Is the desire to establish a 'no blame' culture around patient safety becoming dangerously close to being seen as an end in itself rather than as a necessary aid to progress?

Is the desire to establish a 'no blame' culture around patient safety becoming dangerously close to being seen as an end in itself rather than as a necessary aid to progress?

It is a case made forcefully by Frank Burns, until his recent retirement one of the most experienced and well respected NHS chief executives, in our main opinion piece this week (page 16-17).

He argues: 'The test of success is not whether staff feel confident enough to treat mistakes and near misses as a learning experience. The test is whether or not the NHS is improving the safety of patients.'

Mr Burns is not disputing that a culture of safety will falter if people are too scared to report incidents and therefore learn from them. But he is saying that removing that fear does not by itself bring improvement - and more than that, it can breed complacency.

His point is that individual accountability cannot afford to be sacrificed when the numbers are so grim - 600 fatalities in the first three months of 2006-07 due to safety incidents. This is particularly the case when mistakes are repeated despite clear guidance. The same danger applies to the concept of group error - in effect a muddy sense that somehow a depersonalised system is the culprit. When everyone is a little bit to blame, in effect no-one is.

With little sign of improvement, it is entirely possible that the NHS will have more draconian measures forced on it. The best managers will be working hard to convert no blame into no error before that happens.