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Clinical governance
Abstract: Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence will flourish (Department of Health).
Clinical governance encompasses quality assurance, quality improvement and risk and incident management.
Source: NHS England, Feb 2026
The Seven Pillars of Clinical Governance
Abstract: In today’s ever-evolving landscape of healthcare, ensuring the delivery of high-quality clinical care is paramount, especially within the NHS. To achieve this goal, healthcare organisations must implement a robust framework known as clinical governance.
Source: Flint J. Salford Professional Development, Jan 2024
What is clinical governance?
Abstract: Our health inequalities hub shines a light on case studies focusing on health inequalities from councils across the country.
Source: Macfarlane A J R. BJA Education, Mar 2019; 19(6): 174-175
Shared clinical governance arrangements between NHS and independent acute hospitals in England: Findings from a national survey of senior leaders
Abstract:
Objectives:
To present the findings from a national survey of senior leaders in NHS and independent hospitals in England concerning the effectiveness of shared arrangements for clinical governance. To provide a comprehensive overview of shared arrangements for the oversight of consultants' practice, processes for appraisal and revalidation, and the management of significant concerns. The results from this study will improve understanding of the practical functioning of clinical governance processes at the interface between the NHS and the independent sector.
Methods:
Between December 2023 and April 2024, an online survey was distributed to senior leads with governance responsibilities in NHS and independent hospitals in England.Results320 responses were received (response rate 42%), 235 from individuals working in NHS trusts (response rate 40%) and 85 from individuals in independent hospitals (response rate 48%). Respondents reported that some clinical governance arrangements are established across both sectors, with some relationships characterised as positive and relatively strong. However, relationships often depended on goodwill, personal connections, and consultant probity, rather than the systematic implementation of recommended processes. Respondents expressed concerns regarding the non-mandatory and unregulated nature of processes for sharing concerns, believing this led to insufficient resources and challenges in verifying information. They called for improved data quality, better communication and information sharing and more robust and formalised processes.
Conclusions:
Shared clinical governance arrangements between the NHS and independent sectors are in place in some but not all of the organisations where respondents' consultants worked. This raises concerns about progress towards implementing the Paterson inquiry recommendations, including access to consultants' whole practice information and sharing concerns about consultants working across different providers. The findings may also hold relevance for international audiences where medical staff work across multiple healthcare providers. Further empirical research is needed to compare clinical governance arrangements between the NHS and independent sectors, and suggest how shared clinical governance can be organised to assure the quality and safety of care.
Source: Stringer G. Journal of Health Services Research and Policy, Mar 2026; 19: 13558196261431315
Monitoring the safe delivery of new invasive interventional procedures and devices: an analysis of NHS organisation policies
Abstract:
Background:
The introduction and monitoring of innovative invasive procedures and devices (IP/Ds) was included in the Independent Medicines and Medical Devices Safety (IMMDS) Review led by Baroness Cumberlege. Currently, innovative IP/Ds may be undertaken with local National Health Service (NHS) organisation approval via new procedure committees (NPCs) or approval from the Health Research Authority (HRA). The National Institute for Health and Care Excellence Interventional Procedures Advisory Committee (NICE IPAC) provides guidance for appropriate approvals. Outcome monitoring is performed to inform decisions about continuing with the new IP/D or abandoning/pausing if safety data show signals of harm; this is the responsibility of local hospitals. Hospital policies for this process have hitherto not been investigated.
Aim:
To explore local hospital NPC processes for monitoring clinical and safety outcomes and decision-making regarding the delivery of new IP/Ds.
Methods:
NHS organisation policies for the introduction of new IP/Ds from England and Wales were systematically examined using a standardised extraction form developed a priori. All policies and associated documents were analysed using the principles of content analysis, and information extracted included (1) the collection of safety and outcome data for approved IP/Ds; (2) requirements to adhere to NICE guidance and (3) how committees decide to abandon/pause the use of new IP/Ds.
Results:
All policies (n=113) included information about monitoring outcomes of new IP/Ds. Substantial variation between hospitals in monitoring requirements was observed. Just 66 provided details of safety reporting oversight methods. Only 72 policies explicitly recommended following NICE IPAC guidance for the IP. Information about how decisions were made to abandon/pause new IP/Ds was included in 25 policies.
Conclusion:
There is a disparity among hospitals in how outcome and safety data of new IP/Ds are monitored. This has implications for patient safety. Our findings support the IMMDS report recommendations for the need for better oversight and governance of innovative IP/Ds, including collecting and sharing robust outcome data to inform decision-making.
Source: Wallis L. BMJ Open Quality, May 2025; 14(2):
A national review of NHS policies and patient perspectives on surgical video: a prospective, mixed methods qualitative analysis
Abstract:
Background:
Robust governance policy is a fundamental requirement for the adoption of routine surgical video recording at scale. The true extent of existing local National Health Service (NHS) policies relevant to the recording of surgical video is currently not known, as are patient attitudes to the use of these videos by healthcare providers.
Methods:
This was a prospective, mixed methods qualitative analysis. All 144 NHS trusts/boards in England and Wales were asked to provide policies relating to surgical video between 20th February and 20th March 2023. Policies were assessed in accordance with United Kingdom (UK) General Data Protection Regulation (GDPR) principles. A patient and public questionnaire was performed on 14th September 2024 to analyse public views on the role of surgical video within healthcare and to identify issues surrounding video recording of surgical procedures within the NHS.
