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  4. Harmed Patient Pathway

Harmed Patient Pathway

Our groundbreaking pathway which supports healthcare organisations to respond honestly, compassionately, and take ownership when patients are harmed.

What is the Harmed Patient Pathway?

The Harmed Patient Pathway (HPP) is a patient safety framework developed by Avma in collaboration with the Harmed Patients Alliance. It sets out a structured set of recommended expectations, principles, and duties for how the NHS should respond to patients and their families when they experience avoidable medical harm.

The project to develop the HPP was launched in February 2021, with the full Pathway published in December 2025. It is based on the concept that healthcare providers owe a moral duty of care to patients who have been harmed, and their families, to do no more harm and support their recovery as much as possible. The Pathway consists of six core commitments that organisations are asked to make in relation to patient safety and care when harm has occurred.

The six core commitments

The Pathway consists of six core commitments that organisations are asked to make, with an explanation of why each is necessary from a healing perspective, together with the actions which may be necessary (depending on individual patient/family needs) to honour each commitment.

These commitments are not a ‘checklist’ to be ticked off; rather, they represent a cultural mindset in how to think about and practically respond to the healing needs that result from harm, for patients and their families, as well as staff who we recognise as being impacted by harm events.

  • Commitment 1: We ensure compassionate and honest communication with harmed patients and their families that supports dignity, trust and just relations.
  • Commitment 2: We ensure that harmed patients/families get the support they need as far as possible and we assist them with access to specialist independent advice and support in order to support their wellbeing.
  • Commitment 3: We support meaningful involvement of harmed patients/families in investigations or other review processes related to their treatment.
  • Commitment 4: We provide harmed patients/families with opportunities to contribute to patient-safety and patient-experience improvements in a meaningful way.
  • Commitment 5: We respect that harmed patients/families may choose to use external or parallel processes to seek answers and accountability as well as to improve safety for others. We will not allow this to change or needlessly delay our engagement with them.
  • Commitment 6: We prioritise human wellbeing, trust and just relations in all we do.

Read the Harmed Patient Pathway

You can read the full Harmed Patient Pathway here. We have also developed a plain English guide to help patients, families and carers understand the Pathway and how it can help when avoidable medical harm happens, if the healthcare provider has adopted its commitments.

Read the Harmed Patient PathwayRead the guide for patients, families and carers

Starting to implement the Pathway

Whether you are beginning to explore the concept of restorative justice, or looking to implement all or part of the Harmed Patient Pathway within your organisation, these materials offer practical guidance and insights for health professionals keen to support safer, more transparent care.

See our preliminary thoughts for healthcare providers

Harmed Patient Pathway discussions