Patient safety expert calls for change in the NHS

The need for change in the NHS has been further underscored by another critical report, published this time by Professor Don Berwick.

The paper titled ‘Improving the Safety of Patients in England’ comes after a series of other critical reviews including Sir Bruce Keoghs investigation into high mortality rates. Prof Berwick, a healthcare expert from the US, was asked to give his assessment of the NHS by the Prime Minister after the disturbing reality about mortality rates was revealed in Keogh’s report and the extent of failures of care at Stafford Hospital were made clear by the Francis Report.

Unlike the 2,000 page Francis Report with its 300 suggestions, Prof Berwick’s publication is very succinct. The report is just 50 pages long Berwick restricts himself to 10 recommendations.

Berwick focuses on the need to monitor more closely the care being provided to patients and to respond more quickly so that substandard care does not become endemic. Indeed, it is Berwick’s belief that a better structured system is needed to protect patients.

In order to improve the system, Berwick advises that the NHS encourages all staff-members to learn more about healthcare. In terms of staffing, he suggests that staffing levels do not dip below a certain point and that staff members who deliberately act negligently, recklessly or neglectfully are criminally convicted (although accidental errors should not lead to criminal punishment). He also stresses that complaints procedures should be relatively reviewed and used in conjunction with mortality rates and other indicators to judge performance.

Berwick also advises all staff are made aware of four fundamental principles of healthcare so that a culture of learning can be cultivated. These principles are as follows:

• Care for the patient: nothing else is more important than this

• Strive to improve: take the professional development of staff seriously to ensure that they are properly able to perform their roles safely

• Listen: patients, their families and carers should be listened to and respected

• Openness and transparency: the NHS must at all times remain accountable and honest so that patients can have faith in the system and senior figures can be made aware of problems which arise

Whilst Berwick did not set a specific figure for a minimum staffing level, the issue of whether such a limit should be legally imposed was carefully considered and the report suggests that a formula could be used so that a safe staff-patient ratio could be ensured on different wards. However, regular monitoring of patient care remains of paramount concern.

Although much of Berwick’s report focused on cultural changes, the idea of a criminal conviction for deliberate acts of neglect, abuse and recklessness was also put forward and it is such acts (as well as many undeliberate negligent acts) which generate many medical negligence claims. Attempting to deceive regulators is another misdemeanour for which a criminal sanction has been proposed. Such laws could also lead to the offender being prevented from taking senior roles in the future, fines for employers and up to 5 year prison terms.

All of the recent reviews in NHS failures have found understaffing to be a major issue which needs to be addressed. Developing a more open and honest culture has also been mentioned numerous times in the media as well as the various reviews. It seems as though there has been a culture of concealment at the NHS in recent years as managers bid to prevent the public and the media from hearing about their failings – this certainly has to change.

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