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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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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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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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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.
Read the full article
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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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Blog

The investigator's toolkit: SEIPS

17 January 2024

Continuing our series of blogs that look at the range of investigation methods we use, Deinniol Owens and Dr Helen Vosper highlight how SEIPS can be the investigator’s ‘swiss army knife’ when plannin…
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News

Reflecting on three months as HSSIB

21 December 2023

This week marks three months since an event was held at Kings College London to formally recognise our formal establishment as the Health Services Safety Investigations Body (HSSIB).
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Blog

Electronic patient record systems: recurring themes arising from safety investigations

19 December 2023

Senior Safety Investigator, Helen Jones, blogs about some of the key benefits and risks of electronic patient record (EPR) systems used in healthcare, sharing what we are learning from our safety inv…
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An older male patient talks to a GP, sat either side of a desk in a consulting room.
News

Change needed in how GP continuity of care is prioritised at a national level

30 November 2023

Making continuity of care an ‘essential requirement’ for GP practices could reduce the risk of a delay in diagnosing serious health conditions, and ease significant pressure on GP’s workload and welf…
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News

Investigation explores risk of patients not receiving crucial medication through a portable medical device

14 November 2023

Alarms on a portable medical device may not notify staff that medication is not being delivered as it should, creating a ‘hazardous situation’ and increasing the risk of harm to patients.
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News

New report shows needs of learning disability patients ‘not consistently met’ when they are in hospital

2 November 2023

Despite national efforts to address inequity, the health and care system is not always meeting the needs of people with a learning disability when they are cared for in hospital, says our latest repo…
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Blog

The impact of menopause on mental health

30 October 2023

Amber Sargent and Helen Jones blog about the patient safety issues that arise when the impact of menopause on mental health is not considered during clinical assessments.
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News

Our response to the Care Quality Commission State of Care report 2022/23

20 October 2023

State of Care is the annual assessment of healthcare and social care in England by the Care Quality Commission (CQC).
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News

HSSIB officially launches with aim to drive radical change in patient safety

18 October 2023

As our newly formed investigation body officially launched today, clear messages came from our leadership team that we will aim to drive ‘radical’ change in how patient safety is managed across healt…
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News

Report explores ‘proactive and integrated approach’ to managing safety in healthcare

18 October 2023

Today we publish our first report as the Health Services Safety Investigations Body, exploring the use of safety management systems and how they could contribute to more effective safety management i…
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News

Philippa Styles appointed as Director of Investigations

16 October 2023

Philippa Styles will join our team shortly as Director of Investigations. This is a critical role within the leadership team, overseeing all investigations undertaken by the Health Services Safety In…
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HSIB legacy content
Blog

The importance of non-patient facing NHS services in patient safety

19 July 2023

Senior Safety Investigators Russell Evans and Craig Hadley highlight how behind-the-scenes services are crucial to help the NHS operate effectively and safely, in our latest blog.
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HSIB legacy content
Blog

Helping NHS staff to do their jobs: design of information in the workplace

29 June 2023

Senior Safety Investigators Clare Crowley and Nick Woodier blog about the simple but often overlooked measures that NHS staff and organisations can take to improve the design and display of informati…
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HSIB legacy content
Blog

The investigator's toolkit: Using Appreciative Inquiry in safety investigations

5 June 2023

In the first in a series of blogs looking at the range of investigation methods we use, Nichola Crust reflects on how Appreciative Inquiry can be used to examine patient safety and identify opportuni…
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HSIB legacy content
Blog

Building an international network for patient safety investigation

4 May 2023

Our Chief Investigator, Rosie Benneyworth, writes about exciting developments in the world of international patient safety investigation.
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HSIB legacy content
Blog

Failing to communicate: challenges with electronic communication systems

18 April 2023

Matt Mansbridge and Melanie Ottewill blog about the patient safety issues that arise when systems are unable to communicate with each other, as highlighted in three of our national investigations to …
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HSIB legacy content
Events

The impact of staff fatigue on patient safety: how do we manage the risk

17 March 2023

We facilitated a half-day event on 17 March 2023 to ask how healthcare can understand and start to manage the risk of staff fatigue.
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HSIB legacy content
Blog

Starting the conversation around NHS staff fatigue and patient safety

8 March 2023

Laura Pickup blogs about NHS staff fatigue in the run up to World Sleep Day and our fatigue event on 17 March 2023.
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