Findings:
143/144 (97.9%) NHS trusts/boards responded to the request. Relevant policies were provided by 43/144 (29.9%) trusts/boards. 35/43 (81.4%) addressed consent processes clearly, 21/43 (48.8%) provided clear statements regarding patient access, and 35/43 (81.4%) policies asserted the trust/board's copyright. 19/43 (44.2%) clearly stated data minimisation and data accuracy requirements. 11/43 (25.6%) stated storage duration and 20/43 (46.5%) specified storage location. 255 members of the public completed our surgical video questionnaire. Identified expected uses of video were education, record keeping, and research; benefits were its use as an educational tool, objective evidence of the procedure, and patient satisfaction; concerns were raised about data privacy, consent, and security. 80/255 (31.4%) of participants agreed that all surgical procedures should be recorded. 186/255 (72.9%) would be interested in their own procedure. Video use for surgical quality assurance (236/255, 92.5%), education (241/255, 94.5%), and research (242/255, 94.9%) was supported.
Interpretation:
The majority of NHS trusts/boards do not have policies governing surgical video recording, use, and/or storage. The supplied policies addressed UK GDPR principles variably, focusing mainly on consent. Patients strongly support the use of surgical video for quality assurance and education, but there is disagreement if this should be performed routinely. The discordance between patient expectation and current NHS practice for the routine recording of surgical video must be addressed when policy is revised.
Source: Yiu A. eClinicalMedicine, Oct 2025; 88: 103490
Making clinical guidelines work for people with multiple long term conditions: analysis and recommendations from review of single condition guidelines
Abstract:
Objectives:
To evaluate how UK guidelines for individual health conditions consider coexisting multiple long term conditions and to propose improvements to guideline development processes so that guidelines appropriately account for and consider coexisting multiple long term conditions.
Design:
Analysis and recommendations from review of single condition guidelines.
Setting:
Clinical guidelines developed by the National Institute for Health and Care Excellence (NICE), UK, 1 January 2013 to 31 December 2024.
Population:
56 clinical guidelines developed by NICE covering a broad range of long term conditions.
Main outcome measures:
The extent to which guideline recommendations consider multiple long term conditions and coexisting conditions, distinguishing between concordant conditions (those affecting the same organ system as the index condition) and discordant conditions (those affecting different systems).
Results:
All but one of the NICE guidelines (n=55, 98%) included some advice on managing the index condition in the presence of coexisting conditions, and 50 (89%) guidelines offered general guidance on tailoring care. Only 11 (20%) guidelines, however, explicitly referred to multiple long term conditions, and none included a dedicated section on multiple long term conditions or how care should be adapted in this context. 19 (34%) guidelines featured sections looking at specific coexisting conditions or coexisting conditions generally. Coverage of coexisting conditions varied widely across categories of conditions, with mental health guidelines dealing with the most coexisting conditions (median 10, interquartile range (IQR) 4.5-14.75) in contrast with guidelines on cancer and eye disease covering the fewest conditions (median 3, 1-4.5; median 3, 2.25-2.75, respectively). Of the 397 possible concordant pairings, 120 (30%) were referenced, whereas of the 3859 possible discordant pairings, 259 (7%) were referenced, indicating greater coverage of same system combinations. Data on the composition of guideline committees showed wide variation in size, disciplinary diversity, inclusion of generalist clinicians (eg, general practitioners, general physicians, or others with no single specialty focus), and public contributors, although lived experience of multiple long term conditions was rarely specified.
Conclusions:
Despite widespread acknowledgement of coexisting or multiple long term conditions, NICE guidelines are predominantly condition specific and offer limited tailored support for the care of multiple long term conditions. Recommendations rarely considered common condition clusters or the cumulative effect of multiple long term conditions. Structured improvements, such as clearer guidance on adapting care, broader cross condition referencing, and more transparent inclusion of lived experience could enhance the relevance and usability of guidelines for clinicians managing patients with multiple long term conditions.
Source: Pretorius S. BMJ Medicine, Feb 2026; 5(1): e001495
Report on an audit of two decades’ activities of a clinical ethics committee: the Newcastle upon Tyne Hospitals NHS Foundation Trust Clinical Ethics Advisory Group (CEAG)
Abstract:
Background:
‘The Clinical Ethics Advisory Group’ (CEAG) is the clinical ethics support body for Newcastle upon Tyne Hospitals National Health Service Foundation Trust. A significant change in CEAG’s way of working occurred over the past 5 years as a result of Court decisions, increasing public expectations and an increase in CEAG’s paediatric case flow.
Purpose:
Review historical data: (a) as a useful benchmark to look for the early impact of significant service changes and (b) to seek possible reference (‘sentinel’) cases for use with a posited practical (casuistic) case-based reasoning model.
Methods:
Audit of the minutes of the first 22 years’ meetings was undertaken by the two chairs of CEAG over that period of time.
Results:
223 matters discussed: 86 Trust policy issues; 117 clinical cases (84 adult (32 urgent), 33 child (8 urgent)); 12 CEAG procedural issues and 8 UK Clinical Ethics Network ‘round robin’ cases. The range of topic areas was wide. A broad range of ethical structures were deployed, principlism predominated. Quality was subjectively assessed by each reviewer, but different methods were used. This proved highly concordant between the two reviewers. 47% (105/223) of discussions were ‘excellent’ (*A4C4–A4C4) and 70% (156.5/223) ‘good’ or better (*A4C4–A3C3). By meeting the criteria of ‘excellent’ and ‘prospective’, 92/223 (41%) of matters were deemed potentially suitable as sentinel cases.
