NHS staff should face jail in cases of “neglect or wilful misconduct”, a review tasked with making zero-harm care a reality in the NHS has recommended.
However, the review, chaired by former health advisor to President Obama, Professor Don Berwick, rejected calls for a duty of candour on individual members of staff.
Professor Berwick said a requirement to tell patients about every error or near miss would lead to “defensive documentation” by professionals and a bureaucratic burden.
Instead, the Care Quality Commission should require patient or carers affected by a serious incident, as defined by NHS England, to be notified and supported, his report said.
A new criminal offence should be created for cases where individuals had demonstrated a “couldn’t care less attitude” to the treatment of patients, the report recommended. Professor Berwick said this could apply equally to managers if they had acted recklessly.
It recommended sanctions should be equivalent to those in section 44 of the Mental Health Capacity Act, which include up to five years in prison.
The Berwick review was commissioned by the government back in February following the publication of the Francis report into the care scandal at Mid Staffordshire Foundation Trust.
It brought together top academics, patient representatives and NHS leaders, including Salford Royal Foundation Trust chief executive David Dalton and chief nurse Elaine Inglesby-Burke.
The review did not propose a minimum staffing level for nursing – contrary to suggestions in the national media – but supported Robert Francis QC’s recommendation that nationally recognised tools be developed to determine staffing levels.
It also said the government should review the regulatory system for the NHS by 2017, and consider again Mr Francis’ recommendation that the economic and quality regulator be merged.
Professor Berwick, who described his review as “philosophical”, said the most important of his recommendations was that all NHS staff should be educated in quality improvement methodology.
“If I could give one recommendation to the secretary of state it would be to invest in giving people these skills…
“Continuous improvement [means] never good enough. The alternative is the tick-box thinking, we are good enough, we’ve done it, we’re home. You’re never home,” he said.
NHS England chief nursing officer Jane Cummings said the NHS should use the report to “move on” from the criticism over poor care received by patients in Mid Staffordshire and other places.
“We can’t forget what’s happened before but we need to use this opportunity to move on,” she said.
“The best wards, the best nurses, do sometimes make mistakes,” she added.
“We need to have the culture and environment where staff can be open and learn from their mistakes. If we do that listen to patients we can make that [culture].”
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