The Emergence of Patient Safety as an Object of British Health Policy, 1948–2023

Please join the University of Exeter's Wellcome Centre for Cultures and Environments of Health and Centre for Medical History for a webinar with Dr Chris Sirrs on histories of patient safety in the NHS.

For centuries, clinicians have recognised the dangers of iatrogenic injury—harm to patients caused by the process of healthcare itself. However, it is only since the 1990s that researchers have begun to appreciate the extent of iatrogenic injury in healthcare systems, and a new, systemic way of thinking about and approaching patient harm has developed. On either side of the Atlantic, major studies and reports drew attention to the sheer numbers of people harmed or killed through healthcare, often because of errors, or mistakes in treatment. For instance, in the United States, a report by the Institute of Medicine, To Err is Human, highlighted that between 44,000 and 98,000 deaths every single year were linked to errors in US hospitals. This mortality rate, the report dramatically noted, was higher than that of motor accidents, AIDS, and even breast cancer.

In 2000, the UK Department of Health’s report An Organisation with a Memory estimated that 1 in 10 patients admitted to NHS hospitals, or around 850,000 patients a year, experienced an ‘adverse event’—a physical or psychological injury resulting from clinical care. This revelation that patient harm was a routine feature of the patient experience in hospitals, rather than a rare or peripheral phenomenon that could be overlooked, encouraged a new focus on the prevention and avoidance of harm. Subsequently, a commitment to ‘patient safety’ spread throughout the NHS, and in other healthcare systems around the world.

The rise of patient safety suggests a profound shift in attitudes towards patient harm. Many harms to patients are now thought to be preventable, avoidable, or otherwise manageable through measures put in place by clinicians, managers, regulators, and others. In this paper, I explore the emergence of patient safety as an explicit object of British health policy around the millennium. I explain why, despite the ancient mantra of doctors to ‘do no harm’, a systematic approach to patient safety developed in healthcare only recently.

Dr Christopher Sirrs is Research Fellow at the Centre for the History of Medicine, University of Warwick. His current research, funded by the Wellcome Trust, explores the history of safety in NHS hospitals. Chris’s broader research interests lie at the intersection of contemporary history and health policy. Previously, he has investigated the emergence of anxieties around ‘fake’ drugs in global health, and the intellectual and policy history of ‘health systems’. His PhD, completed in 2016, explored the historical development of the British system of health and safety regulation: a theme he is now continuing to explore, in the domain of healthcare.

Chris can be followed on Twitter at @hazardhospitals.