Conclusions:
The audit provides a rich vein of information. There is demand for CEAG’s services, workload is becoming more complex. Formal funding for such services seems justified.
Source: Mohindra Raj K. Journal of Medical Ethics, Aug 2025; 51(8)
Clinical referral to the NHS following multi-cancer early detection test results from the NHS-Galleri trial
Abstract:
Introduction:
The large, randomised, controlled NHS-Galleri trial (NCT05611632) is assessing the clinical utility of a multi-cancer early detection (MCED) test for asymptomatic cancer screening in England. We describe how we enabled the efficient referral of trial participants into existing National Health Service (NHS) urgent suspected cancer pathways for diagnostic investigations.
Methods/Results:
Participants were enrolled across eight of the 21 Cancer Alliance regions in England, served by 56 Hospital Trusts. We used the existing NHS e-Referral Service (e-RS) and a new e-referral form to enable referrals from the trial into any participating Trust, and to standardise information provided with trial participant referrals. Referrals were made by trial nurses directly into secondary care, minimising any additional burden on primary care. At most Trusts, a designated Trust-based referral coordinator triaged referrals and referred participants into the most appropriate local pathway, selected based on the tissue type or organ associated with the cancer signal (cancer signal origin; CSO). At other Trusts, trial nurses referred participants into the appropriate pathway. Guidance mapping predicted CSO(s) to NHS pathways was provided by the trial team to help clinicians understand trial referrals. The trial team and Trust referral coordinators were responsible for central and Trust-level safety netting measures, respectively.
Conclusions:
To our knowledge, the NHS-Galleri trial has established the first model for the standardised clinical referral of asymptomatic individuals from a trial into NHS standard-of-care cancer pathways. We hope insights from our work could help accelerate screening trial conduct in the UK, and support MCED population screening programme implementation in future.
Source: Lowenhoff I. Frontiers in Oncology, May 2025; 15
Clinical guidelines and pathways for the management of non-traumatic wrist disorders: A review and synthesis
Abstract:
Introduction:
Non-traumatic wrist disorders (NTWD) are commonly encountered across a range of healthcare settings. Uncertainty exists regarding optimal management and how this is reflected in care provision through clinical guidelines and pathways. We aimed to identify existing UK-based clinical guidelines and pathways and examine their quality.
Methods:
For this review, we searched MEDLINE, PubMed, Embase, CINAHL, ProQuest, Scopus, Web of Science, Google, The National Grey Literature Collection, TRIP, and the National Institute for Health and Care Excellence and undertook targeted outreach and engagement activities with healthcare professional networks. We included clinical practice guidelines and pathways for NTWD published after 2010. The AGREE II tool was used to assess guideline quality based on the domains of topic selection, best practice identification, data collection, and rigor of analysis.
Results:
Of 7017 records identified, 15 eligible clinical guidelines and pathways for NTWD management were eligible and included. De Quervain’s tenosynovitis and ganglion cyst were most frequently covered while other NTWD had few or no guidelines or pathways. Variation in the composition and nomenclature of sources was found. Quality assessment using the AGREE II tool identified variability and overall unsatisfactory quality.
Conclusion:
There is a lack of high-quality clinical guidelines and pathways for NTWD within the UK healthcare system indicating an obstacle to improvements in healthcare delivery.
Source: Myers C. European Observatory on Health Systems and Policies, 2025
Embedding equity, diversity and inclusion processes within clinical trials and health and social care research
Abstract:
The lack of diverse and inclusive clinical research populations fuels health inequalities in the UK, and there is an urgent need to reverse this. This communication provides a practical framework for positive action to integrate equity, diversity and inclusion (EDI) processes into clinical research design, protocols and implementation and to establish accountable clinical research systems that are trustworthy to the public and accessible to diverse communities.
This framework is a consensus- based guide developed by the Equality, Diversity and Inclusion working group of the National Institute for Health and Care Research’s (NIHR’s) Clinical Research Network in North West London. This work involved analysing challenges to integrating EDI within the clinical research process, such as clinical trial protocols as directed by industry sponsors and National Health Service investigator teams. It aligns with the UK government’s clinical research strategy and NIHR’s INCLUDE project.
It advises an interconnected approach to embedding EDI throughout the clinical research lifecycle. By following this framework, we aspire to guide clinical research towards a more equitable, inclusive and representative model that better serves the needs of all populations.
Source: Gedela K. BMJ Open, Mar 2025, 15(3)
Health Bill brings NHS management back into government
Abstract:
The government’s narrative is that the NHS must become more democratic to run effectively. But the legislation includes a range of changes to how the health service operates, spanning digital and data policy to the role of patients.
Source: Alderwick H. BMJ, May 2026; 393: s958
Digital Capability, Open-Source Use, and Interoperability Standards Within the National Health Service in England: Survey of Health Care Trusts
Abstract:
Background:
In 2016, the National Health Service (NHS) England sought to drive digital transformation within select NHS trusts through the Global Digital Exemplar (GDE) program. While the program did advance the NHS’s integration with digital technologies, disparities in digital maturity persisted between GDE-funded and nonfunded NHS trusts. The Department of Health and Social Care (DHSC) launched a data strategy in 2022 that aimed to develop the appropriate technical infrastructure and data architecture to enable more effective and efficient use of its data. Given the diversity in digital capabilities, open-source adoption, and interoperability standards within NHS services, official guidance has continued to struggle to provide effective unification. Data about capabilities and technologies from application development teams in the NHS trusts, crucial for advancing these areas, remains insufficient.
