 22,500 a year for the first time ev…
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A young burnt out doctor sits resting his chin on his hands.
News

Report warns NHS staff fatigue is still not recognised as a serious risk to patient safety

24 April 2025

Fatigue amongst NHS healthcare staff poses a significant yet under-recognised risk to patient safety, says our latest investigation report.
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A district nurse cares for an elderly man with a head injury in his living room at home.
News

Frequent failures in co-ordinating care for patients with long-term health issues

10 April 2025

A lack of co-ordination of care for people with long-term health conditions is taking a toll on patients and carers. As a result they experience burnout, distress and harm, says our latest report.
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Five patient safety leaders sit on a stage to take part in a panel discussion, introduced by a compere standing next to a microphone.
News

HSSIB takes to the world stage at patient safety summit

7 April 2025

The 7th Global Ministerial Summit for Patient Safety took place last week (3-4 April 2025) in Manila, Philippines. Dr Rosie Benneyworth took to the stage to help kick-off the first day of the summit …
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News

Our response to ‘The Safety Gap’ report

1 April 2025

A new report from the Patient Safety Commissioner shows that people with sensory impairment experience a safety gap with medicines and medical devices.
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A young woman with a pained expression lies in an ambulance with her eyes closed while two paramedics treat her.
News

Report highlights concerning variation in paramedic ECG education and training

27 March 2025

HSSIB’s latest report calls for more consistency in the way paramedics are educated and trained to carry out and interpret ECGs of patients who could be critically ill.
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News

HSSIB celebrates making the shortlist for HSJ Digital Awards 2025

17 March 2025

We are very pleased to announce that the Health Services Safety Investigations Body (HSSIB) has been shortlisted in the ‘Digital Clinical Safety Award’ category at the HSJ Digital Awards 2025.
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A female nurse speaks with an elderly male patient laying in a hospital bed. She is using a digital tablet device.
News

Learning prompts for hospitals to improve anticoagulation medication safety

13 March 2025

We’ve published a report that examines a patient safety event involving an 87-year-old man on anticoagulation medication. The report demonstrates the highly complex and dynamic nature of clinical dec…
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Blog

Patient safety in Japan: no-fault compensation for birth injury

3 March 2025

In the last of three guest blog posts for HSSIB, Professor Shin Ushiro talks us through the no-fault compensation system for birth injury in Japan, in particular how they worked with patients and fam…
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Two pharmacists stand behind the counter in a well-stocked pharmacy, providing assistance to a customer.
Blog

Patient safety in Japan: national reporting and learning system

20 February 2025

In part two of three guest blog posts for HSSIB, Professor Shin Ushiro talks us through the development of the national reporting and learning system in Japan, and its value to frontline healthcare s…
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A smiling health visitor wearing green scrubs helps an older woman to walk in her home.
News

Report finds there is no 'consistent' approach to managing safety risks when patients' care spans multiple providers

13 February 2025

Our latest report found that integrated care boards (ICBs) do not have visibility of some patient safety risks, which impacts on their ability to effectively deal with those risks to keep patients sa…
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Flag of Japan on the world map.
Blog

Patient safety in Japan: a brief history

5 February 2025

In the first of three guest blog posts for HSSIB, Professor Shin Ushiro discusses Japan’s patient safety journey, similarities with other countries and future perspectives.
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News

Report ‘evidences a system still not learning’ from mental health inpatient deaths

30 January 2025

Significant systemic issues, lack of patient and family involvement and cultures of fear and blame contribute to mental health services not learning from inpatient deaths, says our latest report.
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News

Our response to increased violence against ambulance staff

7 January 2025

Dr Rosie Benneyworth responds to new statistics that show ambulance services are on course for the highest rate of reported incidents of violence.
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News

Response to National State of Patient Safety Report 2024

19 December 2024

In welcoming the report, its findings and recommendations, Chief Executive, Dr Rosie Benneyworth says:
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Blog

Consolidating safety investigation: Finland’s journey and the influence of the HSSIB

19 December 2024

In our latest guest blog post, Hanna Tiirinki of the Safety Investigation Authority Finland cites how HSSIB has significantly influenced Finland’s approach at the beginning of its national safety inv…
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An AI generated image of a young person and an adult stood back-to-back, one on a young person's ward and one on an adult ward.
News

Report explores keeping young people safe when moving between mental health services due to reaching adulthood

12 December 2024

Moving from inpatient children and young people’s mental health services due to a change in age rather than a change in need can have a significant impact on young people, their families and carers, …
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Two ambulances parked outside a hospital emergency department entrance.
News

Report highlights impact of emergency departments missing or delaying ‘time critical’ medication for patients with existing conditions

5 December 2024

We’ve published a report examining the case of a patient who did not receive time critical Parkinson’s medication whilst attending an emergency department.
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The Swedish flag stuck into a map of the Scandinavian region of Europe.
Blog

How HSSIB contributes to patient safety: a view from Sweden

3 December 2024

The leadership team of the Swedish Accident Investigation Authority compare their capacity for healthcare safety investigations to that of HSSIB and highlight how our international counterparts consi…
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Empty chairs outside double doors leading to an outpatients department in an NHS hospital.
News

Dignity fears contribute to prisoners not attending hospital or clinic appointments

