Impact assessment

Health Bill: transferring the Health Services Safety Investigations Body to the Care Quality Commission - equality impact assessment

Published 14 May 2026

Applies to England

Introduction

The general equality duty that is set out in the Equality Act 2010 requires public authorities, in the exercise of their functions, to have due regard to the need to:

• eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the act (equality aim 1)
• advance equality of opportunity between people who share a relevant protected characteristic and those who do not (equality aim 2)
• foster good relations between people who share a protected characteristic and those who do not (equality aim 3)

The general equality duty does not specify how public authorities should analyse the effect of their existing and new policies and practices on equality but doing so is an important part of complying with the general equality duty.

In addition, the Secretary of State for Health and Social Care has a duty under the National Health Service Act 2006 (NHS Act 2006) to have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

This document therefore considers the impact of the Health Bill (‘the bill’) on people with one or more of the 9 protected characteristics under the Equality Act 2010, as well as additional factors that have been strongly linked to inequalities related to the health service.

Summary of policy

The government intends to abolish the Health Services Safety Investigations Body (HSSIB) and transfer its functions into the Care Quality Commission (CQC). This requires changes to primary legislation.

The transfer of functions is part of a wider set of recommendations and commitments following the Review of patient safety across the health and care landscape (the Dash review) and the 10 Year Health Plan for England. The changes aim to improve quality of care, including safety, by:

• making it clear where responsibility and accountability sit at all levels of the health and care system
• making it easier for staff, patients and users to directly influence how the health and care system operates

Intended aims

As outlined in the bill, the legislation proposes to abolish HSSIB as a separate body. Staff, property and liabilities are proposed to be transferred to CQC. CQC would be provided with new powers to enable it to carry out existing HSSIB functions. HSSIB offers a ‘safe space’ for investigations to be carried out without fear of retribution to those that disclose information as part of the investigation procedure. Currently, such information may only be disclosed by HSSIB in exceptional circumstances.

It is vital for the success of the investigations that this ‘safe space’ continues in CQC. Mechanisms will be in place to ensure that investigation information is not passed between the new investigation function of CQC and the existing regulatory function of CQC, therefore providing a ‘safe space’ to effectively carry out trusted investigations. Governance arrangements would be established outside of legislation.

The proposal is for CQC to continue HSSIB’s legacy to be a centre of excellence for system-wide investigations to enable learning. It would operate a dedicated, expertise-led investigation function that can be used in a responsive way to minimise the number of externally commissioned reviews and inquiries that might otherwise be required. It would retain discretion to initiate and undertake investigations and can be directed by the Secretary of State to undertake investigations.

At the same time, most local investigations into safety incidents would continue to be managed within provider organisations and commissioners (integrated care boards (ICBs)), with support from regions where required. This process will sit outside of the responsibilities of the planned new investigation function of CQC as it currently does for HSSIB.

Effect on staff

If the provisions in this bill come into force (subject to Parliamentary process), the transition will have effects on both HSSIB and CQC teams. Areas of impact include:

• contractual and employment arrangements: staff will transfer from HSSIB to CQC under Transfer of Undertakings (Protection of Employment) (TUPE) arrangements. This may lead to differences in terms and conditions, contracts, pay structures and benefits between staff in the regulatory function (who are on CQC terms and conditions) and the investigation function (who are on NHS Agenda for Change conditions). This could lead to uncertainty and dissatisfaction among staff who will be part of the same organisation
• morale and wellbeing: the uncertainty coupled with organisational change may negatively affect staff morale. This could result in increased levels of stress, absenteeism, sick leave and additional pressure on existing resources for all employees
• staff turnover and capacity: some staff may choose to leave during the transition period, which could impact on skills and experience which may then affect the service delivery and continuity. It is uncertain whether disruptions to service delivery would differentially impact staff groups with certain protected characteristics
• cultural integration and organisational change: this might provide an opportunity for CQC to review the culture and ways of working within the organisation, especially at a time when the regulator is undergoing its own reforms. However, these changes may introduce uncertainty or affect morale. A staff consultation will ensure that these issues are identified early, and risks are kept minimal

Effect on patients

As HSSIB functions would continue in CQC, patients and service users may experience some effects during the transitional period. This may include fewer investigations due to potential staff turnover or resource pressures during the transition. HSSIB may reduce or pause the number of investigations initiated until they transfer to the new organisation.