Objective:
This study aimed to further document the capabilities and technologies used in the NHS to develop digital capacity, comparing those with standard funding against those with additional GDE funding. This comparative analysis provides a foundational understanding for evaluating current practices and identifying potential areas for improvement in the NHS digital transformation efforts.
Methods:
This study was conducted using Freedom of Information (FOI) requests and systematic website searches. The Freedom of Information Act (FOIA) allows individuals to request information held by public authorities. This process supports transparency and accountability by ensuring public access to government data. Data were compiled from two sources: (1) FOI requests submitted to NHS trusts between July 2020 and December 2020, and (2) systematic website searches for technology conducted between August 2020 and July 2021. A series of chi-square tests was conducted to validate and strengthen the robustness of the FOI questions.
Results:
A total of 191 (84.5%) of the then 226 NHS trusts completed the FOI request, and 161 of the 191 (84%) had software and app development, website, or innovation teams. A total of 112 (69.6%) teams developed front-facing service user websites and apps. Out of 191, 150 (93.2%) worked with clinical staff to formulate innovative ideas, 55 (34.2%) carried out developments for other trusts and external entities, 35 (21.7%) had attempted to secure an innovation grant, and 138 (86%) disclosed the technologies they use. A total of 25 (15.5%) said they always used open-source technology, and 24 (17%) disclosed technologies associated with interoperability standards in their responses.
Conclusions:
The NHS must adopt a cohesive strategy and refine policies to ensure the success of its digital, open-source technology and interoperability standards initiatives. Five recommendations toward greater organizational interoperability are made by the authors. Future research should examine digital innovation across NHS trusts, focusing on barriers such as limited resources, organizational culture, and technical expertise. Identifying these challenges is essential for developing strategies to reduce disparities and promote equal progress.
Source: Elliott H. BMJ Open, Oct 2025; 15(10): e102163
Governing AI with trust: an adaptive framework for institutional legitimacy in the UK public sector
Abstract:
Purpose:
This study aims to examine the limitations of artificial intelligence (AI) regulation in the UK public sector, particularly its fragmented and non-binding nature. It argues that current regulatory approaches lack the institutional coordination, legitimacy and transparency required to foster public trust in algorithmic decision-making. The paper proposes a conceptual model that reframes trustworthy AI not as a product of compliance or ethics alone but as the outcome of adaptive, legitimacy-centered governance.
Design/methodology/approach:
The study uses a conceptual policy analysis approach, synthesizing literature from public administration, regulatory theory and AI governance. It critically assesses the UK’s “pro-innovation” regulatory model and develops a governance-oriented framework grounded in legitimacy, coordination and accountability. The framework is supported by illustrative cases from National Health Service AI applications and the GOV.UK algorithmic transparency initiative, with broader applicability discussed in relation to other public sector domains.
Findings:
The analysis finds that non-binding, sector-led regulation in the UK lacks institutional alignment and accountability mechanisms, undermining public trust. The proposed framework reframes AI governance as a dynamic process of inter-agency coordination, transparent oversight and legitimacy production.
Research limitations/implications:
As a conceptual paper, this study does not present empirical validation. However, it offers a testable framework for future research. The model can be adapted for comparative studies or case-based evaluation in other governance domains such as justice or finance, and it calls for the development of legitimacy indicators and enforcement mechanisms in AI policy.
Practical implications:
This framework provides actionable guidance for policy designers, suggesting the need for institutionalized coordination, independent review bodies and legitimacy-based metrics for public sector AI oversight. It supports the design of governance models that go beyond technical compliance and embed trust and accountability into digital systems.
Social implications:
By positioning legitimacy as a governance outcome, the framework underscores how AI policies should address not only risks but also public perception, equity and institutional behavior. It highlights the role of citizen engagement, redress mechanisms and transparency in sustaining democratic accountability in algorithmic systems.
Originality/value:
This article makes an original contribution by framing AI governance as a public trust challenge and proposing a conceptual model rooted in legitimacy, institutional coordination and adaptive oversight. Unlike principle-based or compliance-driven approaches, the model bridges legal regulation and democratic accountability, offering a realistic, governance-centered alternative for the public sector.
Source: Cojocaru A. Emerald Insight, Dec 2025; 1-22
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Implementing integrated care infrastructure: A longitudinal study on the interplay of policies, interorganizational arrangements and interoperability in NHS England
Abstract: This essay was written by the Centre for Local Economic Strategies and The King's Fund, as part of a programme of work commissioned by The Health Foundation. Strategic authorities and integrated care systems are increasingly powerful entities with the potential to tackle health inequalities and improve population health. However, achieving this will require them to work together effectively. This essay explores the changing policy context in which these bodies exist, and the way the dynamics between them could and should evolve as devolution beds in.
Source: Elizondo A. Health Policy, Oct 2025; 160: 105237
Improving productivity in the NHS
Abstract: No abstract available.
Source: Gainsbury S. BMJ, Aug 2025; 390: r1722
Reforming financing of the NHS
Abstract: No abstract available.
