The future of the NHS 

Fit for the future: 10 year health plan for England 

The government’s plan for NHS reform in England was published on 3 July 2025. It describes the NHS as standing at an “existential brink” with a stark choice - “reform or die.”  The plan is to create a new model of care fit for the future. The plan describes the reinvention of the NHS through “three radical shifts.” 

• Hospital to community. 
• Analogue to digital. 
• Sickness to prevention. 

The plan should be read in conjunction with the Dash review, which was published on 7 July. Dr Dash’s conclusions include:  

• The shift towards safety over the last 5 to 10 years has brought relatively small improvements despite the deployment of considerable resources. 
• Recommendations from reviews/ inquiries have not received (an adequate) cost-benefit analysis. 
• Greater strategic focus on care delivery and management is needed to improve the quality of care. 

Transparency of quality of care. 

Transparency is a key theme of both the 10 year plan and the Dash report. It will be achieved by (amongst other things): 

• Setting up a national independent investigation into maternity and neonatal services (led by Baroness Amos) plus a taskforce chaired by the Secretary of State – to inform a new maternity and neonatal action plan, co-produced with bereaved families.  
• Reform of the complaints process and improvement of response times to PSIs and complaints. 
• Review of how to improve patient experience of clinical negligence claims. 
• Revamping and significantly enhancing the role of the National Quality Board (NQB), developing a new quality strategy, building on: 
  • Data and analysis about the current quality of care 
  • Evidence and examples of high-quality care. 
  • Where appropriate, recommendations from previous reviews and inquiries. (See also Health Services Safety Investigations Body exploratory review, which references the challenge of implementing inquiry recommendations.) 

Clinical negligence reform 

It has been announced separately that David Lock KC has been appointed to advise on clinical negligence reform/costs of clinical negligence claims. The announcement suggests that the recommendations will be made at the same time as the government announces how it will deliver the 10 year plan, which references the timeframe as being “later in the summer.” 

Comment: Dr Dash’s recommendation regarding the complaints process references 2023-24 statistics for the most common cause of complaint. The top three cases (in order) were communication, nutrition and hydration and staff values/ behaviour. Poor communication within and between teams delivering care to a patient is a common feature of many clinical negligence complaints and claims. Managing risk around pinch points such as handover, transfer (e.g. to ICU or another hospital), and induction of new staff can assist in reducing the potential for patient harm. 

It will be interesting to see the shape of the proposals for clinical negligence reform and whether this means the historic proposal for fixed costs in Lower Damages Fixed Recoverable Costs (LDFRC for claims worth up to £25,000), are taken forward or even extended to claims of a higher level of value. Further information on LDFRC can be found in Clinical Law Insight: Summer 2024. 

Safety & Learning (Maternity) 

Maternity services: acting with compassion and care 

NHS England’s letter to Trust CEOs and Chairs called for the systemic issues behind failings in maternity care to be addressed with urgency. It referenced the independent investigation announced by the Secretary of State and the urgent reviews of “up to 10 trusts where there are specific issues.”  In the meantime, every local NHS board with maternity and neonatal responsibilities is asked to: 

• Rigorously tackle any poor behaviour and culture. 
• Listen directly to families who have experienced harm when concerns are first raised.  
• Create the conditions where staff feel able to speak up and learn from mistakes and (if necessary) robustly manage those who demonstrate a lack of compassion/ openness. 
• Ensure the board has set the right culture. 
• Review their approach to reviewing quality data. 
• Retain a “laser focus” in tackling inequalities, discrimination, and racism. 

What this means for you: The letter is a blueprint to assist every provider of maternity and neonatal services in ensuring an open and transparent culture exists, where the duty of candour is both understood and fully implemented to enable learning from error to prevent future harm. See also the new NMC ‘Principles for supporting women’s choices in maternity care’, below. 

