The Berwick Report: Improving the Safety of Patients in England

7 August 2013

The Berwick Report: Improving the Safety of Patients in England

By Saurav Dutt

A long-awaited report into safety in the NHS has affirmed that new guidance to protect patients against “the dangers of inadequate staffing” needed to be set up “as soon as possible.” This has been echoed by Health Secretary Jeremy Hunt who adumbrated the key findings by Professor Don Berwick that the danger of understaffed NHS wards can no longer be ignored, but in doing so setting national minimum safe staffing levels would create an “artificial target” and harm patient care.

Hunt’s comments reinforce the inaction of the government thus far despite the fact that nursing leaders and patient groups have called for national minimum nurse-to-patient ratios, and where Robert Francis QC called for nationally recognised tools for setting safe levels of staffing in his own report into endemic failings at the Mid Staffordshire NHS Trust.

While Professor Berwick opined in his report-which broadly reviewed the 290 recommendations within the Francis Report itself-that the vast majority of NHS staff provided excellent patient care, the inherent flaws within the structural hierarchies of individual hospitals meant that “the systems, procedures, conditions, environment and constraints they face…lead to patient safety problems”.

The Berwick Report called for a culture of “complete, timely, and unequivocal” transparency, in which errors were admitted to and resolved without blame. However new laws were recommended to punish clinicians in “rare” cases of “recklessness and wilful neglect”.

The Berwick Report: Improving the Safety of Patients in England

With specific regards to the question of safe-staffing, Professor Berwick called for the National Institute for Health and Care Excellence (NICE) to formulate the means for determining safe nurse-to-patient ratios that could be applied on a ward-by-ward basis.

The question of setting a legal precedent for minimum safe staffing levels was mooted but with the conclusion that this should be rejected and formulated instead at a national level, so as to better apply it on a local basis. “If I’m running a hospital, I should have a way to know whether staffing on [a ward] is appropriate or not,” Prof Berwick opined.

Following the publication of the Berwick report, Jeremy Hunt spoke to BBC Radio 4’s World at One programme and said that he backed more research but was opposed to “mandating from the centre” on safe staffing standards.

“If you start mandating things from the centre you create an artificial target and hospitals and trusts say: well if we meet that national minimum we’ve done our job as far as staffing’s concerned when actually they haven’t – because you’ll find there are places that need a lot more help and a lot more care,” he said.

Mr Hunt said that “there may be hospitals that are not adequately staffing their wards” and that it would be the task of the Care Quality Commission’s new chief inspector of hospitals, Sir Mike Richards, to identify them"

You can read the full report here, will focus on the divisive issue of NHS staffing levels in its next article focusing on the Berwick Report.

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