Section 1

Why This Matters

The board's role in digital clinical safety

Every year, NHS organisations deploy, configure, and operate health IT systems that carry real risk of harm to patients. Electronic prescribing. Clinical decision support. Diagnostic software. These are complex, safety-critical systems — and their governance belongs at board level.

When things go wrong — and they do — the question asked is not whether the IT team knew. It is whether the organisation had adequate governance, leadership, and resource in place to manage the risk. That accountability sits with top management.

HSSIB's investigation into ePMA systems found wide variation in how NHS trusts implement legally mandated safety standards, under-resourced Clinical Safety Officers, and a systemic gap between digital safety and patient safety teams. This is not a technical failure. It is a governance failure.

DCB 0129 and DCB 0160 are not guidelines. They are legally mandated standards. Your organisation's compliance is your responsibility as a board.

The standards require that top management actively engages with clinical risk management — not as a sign-off exercise, but as a genuine governance function. That means resource, authority, and visible leadership.

Digital clinical safety is not an informatics concern. It is a patient safety concern.

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Section 2

Your Accountability

What the standards require of top management

DCB 0129 and DCB 0160 place explicit obligations on your organisation. Tick each item as you review your position.

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  • Designated Clinical Safety OfficerA named, qualified CSO with clinical knowledge, authority, and protected time — not an honorary title.
  • Clinical Risk Management SystemA documented, maintained CRMS actively used — not filed and forgotten.
  • Clinical Safety Case ReportsEach in-scope system must have a CSCR reviewed, updated, and signed off. Completion at deployment is not sufficient.
  • Hazard Log MaintenanceLiving documents — reviewed regularly and updated when incidents, near misses, or system changes occur.
  • Top Management Sign-OffCRMS sign-off is a governance act, not a formality. You are attesting to the adequacy of your clinical risk management.
  • Adequate ResourcingYour CSO must have protected time, appropriate training, and authority. Resource constraints do not reduce legal obligations.
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Section 3

Building Safety Culture

Five pillars of digital clinical safety leadership

Compliance with DCB 0129 and DCB 0160 is necessary — but not sufficient. Genuine safety culture is what closes the gap between ticking boxes and protecting patients.

🗣️ Psychological Safety

Staff must feel safe raising concerns about digital systems without fear of blame. Silence is not safety.

🔗 Cross-Team Collaboration

Digital safety cannot sit in a silo. Clinical, informatics, and patient safety teams must work together.

👁️ Visible Leadership

Board-level engagement signals that digital clinical safety is a priority — not an afterthought.

📚 Learning, Not Blame

Near misses and incidents are intelligence. Build systems for learning, not for finding fault.

🏗️ Safe by Design

Safety must be embedded from procurement through to decommissioning — not bolted on after deployment.

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Section 4

Your Action Plan

A 90-day roadmap for top management
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Days 1–30 · Foundation
  • Confirm your named Clinical Safety Officer and review their protected time and capacity
  • Request a briefing on the current status of your Clinical Risk Management System
  • Identify all in-scope health IT systems and confirm a CSCR exists for each
  • Review whether DCB 0129 / DCB 0160 compliance is on your board assurance framework
Days 31–60 · Governance
  • Add digital clinical safety as a standing item on a relevant board sub-committee
  • Confirm CSCR sign-off process includes genuine top management engagement
  • Commission a gap analysis against DCB 0129 / 0160 if one has not been done recently
  • Ensure procurement and commissioning processes include clinical safety requirements
Independent Assurance · Optional but Recommended

Not sure where you stand?

Some organisations want independent eyes on their position before committing to a programme of work. ORTHON offers a digital clinical safety readiness review — assessed by practitioners who have operated at national level within these standards, not a generic compliance team. Get in touch →

Days 61–90 · Culture
  • Brief the board on what digital clinical safety means — and what it requires of them
  • Ensure all clinical staff have completed the NHS e-LfH digital clinical safety essentials
  • Identify whether your CSO has access to peer networks and ongoing CPD
  • Establish a mechanism for staff to raise digital safety concerns and have them reviewed
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Section 5

Essential Training

Building knowledge and competence across your organisation

For all staff: NHS e-Learning for Healthcare

Free digital clinical safety e-learning for all NHS staff. Access directly via your NHS email account at the NHSE e-LfH Hub.

Level 1

Essentials of Digital Clinical Safety
  • Designed for all staff working with health IT systems
  • Covers the basics of clinical risk and why it matters
  • Introduces DCB 0129 and DCB 0160
  • Suitable as mandatory organisational training

Level 2

Intermediate Digital Clinical Safety
  • For staff with a clinical safety role or responsibility
  • Deeper coverage of hazard identification and risk assessment
  • Documentation requirements and governance processes
  • Builds readiness for practitioner-level training

For those with a clinical safety role, ORTHON's CPD-certified courses provide structured, expert-led development.

Part 1

Applied Clinical Risk Management
  • Clinical risk management theory & DCB standards
  • The clinical risk management process
  • Documentation and incident management
  • Hazard assessment workshop (practical)
  • Introduction to Clinical Safety Case Reports

Part 2

Clinical Risk Management in Practice
  • Developing and structuring a CRMS
  • Writing a Clinical Risk Management Plan
  • Running a hazard assessment workshop
  • Authoring a CSCR for different system types
  • System of systems and complex deployments

Some organisations will want more than training. They want to know whether their clinical safety governance is genuinely robust — not just whether the documents exist, but whether they hold up.

ORTHON Advisory: Digital Clinical Safety Readiness Review

For organisations that want independent assurance on where they stand, ORTHON offers a structured readiness review across your clinical risk management system, documentation, processes, and governance — assessed against DCB 0129, DCB 0160, and what demonstrably good practice looks like in the field.

This isn't a generic audit by a compliance team working from a checklist. The people doing this work are the same people who have operated inside these standards at national level, trained practitioners across the NHS, and understand the difference between a safety case that looks right and one that actually is.

The result is a clear, honest picture of your organisation's safety readiness — where the gaps are, what the risks are, and what needs to change.

Interested in independent assurance on your clinical safety maturity? Let's talk.

Enquire now
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