It was developed to support those wanting a deeper understanding of the themes found by Sir Robert Francis, author of the Mid Staffordshire Inquiry report.

Safety is essential in all health and social care environments and is central to delivering high‑quality care. Every day, staff across the UK work to provide safe, effective care. Understanding how people, systems, and environments interact is crucial to preventing harm and improving outcomes.

The terms ‘patient’ or ‘service user’ may be used interchangeably throughout this resource, although it is recognised that some settings prefer alternatives such as ‘resident’ or ‘client’. Fundamentally, these terms all refer to the person using the health or social care service, and the principles of safety remain the same regardless of the terminology used.

1. The foundations of clinical governance

• The seven pillars of clinical governance and how they support high standards of care and accountability.
• The regulatory and governance frameworks that underpin quality and safety across health and social care settings in the UK.

2. The principles of patient safety

• The definition of patient safety and key strategies to prevent avoidable harm and errors.
• How workplace factors—such as incivility and psychological safety—impact patient outcomes and the wellbeing of the health and social care workforce.

3. Insight into human factors in health and social care

• How human factors influence individual, team and system‑level performance across health and social care environments.
• Approaches to creating safer workplaces and improving how people, equipment and processes interact.

4. The need for a culture of safety and quality improvement

• The importance of compassionate leadership, effective communication and learning from adverse events to build a culture of safety.
• The principles of improvement science to enhance patient safety and support sustainable change in health and social care systems.

Nursing, as the largest safety-critical profession in health care, is at the forefront of care delivery, managing risk and safety across all health and social care settings. The care of the nursing workforce, across all health and social care settings, is therefore critical to the safety of people using those services, the prevention of avoidable harm and the management of risks.

The nursing workforce often leads and champions change in the workplace to promote safety and to improve outcomes for the people using their services. The NMC Code and the RCN Principles of Nursing both uphold safety as an expectation of what everyone, from the nursing workforce to people and populations, can expect to deliver safe and effective nursing care.

“Patient harm is a leading cause of global disease burden with considerable morbidity, mortality, and economic impacts for individuals, families and wider society.” (Hibbert et al., 2023, p1.)

Nearly 1 in 10 patients is harmed in health care, which translates to over three million deaths globally each year, of which harm from more than half is preventable. Harm is intrinsically connected to human involvement, either directly or indirectly.

This may arise from departures from established standards or norms due to negligence, recklessness, lack of competence or intentional criminal behaviour.

More than 10 years have passed since the Mid Staffordshire Inquiry; however despite the passage of time, the more recent ‘Review of Maternity Services at The Shrewsbury and Telford Hospital NHS Trust’ (Ockenden, 2022) continues to highlight:

• Weak governance and leadership, which made it harder to learn and improve practice.
• A workplace culture where people did not feel safe to raise concerns.
• Reports of staffing pressures, with staff describing stress and worry about safety.

Why this matters

• When staffing is low, nurses report more care being left undone (PDF) because there is not enough time.
• Lower nurse staffing is linked with worse safety and quality outcomes.

Poor communication and negative behaviours within teams can directly affect the quality and safety of patient care. However, we cannot improve patient safety without supporting the workforce. Safe care needs the right staff, with the right skills, in the right place, at the right time. This includes campaigning for safe nurse-to-patient ratios in every setting.

A sustained focus on clinical governance, patient safety, human factors and quality improvement can help create healthier workplaces. Improving working conditions for health and social care staff can also help services meet people’s needs more effectively.