PSIRF: what the NHS Patient Safety Incident Response Framework asks of providers
For NHS trusts, independent providers and primary care in England: what PSIRF replaced, who must apply it, the policy and plan you need, the learning response methods, SEIPS, and the standards your responses are checked against.
PSIRF sets out how NHS-funded providers in England respond to patient safety incidents so they learn and improve. It replaced the Serious Incident Framework, dropped the “Serious Incident” label and its threshold, and lets each provider plan which incidents get which kind of response.
| What | What NHS England says |
|---|---|
| Published | August 2022, replacing the Serious Incident Framework (2015). NHS England last updated the framework on 23 September 2025. |
| Who must apply it | Every service provided under the NHS Standard Contract, including NHS-funded care from independent providers and some primary care. |
| What you need | A patient safety incident response policy and plan, agreed with your commissioners and your board, and published on your website. |
| How you respond | With the learning response your plan sets for that type of incident, such as a swarm huddle, an after action review, an MDT review or a patient safety incident investigation (PSII). |
| What’s set nationally | A short list of events with a fixed response, such as a PSII for deaths thought more likely than not due to problems in care. |
| How long | Start as soon as possible, usually finish within one to three months, and take no longer than six months for a PSII. |
| The standards | The patient safety incident response standards, version 1.3 (January 2026). |
What is PSIRF?
The Patient Safety Incident Response Framework (PSIRF) sets out how the NHS in England builds and keeps up its systems for responding to patient safety incidents, so it can learn and improve patient safety. NHS England defines a patient safety incident as an unintended or unexpected event, including an omission, in healthcare that could have harmed or did harm one or more patients.
PSIRF replaced the Serious Incident Framework (2015). It makes no distinction between patient safety incidents and Serious Incidents, so the “Serious Incident” classification and its threshold are gone.
Under PSIRF, each provider decides what to learn from. You study your own incident data, agree your main safety issues with stakeholders, and set out in a plan how you’ll respond to each type of incident. Some incidents get an in-depth investigation. Many get a shorter learning response. Some need no individual response beyond recording the incident and talking to the people affected.
PSIRF responses exist only to learn and improve safety. They don’t decide blame, liability, preventability, fitness to practise or cause of death. Those questions go through separate processes, such as a coroner’s inquest, the police or a professional regulator, and NHS England says to keep them entirely separate.
Who must apply PSIRF
Any healthcare service can use PSIRF. It’s mandatory for services provided under the NHS Standard Contract.
- NHS trusts and foundation trusts: acute, ambulance, mental health and community services, including maternity and all specialised services.
- Independent providers: all NHS-funded care you provide under the NHS Standard Contract. You can apply PSIRF to your other services too, including social care, so you handle incidents one way across the organisation. NHS England expects you to apply the principles in proportion to your risk, size, geography and complexity.
- Primary care: services contracted under the NHS Standard Contract must comply. Other primary care providers can adopt PSIRF by working with their integrated care board (ICB).
- Social care: PSIRF is a healthcare framework. Social care organisations must adopt it for care they provide under the NHS Standard Contract, and can choose to adopt it for the rest.
Services outside the NHS Standard Contract, such as some air ambulance services, can still use the free PSIRF training described below.
The four principles of PSIRF
- Compassionate engagement and involvement of those affected. Work with the patients, families and staff affected by an incident to understand and answer their questions, and point them to support. When you run a learning response, involve them in it if they want to be.
- A range of system-based approaches to learning. Use the national learning response tools, or system-based equivalents, to explore the many factors that contributed to an incident or a cluster of incidents.
- Considered and proportionate responses. You have finite resources, so put them where they’ll bring the most improvement. Where you already understand an incident type well and improvement work is under way, spend the effort on that improvement work.
- Supportive oversight focused on improvement. ICBs and regulators look at how strong and effective your incident response system is. Your own leaders are accountable for the quality of each learning response, and you don’t need your ICB to sign off response reports.
What you need in place
A patient safety incident response policy
The policy describes your overall approach to responding to and learning from incidents: how you engage the people affected, how oversight works, and how you put the four principles into practice. NHS England publishes a national template. The standards also ask that your policies support a just culture, for example by not suspending staff automatically after an incident, and that you publish the policy on your website.
A patient safety incident response plan
The plan sets out how you’ll respond to incidents over the next 12 to 18 months, and which methods you’ll use. Before you plan, NHS England asks you to understand your capacity to respond and map your services. Then you work through four steps with your stakeholders:
- Examine your incident records and safety data, including investigation reports, complaints and inequalities data.
