NHS safety report set to call for minimum staffing levels

NHS safety report set to call for minimum staffing levels Berwick review expected to recommend legal duty for doctors, nurses and other health workers to admit mistakes

A review of patient safety in the NHS by an acclaimed US expert, Don Berwick, is expected to recommend minimum staffing levels for hospitals and a legal duty for doctors, nurses and other NHS workers to admit their mistakes.

The Berwick review will be published Tuesday lunchtime without the sort of fanfare that government-commissioned inquiries attract if their conclusions find favour with ministers. The health secretary, Jeremy Hunt, will appear at the briefing with Berwick, who is flying to London for the day, but will not give an immediate verdict on the proposals.

Some of the measures are likely to be less than welcome to the government. The Francis report into what went wrong at the Mid Staffordshire NHS foundation trust – which found poor care and neglect, particularly of elderly patients – recommended nationally agreed minimum numbers of nurses for hospitals but the government rejected the idea.

Berwick, director and co-founder of the Institute for Healthcare Improvement in Boston, is also expected to call for the regulation of healthcare assistants, another Francis recommendation that the government did not endorse.

At the time, Peter Carter, general secretary of the Royal College of Nursing, described the government response as "very disappointing". He said: "We know that some of the most important recommendations from the Francis inquiry are being ignored, potentially leaving in place the systemic failures which allowed such a tragedy to happen in the first place."

Peter Walsh, of the patient safety charity Action against Medical Accidents (AvMA), was invited by Berwick to act as an adviser to his review.

"Whilst no one except Don Berwick and his committee know what the report will actually say, I would be very surprised if it did not back up and reinforce some of the recommendations from Robert Francis QC's report, such as national guidance on minimum staffing levels, regulation of healthcare assistants and a legal duty of candour applying to individuals," he said.

"These are things which the government have so far been resistant to, but they are important for patient safety."

Walsh said he was also hopeful that Berwick would back the Francis recommendation on Healthwatch, the local organisations intended to support patients and their families who want to complain about healthcare or social care. Francis said all Healthwatch organisations should look alike, instead of being set up according to local needs, and their funding should be ringfenced. "We cannot rely on there being a Julie Bailey in every town," said Walsh (Bailey founded Cure the NHS, the group that campaigned for the Mid Staffs public inquiry). "Ever since the abolition of community health councils we have lacked a credible local patients' watchdog."

The Berwick inquiry was announced by the prime minister in February on the day of the publication of the Francis report into Mid Staffs. David Cameron said he had asked Berwick to look at what needed to be done "to make zero harm a reality in our NHS." He went on: "Quality of care means not accepting that bed sores and hospital infections are somehow occupational hazards and a little bit of these things is somehow ok. It is not ok. They are unacceptable... That's what zero harm means."

But Berwick, in an interview with the Guardian, made it clear that his review would look at the big issues – the changes needed to create a whole culture which puts patient safety first. It would address staffing levels, training, reconfiguration and the way hospitals integrate with primary care.

"If you own a car and ask how good is the car, the answer won't be a single dimension," Berwick told the Guardian. "It will be multidimensional – so how good your car is includes its fuel economy, its safety, how much fun it is to drive, how pretty it looks, how long it lasts. Quality is always a multidimensional concept."

He identified six aspects of quality: safety, effectiveness (evidence-based appropriate care), patient-centredness, timeliness (the avoidance of delays), efficiency and equity.

"If you actually look at how hospital healthcare runs, it's really hard to work on one aspect without affecting the others," he said. "In fact, I would suspect in Mid Staffs the safety problems that were there were mirroring problems of patient-centredness, problems of effectiveness, even efficiency. So we can talk about safety but we will be, without doubt, thinking about a broader universe of performance characteristics.

"What unites them is leadership and the proper structure and maintenance, and routine improvement, of systems. So I suspect our report, much as the Francis report itself, will be advisory about overall excellence and not just one dimension."

Guardian