The phone call was in hushed tones. ‘It’s chaos at NHS England’ they said. I wasn’t sure what was meant, but I had a good idea. ‘They’re reconstructing the NPSA systems because people have suddenly realised what they’ve lost’ they continued, ‘but here’s the catch: most of the people with the real knowledge have gone elsewhere’.

My mind drifted back to my first encounter with the NPSA, the National Patient Safety Agency. Sir Liam Donaldson had the right idea when he set it up, but in my opinion with one glaring omission – he didn’t give it any real power.

I first heard of the NPSA just after my late wife died. It was during a conversation with a human factors expert, I said ‘so you’re telling me there’s an organisation responsible for patient safety?’ My colleague said, ‘well, it’s not that simple Martin’. And he was right. It’s fair to say that the NPSA had become just another big organisation without the power, or even desire to shake the system up. It was kind of a regulator, who kind of regulated, in a kind of way; but then again it wasn’t.

However, over time I saw some real talent. Passionate people who really understood safety, but also really understood the challenges at the front line, improvement practice and the things that create safety. And as the leadership changed and developed, and the NPSA mobilised the safety agenda, it started to develop into a centre of knowledge, an organisation that was learning and had real potential. The Patient Safety First campaign, a joint collaboration between a number of organisations did save lives, it did help raise awareness and, I dare say, it did start an informal education process that has started to created excellence in some areas.

And then it stopped.


In many respects the NPSA and Sir Liam were too far ahead, too visionary. Talk of learning from ‘near misses’ didn’t mean anything to the NHS who didn’t have a safety problem, didn’t understand disasters let alone near misses, and didn’t understand safety science anyway.

And after the reorganisation, suddenly the NHS found a mission to be safer.

And that mission was driven not by the centre, but by people like Julie Bailey. A cafe owner from Stafford. I would suggest that if you look at what’s happened to the regulatory environment that healthcare now finds itself in, if you look at the emphasis on the patient, if you look at the emphasis on doing it right for the patient and making things safer and better, if you listen to some of the new wave of leaders in healthcare, then much of what is being done is the direct result of people like Julie, people like James Titcombe, people like Ann Clywd MP.

So perhaps we should let patients take the lead? It’s now trendy to talk of ‘patient leaders’, ‘patient collaboratives’. 

Or has ‘patient led’ become a way of saying ‘let’s abdicate responsibility’? We can’t lead so let’s get patients to do it, then we don’t have to stick our head above the parapet.

I won’t hide my support for people like Professor Sir Bruce Keogh, who show leadership, who are prepared to challenge the system over the ‘acceptability of harm’. It’s inspiring and empowering for people to hear their leaders speak in this way. And people like Mark Newbold, Stuart Poyner, Dr Umesh Prabhu and Dermot O’Riordan do the same at a more local level.

But what about NHS England and the centre – is anyone else prepared to lead? Or has the knowledge left the building? Or is it there, just buried in the politics of Whitehall? 

We mustn’t return to top-down, but we also need people at the centre to set the vision and the values, based on a balance of passion and science. The role of the centre, like the upturned pyramid, is to support the frontline. And, right now, passion isn’t trendy and the science isn’t well understood at the centre. 

In my view what the centre lacks at the moment is capacity, expertise and maybe some bravery to inspire. Many of the experienced patient safety people have gone elsewhere. In the month after the National Quality Board published its ‘Concordat’ on human factors, the exact sum of ergonomists/human factors professionals at NHS England was zero. No one.

If there’s anything that NHS England should learn from elsewhere, from the successful business leaders, from the successful safety critical organisations, and from organisations like the Clinical Human Factors Group, it’s ‘surround yourself with the very best people, look after them, facilitate and inspire their brilliance’.

Patients have a place at the table, patients can bring about change, but don’t think you can abdicate to us. We don’t have the breadth of expertise. The expertise to make the NHS the safest most efficient healthcare system in the world is available, someone needs to track it down and bring it home.

Martin is a pilot and the founder and current Chair of the Clinical Human Factors Group,

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