Berwick chief: review critics 'miss the point'

Don Berwick, a former health advisor to President Obama, was commissioned by the government to look at making zero harm a reality in the NHS following the publication of the Mid Staffordshire Foundation Trust Public Inquiry in February.  

The review, which was published earlier this week, stopped short of recommending the regulation of healthcare assistants or a mandatory minimum nurse staffing level. It instead focused on the need for the health service to develop a “learning culture” that listened to staff and patients.

King’s Fund assistant director of policy Catherine Foot was among a number of commentators who noted the recommendations were “not new”, health blogger Roy Lilley described it as “soft” and the Patients Association called it “heavy on platitudes and good intentions but light on practical solutions”.

Salford Royal Foundation Trust chief executive David Dalton, the only NHS chief executive on the 15 strong review team, told HSJ he was “disappointed” critics of the report appeared to want an action list “as though we could just get the spanner out and make a few adjustments”.

“It’s fundamentally missing the point which is the need for a change in culture,” he said. “The reaction itself is a reflection of the fact people have in the past expected to be told what to do.”

He said the report sought to move the focus from “hard edged regulation and enforcement issues” to the “much more difficult softer things, such as how measurement can be used to improve quality”.

The Berwick review is the third of four reports commissioned by ministers in the wake of the Francis report.

Asked what his report would add, Professor Berwick told HSJ he was encouraged by the “convergence” with the findings of Sir Bruce Keogh’s review into trusts with high mortality rates.

Notable overlaps between the two pieces of work include improving use of data to drive quality improvement, increasing the status of the patient voice in decision making and noting the importance of an engaged workforce to care quality.

Professor Berwick said: “We are getting some real reaffirmation about what’s needed. The real test now is taking action and making a difference.”

He said “central resources” would be essential for the training needed to make the “learning culture” a reality. However, he said the “history of investment in learning” - through the now abolished Modernisation Agency and NHS Institute for Innovation and Improvement - meant there were “hundreds of people all over the country” with the skills to improve quality.

HSJ understands the review team was keen that the overall message of the report did not get overshadowed by a few headlines around staffing levels or new criminal sanctions.

Salford Royal executive nurse Elaine Inglesby-Burke told HSJ the report had not rejected HCA regulation outright and had been “specific” that staffing levels should not fall below one staff member to eight patients on acute surgical or medical wards.

However, she acknowledged there was “nothing new” in the report.

She said: “Isn’t that what’s disappointing? That we know all of these things?

“What the report provides is a set of actions to use moving forward. We don’t have to wait for permission from the government.”