- Describe the safety issues the data shows, until stakeholders accept the list as your incident profile.
- Identify the improvement work already under way.
- Agree the response method for each issue or incident type.
Your ICB, any other commissioners where required, and your board (or leadership group) must agree the plan. Then publish it on your website alongside your policy. Review it every 12 to 18 months, and run a full planning exercise at least every four years.
Engagement with those affected
Give each affected patient, family member and staff member a named main contact. When a learning response goes ahead, let them help shape its terms of reference, agree a realistic timeframe, and review the draft report while their comments can still change it.
Oversight
Make sure staff understand who is responsible for what. Everyone in an oversight role, including executives, non-executives and ICB leads, needs PSIRF oversight training. NHS England changed the oversight training requirements in January 2026.
Trained people
| Role | What the standards require |
|---|---|
| Learning response leads | Training in a systems approach to learning from patient safety incidents, patient safety syllabus levels 1 and 2, yearly CPD, and at least two learning responses a year. NHS England recommends Band 8a or above, with dedicated paid time. A lead never runs a response into an incident they were involved in, or one involving staff they manage directly. |
| Engagement leads | Training in involving those affected in learning from patient safety incidents, patient safety syllabus levels 1 and 2, yearly CPD, and at least two learning responses a year. One person can be both the engagement lead and the learning response lead. |
| Oversight leads | PSIRF oversight training, patient safety syllabus level 1 for boards and senior leadership teams, level 2, and yearly CPD. |
The learning response methods, and when to use each
NHS England’s learning response toolkit holds four national methods. Your plan says which one you’ll use for each type of incident, and you can combine them.
| Method | What it is | Use it when |
|---|---|---|
| Swarm huddle | A multidisciplinary discussion started as soon as possible after the incident. Staff “swarm” to the site to find out what happened and why, and decide what to do to reduce the risk of it happening again. | You want to capture insight straight after an incident, while memories are fresh. Patients, families and carers can take part. |
| After action review (AAR) | A structured, facilitated discussion built on four questions: what did we expect to happen, what actually happened, what was the difference, and what’s the learning? | An outcome differed from what you expected, good or bad. NHS England’s after action review handbook puts a session at 30 minutes to an hour. |
| MDT review | An open discussion with a wide range of staff, often after observations and walkthroughs, to agree the key contributory factors and system gaps. | The incident happened some time ago, staff recollections are hard to collect, or you want to learn from several similar incidents together. |
| Patient safety incident investigation (PSII) | An in-depth review of a single incident or a cluster of incidents, to understand what happened and how. Reports use NHS England’s national template. | An incident or near miss shows significant patient safety risk and potential for new learning, or national rules require one. |
Responses set nationally
For a short list of events, NHS England’s guide to responding proportionately (version 1.3, September 2025) sets the response:
- Deaths thought more likely than not due to problems in care: a locally led PSII.
- Deaths of patients detained under the Mental Health Act 1983, or where the Mental Capacity Act 2005 applies, where problems in care may be linked: a locally led PSII.
- Never Events: a proportionate learning response. The Never Events framework is under review, and a PSII is no longer mandatory for them.
- Mental health-related homicides: refer to NHS England’s Regional Independent Investigation Team.
- Maternity and neonatal incidents that meet the national criteria: refer for an independent investigation.
- Child deaths: refer to the Child Death Overview Panel.
- Safeguarding incidents that meet the criteria: refer to the local authority safeguarding lead.
- Incidents in NHS screening programmes: refer to the local screening quality assurance service.
When an incident needs no individual response
You can decide an incident needs no individual learning response, beyond recording it in your incident log and engaging the people affected. If an affected patient, family member or staff member asks for one, consider the request carefully. If the incident caused moderate or greater harm, you still owe them the duty of candour.
Timeframes
Start a response as soon as possible after you identify the incident, and usually finish within one to three months. Agree a PSII’s timeframe with those affected when you set its terms of reference. A PSII should take no longer than six months, and NHS England says that limit “must not become a new default target”. If you need longer, for example because a partner organisation asks you to pause, agree the extension with those affected.
The other tools in the toolkit
- To gather information: observations, walkthrough analysis, link analysis and an interview guide.
- To make sense of it: timeline mapping and a work system scan.
- For broad issues: a thematic review of past responses, or a horizon scan of a pathway.
- For safety actions: the safety action development guide and the SHARE debrief.
