Policy paper

Health Bill: patient safety - fact sheet

Published 19 May 2026

Applies to England

Introduction

The 2025 review of patient safety across the health and care landscape (the Dash review) set out a clear need to streamline, simplify and consolidate across the patient safety landscape, in order to remove duplication and improve clarity over where responsibility for improving the quality and safety of services sits. It found removing duplication and overlap could help to make processes simpler and more effective for users and patients.

The Health Bill (‘the bill’) looks to address this, strengthening patient safety by streamlining the landscape. This includes provisions to:

• integrate the functions and powers of the Health Services Safety Investigations Body (HSSIB) into CQC while maintaining the ‘safe-space’ protection
• extend the limitation period for CQC prosecutions
• transfer the statutory duties related to patient safety previously carried out by NHS England to the Secretary of State. See the Health Bill: roles and functions of the restructured DHSC fact sheet for more information
• establish a single patient record. See the Health Bill: single patient record fact sheet for more information

The measures in the bill are part of a wider set of ambitions on quality and safety set out in the 10 Year Health Plan for England. Taken together these measures will ensure the right support, incentives, transparency, learning and patient feedback are in place to facilitate sustained improvements in safety and quality.

Background

Review of patient safety

In 2024 the Secretary of State for Health and Social Care commissioned Dr Penny Dash to undertake a review of patient safety across the health and care landscape, following her review of the operational effectiveness of CQC. Published in July 2025, the review found there is a need to streamline, simplify and consolidate functions where considerable duplication and overlap currently exist. It highlighted investigations as an important area of focus as they produce a high volume of recommendations without resulting in tangible improvements.

Penny Dash’s findings are an important influence on our work to reform the patient safety landscape, and in the 10 Year Health Plan we went further, placing an emphasis on safety as part of a broader approach to improve the quality of care across the NHS. This involves a strong focus on all 3 domains of quality together: patient safety, clinical effectiveness and patient experience. To develop this work we have established a revitalised National Quality Board with a more strategic role, responsible for developing a comprehensive strategy to improve quality of care, as well as amplifying patient voice as a core component of building a robust safety culture.

Health Services Safety Investigations Body (HSSIB)

The Healthcare Safety Investigation Branch (HSIB) was established within the NHS Trust Development Authority in 2017, modelled on accident investigation bodies from other industries. HSSIB, replacing HSIB, was established in 2023 as a non-departmental body under the Health and Social Care Act 2022. HSSIB carries out independent patient safety investigations into any patient safety incident linked to NHS-provided or privately provided healthcare in England, with a focus on learning not on blame or liability. Investigations provide an independent safe space for individuals to raise issues without a focus on the underlying causes of safety issues, rather than assigning individual liability. They identify risks to the safety of patients and make recommendations to address those risks.

The Dash review recommended, and the government accepted, that the investigatory functions should transfer from HSSIB to CQC, reducing duplication and improving coordination between investigations and oversight.

Care Quality Commission time limits

The Health and Social Care Act 2008 set a limitation period for CQC offences. This requires CQC to initiate proceedings for a Part 1 offence within 12 months of sufficient evidence coming to the prosecutor’s attention, and no later than 3 years after the offence occurred.

It is possible that in complex cases, the 3-year period runs out before CQC can complete their proceedings and access all relevant information to initiate legal proceedings. The extended timeframe is expected to prevent that from happening, giving more families the justice they are seeking. This was a commitment in the 10 Year Health Plan for England.

Objectives for the bill

Health Services Safety Investigations Body (HSSIB)

Abolishing HSSIB and transferring its functions to CQC will simplify the patient safety landscape. System users will be clearer about who does what in the system and how to effect change. It will increase the effectiveness of patient safety recommendations and lead to more consistent system-wide learning and tangible improvements in patient safety outcomes.

Having CQC undertake investigations (through a discrete function) will mean that the prominence of the investigation recommendations will be increased by virtue of being part of the sector’s regulator. The safety recommendation will therefore be heard clearly by providers across the system.

Transferring investigation powers to CQC will be an opportunity to strengthen CQC itself. CQC can learn and improve from HSSIB’s best practice. It is an opportunity for:

• CQC to take a more holistic approach to patient safety
• CQC’s regulatory and investigation functions to learn from each other and exchange skills
• the link between learning, oversight and improvement to be strengthened so patient safety insights lead to real and sustained change across the system

The transfer of investigation functions includes retaining the ‘no blame’, ‘safe space’ model which prohibits the unauthorised disclosure of protected material obtained during investigations. The prohibition on sharing protected materials outside of the investigation function will continue when performed by CQC. This means that disclosure of protected materials to CQC personnel will continue to be prohibited unless they are working under the investigation function or statutory exceptions apply. It is essential that the credibility of safe space protections is not compromised, and we will ensure this through both the legislation and the practical work to integrate the investigation functions into CQC. We will ensure staff and other participants in investigations will have confidence in providing full and candid accounts and insights so that lessons are learned and safety is improved.

Powers currently held by HSSIB safety investigators will be carried over to CQC, including powers of entry and the ability to demand and secure documentary and other evidence. 

HSSIB’s role in education and training in patient safety investigation skills for NHS and healthcare staff will also transfer. This will ensure the continued development of investigatory expertise across the health and care workforce.

Care Quality Commission time limits

The bill will amend the Health and Social Care Act 2008 giving CQC up to 5 years (revised from 3) for bringing proceedings against providers for failure to provide safe care or treatment or carrying out regulated activities without proper registration with CQC.

This amendment does not change the existing upper limit of 12 months from the date CQC became aware of the offence, meaning CQC must begin their proceedings within the 12 months of the offence coming to their attention.

Strengthening the patient safety landscape

Health Services Safety Investigations Body (HSSIB)

Bringing together the ‘no blame’ investigatory approach of HSSIB, including the critically important ‘safe space’, with CQC’s wider role as an independent regulator informing the public about the quality of care will benefit both CQC and the investigatory work currently undertaken by HSSIB.

CQC through its core functions already contributes to patient safety, and it is well known to the public, staff and patients. CQC will benefit from the thematic insights into quality and safety that the investigation functions will provide. The investigation function of CQC will be better positioned to amplify and ensure greater impact for the insights it generates.

This will also enable the reformed CQC to use the investigation function more strategically, working in partnership with the National Quality Board (NQB) to ensure that it aligns its safety investigation activity closely to the national priorities as set out by NQB. By drawing together evidence, thematic insights and recommendations from investigations, reviews and inquiries, NQB will prioritise and coordinate system-wide action, monitor implementation and impact, and ensure that learning is translated into sustained improvements in outcomes, quality and value across health and care.

The investigation functions will be transferred when CQC is ready. The legislation will not make this change immediately. We will only bring into force the transfer of functions when we are satisfied CQC has improved and that it is being supported and held to account to recover its effectiveness.

Care Quality Commission time limits

The current 3-year time constraints put significant pressure on CQC’s legal and enforcement teams, and proceedings may conclude at or near the limitation date. The extended 5-year limitation period is expected to avoid that from happening, giving more families the justice they are seeking.

Evidence from CQC states that the enforcement team needs at least 9 months remaining on the limitation clock to investigate fully, meaning that proceedings must start within 2 years and 3 months of the incident, increasing the potential for delays in complex cases.

CQC’s primary function remains to prioritise quality and safety. This change will allow more cases to be comprehensively reviewed. A provider being subject to a more robust enforcement process will provide assurance to victims that a provider has learnt and acted upon their experience to improve the service for better patient outcomes and experience, which is an important aim of the 10 Year Health Plan.