Principles for supporting women’s choices in maternity care 

The Nursing and Midwifery Council (NMC) has published new guidance to support midwives and organisations providing personalised care for women during pregnancy, birth and the postnatal period. The guidance comprises eleven principles, which include: 

• Putting women at the centre of decision-making. 
• Providing them with a range of options/ alternatives in a non-coercive manner and explaining the relative risks and benefits. 
• Presenting information in a way that is easy to understand using a range of formats and ensuring accessibility. 
• A personalised care and support plan for each woman that reflects and respects their views, preferences and decisions, (including where care is declined) and does not require them to justify their decision. 
• Provision of evidence-based information to make an informed choice. 
• Multi-disciplinary team (MDT) liaison, working and training to promote best outcomes for women and newborns 

The guidance also contains principles relating to the role of the midwife which include the need to provide care based on informed consent, discussion of alternative care pathways, the importance of communication and the need to keep contemporaneous records. In addition, there are sections on the role of the employer and the NMC. 

What this means for you:  The principles echo a major theme in the NHSE letter to CEO’s of 23 June 2025 – the need to provide compassionate care.They also focus heavily on the importance of communication, the need to obtain informed consent and record keeping. These are three of the most significant areas of omission in maternity medico-legal claims and are often inter-related. Obtaining informed consent to any procedure (including one which is declined) should be based on the principles set out in the Supreme Court decision in Montgomery (2015) i.e. that the clinician has a duty of care to ensure that the patient is aware of any material risks (to them) of the proposed treatment and of any reasonable alternative/ variant treatments. Documenting the key elements of the discussion is crucial.  

Safety & Learning (General)

Safeguarding the security and dignity of deceased people 

The final report of the Fuller Inquiry has been published. Its aim was to assess the effectiveness of systems and processes designed to ensure the security and dignity of the deceased across all sectors where they may be cared for and prevent similar crimes from being committed in future. The Inquiry was launched following the conviction of mortuary electrician, David Fuller, for the sexual abuse of the bodies of over 100 women and girls in Kent Hospital mortuaries and the unrelated murders of two women.

Recommendations for all NHS Trusts with mortuaries/ body stores, from the three Inquiry reports include: 

• A specialist strategic review of systems in place to protect deceased people should be commissioned and include a detailed risk assessment of potential breaches of security that could occur. 
• Installation of CCTV inside the mortuary with cameras facing all doors and access points, the reception area and the doors of body fridges, while maintaining the security and dignity of deceased people. 
• Routine audit of access data of all facilities used to store deceased people. 
• Use of systemic operational barriers should be considered e.g. implementation of a rule preventing phones or cameras from being taken into a mortuary other than for approved reasons. 
• ‘Swipe to exit’ should be considered for mortuary facilities to enable monitoring and audit of entry and exit, as well as time spent there. 
• A formal annual report on matters relating to mortuaries/ body stores (similar to the annual safeguarding report). 

What this means for you: The strategic review of systems and associated risk assessment is central to Trusts providing the requisite assurance that deceased people are being cared for appropriately. The Inquiry report has a strong focus on governance, not only in the shape of the annual Trust mortuary report, but also the need for Trust boards to assure themselves that the recommendations of the Inquiry report have been implemented. Boards will need to ensure that they apply to temporary as well as permanent facilities and that mortuary services are treated with equivalent regard to other regulated activities. In addition, the security and dignity of deceased people should be included in safeguarding training, policies and assurance.  

Managing risk around the use of ambient scribes software 

‘Ambient scribes’ or Ambient Voice Technology (AVT) software uses AI and natural language processing to listen to doctor/ patient conversations, auto generate clinical notes/ summaries and integrate them into electronic health records. As a result of concerns around information governance and patient safety risk the NHSE Chief Clinical Information Officer (CCIO) has sent a letter to GP practices and Trusts, and the BMA General Practice Committee for England (GPCE) has issued guidance to general practice. 

