The Berwick Report: Subtle, Eloquent and Powerful

Improving service quality
11th August 2013

The Berwick Report was published this week. It distils the lessons learned and specifies the changes needed in the wake of the Frances Inquiry into the Mid Staffordshire tragedy. 

I’m familiar with Don Berwick’s writing and I’ve heard him speak. A giant in the world of healthcare quality improvement, he has inspired me to see the world differently. I hoped that his voice would not have lost any of its impact and I was not disappointed. The Frances report was a landmark publication for NHS England with implications for the rest of the UK but the Berwick Report is one for the NHS of Great Britain. It has important messages for all.

Reading the social media sites, it’s apparent that the Berwick Report has had a mixed reception with various groups feeling that the recommendations just don’t go far enough. Everyone has a perspective borne of their experience and I respect their view.  However, I urge the critics to look deeper. 

The report acts as a stabiliser in what has been one of the most distressing times in the history of the NHS. It reaches out to patients, carers and staff with a combination of humility, expert knowledge and common sense.  Importantly it reminds us that to be compassionate, people need some compassion themselves. It separates wilful neglect from unintended errors and, crucially, asks if poor performance caused by systemic issues beyond the control of those involved is indeed legitimate i.e. 

Good people can fail to meet patients’ needs when their working conditions do not provide them with the conditions for success. 

While no one will forget what happened at Mid Staffordshire, the Berwick Report brings balance and solace to those who always had the best of intentions. But it does not shirk the issues either. It’s just more subtle than what has gone before. For example, nursing groups have been disappointed that the Report did not go all the way and stipulate minimum staffing levels. However it includes a lever that might actually be far more powerful i.e.      

They (Boards and leaders of organisations) should make their conclusions (on exercises to determine staffing levels) public and easily accessible to patients and carers and accountable to regulators.

The Frances report was about regulation, assurance and control and this latest report is about identifying leverage for improvement. Arguably we need both to create the right amount of tension in a system for change to happen. My plea is that the NHS focus less on what is absent from the report and more on what it actually says.  It’s time to switch from dipped headlights to full beam!


Other posts of interest: