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Berwick report highlights the dangers of inadequate staffing

Professor Don Berwick said in his long-awaited report into patient safety in the NHS that new guidance to protect patients against “the dangers of inadequate staffing” needed to be set up “as soon as possible".

The report, a broad review of Francis’ 290 recommendations, contained glowing praise for “the vast majority” of NHS staff but said that “the systems, procedures, conditions, environment and constraints they face…lead to patient safety problems”.

Nursing leaders and patient groups have called for national minimum nurse-to-patient ratios, and Robert Francis called for nationally recognised tools for setting safe levels of staffing in his landmark review into failings at the Mid Staffordshire NHS Trust. However, the Government is yet to act on the recommendations. 

Professor Berwick’s report called for a culture of “complete, timely, and unequivocal” transparency, in which errors were admitted to and resolved without blame. However new laws were recommended to punish clinicians in “rare” cases of “recklessness and wilful neglect”.

Addressing the question of safe-staffing, Professor Berwick called for the National Institute for Health and Care Excellence (NICE) to develop a formula for determining safe nurse-to-patient ratios that could be applied on a ward-by-ward basis.

Although he rejected setting minimum safe staffing levels by law, he said that the formula should be devised at a national level, in order to be applied locally.

“If I’m running a hospital, I should have a way to know whether staffing on [a ward] is appropriate or not,” he said.

Reckless neglect

Professor Berwick’s report also contained a recommendation for “a new general offence of wilful or reckless neglect or mistreatment applicable to both organisations and individuals". Sanctions under the new law would include disqualification from future leadership roles, public reprimand and, in extreme cases, financial sanctions for organisations and up to five years in prison for individuals.

Professor Berwick, a former advisor to President Obama, described his report as “philosophical”. He praised staff in the NHS, which he called “an international gem” and the “envy of many countries” and set out four broad targets: prioritising patient care, listening to patients, transparency, and constant improvement.

However, the systemic problems that led to the “tragedy” of Mid Staffordshire, including under-staffing, were not isolated to one trust alone and the NHS needed to “adopt a culture of learning”, Professor Berwick said.

“In any organisation, mistakes will happen and problems will arise, but we shouldn’t accept harm to patients as inevitable. By introducing an even more transparent culture, one where mistakes are learned from, where the wonderful staff of the NHS are supported to learn and grow in their capacity to improve the NHS, and patients and are always put first, the NHS will see real and lasting change,” he said.