Patient safety 'must be top priority in NHS'


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Patient safety must become the top priority in the NHS in England, according to a major review.

The report by Prof Don Berwick, US President Barack Obama's former health adviser, said problems existed "throughout" the system.

But he added the NHS remained an "international gem" and could be the safest system in the world.

He said a series of cultural changes were needed, but also recommended criminal sanctions in extreme cases.

Prof Berwick said charges should be applied where organisations misled regulators or in the rare cases in which "wilful or reckless neglect" by organisations or individuals had harmed patients.

Case study

Chatting at the bedside to a patient, a nurse updates the information in their electronic record via a tablet computer. This is the raw material driving improvements in safety at the Queen Elizabeth Hospital in Birmingham, writes Branwen Jeffreys.

The information from that individual record is translated into day-by-day monitoring of quality. For the nurse in charge of a ward that means they can get information updated at midnight each day on how they are doing on delivering safe care.

It counts infections, patients falling on wards, how many are assessed for the risk of clots and the many thousands of decisions made about medicines.

Mobile computer units on each ward translate that into colour-coded charts that give an update at a glance. The data shows what each doctor prescribes, and what drugs each nurse is giving to individual patients.

The aim, says the trust, is to make every error count. Teams are held to account if they're lagging behind and new quality targets are set constantly. But perhaps the most powerful tool is transparency - each ward can see how they're doing compared to the others.

But he stopped short of calling for a duty of candour, which would compel the NHS to inform patients of any errors made in their care.

He said this would be too bureaucratic and should instead be applied only after serious incidents had happened.

He also resisted calls for set minimum staffing ratios, but said trusts should be keeping a close eye on staffing levels to make sure patient care was not suffering.

Prof Berwick was asked by ministers to conduct the review after the public inquiry into the neglect and abuse at Stafford Hospital concluded the NHS had "betrayed" the public by putting corporate self-interest before safety.

More co-operation

Many of his recommendations in the 45-page report focus on the creation of a new culture of openness and transparency.

He said all information - apart from personal details - should be made publicly available.

Prof Berwick also called for more co-operation between the various regulators and management bodies in the NHS.

He said the current system was bewildering in its complexity and there should be a review by 2017 to make sure the different bodies were working together on the issue.

And he said staff must be given good support and training to help make sure they took pride and joy in their work.

He said where honest errors were made there should be a culture of "no blame".

If all this was done, Prof Berwick said he could see no reason why the NHS could not become the "safest in the world".

But he said too often in complex organisations like health systems with targets to hit and budgets to manage priorities could become skewed.

Who is Prof Don Berwick?

Don Berwick

Prof Don Berwick has won global recognition for his work on making hospitals safer. His mantra has been that health systems should not see mistakes as inevitable - and instead should learn from businesses such as the airline industry which advocate zero harm.

The Institute for Healthcare Improvement, which he co-founded in Cambridge, Massachusetts, has worked with healthcare systems around the world.

Prof Berwick described the NHS as "one of the astounding human endeavours of modern times" in a speech marking its 60th anniversary in 2008.

His admiration for the publicly funded and provided NHS led to criticism from Republicans when President Obama appointed him Administrator of Medicare and Medicaid. He stood down after a year, shortly before facing a nomination hearing.

"In any organisation, mistakes will happen and problems will arise, but we shouldn't accept harm to patients as inevitable," he said.

"By introducing an even more transparent culture, one where mistakes are learnt from, where the wonderful staff of the NHS are supported to learn and grow, the NHS will see real and lasting change."

The government will respond to the review in detail at a later date.

But Health Secretary Jeremy Hunt said he would be seeking to act on the recommendations.

"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."

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."

But Roger Goss, co-director of Patient Concern, said action was needed.

"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."


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  • rate this

    Comment number 33.

    My top priority would be the safety of the NHS.
    Low wages, deliberately impossible "targets" and bad-press - nice one uk govt. !
    When the NHS is gone we will be like the US - and that's no good thing.

  • rate this

    Comment number 32.

    More anti-NHS propaganda from a government desperate to make their mates even richer.

    Stop the Tory NHS privatisation -

  • rate this

    Comment number 31.

    Is this a gimmick I ask?

    Are we on about walking on clean floors or..... does it include Doctors whose handwritten prescriptions are unreadable?

    Of course it may include giving people the correct X-rays, not chopping the wrong limbs off.

