We are not getting safer: Patient safety and the NHS staff survey results

  • 26th March 2024

In this report, Patient Safety Learning analyses the results of questions in the NHS Staff Survey 2023 specifically relating to reporting, speaking up and acting on patient safety concerns. It raises questions as to why there has been so little progress despite policy intention in this area. It concludes by setting out the need to improve the implementation, monitoring and evaluation of work seeking to create a safety culture across the NHS. This article contains a summary of the report.

Action is needed to tackle the persistence of blame cultures and fears of speaking up in the NHS, says Patient Safety Learning.

Five years into the NHS Patient Safety Strategy, a new report, We are not getting safer: Patient safety and the NHS staff survey results, argues that NHS leadership needs to introduce clearer plans to help organisations create and maintain safety cultures.

The report looks in detail at responses to the NHS Staff Survey 2023 relating to the reporting, speaking up and acting on staff patient safety concerns. It argues that the latest results indicate that blame cultures and a fear of speaking up continue to persist in a significant part of the NHS, highlighting several alarming statistics, including:

  • 40% of staff are unable to say with confidence that their organisation treats them fairly if they are involved in an error, near miss or incident.
  • More than 260,000 staff were unable to say that they felt safe to speak up about anything that concerns them in their organisation.
  • 43.19% of staff could not say that they were confident that their organisation would address any clinical practice concerns raised.

Coupled with findings of patient safety inquiries and whistleblower testimonies, Patient Safety Learning believes that this demonstrates the need for a more transformative effort and commitment to creating a safety culture.


The report makes two recommendations:

  1. NHS England and Integrated Care Systems should set out how they will support and ensure the effective and consistent implementation of safety culture guidance and best practice across the country.
  2. NHS England should set out actions to seek to address the discrepancies identified in responses on patient safety and speaking up specifically concerning Ambulance Trusts and the ethnic background of respondents.

Commenting of the report, Patient Safety Learning Chief Executive Helen Hughes said:

“It is vital that we create a culture in healthcare that supports raising, discussing and addressing the risks of unsafe care. Results of this year’s and previous years’ staff surveys, coupled with evidence from patient safety scandals and whistleblower testimonies, show that in too many parts of the NHS this is simply not the case.

It is difficult to imagine that the evidence of an unsafe culture in other safety critical industries, where the consequences of incidents may also be serious injury or loss of life, would be deemed acceptable. Surely it must be unacceptable in healthcare.

We are calling on NHS England to acknowledge the scale of this problem and respond to this as part of its expected update on the implementation of the Patient Safety Strategy this year. If there is to be any positive movement on scores on safety issues in coming years, now is the time to act.”

Staff Survey Report Website


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