SEIPS, and why root cause analysis is no longer preferred
SEIPS, the Systems Engineering Initiative for Patient Safety, is the system-based framework PSIRF endorses, and every national PSIRF tool builds on it. NHS England’s version combines SEIPS 2.0 and SEIPS 101. It shows how a work system shapes the work people do, and how that work shapes outcomes.
The work system has six elements:
- External environment
- Organisation
- Internal environment
- Tools and technology
- Tasks
- Person(s)
NHS England places people at the centre of the work system, to stress that the system’s design should support them. Incidents come from many interactions between these elements, so SEIPS prompts you to look for how they interact. NHS England’s toolkit includes a quick reference guide, a work system explorer with questions for each element, and a blank template.
NHS England says root cause analysis “prompts simple linear cause-and-effect analysis” and has failed to deliver benefits at the scale needed. Its guidance for providers outside NHS trusts says root cause analysis “is no longer the preferred approach”. You can use another system-based framework if your team is trained in it, and significant event audits count as a proportionate response when they explore the system factors behind an event.
PSIRF for independent providers and primary care
NHS England’s FAQ for organisations that aren’t NHS trusts (July 2024) answers the practical questions. Here’s what it says.
- You can share trained leads. A small provider may not manage a trained learning response lead and engagement lead at every site. You can share these resources with larger organisations, especially ones you provide services for. Multi-site providers can form a virtual learning response team that supports every site.
- Your policy and plan can cover the whole organisation or one site. You can also adapt existing documents to show how you meet the standards, or write a plan with other providers in your sector or local system, if your commissioners agree. Whoever manages incidents at each site must know where to find the documents and how to apply them.
- Agree your plan with your commissioners. With one commissioner, agree an approach together. With several, work through a lead commissioner and give the others sight of your drafts. If no lead commissioner comes forward despite your best efforts, say so in your plan and finalise it from your side.
- Bring in the right people early. Internally, that’s your clinical services, governance, safeguarding and HR. Externally, it’s patient groups such as Local Healthwatch, and, at the earliest opportunity, coroners and your CQC relationship owner.
- You can train staff without NHS access. HSSIB offers its course on a systems approach to learning from patient safety events free of charge to the independent sector. Levels 1 and 2 of the patient safety syllabus sit on e-Learning for Healthcare, and you don’t need an NHS email address. If training isn’t complete when you transition, record a plan to meet the standards within a reasonable time.
- Board members need oversight training. That applies to independent provider board members who take on the PSIRF executive lead roles.
A PSIRF standards self-check
NHS England’s patient safety incident response standards set the minimum expectations of PSIRF. Run these checks against them now.
- Your policy and plan are both on your website, and your commissioners and board have agreed the current plan.
- Your plan rests on an analysis of your own incident data and a recorded engagement process with stakeholders, and it gives a reason for each response you’ve chosen.
- Your policies support a just culture, with no automatic suspension or removal from duties for staff involved in an incident.
- Your learning response leads are trained, have dedicated paid time, work as part of a team, and lead at least two responses a year.
- Your engagement leads are trained, and each affected patient, family and staff member gets a named contact and the chance to review the draft report.
- Everyone in an oversight role has had PSIRF oversight training and patient safety syllabus levels 1 and 2.
- Your responses start as soon as possible and usually finish within one to three months, with timeframes agreed with those affected.
- Your PSII reports use the national template, and your responses use the national tools or system-based equivalents.
- You develop each safety action with the people who’ll carry it out, and a named person checks whether it’s working.
- You meet the duty of candour for every incident that needs it.
Request a PSIRF standards self-assessment
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NHS England’s PSIRF templates and tools
NHS England publishes the templates and guides you need to build your PSIRF documents and run your responses.
- Patient safety incident response policy template (Word)
- Patient safety incident response plan template (Word)
- PSIRF preparation guide (PDF)
- Guide to responding proportionately to patient safety incidents (PDF, version 1.3)
- Patient safety learning response toolkit: the method guides, the PSII report template, the SEIPS guide and template, and the information-gathering tools
- Engaging and involving patients, families and staff following a patient safety incident (PDF)
- Oversight roles and responsibilities specification (PDF)
- Patient safety incident response standards
- Applying PSIRF outside of NHS trusts
Choosing software for PSIRF? Read our PSIRF software buyer’s guide.
Or show why each incident got the response it did
CompliantCare’s Incident Management suggests a response for each new incident based on your PSIRF plan, from a quick review to a full learning response. A named person accepts or overrides the suggestion on the record. After action reviews and other learning responses run in the same place, and CompliantCare drafts the synopsis, timeline and contributing factors from the record for a person to sign. When your ICB or CQC asks why an incident got the response it did, you can show them.
