Health Secretary Wes Streeting has pledged to proceed with "enormous care" regarding the sensitive plan to merge the Health Services Safety Investigations Body (HSSIB), the NHS’s respected, independent safety watchdog, into the Care Quality Commission (CQC). This commitment, made in the House of Lords, addresses widespread concerns about integrating the HSSIB into the CQC, a statutory regulator that ministers and stakeholders have themselves described as "failing" and which is currently undergoing significant internal reform. The move is part of sweeping changes to England’s patient safety landscape.
The proposal, which originated from recommendations in NHS England chair Penny Dash’s review, would see the HSSIB subsumed by the CQC. HSSIB, established in 2017, conducts independent, non-punitive investigations into serious safety incidents, with a core focus on system-wide learning rather than assigning blame. This independent ethos is central to its success. In stark contrast, the CQC inspects and rates providers and enforces standards, but has recently faced heavy criticism over issues like inspection backlogs, inconsistent reporting, and challenges to its credibility. Critics fear that integrating a successful investigative body like HSSIB into an organisation with acknowledged operational weaknesses could dilute HSSIB’s core culture and investigative integrity, despite the Government’s aim for closer alignment between investigation and regulation.
The CQC is aware of its need for substantial improvement and has launched the "Rebuilding CQC" programme, an ambitious agenda extending through 2026 and beyond. This reform aims to overhaul regulatory methods, reduce backlogs, and strengthen processes through regulatory framework redesign and the introduction of new technology. While the CQC has made progress on backlogs and digital processes, confidence remains mixed, with professional bodies highlighting ongoing issues regarding inspection capacity, data systems, and sector expertise.
Patient safety campaigners and workforce leaders have welcomed Streeting’s promise of "enormous care," emphasising the vital need to preserve HSSIB’s investigative culture. They stress that safety investigations must remain free from regulatory or enforcement bias to ensure candour and trust among clinicians. Some experts have gone further by calling for HSSIB to be granted statutory independence to protect its mission within the larger regulatory framework. This integration is part of a broader Government reform agenda, signalling that ministers are aware of the political and practical sensitivities involved in reshaping institutions that profoundly affect clinical oversight, patient trust, and service quality.
