HSJ Live 06.08.13: Reaction to Berwick review

17.55pm: The General Medical Council’s response to Berwick is vague, saying it welcomes the call for a “transparent culture” but making no mention of the recommendation of criminal sanctions, or the non-recommendation of a duty of candour.

15.52pm: The King’s Fund said it recognised the importance of staffing levels but said they were probably too complicated to set a national ratio for.

Assistant director of policy Catherine Foot said: “We know from Mid Staffordshire hospital and elsewhere the importance of maintaining adequate staffing levels. We welcome the recommendation that NICE should interrogate the available evidence to develop guidance for the NHS. Staffing levels are likely to be too complex for a nationally mandated minimum staff-to-patient ratio to be set.

“Hospital boards should use good evidence in deciding on the right staffing level for different services, and indicative staffing ratios could be used to highlight cause for concern, but feedback from patients and staff is just as important, if not more so.”

15.34pm: A medical defence union has welcomed Professor Berwick’s refusal to recommend a statutory duty of candour but expressed its misgivings about criminalising abuse and neglect.

Medical Defence Union chief executive Dr Christine Tomkins said: “We are uneasy about the suggestion that a criminal sanction of wilful or reckless neglect be introduced. Doctors who are accused of wilfully neglecting patients can already be reported to the General Medical Council and face having their license revoked if found guilty.

“We believe this is adequate for the protection of the public and doubt the additional threat of potential police investigation is necessary or likely to lead to successful prosecutions. If the government decides to take this forward, we will need to look carefully at what it proposes.

“In our experience, doctors are honest and do not deliberately withhold information from patients, so we agree it would be disproportionate to introduce a statutory duty of candour on individuals. We are pleased the report has rejected this suggestion which would have imposed another layer of unnecessary regulation on doctors and other healthcare professionals, who already have a duty to be open and honest with patients in their professional codes of conduct.”

15.11pm: The National Health Action party has the most vociferous take on Professor Berwick’s report.

In a statement co-leader Dr Richard Taylor, former MP and ex-member of the Health Committee, said:“When will this government stop commissioning reviews and start implementing them? The last Health Committee issued its report on patient safety on 3 July 2009. As with all such reports this was extensively researched. It was assisted and advised by world renowned experts in patient safety, including those with knowledge of airline safety procedures. Instead of being actively enforced, this report and its recommendations are, I presume, gathering dust on some neglected shelf in the Department of Health.”

He added: “This Berwick Report has many recommendations that are basic common sense, but which are in direct conflict with the government’s NHS policy. Firstly, putting patient care and patient safety above all other aims isn’t possible alongside the government’s escalating privatisation of the NHS which puts profits before patients.

“Secondly, greater transparency is at odds with the rising use of private contractors which brings with it increasing commercial confidentiality.  And if the government was serious about increasing patient power it would reintroduce Community Health Councils and reform the NHS complaints process as we have been calling for.”

15.04pm: Further detail on the Berwick review of patient safety from the HSJ’s Shaun Lintern here.

14.29pm: Chief executive of the Nursing and Midwifery Council Jackie Smith said the recommendation of a criminal offence for abuse or neglect was “significant and we will need time to consider it.”

She added: “We are pleased that the report recommends the introduction of assessing the performance of all clinical staff. This will support our programme of work for the introduction of revalidation for nurses and midwives, due to be launched in 2015.

“In our response to the Francis Inquiry report, we have stated our commitment to sharing information and working better with other regulators. We support the report’s recommendation for information to be shared between all relevant parties, including patients and the public in a timely fashion.”

14.11pm: The Foundation Trust Network welcomed the criminalisation of neglect or wilful misconduct.

Chief executive Chris Hopson said: “As part of this safety revolution must come responsibility and accountability by individual staff who have had support from their leaders and employers in changing their practice.

“For this reason, we agree with Professor Berwick’s recommendation that in those rare instances where harm is caused by staff with a “couldn’t care less attitude” leads to “neglect or wilful misconduct”, those individuals responsible should face the prospect of prison for what is, in effect, criminal harm. It seems unlikely that new legislation is required for this; simply implementation of existing law.”

13.56pm: The British Medical Association expressed some caution about the criminal offence recommendation.

Chair of the BMA Council Dr Mark Porter said: “We firmly believe that there must be a change of culture across the NHS and we support Professor Berwick’s call for patient care to be made paramount and for a culture of support, not blame, to empower staff. Doctors care deeply about patient care and we now look forward to hearing more from the government on how Professor Berwick’s review will be implemented.

“We need to examine further the proposals for new criminal offences and work with the Department of Health to see if these add anything further to the existing sanctions. There are already a number of ways in which healthcare workers, including doctors, can be held to account for their actions and we support Professor Berwick’s decision not to call for a new statutory duty of candour for individuals.”

13.40pm: Royal College of Nursing chief executive and general secretary Peter Carter said the NHS needed to “commit to acting on the evidence on issues such as safe staffing levels.”

He added: “This is the latest in a series of thorough reports by well respected experts which is urging a focus on having the right number of registered nurses and support staff to care for patients. The growing body of evidence shows that the only way to ensure patient safety is to have adequate staff with the right skills and the opportunity to learn and develop on an ongoing basis.”

13.33pm: In a statement the Royal College of Physicians said: “[Berwick] is right to identify cultural change as the most important factor in reducing harm to patients.

“An emphasis on appropriate staffing levels would also help the NHS cope with the increasing strain it is under due to the inexorable rise in emergency admissions, the increasing proportion of inpatients with dementia and comorbidities, poor continuity of care, out-of-hours care breakdown and a looming medical workforce crisis.”

