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Accountability, fear and public safety

A photo of an operation being carried out
  • How can professional regulation protect the public without undermining efforts to address toxic, fear-based cultures in health and social care?
  • How can we deliver cultural change in frontline care without undermining individual accountability?

These are some of the questions we ask in chapter 4 of Safer care for all. It is vital that workplaces embrace just, learning cultures. At the same time, people need to be accountable for their actions when care has gone wrong, as this helps to keep patients and service users safe from poor practice. Professional regulation is not there to punish, but the public also need to have confidence that serious failures are dealt with – could professional regulation do more to explain its role in keeping people safe so that professionals are not practising in fear of unfair sanction? How can the use of confidential ‘safe spaces’ for learning coexist with candour and accountability? Read Chapter 4 to find out more. 

Event write-up

Accountability, learning and public safety roundtable: 5 March 2024

In Safer care for all, we committed to ‘bring people together to find ways for the HSSIB England’s ‘safe spaces’ approach, and other initiatives for improving safety culture, to support candour and accountability. This will include patients, service users and families, professionals, regulators and many others.’

We started this work by hosting a roundtable on 5 March with the intention to help bridge some of the policy and implementation gaps identified in this chapter of Safer care for all. The roundtable aimed to:

  • To identify challenges to the effectiveness of professional regulation and other individual accountability and redress mechanisms posed by the implementation of safety culture initiatives (such as HSSIB ‘safe spaces’, PSIRF, local just, restorative, learning cultures)
  • To identify challenges to the implementation of safety cultures posed by professional regulation and other individual accountability and redress mechanisms
  • To identify prospective means of addressing these challenges so that individual accountability and safety culture initiatives can work hand-in-hand for patient safety.

It was a rich and varied discussion, bringing together different perspectives and examining some of the challenges and possible ways forward. Discussions covered:  what patients and services users want when things have gone wrong, how to make staff feel safe and reduce the fear factor associated with regulatory and other mechanisms whilst still maintaining a focus on appropriate individual accountability and how different understanding of key concepts such as a ‘just culture’ can make a big difference in how things play out in practice. We’ll be digesting the output from the event and considering next steps for the PSA in this area over the year ahead.

Our Chair for this roundtable was Anna van der Gaag - visiting Professor, Ethics and Regulation, University of Surrey. You can read Professor van der Gaag's reflections on the roundtable in her guest blog.


Find out more

What would you like to read? We have several versions available. You can download:

There is also a Welsh translation available of front part of the report, including The essentials and the executive summary. You can download it here

Please get in touch (via the email address below) with us if you would like a Word version of the full report.

Get in touch

Contact us if you would like to join the discussion about how we can work together to make health and social care safer for all. You can get in touch by emailing