'We should not fail to take previously missed opportunties to learn from some excellent reports', says Tony Yeaman. Photograph: Christopher ThomondProf Don Berwick's report Improving the Safety of Patients in England follows a long line of investigations into failures in care within the NHS and a plethora of responses to them; and yet we are no closer to the solution of the wide-ranging problems.
While a number of commentators say the Berwick report contains nothing new, this should not devalue its positive recommendations and the chance it provides to advance patient safety throughout the NHS. Nor should we fail to take previously missed opportunities to learn from some excellent reports, not least Robert Francis's two reports into Mid Staffordshire.
Berwick's advisory group identified a number of problems that related more to systems, procedures and priorities than staff, and argued that there was a lack of focus on the patient. The group advised that continuous improvement and investment in life-long learning is needed, with the patient at the heart of this. It also suggested a move away from a blame culture to greater transparency. They recommended that the service must accept the need for systemic change, move away from blame as a tool and work more closely with service users and providers. A more careful approach on quantitative targets is needed, as is clarity on which body is actually charged with delivering safety.
There is a real opportunity – and importantly public and political appetite – for change, with a radically reformed NHS putting clinicians at the heart of commissioning through CCGs, a public shift in attitude, and a willingness to learn and share experience exemplified by the NHS Litigation Authority's new approach of using its unique data sets from claims to develop learning initiatives to reduce harm, thereby improving patient and staff safety.
The biggest challenge for all those in healthcare – the commissioners, providers and regulators who wholeheartedly accept this drive for improved patient safety – is to have sufficient time and resources to implement the changes needed against a moving target that is created by publication of report after report, making slightly different but overlapping recommendations, guidance and regulation. This job is made all the more difficult by the reality of working under the spotlight of external review and public suspicion, and doing so in a constrained financial environment.
Going forward it will not just be the providers who will have to ensure patient care is at the top of their agenda, but also those who commission care and regulate the service. Commissioners will have to ensure they commission with safety at the heart of their intentions, assuring themselves of a provider's track record and ongoing safe performance, using appropriate data metrics to do so. There will be an extra impetus on them not to miss any warning signs – whether they be complaints, claims or mortality indicators.
The whole healthcare economy will have to work much more closely and find a way not only to hear the voice of regulators but importantly patients, their representatives and those delivering the care in a more open blame-free environment. But as Berwick points out, in order to keep this promise it's not just about the staff – even Berwick's recommendation of a criminal sanction against those found to have wilfully neglected patients comes with this warning.
It is more instead about systems, procedures and culture and all these require a unified approach and proper resourcing. Boards are being asked to take a long hard look at their organisations and ensure they are adopting current and best practice, and their staff as a whole are being developed. Let's hope they are given time to do so.
Tony Yeaman is head of healthcare at law firm Weightmans LLP
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