Berwick will look at Francis report with 'a critical eye'

International patient safety expert Don Berwick is due to complete a broad review of all 290 of Robert Francis QC’s recommendations – and of how the health service can improve its ‘whole system’ approach to safety – in July.

A review of trusts with consistently high mortality, rates led by NHS medical director Sir Bruce Keogh, is expected to report in the same month. HSJ has been told the review will make wide-ranging recommendations, covering – among other things – the work of the proposed chief inspector of hospitals.

• Full coverage of the Keogh review

Professor Berwick was formerly president of the Institute for Healthcare Improvement, and is regarded as one of the world’s leading experts on patient safety and improvement. He was appointed to lead the US public healthcare system in 2010, but had to resign a year later due to political opposition.

He has previously led patient safety work in the English health service, and has been mooted by some as a possible future chief executive of the NHS Commissioning Board.

He was asked to carry out the review by prime minister David Cameron, in the wake of the public inquiry into the Mid Staffordshire Foundation Trust care scandal. In his first interview since accepting the task, Professor Berwick told HSJ: “There is no reason why English care cannot be the safest in the world.”

He revealed the work he will lead will include a review of all Robert Francis’ recommendations, of the state of patient safety and quality in the NHS, and of how to improve it.

Professor Berwick said his review would “study the findings of the Francis report and the circumstances as documented [by Francis] in Mid Staffordshire, and review the recommendations.”

The “system wide” review would be “grounded in science”, he said, and would recommend “next steps” for improving safety.

Asked why the findings of the two-year public inquiry needed to be reviewed, Professor Berwick said: “We can look at the Francis report with a critical eye.”

He said the review group would “be looking at those recommendations carefully and judging based on science” how they should be addressed. It was sensible for “some of the world’s greatest experts” to give “further thinking” to Mr Francis’ “290 recommendations and a report of that scale”, he said.

Asked about Mr Francis’ proposal for criminal sanctions for individuals and organisations involved in serious patient safety failures, Professor Berwick indicated such an approach was unlikely to be in keeping with safety improvement evidence.

“Safety science is founded on a very strong premise that the workforce really do want to do well – they want to practice in a safe way,” he said.

By contrast, he said, “participation of and voice from patients and carers and families and communities” – issued also highlighted by Francis – were “very likely to end up being a strong theme” of his work. It would also consider the role of the current NHS “structures”, he said.

The review comes amid prominent criticism by politicians and campaigners of NHS culture and performance management, and particularly the approach of NHS chief executive Sir David Nicholson.

An IHI review of NHS quality improvement for the Department of Health in 2008, in which Professor Berwick was closely involved, found that significant barriers included “a culture of fear and top-down control rather than shared learning and participative improvement”.

Similar problems were highlighted by the Francis report. Professor Berwick said he did not yet have a view about whether the problems persisted, but that the review would be “asking questions” about leadership.

Asked about the role of Sir David and other NHS leaders in relation to Mid Staffordshire, Professor Berwick said his remit did not include individuals’ roles. However, he said: “Overall the theme of leadership is a strong one. Safety requires the continual attention of leaders. Francis reaffirms that.”

In relation to the possibility of becoming commissioning board chief executive in future himself he said: “My long experience of the NHS and its leadership tells me England and the UK has superb leaders.”