July 2025
ARC England welcomes the Dr Penny Dash Review and acknowledges its robust evaluation of patient safety across the health and social care system. The report offers a critical examination of longstanding challenges and proposes decisive reforms to improve safety and quality outcomes.
The review highlights that, despite considerable investment amounting to billions of pounds, progress in patient safety remains limited. A disproportionate focus on safety has at times overshadowed broader elements of care quality, such as effectiveness and patient experience. This is especially true in the experience of people with learning disabilities and autistic people.
Oversight across the sector remains excessively fragmented — with over 40 statutory bodies (including the CQC, Healthwatch, NHS Resolution and the National Guardian’s Office) contributing to duplication and ambiguity. Additionally, the report cites the volume of inquiries and recommendations — often lacking cost-benefit clarity — as a contributing factor to inefficiency and slow systemic change.
The NHS’s data assets, although rich, are reportedly underutilised, particularly in shaping proactive safety improvements. Adult social care continues to lack a national quality framework, and complaint handling remains inconsistent, slow, and overly complex.
In response to these findings, ARC England fully endorses the report’s recommendations, notably:
- The streamlining of governance structures to reduce duplication and provide clarity of leadership
- The creation of a national strategy for adult social care quality with defined metrics and outcome measures
- The consolidation of complaints and patient feedback mechanisms to improve responsiveness and public trust
- The enhanced use of data and artificial intelligence to support proactive oversight
- The embedding of cost-benefit analysis and true accountability within the inquiry process
Furthermore, ARC England supports broader themes identified within the review, including restoring regulatory performance and clarity within the Care Quality Commission and rebalancing the concept of “quality” to incorporate safety, effectiveness, and the lived experience of individuals.
However, we would caution concern regarding the proposed reallocation of Healthwatch functions to Integrated Care Boards (ICBs) and Local Authorities.
Healthwatch has historically served as an independent and trusted channel through which citizens could voice concerns about health and social care. Its ability to advocate impartially and independently on behalf of people who draw on care and support services is vital and must not be compromised. Transferring these duties risks undermining public trust and weakening the representative voice of the community.
We welcome the renewed attention to adult social care and stand ready to contribute to the development of a national quality framework and measurement matrix. We strongly advocate for the co-production of outcome measures with people with lived experience of learning disabilities and autism, ensuring that reform efforts are grounded in real experience and reflective of those they serve.
This review offers both diagnosis and direction, and ARC England affirms our commitment to supporting meaningful change across the system in pursuit of improved safety, trust and quality of healthcare for people with learning disabilities and autistic people.