Henrietta Hughes: ‘If you don’t have partnership with patients, you’re on a risky road’

England’s patient safety commissioner and GP, Henrietta Hughes, says the traditional in-person consultation is “gold standard” when it comes to holistic care.

Digital technologies which enable remote care can adversely affect the patient experience and introduce risks.

But if technology is creating risks, it is also offering novel ways to protect patients from harm.

Ahead of her keynote at Digital Health Rewired 2025, Hughes tells Digital Health News that digital technology can have a “transformational” impact on safety – but only if leaders are prepared to engage in genuine partnership with patients.

There have been some cases where poor implementation of electronic patient records (EPRs), has resulted in patient harm. What needs to change to make patient safety central to EPR development and implementation?

Individual providers shouldn’t have to have conversations [about safety] with EPR designers. This is something that should go into the national specification so that when anybody is developing an EPR they put patient safety up front and think about how we make sure the EPR promotes patient safety and doesn’t create additional risk.

Once a system is up and running it is often difficult or expensive to make changes to it.

By bringing in the voices of patients, family members, carers and staff we can make sure the EPR does what we need it to do, rather than trying to retrofit a system that might have been designed for an alternative reason, such as billing.

A report from the Health and Services Investigations Body (HSSIB) found that patient harm caused by GP online consultation tools is underreported. How do you plan to address the hidden risks of digital technologies in primary and community care?

 We’ve got to balance out the risks and the opportunities. I’m a GP, and I use systems where patients fill in online forms as a way of getting access to primary care services. For some people this is incredibly convenient. The HSSIB report didn’t focus on the benefits that some people experience.

But it is important that patients have multiple different ways of accessing GP services because not everybody finds it easy to fill in a form.

Also, there are some questions that when you answer in a particular way, it tells you “stop” because you have to access care more urgently. I know there have been issues where patients have changed their answer to be able to continue with the form. There’s some question about whether people reading the form should know it has been changed, because that could be a hidden safety issue.

Patients want to have a two-way conversation. One of the issues with online forms and text messages is that it is very much one-way

The holistic approach we have in general practice is more difficult to do if you have somebody on the end of a phone or the end of a form. You don’t get to see if they’re looking very unwell. It’s about having a senior person do triage, so if there is a concern you can invite the person to come in.  If a patient asks to see the doctor face to face, that’s a very clear indication to say “yes”.

Patients want to be able to have a two-way conversation. One of the issues with forms and text messages, is that it is very much one-way.  The administration around healthcare has got to support patient safety and patient experience.

Last October we published the Patient Safety Principles to help organisations plan and deliver care, thinking about decisions from the patient’s perspective. We need to have systems that identify and mitigate risks, and we need to involve the people who are going to be using the services.

There is always a risk that people design systems that work perfectly well for themselves [but not for others]. That’s why, at an integrated care system level, they have a responsibility to be mindful of their entire population and to ensure that the systems work for everybody.

How important is patient engagement and digital inclusion to the patient safety agenda?

They are absolutely vital. If we don’t have partnership with patients, it’s a risky road to go down. Patients will be able to tell you what matters to them – that’s very personal and individual. It means you will be to identify the right treatment for that person.

If we are not listening to the voices of all the people who are going to be using devices, it’s a thoughtless approach. [When you listen to] a triumvirate of manufacturer, clinician and patient we see really positive things happening.

I’m an adviser to the Medtech strategy programme board and I’m very pleased that we’ve set up a patient engagement forum so that all the representative charities are able to input. Because when patients’ voices are involved upfront, we prevent harm from happening.

When engagement is last minute – “here’s the system, what do you think?” – that’s when things have gone wrong. The best examples are where people have done co-production right from the beginning.

Where do you see the greatest scope for digital to improve patient safety?

 There are multiple ways that patient feedback is being looked at in a digital way. For example, there is a system called Care Opinion which is used by the whole of Scotland and some trusts in England; in some organisations they use that information at ward level to make improvements. Seventy per cent of the feedback is positive so it’s also good for staff morale.

Using technology to work out where things have gone wrong can be transformational

AI can identify multiple themes [in complaints] and heat map those and be very specific about the actions that need to be taken. Using [technology] to work out where things have gone wrong can be transformational.

It’s not just about having the system – it’s about leadership, and how leaders use information to improve care and outcomes for patients.

Can you give us a taster of what you will speaking about at Rewired?

I’d really like to talk about elements of our strategy that interplay with digital devices. [Systems have to support] the safe use of devices, and through the Medtech strategy the patient voice is very much involved.

We’re also keen that people give feedback about issues and that includes yellow card reporting. A positive message to get out at Rewired is that you can do a yellow card report for devices.

Hughes  will be speaking at Rewired 2025 at the NEC in Birmingham, 18-19 March 2025. Register here. The event is co-headline sponsored by The Access Group and Microsoft. Alcidion, Nervecentre, Solventum and Cynerio are also sponsors