I welcome Prof Berwick’s report on the NHS in England, published on the 6 August 2013 with its emphasis on improving “the quality of patient care”, “engaging with the patients and staff”, “the development of all the staff” and “embracing transparency” all worthwhile objectives.
Many of his recommendations echo those made by Robert Francis QC in his very detailed report into the neglect and abuse which took place at Mid Staffs Hospital Trust which sadly have still to be implemented.
I do disagree with some of his recommendations:-
- Bizarrely, he stopped short of calling for a legal duty of candour on the part of clinical staff which would compel the NHS to inform patients of any errors made in their care. He said that this should only apply to serious incidents – this begs the obvious question, who determines when this is “serious”. What may be regarded as a minor breach of care in the eyes of the treating doctor, can be viewed as very serious as far as the patient is concerned. It would have been better if the NHS were legally compelled to come clean about all the errors they make;
- He didn’t give any guidelines on minimum staffing levels. Once again, I think this was a missed opportunity. In my experience, many mistakes occur because there are insufficient staff on duty and as a consequence they haven’t got the time to properly care for their patients;
- I don’t agree with criminal sanctions in extreme cases where there has been “wilful or reckless neglect”. This may undermine his attempts to try and establish a more open culture within the NHS and to encourage clinical staff to complain to their managers if something is wrong without the fear that someone in the hospital might be prosecuted.
He should also have recommended a far more robust NHS complaints procedure. This would tie in with a legal duty of candour on the part of the clinical staff. In my experience, the existing procedure is far too slow and often results in a blanket denial of any wrongdoing. Aggrieved patients then have to take legal advice which, in turn, increases the number of claims brought against the NHS. In my view the majority of patients are not seeking compensation. They want an answer to their questions and if something went wrong, an apology and proposals from the clinical staff on how the problem is going to be put right.
If complaints can be resolved at an early stage, potentially this could save the NHS millions of pounds in lawyers’ fees incurred by both parties. This is money much better spent on patient care.