Source: Mays N. BMJ, Sep 2025; 390: r1948
Can a digital NHS be equitable?
Abstract: No abstract available.
Source: Morley J. BMJ, Jun 2025; 389 :r1317
Does the English NHS 10-year health plan offer transformational change and a break with the past or more of the same?
Abstract: No abstract available.
Source: Hunter D J. Journal of Health Services Research and Policy, Apr 2026; 31(2): 69-71
How Were Patient Safety Incidents Responded to, Investigated, and Learned From Within the English National Health Service Before the Implementation of the Patient Safety Incident Response Framework? A Rapid Review
Abstract:
Objective:
To understand how National Health Service organizations routinely responded to, investigated, and learned from patient safety incidents in England before the implementation of the Patient Safety Incident Response Framework, and to identify associated success criteria and barriers.
Methods:
We followed rapid review methodology and searched 2 electronic databases. We aimed to identify and synthesize literature regarding patient safety incident response, investigation, and learning within the English National Health Service, before the implementation of the Patient Safety Incident Response Framework.
Results:
Nineteen articles were included. A narrative synthesis generated 4 concepts: (1) a multifaceted reporting culture, (2) investigation processes, (3) the landscape of support and involvement, and (4) opportunities to learn. Barriers to incident reporting included time, task characteristics, a culture of blame, and lack of feedback. Root cause analysis was cited as the most common investigation method. Studies outlined points of support and involvement for patients and families, the importance of supporting and involving patients and families, and acknowledged contributions from patients and families may be overlooked currently. For health care staff, the need for timely and personalized support soon after an incident was emphasized. Studies underlined the limitations of current approaches to learning and improvement.
Conclusions:
These findings lend support to the challenges associated with health care systems' infrastructures and strategies for responding to and learning from patient safety incidents. These challenges centre on 2 interrelated issues: the investigative challenges of rigorously conducting systems analysis and learning-oriented improvement; and the relational challenges of supporting genuine relationships of care, open and honest communication, and supportive engagement after patient safety incidents.
Source: Louch G. Journal of Patient Safety, Aug 2025; 21(5): e42-e55
Patient Safety Incident Response Framework
Abstract: The Patient Safety Incident Response Framework (PSIRF) sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety.
Source: NHS England, 2026
Introduction to PSIRF
Abstract: At its core, PSIRF helps healthcare providers investigate and respond to incidents in a way that prioritises learning, systems thinking, and meaningful involvement of patients, families, and staff. It ensures that safety investigations are focused not just on what happened, but why it happened, so that changes can be made to reduce future risks.
Source: Patient Safety Incident Response Framework, 2026
Investigating under the Patient Safety Incident Response Framework (PSIRF): sharing HSSIB learning for future development
Abstract: This report shares learning and insights from HSSIB’s education and investigation teams about patient safety incident investigation under the Patient Safety Incident Response Framework (PSIRF).
Source: Health Services Safety Investigations Body, Oct 2025
Feasibility analysis of total quality management in medical quality management and its impact on work efficiency
Abstract:
Objective:
This study aimed to analyze the feasibility of total quality management (TQM) in medical quality management (focusing on three dimensions: management work efficiency, medical service quality, and safety quality) and to evaluate its impact on the work efficiency of medical staff.
Methods:
TQM was introduced in January 2023, serving as the dividing point between the pre-management period (January-December 2022) and the post-management period (January-December 2023). Fifty medical staff members from the same cohort were chosen as study subjects. Comparisons were made between the pre- and post-management periods in terms of work efficiency (hospital culture development, reward and punishment mechanisms, communication and coordination mechanisms, environmental hygiene management mechanisms, and adverse event reporting mechanisms), medical service quality, staff satisfaction, safety quality (incidence of adverse events, unplanned returns to the operating room, qualification rate of medical device sterilization, incidence of infection events, and medical complaints), and overall medical quality (medical safety management, medical training management, and medical hygiene supervision). Data were analyzed using SPSS 29.0. Paired-sample t-tests were employed for continuous variables (scale scores), while χ2 tests were used to categorical variables (satisfaction, safety quality).
Results:
After TQM implementation, the work efficiency of medical staff significantly increased (P < 0.001). Compared to the pre-management period, the post-management period exhibited higher medical service quality scores, greater overall staff satisfaction, lower incidences of adverse events, unplanned returns to the operating room, infection events, and medical complaints, a higher sterilization qualification rate for medical device, and enhanced medical safety, training, and hygiene supervision management (all P < 0.05).
Conclusion:
TQM is feasible and effective in medical quality management. Its implementation can enhance work efficiency and medical service quality among medical staff, improve satisfaction, strengthen safety quality, and comprehensively elevate overall medical quality.
Source: Shi P. Frontiers in medicine, Dec 2025; 12: 1701801
Quality management systems
Abstract: Quality improvement, by itself, does not represent a holistic approach to managing quality.
Quality improvement needs to be used alongside quality planning, quality assurance, and quality control to create a single, consistent management system.
Source: NHS England, 2026
Case Study: Total Quality Management (TQM) at the NHS
Abstract: Total Quality Management (TQM) has played an increasingly significant role in improving healthcare delivery within the
National Health Service (NHS) in the United Kingdom. As a publicly funded healthcare system facing rising demand, financial constraints and heightened public expectations, the NHS has adopted quality management approaches to enhance patient safety, service efficiency and organisational effectiveness. This case study examines how TQM principles have been applied within the NHS, highlighting key initiatives, achievements, challenges and lessons for healthcare quality improvement.
