The Berwick Report on the NHS

Posted 06/08/2013

Professor Don BerwickPutting patient safety as the ‘top priority’ for the NHS may seem a statement of the blindingly obvious but, in the wake of the appalling events at Mid Staffordshire and other scandals, clearly Professor Don Berwick, Barack Obama’s former health adviser, thought this basic principle needed restating in his review of the NHS published this week.Prof Berwick was asked by ministers to conduct the review after the public inquiry into the neglect and abuse at Stafford Hospital concluded that the NHS had “betrayed” the public by putting corporate self-interest before safety.Prof Berwick concluded that problems existed “throughout” the system but added that the NHS remained an “international gem” and could be the safest system in the world. A series of cultural changes were needed, he said, and there needed to be a new culture of openness and transparency. Staff must be given good support and training to help make sure they take pride and joy in their work.The current system is, he said, bewildering in its complexity and different bodies needed to be working together.
He also recommended criminal sanctions in extreme cases (although it is debateable whether those sanctions already exist and are simply not brought to bear).In his open letter to NHS staff he wrote:“We are recommending four guiding principles, among others, to help the English NHS get better faster, and I urge you to think about these and ask how you can help incorporate them into your own daily work.Place the quality and safety of patient care above all other aims for the NHS. (This, by the way, is your safest and best route to lower cost.)Engage, empower, and hear patients and carers throughout the entire system, and at all times.Foster wholeheartedly the growth and development of all staff, especially with regard to their ability and opportunity to improve the processes within which they work.Insist upon, and model in your own work, thorough and unequivocal transparency, in the service of accountability, trust, and the growth of knowledge. “These are all admirable aims and values, and mostly basic common sense. Some patients’ organisations, however, consider he has missed a real trick, failing for example to impose a duty of candour when things go wrong, and failing to set a minimum level of nursing for safe practice. Other critics see another day, another report, but wait to see what action will follow truly to improve patient safety.And of course there is the elephant in the room; the increasing involvement of private companies in providing healthcare services. How will these commitments, standards and monitoring apply to them? If the current NHS system is ‘bewildering in its complexity’, adding another layer of private providers and their insurers is going to do nothing to help the situation.