    Cut the spin, a lot needs to be done I'd say which ought TO BE mandatory!

  • rate this

    Comment number 30.

    Dangerous places hospitals, full of diseases, bugs, and people forever dying in them! Entering means you forsake safety, for the chance of getting away with a cure for something else that ails you.

    By handy though if the staff did not add more risks, and were primarily concerned in caring for you, and then curing you. Keeping track and count on their tools seems not too much to expect.

  • rate this

    Comment number 29.

    #12 Actually one of the problems with the NHS is superfluous "good" managers. When ever there's a re grading exercise, managers get promoted sideways and staff get more work to do.

  • rate this

    Comment number 28.

    6.Jag Sandhu
    Just now
    Poor show indeed that it wasn't the top priority in the first place. If we can't expect the national HEALTH service to put health of it's patients first then we're already lost our way.

    Dont mix up & assassinate the whole NHS with negligent & even criminal self interest & judgement of some of its employees.

    You want perfection, find another planet

  • rate this

    Comment number 27.

    It's interesting that the market driven, Trust dominated English NHS system, well on the road to privitisation, has chosen to look at the Health Board run, care focused Scottish system to see where it has gone wrong.

    Thankfully we value our NHS for what it should be, a publically run health service, and not a way for big business to make even more money at the expense of the tax-payer.

  • rate this

    Comment number 26.

    If HM Government was a company it would have been closed down long ago....the Health and Safety of its Citizens is no longer a concern.

  • rate this

    Comment number 25.

    He said safety should be the top priority (The bleeding obvious) but then he also resisted calls for set minimum staffing ratios?? A self contradiction surely?

  • rate this

    Comment number 24.

    I naively thought they were there to care for patients and treat and where possible cure illness!!

  • rate this

    Comment number 23.


    When the NHS announces that safety should be top priority - I KID YOU NOT - you know that the entire edifice of Western Medicine has failed.

    Public health always descends to the lowest denominator. Always descends to the self-protection and hiding of the health and safety culture.

    Always descends into fear, cowardice, and mendacity.

    Then it's not about Health.

  • rate this

    Comment number 22.

    So once again because ONE NHS Trust performs abominably ALL NHS Trusts are the same. Does this mean that ALL politicians are corrupt, racist, stuck up snobs, because some of them are.

    The majority of the staff working in the NHS are there because they want to do a good job, for the good of the patient. Don't tar us all with the same brush. The patient is our number one priority

  • rate this

    Comment number 21.

    How dare thetories say this,they are destroying the nhs and "public sector" ie public services.
    To people thinking of voting them in again I hope you or youre family don't need expensive treatments etc,that may not be covered by insurance.
    We have had to import nurses for yrs,so what does that say about how we treat them.Lets look after our nurses and not listen to the nasty them out.

  • rate this

    Comment number 20.

    How can all this be achieved when there is a direct order to reduce the budget by£20 Billion.It seems when we have a crisis in a national industry we always bring in an American, Is there no one here that can do the job? It is our NHS and we will protect it. All we need is a party to vote for.

  • rate this

    Comment number 19.

    All for criminal sanctions especially against Politicians who cut and cut NHS budgets until budgets are so small live are endangered. 99.9% of NHS staff are doing the best they can given the pitiful penny pinching resources successive governments.Andyet we can findmillions if not billions to fight wars in Iraq andAfganistan that teh majority of British people didnt want .

  • rate this

    Comment number 18.

    Gosh I wish I had half the brains of Professor Don Berwick. What's he a professor of, 'stating the bleedin' obvious'?

  • rate this

    Comment number 17.

    "Patient safety must become the top priority in the NHS in England, according to a major review."
    No sh*t, Sherlock!

    There's me thinking patient safety is a given.

  • rate this

    Comment number 16.

    How does patient safety fit into the league tables? Just wondering.

  • rate this

    Comment number 15.

    Yes, comparing it to the airline industry is great. Ever heard of the Poisson formula? It works out the probability of unusual occurrences, such as plane crashes. You then use that formula to calculate the cost of paying compensation or making safety improvements. Whichever is cheaper they go with that remember that next time you fly

  • rate this

    Comment number 14.

    The overriding principle that should govern all of the NHS actions has been known to doctors since ancient Rome. "Primum nil nocere." First,do no harm. Any treatment and care delivered to the patient should be designed to have a positive effect on the patient's wellbeing. We know you can't cure everyone, just don't make them worse.


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