'Strong and insightful’ Berwick report calls on Government officials to revitalise and restore the NHS

Barack Obama’s former health advisor has called on Government officials to lead change within the NHS, restoring it to its former glory and ensuring patient safety and high standards of care.

Prime Minister David Cameron asked Professor Don Berwick, a self-professed “great admirer of the NHS”, to carry out a review of the health service in the wake of the Francis Inquiry earlier this year, which found appalling neglect at Mid Staffordshire NHS Foundation Trust between 2005 and 2009.

‘A promise to learn – a commitment to act; improving the safety of patients in England’, published by the Department of Health yesterday, highlights the key problems affecting patient safety within the NHS and calls for key changes to be made, such as abandoning blame, ensuring sufficient staffing levels and creating new criminal offences to punish neglect. The report also recommends that the NHS trust the goodwill and intentions of its staff, while recognising that transparency is essential.

As part of the report, Professor Berwick wrote an open letter to Government officials and health bosses, outlining the issues such as “partial loss of focus on quality and safety as primary aims, inadequate openness to the voices of patients and carers, insufficient skills in safety and improvement”, and suggesting how they can lead change.

After publishing the paper, Professor Berwick said: “I am a great admirer of the NHS – it has been, and still is, very respected around the world. This report is one of a number of recent reports that, taken together, provide the NHS with a real opportunity to deliver the safest healthcare in the world.

“In any organisation, mistakes will happen and problems will arise, but we shouldn’t accept harm to patients as inevitable. By introducing an even more transparent culture, one where mistakes are learnt from, where the wonderful staff of the NHS are support to learn and grow in their capacity to improve the NHS, and patients are always put first, the NHS will see real and lasting change.”

Health Secretary Jeremy Hunt

Health Secretary Jeremy Hunt, who last month promised to tackled “mediocrity” in the NHS following Sir Bruce Keogh’s review of 14 NHS hospitals with high mortality rates, has praised Professor Berwick’s report and pledged to support NHS staff, helping them to become world leaders of patient safety. He said: “For too long, patient safety and compassionate care have been secondary concerns in parts of the NHS and this has to change. I want to get to a point where every patient has confidence that their care will be safe and where every member of NHS staff feels supported to make safe, high quality care the priority.

“The report makes clear that the NHS could lead the world in patient safety. Nothing less is good enough for the patients and families who rely on it, and this Government will back our hard-working NHS staff to make this a reality.”

Professor Berwick’s report has been well-received by a number of health organisations, including the NHS itself. Jane Cummings, chief nursing officer at NHS England, said: “Don Berwick’s report is landing at exactly the right time for the NHS. He has highlighted many of the key areas that the NHS is actively addressing to give our patients quality care every time and support our staff to work with the right conditions for success.

“NHS England welcomes the focus on growing a culture which puts patients first, engages and empowers patients and carers, supports transparency and learning and takes responsibility for poor care. This is all underpinned by having the right staff with the right skills and knowledge. We are already tackling this through the actions set out in ‘Compassion in Practice’ and by working with NICE and other key partners such as Health Education England.

“This report demonstrates the passion for patient safety that so many in the NHS have and will be a touchstone for patient safety in the NHS for the next decade or more. NHS England accepts the challenges set in this report and will lead the way in responding.”

The King’s Fund has also welcomed Professor Berwick’s report and believes that many of the goals set out in the document are achievable with the correct guidance and support. Catherine Foot, assistant director of policy, said: “We welcome this strong and insightful report. Many of the principles and recommendations are not new and echo the findings of previous reviews – the question remains how to make a patient-centred culture that takes safety seriously a reality.

“National bodies can help create the right environment for improvement, and effective regulation is an important backstop against failure. However, the kinds of change that will make the NHS the safest and most effective health care system in the world, as Don Berwick believes we can achieve, happen within teams and organisations and take commitment on the ground over many years.

“We know from Mid Staffordshire hospital and elsewhere the importance of maintaining adequate staffing levels. We welcome the recommendation that NICE should interrogate the available evidence to develop guidance for the NHS. Staffing levels are likely to be too complex for a nationally mandated minimum staff-to-patient ratio to be set. Hospital boards should use good evidence in deciding on the right staffing level for different services, and indicative staffing ratios could be used to highlight cause for concern, but feedback from patients and staff is just as important, if not more so.”

She continued: “We welcome the report’s emphasis on continued learning and improvement. People will not change the way they behave by being told to develop a different culture of care ? they need to be provided with the tools, training and development, ideally within the teams they work with, to help them achieve this shift.

“We also need to provide ongoing support and model learning and openness from board to ward. Staff throughout the health service should be supported to do the right thing, be honest when they make mistakes, which they sometimes will, and speak out where they are concerned about quality of patient care.”

George McNamara, head of policy and public affairs at the Alzheimer’s Society, also agrees with the recommendations and hopes they are extended to ensure the safety of dementia patients in hospitals. He said: “We shouldn’t need a report to tell us that safety and quality care should be at the heart of the NHS, but as Don Berwick shows, too often they are being bypassed. For too long vulnerable older people have been the hardest hit by a lack of accountability and poor standards in the system. This needs to change sooner rather than later.

“A quarter of hospital beds are occupied by someone with dementia and we know they are often staying in hospital too long and coming out worse. We need to see these proposals turned into action and a step change in the way patients, including those with dementia, are treated.”