The NHSE letter: 

• Prohibits the use of AVT solutions which are not compliant with NHS standards 
• Reminds recipients that solutions which generate summaries require at least Medicines and Healthcare Products Regulatory Agency (MHRA) Class 1 medical device status.  
• Mandates providers to complete a clinical safety risk assessment and data protection impact assessment before using these tools. 

The GPCE recommends that practices cease using any product where the above statements are not true until assurance has been received.  NHSE advises deploying organisations that they will be liable for using a non-compliant solution. 

What this means for you: NHS organisations should review compliance with NHSE’s letter as a matter of urgency. If their AVT does not comply with the three elements above, they should cease using it until compliance can be assured. They should also check the indemnity position with the supplier/ manufacturer, as a situation could arise where a practice/ Trust has complied with NHSE guidance, but a patient suffers harm due to a software defect/ malfunction.  

The future of Physician Associates (PAs) and Anaesthetic Associates (AAs) 

Prof. Gillian Leng CBE has reported on her review of the roles of PAs and AAs. The review was commissioned following concerns raised by patients and public opinion, primarily about a lack of clarity regarding the roles, including a lack of confidence in whether patients were seeing an appropriate medical professional. Its principal aim was to determine whether the roles were safe and effective as members of an MDT. Interestingly, the review’s survey results for PAs showed a mismatch in perceptions, with PAs “significantly more likely to believe that certain activities were appropriate for them to carry out.”   

Prof. Leng found that there were neither convincing reasons to abolish the roles nor a case to continue with them unchanged. She made 18 recommendations, including: 

• Renaming the roles as ‘Physician Assistant’ and ‘Physician Assistants in Anaesthesia’. 
• Physician assistants should not see undifferentiated patients (those not already triaged by a doctor), except within clearly defined national clinical protocols. 
• Newly qualified physician assistants should gain at least 2 years’ experience in secondary care before being deployed to primary care or a mental health trust. 

Other recommendations cover team working and supervision, credentialing, professional standards, career development, workforce planning, regulation and accountability. 

What this means for you:  Following publication of the report, the United Medical Associate Professionals (UMAPs) union representing Physician Associates applied for an interim injunction to prevent the government from proceeding with the recommendations. The application was dismissed by Dove J on 15 August 2025. On the same date, NHS England published some FAQs to help NHS organisations navigate the challenges around implementation. The FAQs supplement NHSE’s letter of 16 July.

Governance

Culture is a patient safety issue 

This is the key message from the National Freedom to Speak Up (FTSU) Guardian’s annual report published in August 2025. It spans the period 1 April 2024 to 31 March 2025.  

Key findings  

• The highest number of reported cases annually, since the programme began. 
• Inappropriate attitudes and behaviours remain the most common themes. 
• Increased concerns relating to work safety and wellbeing. 
• Reduced confidence in organisations to address concerns. 

Challenges and barriers 

• Fear of detriment or belief that speaking up will make no difference. 
• Weakening of trust between staff and organisations due to lack of outcomes, delayed feedback, and breakdown in communication. 
• Perceived lack of compassionate response from line managers. 
• Rigid HR processes/ prolonged investigations contributed to anxiety and negatively impacted the wellbeing of whistleblowers. 

Progress has been made in some areas, for example, both concerns relating to patient safety and bullying and harassment have decreased from the previous year. There was also a reduction in the number of cases, revealing detriment for speaking up. 

What this means for you: The report contains a helpful and pragmatic “call to action” section, which emphasises the importance of culture. Creating a culture where speaking up is a routine part of organisational life is vital and requires “deliberate and timely action.” While progress has been made, the ongoing challenges require “unified leadership” and a “strong system-wide commitment.” All healthcare organisations should keep their FTSU policies under close review and ensure that an open and transparent culture free of blame is embedded from ward to board. Although the Dash report contains a proposal to abolish the FTSU Guardian’s Office, the government has confirmed that the FTSU guardian role will remain part of the NHS Standard Contract for 2026-27.