Major NHS review highlights areas for change
Professor Don Berwick, President Obama’s former health advisor in the United States, has undertaken a major review of the NHS in England and prepared a report, recommending various changes to the way our system works. You can read the BBC’s comments on the review here.
Prof Berwick praised the NHS and suggested it could, with changes, be the “safest system in the world”. A series of cultural changes are needed however to bring about the required level of safety which has been lost in recent years (particularly following the Mid-Staffs scandal where a public enquiry concluded that the NHS had betrayed the public, putting corporate self-interest before safety).
He believes that criminal charges should be brought where NHS organisations misled regulators, or where particular members of staff harmed patients through “wilful or reckless neglect”.
Prof Berwick has emphasised the need for openness and transparency within the NHS but stopped short of calling for a duty of candour which has long been debated. Where a clinician makes a mistake and causes harm, should they be under a duty to notify the patient? It has been mooted that being more open about mistakes would help to reduce the amount of patients seeking legal redress, as many are simply seeking an adequate explanation of what went wrong with their care. Prof Berwick however is of the view that such candour would be “too bureaucratic” and should only apply after ‘serious incidents’ had happened.
Surprisingly, Prof Berwick rejected calls for minimum staffing levels. Insufficient numbers of nurses on wards is often cited as a reason for patients suffering accidents (for example when needing to get out of bed to visit the lavatory). Prof Berwick instead suggested Trusts should keep a close eye on staff levels to ensure patient care does not diminish.
Professor Berwick’s mantra is that health systems should not see mistakes as inevitable. He advocates a “zero harm” approach, similar to that adopted by the airline industry. His observations may be considered redundant, since medicine has always been governed by the Latin maxim “primum non nocere” (“first do no harm”).
The lingering question remains: how do we improve the NHS to reduce the number of errors resulting in harm to patients, and this Prof Berwick has failed to address.
If you have concerns regarding patient safety, please contact one of our Medical negligence solicitors for advice.