Source: Islam Mohammad T. Smart Life Skills, Feb 2026
Abstract:
Introduction:
The large, randomised, controlled NHS-Galleri trial (NCT05611632) is assessing the clinical utility of a multi-cancer early detection (MCED) test for asymptomatic cancer screening in England. We describe how we enabled the efficient referral of trial participants into existing National Health Service (NHS) urgent suspected cancer pathways for diagnostic investigations.
Methods/Results:
Participants were enrolled across eight of the 21 Cancer Alliance regions in England, served by 56 Hospital Trusts. We used the existing NHS e-Referral Service (e-RS) and a new e-referral form to enable referrals from the trial into any participating Trust, and to standardise information provided with trial participant referrals. Referrals were made by trial nurses directly into secondary care, minimising any additional burden on primary care. At most Trusts, a designated Trust-based referral coordinator triaged referrals and referred participants into the most appropriate local pathway, selected based on the tissue type or organ associated with the cancer signal (cancer signal origin; CSO). At other Trusts, trial nurses referred participants into the appropriate pathway. Guidance mapping predicted CSO(s) to NHS pathways was provided by the trial team to help clinicians understand trial referrals. The trial team and Trust referral coordinators were responsible for central and Trust-level safety netting measures, respectively.
Conclusions:
To our knowledge, the NHS-Galleri trial has established the first model for the standardised clinical referral of asymptomatic individuals from a trial into NHS standard-of-care cancer pathways. We hope insights from our work could help accelerate screening trial conduct in the UK, and support MCED population screening programme implementation in future.
Source: Lowenhoff I. Frontiers in Oncology, May 2025; 15
Clinical guidelines and pathways for the management of non-traumatic wrist disorders: A review and synthesis
Abstract:
Introduction:
Non-traumatic wrist disorders (NTWD) are commonly encountered across a range of healthcare settings. Uncertainty exists regarding optimal management and how this is reflected in care provision through clinical guidelines and pathways. We aimed to identify existing UK-based clinical guidelines and pathways and examine their quality.
Methods:
For this review, we searched MEDLINE, PubMed, Embase, CINAHL, ProQuest, Scopus, Web of Science, Google, The National Grey Literature Collection, TRIP, and the National Institute for Health and Care Excellence and undertook targeted outreach and engagement activities with healthcare professional networks. We included clinical practice guidelines and pathways for NTWD published after 2010. The AGREE II tool was used to assess guideline quality based on the domains of topic selection, best practice identification, data collection, and rigor of analysis.
Results:
Of 7017 records identified, 15 eligible clinical guidelines and pathways for NTWD management were eligible and included. De Quervain’s tenosynovitis and ganglion cyst were most frequently covered while other NTWD had few or no guidelines or pathways. Variation in the composition and nomenclature of sources was found. Quality assessment using the AGREE II tool identified variability and overall unsatisfactory quality.
Conclusion:
There is a lack of high-quality clinical guidelines and pathways for NTWD within the UK healthcare system indicating an obstacle to improvements in healthcare delivery.
Source: Myers C. European Observatory on Health Systems and Policies, 2025
Embedding equity, diversity and inclusion processes within clinical trials and health and social care research
Abstract:
The lack of diverse and inclusive clinical research populations fuels health inequalities in the UK, and there is an urgent need to reverse this. This communication provides a practical framework for positive action to integrate equity, diversity and inclusion (EDI) processes into clinical research design, protocols and implementation and to establish accountable clinical research systems that are trustworthy to the public and accessible to diverse communities.
This framework is a consensus- based guide developed by the Equality, Diversity and Inclusion working group of the National Institute for Health and Care Research’s (NIHR’s) Clinical Research Network in North West London. This work involved analysing challenges to integrating EDI within the clinical research process, such as clinical trial protocols as directed by industry sponsors and National Health Service investigator teams. It aligns with the UK government’s clinical research strategy and NIHR’s INCLUDE project.
It advises an interconnected approach to embedding EDI throughout the clinical research lifecycle. By following this framework, we aspire to guide clinical research towards a more equitable, inclusive and representative model that better serves the needs of all populations.
Source: Gedela K. BMJ Open, Mar 2025, 15(3)
Health Bill brings NHS management back into government
Abstract:
The government’s narrative is that the NHS must become more democratic to run effectively. But the legislation includes a range of changes to how the health service operates, spanning digital and data policy to the role of patients.
Source: Alderwick H. BMJ, May 2026; 393: s958
Digital Capability, Open-Source Use, and Interoperability Standards Within the National Health Service in England: Survey of Health Care Trusts
Abstract:
Background:
In 2016, the National Health Service (NHS) England sought to drive digital transformation within select NHS trusts through the Global Digital Exemplar (GDE) program. While the program did advance the NHS’s integration with digital technologies, disparities in digital maturity persisted between GDE-funded and nonfunded NHS trusts. The Department of Health and Social Care (DHSC) launched a data strategy in 2022 that aimed to develop the appropriate technical infrastructure and data architecture to enable more effective and efficient use of its data. Given the diversity in digital capabilities, open-source adoption, and interoperability standards within NHS services, official guidance has continued to struggle to provide effective unification. Data about capabilities and technologies from application development teams in the NHS trusts, crucial for advancing these areas, remains insufficient.