13.25pm: Interesting comment from Jo Bibby, a director at the Health Foundation, who was on Dr Berwick’s committee.

“The past few months have seen a barrage of criticism of the NHS, today’s report offers a more balanced and hopeful critique of what needs to change, it’s imperative that the government and the NHS act on the report recommendations” she said.

She added: “We need to shift to a ‘learning’, not ‘blame’ culture like the airline industry who don’t cover up errors but discuss and learn from them. 

“Too much focus of late has been on data sets and league tables which are historical and easily explained away rather than real-time assessment of safety today and tomorrow. The same priority should be given to analysing and managing safety as is currently given to managing finance in the NHS. 

“There is no single action that can make care safe so we need to build skills in patient safety at every level within our organisations, put simply how to make care safer are skills that needs to learnt and applied in an supportive environment, it is the emergent property of every single interaction that happens in healthcare, everyday and every minute.”

13.21pm: NHS Confederation chief executive Mike Farrar said: “Professor Berwick’s comments on culture are spot on - we must do more to develop and protect every member of staff, every patient, and every visitor who speaks up to help maintain and improve safety. We have an army of eyes and ears at our disposal to identify the ways we can do things better - we must ensure every one of these people has a voice, so the case for continual improvement of patient safety cannot go unheard.

“Blame and fear will get us nowhere. Professor Berwick’s belief that a statutory duty of candour will not work for individuals seems sensible. The introduction of such a measure could have unintended consequences that increase rather than remove a climate of fear. However, we support such a duty for organisations, who we rightly expect to be transparent about their standards of care including critically when they fail.”

13.16pm: One of Berwick’s recommendations is that CQC and Monitor be merged but recommended the current regulatory arrangements be given three years to bed in.

13.15pm: Unison head of nursing Gail Adams said: “We would add our voice to the review’s concerns that ‘fear is toxic’. The government must stop running down our NHS and undermining the confidence of staff and patients. It must start listening and working with all parts of the NHS to reduce harm.”

13.09pm: Health secretary Jeremy Hunt welcomed Berwick’s report and said in a statement: “For too long, patient safety and compassionate care have been secondary concerns in parts of the NHS and this has to change. I want to get to a point where every patient has confidence that their care will be safe and where every member of NHS staff feels supported to make safe, high quality care the priority.”

13.02pm: Don Berwick has recommended NHS staff should face jail in cases of “neglect or wilful misconduct”, the high-profile review tasked with making zero-harm care a reality in the NHS has recommended.

The review 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 review does not propose a minimum staffing level for nursing 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 Monitor and CQC be merged.

12.18pm: HSJ has a story on the appointment of the first director of public health from a non-public health background.

John Ashton, president of the Faculty of Public Health, accused the local authority in question of “driving a coach and horses through the system of specialist training for public health specialists”, which provided the knowledge of statistics and evidence-based commissioning required of directors.

11.49am: Interesting piece from the BBC on the bricks and mortar legacy of a previous large-scale service reconfiguration, the move away from inpatient mental health care.

Then health minister Enoch Powell’s famous “water-tower” speech, in which he said the public must The BBC’s piece looks inside a derelict mental health hospital in Essex.

11.31am: Tough times for the private healthcare market. The coverage stands at 11 per cent, the lowest for two decades, and there have been calls to break up some of the bigger firms ahead of the Competition Commission’s report later this month.

11.06am: More on the integration front from Oxfordshire. The shared budget between Oxfordshire County Council and Oxfordshrie CCG will nearly double from £108m to £195m this year.

10.57am: In his column, Michael White says there is something familiar about Dan Poulter’s attempts to improve the NHS’s procurement record and plans to appoint a “procurement champion” (as HSJ reported yesterday).

He writes: “We must all be grateful that the champion is not - so far - being called the ‘rubber gloves tsar’ or even the ‘KY Jelly tsar’. But there is an unavoidable sense of déjà vu here.”

10.28am: Further to the minimum staffing levels debate, Nursing Times reports the majority of nurses say the patient-to-registered nurse ratio on their ward is unsafe.

10.18am: The clinical commissioning groups served by Barking, Havering and Redbridge University Hospitals Trust have ordered an external clinical review of A&E services at the trust.

The last two CQC inspections have severely criticised A&E services at the trust and the first one recommended a cap be placed on admissions, a decision the trust appealed and won.

The CCGs said the “permanent staffing issues” were a significant concern. The trust has tried to attract more senior staff to its A&E, including getting consultants on rotation from Barts Health Trust.

The CCG-ordered review is thought to be the first of its kind commissioned by local CCGs.

10.14am: HSJ’s sister magazine Nursing Times reports that Robert Francis QC is now backing minimum staffing levels. He has done so less than six months after his inquiry into Mid Staffordshire Foundation Trust ducked making a recommendation on minimum staffing.

9.57am: The Guardian reports that Don Berwick’s report will call for minimum safe staffing levels.

The paper’s report said: “Some of the measures are likely to be less than welcome to government”, adding, erroneously, that Robert Francis QC had recommended minimum staffing levels in his report on Mid Staffordshire.

It adds: “The Berwick Review will be published at lunchtime today without the sort of fanfare that government-commissioned inquiries attract if their conclusions find favour with ministers.”

9.45am: Good morning. Professor Don Berwick’s review of patient safety is expected to be published today. Coverage of the review will be free for registered users.

Professor Berwick, who advised President Barack Obama on his health reforms, was chosen by the government to lead a “zero harm” agenda in the NHS. David Cameron made the appointment in February as part of the government’s response to the Francis report. Professor Berwick said in March he would look at the report’s recommendations with “a critical eye”.

HSJ reported on speeches by Professor Berwick in April and he spoke to HSJ.