PATIENT safety must be the most important consideration for the NHS in England, according to a major new review.
The report by international patient safety expert Professor Don Berwick said patient safety problems existed “throughout the NHS”, citing the deaths at Mid Staffordshire as a recent example. But he added that the health service remained an “international gem” and could be the safest in the world.
Professor Berwick said “incorrect priorities” have had a negative impact on quality of care, with some organisations wrongly favouring hitting targets and cutting costs over meeting patient needs.
He said clinicians and managers must “place the quality and safety of patient care above all other aims” and believes this is the safest and best route to reducing costs. The key to this, he added, lies in improved education and training for staff.
The former health adviser to President Barack Obama admitted the 10 recommendations in his report present the health service with a “monumental challenge” that will require “unprecedented acts of will” by both NHS and political leaders.
He went on to say that NHS staff should not be blamed for failings, describing as unjustifiable attempts to label them as “uncaring, unskilled, or culpable.” The vast majority, he believes, want to do a good job, adding: “Good people can fail to meet patients’ needs when their working conditions do not provide them with the conditions for success.”
Criminal charges should apply in extreme cases of “wilful or reckless neglect or mistreatment” and where organisations mislead regulators. However, he stopped short of recommending a duty of candour that would require the NHS to inform patients of errors made in their care. He said staffing levels should be adequate to meet patient needs and be “based on evidence”.
The professor also said the culture of blame within the NHS must be replaced by a new culture of openness and learning from mistakes.
Regulation alone, he stated, cannot solve the problems highlighted by Mid Staffordshire, adding: “In the end, culture will trump rules, standards and control strategies every single time, and achieving a vastly safer NHS will depend far more on major cultural change than on a new regulatory regime.”
The report also called for more cooperation between NHS regulators and management bodies, suggesting the “complex” system is reviewed by 2017.
Health secretary Jeremy Hunt said he would be seeking to act on the report’s recommendations. He said: "This is a fantastic report. For too long, patient safety and compassionate care have become secondary concerns in parts of the NHS and this has to change." The government will give a more detailed response in due course.
Royal College of Nursing chief executive Peter Carter said: "Patient safety has to be at the heart of the daily work and culture of everyone in the NHS, from the government and chief executives to porters, cleaners and every clinician.
"For this to happen we need to see a greater transparency, a no-blame culture where individuals can speak up and challenge any problems which threaten the quality or safety of patient care and feel that their concerns are being heard."
BMA Council chair Dr Mark Porter welcomed the report and said: “[W]e support Professor Berwick’s call for patient care to be made paramount and for a culture of support, not blame, to empower staff. Doctors care deeply about patient care and we now look forward to hearing more from the Government on how Professor Berwick’s review will be implemented.”
But Roger Goss, co-director of Patient Concern, called for more practical measures. "Like all reports of NHS's failings, it sounds as if it is long on what is needed but short on how its recommendations will be made to happen."
Read the report in full here