The Berwick Review: instigator of patient safety change or political piñata?

Amid much anticipation, US healthcare expert Professor Don Berwick will today set out his recommendations as to how the NHS can improve levels of patient safety, with all the indications being that he will argue in favour of minimum staffing levels for hospitals and an effective ‘duty of candour’ under which doctors, nurses and other NHS professionals would have a legal obligation to admit mistakes leading to patient harm. The topic of Berwick’s review makes the furore surrounding it inevitable, but add in the timing of the report during a quiet point in Westminster (MPs and Peers now being on recess) and the recent publication of the Francis Report into the failings at Mid-Staffordshire, and one has a potential powder keg.

The report, which has been heavily trailed in the national newspapers, will not make entirely pleasant reading for the Government and it is significant that among the report’s influences are the likes of Peter Walsh of Action against Medical Accidents. The expectation, therefore, is that Berwick will largely endorse Robert Francis’s recommendations of earlier this year, which called for (amongst other measures) the regulation of healthcare assistants and the aforementioned minimum staffing levels and duty of candour. This will present problems for the Government, which can be accused of failing to act a number of recommendations in the Francis report, and which is disinclined to introduce either statutory regulation of healthcare assistants (or other unregulated healthcare professionals for that matter) or a personal duty of candour.

The review’s recommendations raise some interesting questions – not least why regulation should be extended to only healthcare assistants and not to the likes of clinical physiologists, who were first recommended for regulation more than a decade ago, and who not only work directly with patients but whose work has the potential to cause harm.  Further questions that should be asked include how a legal duty of candour on individuals will be enforced in the case of healthcare professionals not subject to any form of statutory regulation – and what will be done to identify and address those instances when unregulated professionals do not come forward.

The big question is of course whether the Berwick Review will lead to long-term change in attitudes and practice within the NHS, and for this to happen the report cannot be overtaken by the inevitable political squabbling as the Coalition and Labour attempt to seize control of the narrative. Labour will inevitably accuse the Coalition of failing to act on Francis’s recommendations and will point to NHS staffing cuts caused at least in part by the Government’s large-scale and controversial reforms of the health service. For their part, the Coalition will likely use Francis’s report as an opportunity to challenge Labour’s legacy (and that of former Health Secretary Andy Burnham) and credentials as the ‘part of the NHS’.

The Berwick Review will not be subject to the same partisan raucous debate in the House of Commons as the Francis Report. However, if it spawns the same sort of finger-pointing rather than meaningful debate and action, it will simply become a political piñata that could ultimately fail to address the problems it was commissioned to solve.


Chris Rogers