There may also be delays in publication of reports as ongoing investigations may take longer to complete. These delays may raise uncertainty for patients about the timeliness of any findings and recommendations arising from live investigations. We anticipate that this will be temporary and relatively short term, and that CQC will minimise this risk by agreeing a communications plan with HSSIB during transitional arrangements around what investigations are impacted and for how long.

Although there may be these temporary effects, there will be no direct change to the way patients and service users engage with the new investigation function. The new investigative function of CQC will remain committed to maintaining its core functions during the transition, including ensuring that individuals have a ‘safe space’ to openly disclose information.

Effect on service users

Currently, patients, families, carers and healthcare staff can report concerns to HSSIB. We expect no change to this, except that concerns will now be reported to the investigation function of CQC.

The Secretary of State will continue to be able to direct investigations, ensuring continuity in the process and not differentially impacting groups with protected characteristics. However, investigations would still operate under the same principles and apply the same HSSIB investigative criteria that are in place now.

There will therefore only be minimal changes to the way in which patients, staff and families interact with the investigation function, contacting CQC instead of HSSIB to report concerns and raise incidents.

Effect on carers and family

As above, we expect no long-term impact as investigations will continue under HSSIB’s ‘safe space’ principles. However, as noted above, during the transitional period there may be delays to reports being published that may raise uncertainty for patients about the timeliness of any findings and recommendations arising from live investigations. We anticipate that this will be temporary and relatively short term.

Effect on trusts and organisations

The new investigation function of CQC will continue to be able to provide its education and training programmes, aiming to build a centre of excellence. This ongoing support will help trusts and organisations improve their investigatory skills and enhance patient safety outcomes.

Evidence

Because of the anticipated impact of this transfer of functions on staff, service users, patients, their carers and families being limited, the review of evidence was proportionate to this. The relevant academic literature is cited throughout this document.

Engagement and involvement

Throughout the review of patient safety across the health and care landscape, Dr Dash worked closely with senior leaders at 6 organisations and heard from more than 100 individuals or organisations with an interest in patient safety. A full list of those Dr Dash spoke with and involved in the review is in appendix 1 of the Dash review.

The Department of Health and Social Care (DHSC) has engaged with HSSIB through sponsorship meetings and will hold more detailed discussions through a programme or transition board in 2026.

Analysis of impacts

Disability

We do not anticipate any differential impact on disabled people due to HSSIB’s functions transferring into CQC, because the functions remain the same. The new investigations arm of CQC will continue to fulfil HSSIB functions with no persistent effects on their staff, patients or service users or their carers and families due to a disability.

There may be some short-term disruption during the transition phase which will affect staff. HSSIB has some disabled staff members (13% have declared a disability)^{[footnote 1]}. There is no robust evidence that merging organisations has a disproportionately negative effect on staff members with disabilities. Staff with disabilities will continue to be protected under the Equality Act 2010 as their employment transfers to CQC.

Sex

We do not expect any differential impact based on sex for staff, service users, patients, their carers or families due to HSSIB’s functions transferring into CQC, because the functions remain the same.

Sexual orientation

We do not expect any differential impact based on sexual orientation for staff, service users, patients, their carers or families due to HSSIB’s functions transferring into CQC, because the functions remain the same.

Race

We do not expect any differential impact based on race for staff, service users, patients, their carers or families due to HSSIB’s functions transferring into CQC, because the functions remain the same.

Age

We do not expect any differential impact based on age for service users, patients, their carers or families due to HSSIB’s functions transferring into CQC, because the functions remain the same.

Only 2% of HSSIB employees are aged 66 and older, only 13% are aged 26 to 35 and most (85%) are aged 36 to 65^{[footnote 2]}. Pension arrangements for HSSIB staff members are expected to continue under TUPE arrangements. This is true for all employees but is highlighted in this section as it may be more immediately relevant for older HSSIB employees.

Gender reassignment

We do not expect any differential impact for staff, service users, patients, their carers or families with the protected characteristic of gender reassignment due to HSSIB’s functions transferring into CQC, because the functions remain the same.

Religion or belief

We do not expect any differential impact based on religion or belief for staff, service users, patients, their carers or families due to HSSIB’s functions transferring into CQC, because the functions remain the same.

Pregnancy and maternity

We do not expect any differential impact based on pregnancy or maternity for service users, patients, their carers or families due to HSSIB’s functions transferring into CQC, because the functions remain the same.

