Patient safety report shows decline in maternity services, North-South divide

Patient safety in England has deteriorated in a majority of categories over the past two years, a new report finds.

Analysis of publicly available data for the National State of Patient Safety 2024 report shows worsening performance on several key patient safety indicators, particularly in maternity services.

The report also highlights a stark divide between the North and South of England: Harmful, unintended effects of medical treatment are twice as high in the North East than in Greater London.

The report’s authors call on national organisations to urgently agree a focused set of patient safety improvement priorities, describing the current situation as ‘opaque’, with too many recommendations for the health service to keep up with. 

Coming just three months after Lord Darzi’s independent investigation into NHS performance, the report finds a similarly concerning picture for patient safety.

Produced by the Institute of Global Health Innovation at Imperial College London, and commissioned by the charity Patient Safety Watch, the National State of Patient Safety 2024 Report (NSPS) calls for a renewed focus on key patient safety priorities.

The NSPS report (published every two years) involves a review of published performance data, analysis of Healthcare Trusts’ patient safety incident response plans, and a survey on the patient safety priorities of staff and the public. It aims to provide a comprehensive assessment of the situation across England.

Maternity and neonatal services

Many patient safety indicators have declined over the past two years (see Table 1), with a particularly alarming picture in maternity and neonatal services. Rates of stillbirths, neonatal deaths and maternal deaths have all worsened. For example, maternal deaths per 100,000 maternities increased from 9.71 in 2022 to 13.41 in 2024.

The report shows that rates of maternal and neonatal deaths have risen for the first time in a decade while mothers from Black ethnic backgrounds are almost three times more likely to die from causes linked to their pregnancy than White women.

In a poll of the public conducted for the report with YouGov, people from Black ethnic backgrounds were more concerned about safety in maternity services than people from any other group.

Stark divide between the North and South

The impacts of unsafe care are not spread evenly across England, but are greater in the North than the South.

For example, the impacts of adverse effects of medical treatment, which refer to death or disability caused by a treatment, are twice as high in the North-East of England than in Greater London. 

The NHS estimates the number of expected deaths per hospital trust in England through the Summary Hospital-level Mortality Indicator. Compared to the rest of England, these estimates show the North has the highest proportion of hospital trusts with a greater than expected number of deaths.

This figure has also increased since the last NSPS report in 2022, from 8% of hospital trusts in the North in 2022 to 14% in 2024.

Overall picture of patient safety

Compared to the 2022 report, performance improved on seven key patient safety measures and worsened on 12 measures. 

• The estimated cost of treating patients who have been harmed during their care in England in 2023/24 was £14.7 billion. This figure excludes wider costs, such as to people’s quality of life or their ability to work, or rising clinical negligence claims.
• Overall, members of the public, NHS and social care workers reported that waits for urgent care – for example, waiting to be seen in A&E, or waits for an ambulance – were their number one safety concern.
• The gap between the UK and the best performing OECD countries for deaths from treatable causes, such as sepsis and blood clots, has widened. If the UK matched the top 10% of OECD countries, this would equate to 13,495 fewer deaths per year. In our 2022 report, this figure was 12,675 deaths.
• Rates of hospital-acquired Clostridium difficile have increased by 54% between 2018/9 and 2023/24, raising concerns about the NHS slipping on progress tackling hospital infections in previous years.

“The NHS is now falling behind leading nations in patient safety. We urgently need to address these issues to repair the health service, and provide high quality care for all patients and their families.” Professor Lord Ara Darzi, Co-Director, Institute of Global Health Innovation 

Professor Lord Ara Darzi, Co-Director, Institute of Global Health Innovation said: 

“Our latest report on patient safety in England reveals alarming declines. The deterioration in maternity care, in particular, requires immediate action. Our analysis highlights a troubling increase in neonatal and maternal deaths, with Black women disproportionately affected. ”

Patient Safety Priorities

The report finds a complex picture of national patient safety priorities and bodies, and evidence that the health system cannot keep pace with the number of recommendations made to it. The authors advise that a focused set of patient safety priorities must be agreed for the system to rally around. 

They also want NHS Trusts to have more support to adopt proven approaches to tackling the most common and harmful safety problems.

They say the current Change NHS consultation, and development of the 10-year plan, provide the ideal opportunity to do this in partnership with patients, the public and the workforce.

Report co-author Melanie Leis, Director of Policy and Analysis, Institute of Global Health Innovation, said: “Our analysis paints a worrying picture of patient safety across many areas, making it very difficult to choose specific areas to prioritise. We hope the clear signal sent by the public, healthcare and social care workers through our survey results can help inform this decision-making process.”

James Titcombe OBE, CEO, Patient Safety Watch, said: “This report delivers a stark and urgent message: since 2022, patient safety in the NHS has deteriorated in far too many areas. Its findings and recommendations must contribute to urgent and meaningful discussion about the changes needed, so that when we revisit the data in two years, we see these troubling trends reversed and tangible progress in reducing the devastating impact of healthcare harm on patients, families, and healthcare professionals.”