Objective:
This study aimed to further document the capabilities and technologies used in the NHS to develop digital capacity, comparing those with standard funding against those with additional GDE funding. This comparative analysis provides a foundational understanding for evaluating current practices and identifying potential areas for improvement in the NHS digital transformation efforts.
Methods:
This study was conducted using Freedom of Information (FOI) requests and systematic website searches. The Freedom of Information Act (FOIA) allows individuals to request information held by public authorities. This process supports transparency and accountability by ensuring public access to government data. Data were compiled from two sources: (1) FOI requests submitted to NHS trusts between July 2020 and December 2020, and (2) systematic website searches for technology conducted between August 2020 and July 2021. A series of chi-square tests was conducted to validate and strengthen the robustness of the FOI questions.
Results:
A total of 191 (84.5%) of the then 226 NHS trusts completed the FOI request, and 161 of the 191 (84%) had software and app development, website, or innovation teams. A total of 112 (69.6%) teams developed front-facing service user websites and apps. Out of 191, 150 (93.2%) worked with clinical staff to formulate innovative ideas, 55 (34.2%) carried out developments for other trusts and external entities, 35 (21.7%) had attempted to secure an innovation grant, and 138 (86%) disclosed the technologies they use. A total of 25 (15.5%) said they always used open-source technology, and 24 (17%) disclosed technologies associated with interoperability standards in their responses.
Conclusions:
The NHS must adopt a cohesive strategy and refine policies to ensure the success of its digital, open-source technology and interoperability standards initiatives. Five recommendations toward greater organizational interoperability are made by the authors. Future research should examine digital innovation across NHS trusts, focusing on barriers such as limited resources, organizational culture, and technical expertise. Identifying these challenges is essential for developing strategies to reduce disparities and promote equal progress.
Source: Elliott H. BMJ Open, Oct 2025; 15(10): e102163
Governing AI with trust: an adaptive framework for institutional legitimacy in the UK public sector
Abstract:
Purpose:
This study aims to examine the limitations of artificial intelligence (AI) regulation in the UK public sector, particularly its fragmented and non-binding nature. It argues that current regulatory approaches lack the institutional coordination, legitimacy and transparency required to foster public trust in algorithmic decision-making. The paper proposes a conceptual model that reframes trustworthy AI not as a product of compliance or ethics alone but as the outcome of adaptive, legitimacy-centered governance.
Design/methodology/approach:
The study uses a conceptual policy analysis approach, synthesizing literature from public administration, regulatory theory and AI governance. It critically assesses the UK’s “pro-innovation” regulatory model and develops a governance-oriented framework grounded in legitimacy, coordination and accountability. The framework is supported by illustrative cases from National Health Service AI applications and the GOV.UK algorithmic transparency initiative, with broader applicability discussed in relation to other public sector domains.
Findings:
The analysis finds that non-binding, sector-led regulation in the UK lacks institutional alignment and accountability mechanisms, undermining public trust. The proposed framework reframes AI governance as a dynamic process of inter-agency coordination, transparent oversight and legitimacy production.
Research limitations/implications:
As a conceptual paper, this study does not present empirical validation. However, it offers a testable framework for future research. The model can be adapted for comparative studies or case-based evaluation in other governance domains such as justice or finance, and it calls for the development of legitimacy indicators and enforcement mechanisms in AI policy.
Practical implications:
This framework provides actionable guidance for policy designers, suggesting the need for institutionalized coordination, independent review bodies and legitimacy-based metrics for public sector AI oversight. It supports the design of governance models that go beyond technical compliance and embed trust and accountability into digital systems.
Social implications:
By positioning legitimacy as a governance outcome, the framework underscores how AI policies should address not only risks but also public perception, equity and institutional behavior. It highlights the role of citizen engagement, redress mechanisms and transparency in sustaining democratic accountability in algorithmic systems.
Originality/value:
This article makes an original contribution by framing AI governance as a public trust challenge and proposing a conceptual model rooted in legitimacy, institutional coordination and adaptive oversight. Unlike principle-based or compliance-driven approaches, the model bridges legal regulation and democratic accountability, offering a realistic, governance-centered alternative for the public sector.
Source: Cojocaru A. Emerald Insight, Dec 2025; 1-22
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Implementing integrated care infrastructure: A longitudinal study on the interplay of policies, interorganizational arrangements and interoperability in NHS England
Abstract: This essay was written by the Centre for Local Economic Strategies and The King's Fund, as part of a programme of work commissioned by The Health Foundation. Strategic authorities and integrated care systems are increasingly powerful entities with the potential to tackle health inequalities and improve population health. However, achieving this will require them to work together effectively. This essay explores the changing policy context in which these bodies exist, and the way the dynamics between them could and should evolve as devolution beds in.
Source: Elizondo A. Health Policy, Oct 2025; 160: 105237
Improving productivity in the NHS
Abstract: No abstract available.
Source: Gainsbury S. BMJ, Aug 2025; 390: r1722
Reforming financing of the NHS
Abstract: No abstract available.
Source: Mays N. BMJ, Sep 2025; 390: r1948
Can a digital NHS be equitable?
Abstract: No abstract available.
Source: Morley J. BMJ, Jun 2025; 389 :r1317
Does the English NHS 10-year health plan offer transformational change and a break with the past or more of the same?