Last reviewed: 8 October 2026. We review this guide every quarter against NHS England’s PSIRF documents. Where ours differs from NHS England’s, NHS England’s is correct.
Common questions
What is PSIRF?
PSIRF is NHS England's framework for how providers respond to patient safety incidents so they learn and improve. It replaced the Serious Incident Framework (2015) and removed the "Serious Incident" classification and its threshold. Each provider studies its own incident data, then sets out in a plan how it will respond to each type of incident, using system-based learning methods.
What does PSIRF stand for?
Patient Safety Incident Response Framework. NHS England published it in August 2022 and last updated the framework on 23 September 2025.
Does PSIRF apply to independent providers?
Yes, for all NHS-funded care they provide under the NHS Standard Contract. They can apply it to their other services as well, including social care. NHS England expects them to apply the principles in proportion to their size, risk and complexity, and its FAQ for organisations outside NHS trusts covers shared trained leads, site or organisation plans, and working with commissioners.
Does PSIRF apply to care homes and social care?
PSIRF is a healthcare framework. Social care organisations must adopt it for care they provide under the NHS Standard Contract. They don't have to adopt it for the rest of their social care, but they can.
What are the four principles of PSIRF?
Compassionate engagement and involvement of those affected by patient safety incidents; a range of system-based approaches to learning from patient safety incidents; considered and proportionate responses to patient safety incidents; and supportive oversight focused on strengthening the response system and improvement.
What is a PSII?
A patient safety incident investigation: an in-depth review of a single patient safety incident or a cluster of incidents, to understand what happened and how. NHS England requires a locally led PSII for some events, such as deaths thought more likely than not due to problems in care. PSII reports use NHS England's national template.
What is a swarm huddle?
A learning response that starts as soon as possible after a patient safety incident. Staff "swarm" to the site for a multidisciplinary discussion about what happened and why, and decide what needs to be done to reduce the risk of it happening again. Patients, families and carers can take part.
What is SEIPS in PSIRF?
SEIPS, the Systems Engineering Initiative for Patient Safety, is the system-based framework PSIRF endorses, and every national PSIRF tool builds on it. It describes a work system of six elements: external environment, organisation, internal environment, tools and technology, tasks, and person(s). It shows how that work system shapes the work people do, and how that work shapes outcomes.
Do Never Events still need a PSII?
No. NHS England's guide to responding proportionately (version 1.3, September 2025) says the Never Events framework is under review and a PSII is no longer mandatory for Never Events. You must still respond to each Never Event with a proportionate learning response.
How long should a PSIRF learning response take?
Start as soon as possible after the incident is identified, and usually finish within one to three months. Agree the timeframe with those affected. A PSII should take no longer than six months, and NHS England says that limit must not become a new default target.
Does PSIRF replace the duty of candour?
No. Standard 12.1 requires you to uphold your duty of candour obligations. NHS England's guide also says that if an incident causes moderate or greater harm, you must meet the duty of candour even when you decide no individual learning response is needed.
Is root cause analysis still used under PSIRF?
NHS England says root cause analysis is no longer the preferred approach, because it prompts simple linear cause-and-effect analysis. PSIRF uses SEIPS-based methods that explore many contributory factors. You can use another system-based framework if your team is trained in it.
References
- NHS England: Patient Safety Incident Response Framework (updated 23 September 2025)
- NHS England: Patient safety incident response framework and supporting guidance
- NHS England: Patient safety incident response standards (version 1.3, January 2026)
- NHS England: Guide to responding proportionately to patient safety incidents (version 1.3, September 2025, PDF)
- NHS England: Applying the Patient Safety Incident Response Framework outside of NHS trusts (July 2024)
- NHS England: Patient safety learning response toolkit
- NHS England: SEIPS quick reference guide and work system explorer (PDF)
- NHS England: Swarm huddle (PDF)
- NHS England: Multidisciplinary team (MDT) review (PDF)
- NHS England: Patient safety incident investigation overview (PDF)
- NHS England: Learning handbook, after action review (PDF)
- NHS England: Engaging and involving patients, families and staff following a patient safety incident (PDF)
- NHS England: PSIRF oversight roles and responsibilities specification (PDF)
- HSSIB: Education programme
- e-Learning for Healthcare: Patient safety syllabus training
For general information only. It reflects our understanding of NHS England's PSIRF documents as of October 2026, so check england.nhs.uk for the current framework and standards.