All leaders in the health service should unite in support of the ideas laid out in Don Berwick’s patient safety review

The Berwick review into patient safety in the NHS is, unsurprisingly, an impressive and thoughtful piece of work.

‘Even when staff and clinicians are doing their very best, errors occur and problems arise for patients that no one intends’

Professor Don Berwick’s keynote address to mark the NHS’s 60th anniversary in 2008 is rightly regarded as a superb intervention in the debate over NHS reform.

His work with the Institute For Healthcare Improvement in the US has won international acclaim for improving the quality and safety of healthcare provider settings and putting safe patient care at the centre of health systems.

He knows what he’s talking about and it shows in his report, the letters at the end and particularly his “letter to the people of England” (wouldn’t you just love to write one of those?).

What I particularly welcomed is the sense that, after six months of lurid headlines, we may now be reaching a balanced, well calibrated, evidence based view of NHS performance on these issues.

Strengths and weaknesses

Five particular points resonated with me. First, alongside identifying what has gone wrong, it is important to celebrate the strengths of the NHS, which is a globally important treasure.

Second, the explicit recognition that problems in care occur in every system in the world as healthcare is complicated. Even when staff and clinicians are doing their very best, which they do most of the time, errors occur and problems arise for patients that no one intends.

‘More enforcement is not the route to the better health service we want; the only way to get there is to create a system of continual learning’

Third, the job of improving will be much harder if staff in the NHS experience a culture of fear, blame, recrimination and demoralisation.

Next, more enforcement is not the real route to the better health service we all want; the only way to get there is to create a system of continual learning and improvement.

Finally, without ever forgetting what happened at Mid Staffordshire, the time has come to move on.

It would be really helpful if all our system leaders could align behind the approach outlined in the Berwick review and, crucially, this tone.

Chris Hopson is chief executive at the Foundation Trust Network

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