Abstract: No abstract available.
Source: Hunter D J. Journal of Health Services Research and Policy, Apr 2026; 31(2): 69-71
How Were Patient Safety Incidents Responded to, Investigated, and Learned From Within the English National Health Service Before the Implementation of the Patient Safety Incident Response Framework? A Rapid Review
Abstract:
Objective:
To understand how National Health Service organizations routinely responded to, investigated, and learned from patient safety incidents in England before the implementation of the Patient Safety Incident Response Framework, and to identify associated success criteria and barriers.
Methods:
We followed rapid review methodology and searched 2 electronic databases. We aimed to identify and synthesize literature regarding patient safety incident response, investigation, and learning within the English National Health Service, before the implementation of the Patient Safety Incident Response Framework.
Results:
Nineteen articles were included. A narrative synthesis generated 4 concepts: (1) a multifaceted reporting culture, (2) investigation processes, (3) the landscape of support and involvement, and (4) opportunities to learn. Barriers to incident reporting included time, task characteristics, a culture of blame, and lack of feedback. Root cause analysis was cited as the most common investigation method. Studies outlined points of support and involvement for patients and families, the importance of supporting and involving patients and families, and acknowledged contributions from patients and families may be overlooked currently. For health care staff, the need for timely and personalized support soon after an incident was emphasized. Studies underlined the limitations of current approaches to learning and improvement.
Conclusions:
These findings lend support to the challenges associated with health care systems' infrastructures and strategies for responding to and learning from patient safety incidents. These challenges centre on 2 interrelated issues: the investigative challenges of rigorously conducting systems analysis and learning-oriented improvement; and the relational challenges of supporting genuine relationships of care, open and honest communication, and supportive engagement after patient safety incidents.
Source: Louch G. Journal of Patient Safety, Aug 2025; 21(5): e42-e55
Patient Safety Incident Response Framework
Abstract: The Patient Safety Incident Response Framework (PSIRF) sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety.
Source: NHS England, 2026
Introduction to PSIRF
Abstract: At its core, PSIRF helps healthcare providers investigate and respond to incidents in a way that prioritises learning, systems thinking, and meaningful involvement of patients, families, and staff. It ensures that safety investigations are focused not just on what happened, but why it happened, so that changes can be made to reduce future risks.
Source: Patient Safety Incident Response Framework, 2026
Investigating under the Patient Safety Incident Response Framework (PSIRF): sharing HSSIB learning for future development
Abstract: This report shares learning and insights from HSSIB’s education and investigation teams about patient safety incident investigation under the Patient Safety Incident Response Framework (PSIRF).
Source: Health Services Safety Investigations Body, Oct 2025
Feasibility analysis of total quality management in medical quality management and its impact on work efficiency
Abstract:
Objective:
This study aimed to analyze the feasibility of total quality management (TQM) in medical quality management (focusing on three dimensions: management work efficiency, medical service quality, and safety quality) and to evaluate its impact on the work efficiency of medical staff.
Methods:
TQM was introduced in January 2023, serving as the dividing point between the pre-management period (January-December 2022) and the post-management period (January-December 2023). Fifty medical staff members from the same cohort were chosen as study subjects. Comparisons were made between the pre- and post-management periods in terms of work efficiency (hospital culture development, reward and punishment mechanisms, communication and coordination mechanisms, environmental hygiene management mechanisms, and adverse event reporting mechanisms), medical service quality, staff satisfaction, safety quality (incidence of adverse events, unplanned returns to the operating room, qualification rate of medical device sterilization, incidence of infection events, and medical complaints), and overall medical quality (medical safety management, medical training management, and medical hygiene supervision). Data were analyzed using SPSS 29.0. Paired-sample t-tests were employed for continuous variables (scale scores), while χ2 tests were used to categorical variables (satisfaction, safety quality).
Results:
After TQM implementation, the work efficiency of medical staff significantly increased (P < 0.001). Compared to the pre-management period, the post-management period exhibited higher medical service quality scores, greater overall staff satisfaction, lower incidences of adverse events, unplanned returns to the operating room, infection events, and medical complaints, a higher sterilization qualification rate for medical device, and enhanced medical safety, training, and hygiene supervision management (all P < 0.05).
Conclusion:
TQM is feasible and effective in medical quality management. Its implementation can enhance work efficiency and medical service quality among medical staff, improve satisfaction, strengthen safety quality, and comprehensively elevate overall medical quality.
Source: Shi P. Frontiers in medicine, Dec 2025; 12: 1701801
Quality management systems
Abstract: Quality improvement, by itself, does not represent a holistic approach to managing quality.
Quality improvement needs to be used alongside quality planning, quality assurance, and quality control to create a single, consistent management system.
Source: NHS England, 2026
Case Study: Total Quality Management (TQM) at the NHS
Abstract: Total Quality Management (TQM) has played an increasingly significant role in improving healthcare delivery within the
National Health Service (NHS) in the United Kingdom. As a publicly funded healthcare system facing rising demand, financial constraints and heightened public expectations, the NHS has adopted quality management approaches to enhance patient safety, service efficiency and organisational effectiveness. This case study examines how TQM principles have been applied within the NHS, highlighting key initiatives, achievements, challenges and lessons for healthcare quality improvement.
Source: Islam Mohammad T. Smart Life Skills, Feb 2026