28 November 2024

Our latest report raises concerns over female prisoners privacy and dignity after an investigation found they are often taken to outpatient appointments by male prison officers.
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Silhouette of a man sitting on the edge of a bed, facing away towards a large, bright window.
News

Harm caused by mental health out of area placements

21 November 2024

Patients experience harm with the continued use of ‘inappropriate’ out of area placements for their mental health inpatient care, says our latest report.
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News

HSSIB stops posting on X

18 November 2024

We have been reviewing the use of our social media channels and have taken the decision to stop posting updates on X from today.
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A map of Australia with the Australian flag pinned to it.
Blog

How HSSIB contributes to patient safety: a view from Australia

4 November 2024

Professor Peter Hibbert from the Australian Institute of Health Innovation reflects on how HSSIB contributes to improved patient safety, plus our education offering and areas for improvement.
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News

Our response to the Care Quality Commission State of Care report 2023/24

25 October 2024

Following the publication of the State of Care report, HSSIB’s Chief Executive, Dr Rosie Benneyworth says:
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News

Report emphasises importance of therapeutic care in mental health units and wards

24 October 2024

We have published the first of our investigations into mental health inpatient settings and make recommendations to ensure that therapeutic care is a priority.
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News

Our response to the Dash Review

15 October 2024

Review of patient safety across the health and care landscape.
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Blog

The investigator’s toolkit: FRAM

9 October 2024

David Fassam, Senior Safety Investigator, continues our series of blogs that take a look at the methods we use in our patient safety investigations. Next up is the Functional Resonance Analysis Metho…
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News

Our response to the Lord Darzi Review

12 September 2024

Following the publication of Lord Darzi’s Independent Investigation into the NHS in England, HSSIB’s Chief Executive, Dr Rosie Benneyworth says:
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A female British Asian healthcare worker makes a hospital bed.
News

Discrimination stops temporary workers speaking up about safety concerns

5 September 2024

Our latest investigation report reveals there is widespread discrimination against temporary staff in the NHS and this creates a culture of fear that stops them speaking up about patient safety.
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Aerial view of a prison site in the English countryside.
News

Unnecessary 999 calls from prisons lead to a ‘significant’ loss in ambulance crew time

29 August 2024

Ambulance crews spend significant time diverting resources to 999 callouts in prisons that are cancelled or not a serious enough medical emergency, says our latest report.
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An older man wearing glasses sits using a laptop.
News

Patient and staff concerns over GP online consultation tools

25 July 2024

Our latest report says that patient safety must be prioritised as online consultation tools in general practice continue to be implemented.
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Annual report 2023-24 cover
News

Annual report sets out progress in our first six months

22 July 2024

Our first annual report and accounts, published today, covers the six months from our launch to 31 March 2024 and sets out our priorities as a new organisation, with achievements and progress to date.
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A young girl with an unhappy look on her face lies on her side in a hospital bed, hugging her teddy.
News

Safer mental health environment needed in paediatric wards

23 May 2024

Our latest report has called for improvements and changes in the design of paediatric wards to ensure they provide a therapeutic environment.
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A sad looking woman lies awake on a hospital bed.
News

Self-harm risk of patients under continuous observation in hospital wards

9 May 2024

Our latest investigation has found ‘limited evidence’ that the current approach to continuous observation of adult patients at risk of self-harm when on hospitals wards is effective.
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Blog

Tackling health inequity: observations from an investigation visit

30 April 2024

Nichola Crust, Senior Safety Investigator, shares how one primary care network in the north of England is tackling health inequity by building relationships beyond traditional healthcare boundaries, …
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A nurse wearing scrubs prepares surgical instruments including swabs.
News

Risk of surgical swabs being left inside patients

16 April 2024

We've investigated the risk of unintentional ‘retained’ swabs after invasive procedures. The investigation was launched after we examined the case of a patient who had two swabs left in her ches…
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A tired hospital doctor rests his head on his hand as he sits at a desk.
News

Share your experience of healthcare staff fatigue

26 March 2024

We’ve just launched an investigation to look at fatigue risk in healthcare and its impact on patient safety.
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Healthcare professionals in a busy hospital corridor.
News

Temporary NHS staff a ‘lost voice’ in crucial patient safety investigations

14 March 2024

Our latest investigation has found that not involving temporary NHS staff in serious incident investigations may ‘undermine’ its ability to improve patient safety.
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A surgical team wearing blue scrubs perform an operation in a hospital theatre.
Blog

Elective care recovery: taking a systems approach

5 March 2024

Senior Safety Investigator, Neil Alexander, blogs about the challenges facing the NHS in tackling the elective care backlog and how learning from our investigation reports may be able to help the NHS…
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A male patient's hand rests on a nurse call button in a hospital bed
News

New learning report brings together learning on patient misidentification

8 February 2024

Our latest report reiterates that the misidentification of patients remains a persistent safety risk across the NHS but is one that is under-recognised and under-researched.
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An anaesthetist performs a nasotracheal intubation of a child.
News

New report charts safety risks associated with managing patients with known ‘difficult airways’ in emergency situations

25 January 2024

Our latest report shows improvement is needed at a national level in the communication, preparation and planning for patients who may have ‘a difficult airway’ – that is the anatomy of their mouth, t…
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