By Nicky Cheetham-Whitfield, Principal Health & Safety Consultant, accuSafe Consulting Ltd.
As a specialist healthcare health and safety practitioner, I work with healthcare providers to help senior leaders understand where responsibility truly sits and how risks to patients, staff and visitors can be evidenced as being effectively controlled in practice. Through my consultancy, accuSafe, my focus is on supporting organisations to move beyond documented compliance to genuine, demonstrable assurance.
A Chief Executive once sat in a board meeting confidently stating that health and safety risks were ‘under control.’ Policies were in place and audits were green. Three months later, a serious incident occurred. During the investigation, she was asked what evidence she had that those risks were being controlled day to day – not just documented. The gap between what she assumed and what she could demonstrate was uncomfortable.
She wasn’t negligent. She cared deeply. But she had been seeking reassurance when she should have been demanding assurance.
The shift in accountability
Regulatory expectations in healthcare are increasingly stringent. Investigations focus not only on what happened, but on what risks were known, what decisions were made, what controls were in place, and what evidence shows leadership oversight.
Under Section 37 of the Health and Safety at Work etc. Act 1974, senior individuals can be held personally accountable where an offence is committed with their consent, connivance, or attributable to their neglect. This responsibility extends beyond board directors to partners, senior leaders and others with influence over how risks are prioritised and managed.
This is not about fear. It is about ensuring those with responsibility have the clarity and support needed to make informed decisions that protect patients, staff and services. Good intentions do not provide legal protection. Delegation does not remove accountability. Assumptions are not evidence.
What effective leadership looks like?
Healthcare leaders who manage this well seek clarity rather than comfort. They value evidence of control over policies alone and understand how systems perform under real pressure, including staff shortages, high demand and competing priorities.
Practical steps include clearly defining accountability, establishing evidence-based oversight rather than relying solely on documentation, creating early-warning indicators that surface concerns before they escalate, and regularly asking: If we were scrutinised tomorrow, what evidence demonstrates we led responsibly?
From compliance to confidence
Organisations move from compliance to confidence when leaders can demonstrate how health and safety is exercised in everyday practice. Confidence grows not because risk disappears, but because leadership can evidence how it is being managed.
Health and safety leadership in healthcare is not about bureaucracy or blame. It is about clarity, confidence and control, and understanding that responsibility is no longer optional.
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