A “better” NHS would involve redesign of service delivery but the answer is not in finding the “right number of agencies”, according to the man leading the government’s zero harm review.

Professor Don Berwick was asked to look at “making zero harm a reality” in the NHS by prime minster David Cameron following the publication of the Francis report in February.

He has put together the National Patient Safety Advisory Committee, which includes leading experts from the US Institute for Healthcare Improvement alongside British academics and patient representatives. Salford Royal Foundation Trust’s chief executive David Dalton and chief nurse Elaine Inglesby-Burke are the only committee members currently working full time in the NHS.

This week health secretary Jeremy Hunt described the aim of the review as to create a culture “where harm is totally unacceptable and treated with the utmost seriousness”.

Seven sub-committees have been formed to focus in detail on particular issues, among them the appropriate consequences for boards who fail to detect problems, and the education and training of staff in patient safety (see table below).

Professor Berwick would not be drawn on what the committee’s recommendations might be when it reports in July, pointing out that he is only its chair. However, he was clear the committee could not ignore the economic context in which the NHS finds itself.

He told HSJ: “You could probably pick safety projects without considering economic context, for example you could eliminate central line infections in the country and you are moving in that direction, but I think overall a truly safer total delivery system… would require an understanding of its interaction with the financial pressures.”

His own mantra is what he describes as the “triple aim” of “better care, better health, lower cost” which he believes can best be achieved through more integrated care supported by a population based funding approach.

While the review will focus on the “rapid acceleration of safety and other dimensions of quality”, the issues involved “intercept” with the design of the healthcare system, he said.

“An overall better NHS would involve redesign,” he added.

However, he told an audience at the King’s Fund earlier this week that trying to find the “right number of agencies” was not the answer.

Professor Berwick agreed that the quality, innovation, productivity and prevention (QIPP) savings programme was based on the same principles as his triple aim, but admitted to being out of touch with its progress. He said other members of the advisory group would be able to provide that “very important” context.

However, he believed there was undoubtedly still waste in the system.

In the US healthcare system, Professor Berwick has identified six categories of waste. At the King’s Fund he highlighted academic research which suggested around 30 per cent of treatment could be unnecessary.

He told HSJ: “Waste means activities, services, advance treatments that are used… that actually don’t help patients. I’m quite sure that an analysis could be done that would reveal a significant percentage of that effort being wasted [in the NHS].

Professor Berwick was forced to resign as administrator of the Centres for Medicare and Medicaid, where he was at the helm of President Obama’s healthcare reforms, because Republicans objected to his appointment.

He said the economic and political situation in the US meant now was not a time for “minor experiments” but for doing things at “scale”.

“The need to get healthcare costs under control is so urgent it’s become a crisis now. Something will be done… what I know is if we take too long the only option will be just to cut and that would be sad.”

By contrast, he was “optimistic” about the NHS. It was “endowed with enormous leadership resource” and had the “greatest resource of activists patients and carers that I have seen anywhere in the world” he said.

“You can invest in improvement of safety as an undertaking, not all nations can,” he said.

Sub-committees of the National Patient Safety Advisory Committee

Identifying aims for improvement in qualityLucian Leape, adjunct Professor of Health Policy at the Harvard School of Pub­lic Health
Building capacity through training and educationJason Leitch, clinical director of the Quality Unit in the Scottish government’s Health and Social Care Directorate
Oversight, accountability and influence: ensuring board members understand what is going on in their organisations and consequences for failureMary Dixon-Woods, Professor of Medical Sociology at the Department of Health Sciences, University of Leicester
Patient and public involvementMaureen Bisognano, President and CEO, Institute for Healthcare Improvement
Measurement, tracking, transparency and learningCharles Vincent, Director of the Imperial Centre for Patient Safety and Service Quality (CPSSQ) and the Clinical Safety Research Unit
Impact of legal penalties/criminal liability on patient safetyDavid Dalton, chief executive of Salford Royal Foundation Trust
LeadershipJean Hartley, professor of public leadership at the Open Univeristy Business School