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Berwick Report: Far too many people have tried to deny that errors ever happen


In just over an hour the long-awaited Berwick report will be out and we will know exactly how he proposes the NHS should run a “zero harm” culture.

There are nearly as many rumours flying around this morning as there were about who would be named the new Doctor Who. And I suspect that #Berwick will be trending above #Capaldi on Twitter once the embargo is lifted at 1pm.

First, he is expected to talk about a legal duty of candour for all staff to admit their mistakes. This is precisely in keeping with the aims of our Nursing Times Speak Out Safely campaign, which we launched just after the publication of the Francis report into care failings at Mid Staffordshire.

Of course there should be such a measure. It seems bizarre that there isn’t already. Once people are allowed to shy away from responsibility, accountability breaks down and the public’s faith in their clinicians is just eroded. But it’s more than about trust.

A legal duty to speak up and own up is important because it is the only way that the health service can learn from its mistakes – by admitting that they happened in the first place.

Far too many people have tried to deny that errors ever happen. We all know that the NHS is not perfect. It is run by human beings – overstretched and overstressed human beings most of the time – and that is just the sort of environment that will create a catalyst for mistakes. If zero harm is to be achieved, staff need to recognise that things go wrong in order to help them work out how to avoid them in the future. Burying heads in the sand is not the answer.

And this brings us neatly to Professor Don Berwick’s  second contentious point. Will he recommend mandated minimum staffing levels?

The rumours are today that he will. And that will not go down well with the government, which is clinging to Robert Francis’ recommendation that evidence-based tools be used to determine safe staffing levels on a case by case basis.

But they should heed the fact that last week Mr Francis strengthened his position and suggested a minimum number of staff – below which it would not be safe to run a ward or unit – should after all be used to maintain patient safety.

The government should not pick and choose over this issue. They hear what they want to hear about minimum staffing levels, and cast aside the stuff that’s hard – or expensive to introduce.

Last month NSH England Medical director Sir Bruce Keogh unequivocally demonstrated that if you have fewer nurses – you have a greater chance of providing care that is not safe.

Healthcare regulation, minimum staffing levels, legal duty of candour – these are the things that will make a difference to the NHS.

And so at some point they have to stop commissioning reports – Cavendish, Francis, Berwick, Keogh – and start implementing some of what is recommended. And not just the easy stuff.


Readers' comments (2)

  • MeThinks

    Jenni, now you're for it - some of the nurses who post on this website refuse to admit that any nurse could ever make a mistake.

    He didn't recommend minimum staffing levels, so that will have disappointed many.

    He seems to have stressed openness, transparency and honesty as the way to push forward improvements - but he didn't explain the mechanism for that, and we need a mechanism for that one.

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  • George Kuchanny

    For me the holy grail of openness, transparency and honesty as the way to push forward improvements is the nub of the matter.

    Right. So how do we go about changing the fundamentals of our culture? This is wider than the NHS itself. The question soon expands to changing the way we bring up the next generation.

    I have personally seen how a newbie steeped in ethical teaching at great expense in Uni picks up bad habits from others that are covert, 'protective of the child like patient' and plain mendacious. Just like that. A few weeks and all the training is dispersed like mist.

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