HSSIB staff currently on maternity leave will be considered in the same way as every other member of HSSIB staff and consulted on any changes in the same way as other HSSIB staff. Any current maternity arrangements would be continued under TUPE.

Marriage and civil partnership

We do not expect any differential impact based on marriage and civil partnership for staff, service users, patients, their carers or families due to HSSIB’s functions transferring into CQC, because the functions remain the same.

Other identified groups

These are not covered by the Equality Act 2010.

Socioeconomic background and geography are routinely included in considerations on health and social care policy. This is due to health inequalities, which are differences in health outcomes that are unfair and avoidable, and which are rooted in socioeconomic background and geography.

Poor mental health is considered to be closely linked to health inequalities and is therefore also routinely included in considerations of health and care policy.

Socioeconomic background and geography

HSSIB operates as a fully remote organisation, and we expect staff to retain their current working arrangements. Additionally, staff will gain the option to work from CQC offices if they wish to do so. Therefore, we do not expect a differential impact due to their geographical location on staff following the transfer of HSSIB’s functions into CQC.

The geographical scope of future investigations will remain the same as it is currently. This is the case for investigations by CQC and the investigation arm within CQC.

Mental health

We do not expect any long-term differential effects due to the transition of HSSIB’s functions into CQC on service users, patients, their carers or families because the functions remain the same.

However, the short-term delays to investigations during the transition period may raise uncertainty for patients about the timeliness of any findings and recommendations arising from live investigations. This may impact those with pre-existing mental health conditions who are personally invested in the investigations being carried out more strongly. We anticipate this to be a temporary and relatively short-term effect. Where urgent patient safety issues arise, HSSIB publishes interim reports which can mitigate this risk.

It is worth noting that 4 out of 9 currently ‘launched’ investigations are related to mental health^{[footnote 3]}. Therefore, a short-term delay may impact users with mental health conditions affected by or invested in those investigations disproportionately.

Organisational change may create uncertainty for employees^{[footnote 4]}, leading to feelings of stress and anxiety. Change processes may negatively impact employees’ mental health or exacerbate existing mental health conditions. Results from German^{[footnote 5]} and French^{[footnote 6]}studies show a link between organisational change and poorer mental health. This risk could be minimised by, for example, putting support measures in place for employees.

Summary of analysis

Overall impact

This document has assessed all 3 aims of the public sector equality duty in relation to the proposed policy. The effects of the proposed changes towards reducing unlawful discrimination, harassment and victimisation (equality aim 1), advancing equality (equality aim 2) and fostering good relations (equality aim 3) are considered for each protected characteristic and additional ones.

We do not expect permanent differential impacts on service users, patients, their carers and families.

HSSIB staff will be impacted by the transition of their employment to CQC. Any potential adverse impacts should be mitigated through TUPE arrangements and change processes.

Addressing the impact on equalities

An implementation board, with HSSIB, CQC and DHSC as members, is to be established during the bill’s progress through Parliament. This board will oversee the transition and will continue to monitor the equality impacts as HSSIB goes through the transition process. The board will address any risks and issues as they occur. CQC as a public body is bound by the Equality Act 2010 and has a duty to have due regard to the 3 principles outlined in the introduction.

Monitoring and evaluation

An overall monitoring and evaluation plan for the bill will be developed as the bill progresses through Parliament and will include provisions to evaluate and monitor the transfer of HSSIB into CQC. Differential impacts on people with protected characteristics will be monitored and evaluated in line with DHSC and Magenta Book guidance. Additionally, effects on staff can be monitored through CQC annual staff surveys and pulse surveys, which gather quick, targeted feedback from staff on specific topics, such as equality, diversity and inclusion (EDI).

1. The figure of 13% may be underestimating the true population as 41% did not declare a disability status. This data is obtained from HSSIB’s records. ↩

2. This data is obtained from HSSIB’s records. ↩

3. This is an assessment as of 1 December 2025 and based on the HSSIB website, patient safety investigations, filtered by theme and status as ‘launched’. ↩

4. Bordia P and others. Uncertainty during organizational change: Is it all about control? European Journal of Work and Organizational Psychology 2024. ↩

5. Brackhaus I and others. Organizational change: challenges for workplace psychosocial risks and employee mental health BMC Public Health 2024: volume 24. ↩

6. Niedhammer I and others. Organisational changes and depression: The mediating role of psychosocial work exposures in the SUMER study Journal of Affective Disorders 2025: volume 369. ↩