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Authors: Dr Chris Subbe, Fellow, Health Foundation, Dr Robert Royce, Researcher


A large number of reports have found that medical errors are common and harm is affecting between five and ten per cent of patients. Half of this harm is potentially avoidable, but 20 years of research into quality improvement has only brought moderate improvements in the rate of patients who suffer from adverse events.

This report illustrates the value and potential of co-production in the prevention of harm through the experience of patient advocates, safety campaigners, health service researchers and people working in healthcare.

The ‘expert witnesses’ show how impactful patients? engagement in their own safety is, especially in the context of chronic disease when the patient is often the person with the best knowledge of their condition and the person with the best perspective to detect deterioration.

The paper summarises 13 testimonies that highlight how the knowledge of patients and those close to them has the power to prevent serious adverse events. This paper also tries to explore how structure, process and outcomes of health services might be affected by making greater usage of the knowledge, skills and passion of patients and their personal networks. It also explores the likely risks and benefits of technology to facilitate safer delivery of future healthcare.

Key recommendations

In a system that is struggling to manage complex healthcare, co-production between public and professionals has the potential to reduce adverse events and improve safety in the NHS

At no time have the principles of ‘Prudent Healthcare’ been more pertinent: Public and professionals need to work as equal partners to co-produce services, focus on those with the greatest health need first and do no harm, do only what is needed as we understand things with our current knowledge and at the same time reduce unjustifiable variation.

This paper intends to inspire those who require medical care and those who work in health or healthcare policy to explore alternative models in an attempt to reduce avoidable harm.

It is our hope, as authors and sponsors, that we can make this an annual learning event for the public and professionals, that it will inspire changes in beliefs and behaviours and ultimately lead to safer healthcare.