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Berwick report: NHS needs 'no blame' culture to improve standards

The NHS must adopt a "no blame" culture if it wants to become one of the safest healthcare systems in the world, a major report has recommended.

The report by Professor Don Berwick, US president Barack Obama's former health adviser, said the NHS requires "wide systematic change".

Berwick said changing the culture of the NHS would trump any new rules and strategies.

In his report he cautioned against creating a system where staff were unwilling to own up to errors they had made.

He said having a culture of fear is "toxic" to both safety and improvement, and where honest errors were made there should be a culture of "no blame".

"Everybody commits errors, and one way to make sure you never know about the error is to start to punish it," Berwick said.

Learning culture

Berwick was asked by ministers to conduct the review after the public inquiry into the neglect and abuse at Stafford Hospital concluded the NHS had "betrayed" the public by putting corporate self-interest before safety.

Most of the recommendations in the 45-page report focus on the creation of a new culture of openness and transparency.

Berwick said: "The report focuses mainly, on culture - a learning culture where the NHS becomes a place where everyone's curious about what's going on, how they're doing, how others are doing, what they can do to improve - that cultural piece is important."

Artificial targets?

The report said staff must be given good support and training to help make sure they take pride in their work.

Berwick said if these changes can be adopted then there is no reason why the NHS can't become the "safest healthcare system in the world".

In his report Berwick also recommended guidelines for minimum staffing levels at hospitals of around eight patients per nurse but stopped short of suggesting these should be legally enforced.

Health secretary Jeremy Hunt welcomed the report but insisted a centrally-set minimum staffing level would amount to an "artificial target".

He said hospitals should be able to adjust staffing as they see fit.

"If you start mandating things from the centre you create an artificial target and hospitals and trusts say: well if we meet that national minimum we've done our job as far as staffing's concerned when actually they haven't - because you'll find there are places that need a lot more help and a lot more care," Hunt said.

NHS confederation chief executive Mike Farrar agreed blame and fear "will get us nowhere", but said some measures might do more harm than good.

"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," he said.