Berwick report: Danger of understaffed NHS wards can no longer be ignored after Mid Staffs scandal, Jeremy Hunt warned

Review says NHS staff responsible for 'recklessness or wilful neglect' of patient safety should face jail

Health Reporter

The danger of understaffed NHS wards can no longer be ignored, the Health Secretary Jeremy Hunt was warned, as another high profile figure review highlighted the urgent need for clear rules on safe staffing levels.

Professor Don Berwick said in his long-awaited report into 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.”

However, Mr Hunt said that setting national minimum safe staffing levels would create an “artificial target” and harm patient care.

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, 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”.

It 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.

Speaking to BBC Radio 4’s World at One programme following the publication of Professor Berwick’s report, Mr Hunt backed more research but said he was opposed to “mandating from the centre” on safe staffing standards.

“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,” he said.

Mr Hunt said that “there may be hospitals that are not adequately staffing their wards” and that it would be the task of the Care Quality Commission’s new chief inspector of hospitals, Sir Mike Richards, to identify them.

The Government has been criticised for presiding over cuts to nursing posts. Nearly 5,000 nursing places have been cut since 2010, with 800 lost in April this year alone. While NHS England  plan to recruit more than 4,100 new nurses next year – a 2 per cent increase – health watchdog Monitor has said that the recruitment drive was “a short term fix”, to be followed by a further 4 per cent cut to nursing posts over 2014-15 and 2015-16.

Labour said that the rate of staff cuts was becoming “dangerous”.

“All the experts are now telling the Government to get a grip on staffing levels,” said shadow health sectary Andy Burnham. “David Cameron must now urgently intervene to ensure safe staffing levels in our hospitals.”

Dr Peter Carter, chief executive of the Royal College of Nursing said: “This is the latest in a series of thorough reports by well-respected experts which is urging a focus on having the right number of registered nurses and support staff to care for patients.”

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.

Profile: Don Berwick

Professor Don Berwick is one of the world's leading experts in patient safety. A former Harvard professor, he spent 20 years leading the not-for-profit Institute for Healthcare Improvement. Based in Cambridge, Massachusetts, the think-tank has worked throughout the world consulting health providers on cutting back on care mistakes and improving practice.

A profound admirer of the NHS, in 2010 he was picked by President Obama to preside over the US Medicare and Medicaid programmes at a time of major reform to the American healthcare system. He left the following year, following attacks from Republican congressmen who refused to support someone who had been so vocal in their support of the NHS - hated by opponents of government-led health policy in the US.

Now Professor Berwick is among the candidates to succeed Sir David Nicholson as chief executive of the NHS. However, he may have set his sights elsewhere, having recently announced his candidacy for Governor of Massachusetts. 

Today is not a good day to go into hospital

Around 6,500 new doctors will begin work on wards around the country today, beginning the period dubbed the “killing season” in NHS hospitals because of the increased death rates associated with new staff. The first Wednesday of August – known as “Black Wednesday” – begins a month-long period in which death rates rise by an average of 6 per cent.

However, this year marks the first trial of measures brought in to address clinical errors associated with the influx of a large number of less-experienced staff. Last year, newly qualified doctors began shadowing more experienced colleagues before beginning work, and the scheme has been rolled out this year.

“We’ve got four days in which people are orientated, so they know who to call, who does what and are not left feeling disorientated,” said the BMA’s junior doctor chair Dr Ben Molyneux.

Charlie Cooper

News
Denny Miller in 1959 remake of Tarzan, the Ape Man
people
Arts and Entertainment
Cheryl despairs during the arena auditions
tvX Factor review: Drama as Cheryl and Simon spar over girl band

News
Piers Morgan tells Scots they might not have to suffer living on the same island as him if they vote ‘No’ to Scottish Independence
news
News
i100Exclusive interview with the British analyst who helped expose Bashar al-Assad's use of Sarin gas
PROMOTED VIDEO
Have you tried new the Independent Digital Edition apps?
News
ebooksAn unforgettable anthology of contemporary reportage
Sport
Angel Di Maria celebrates his first goal for Manchester United against QPR
Football4-0 victory is team's first win under new manager Louis van Gaal
Arts and Entertainment
art
News
newsIn short, yes
Arts and Entertainment
Rob James-Collier, who plays under-butler Thomas Barrow, admitted to suffering sleepless nights over the Series 5 script
tv'Thomas comes right up to the abyss', says the actor
Arts and Entertainment
Calvin Harris claimed the top spot in this week's single charts
music
Sport
BoxingVideo: The incident happened in the very same ring as Tyson-Holyfield II 17 years ago
News
Groundskeeper Willie has backed Scottish independence in a new video
people
Arts and Entertainment
The Doctor poses the question of whether we are every truly alone in 'Listen'
tvReview: Possibly Steven Moffat's most terrifying episode to date
News
i100
Life and Style
Cara Delevigne at the TopShop Unique show during London Fashion Week
fashion
News
The life-sized tribute to Amy Winehouse was designed by Scott Eaton and was erected at the Stables Market in Camden
peopleBut quite what the singer would have made of her new statue...
Sport
England's Andy Sullivan poses with his trophy and an astronaut after winning a trip to space
sport
News
peopleThe actress has agreed to host the Met Gala Ball - but not until 2015
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Teaching Assistant for KS1 & KS2 Huddersfield

£50 - £65 per day: Randstad Education Leeds: We are looking for flexible and i...

Teaching Assistant for KS1 & KS2 Huddersfield

£50 - £65 per annum: Randstad Education Leeds: We are looking for flexible and...

Primary Teaching Supply

£130 - £160 per day: Randstad Education Leeds: Qualified KS2 Supply Teacher r...

Year 1/2 Teacher

£130 - £160 per day: Randstad Education Leeds: Qualified KS1 Teacher required,...

Day In a Page

These Iranian-controlled Shia militias used to specialise in killing American soldiers. Now they are fighting Isis, backed up by US airstrikes

Widespread fear of Isis is producing strange bedfellows

Iranian-controlled Shia militias that used to kill American soldiers are now fighting Isis, helped by US airstrikes
Topshop goes part Athena poster, part last spring Prada

Topshop goes part Athena poster, part last spring Prada

Shoppers don't come to Topshop for the unique
How to make a Lego masterpiece

How to make a Lego masterpiece

Toy breaks out of the nursery and heads for the gallery
Meet the ‘Endies’ – city dwellers who are too poor to have fun

Meet the ‘Endies’ – city dwellers who are too poor to have fun

Urbanites are cursed with an acronym pointing to Employed but No Disposable Income or Savings
Paisley’s decision to make peace with IRA enemies might remind the Arabs of Sadat

Ian Paisley’s decision to make peace with his IRA enemies

His Save Ulster from Sodomy campaign would surely have been supported by many a Sunni imam
'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

Exclusive extract from Janis Winehouse's poignant new memoir
Is this the role to win Cumberbatch an Oscar?

Is this the role to win Cumberbatch an Oscar?

The Imitation Game, film review
England and Roy Hodgson take a joint step towards redemption in Basel

England and Hodgson take a joint step towards redemption

Welbeck double puts England on the road to Euro 2016
Relatives fight over Vivian Maier’s rare photos

Relatives fight over Vivian Maier’s rare photos

Pictures removed from public view as courts decide ownership
‘Fashion has to be fun. It’s a big business, not a cure for cancer’

‘Fashion has to be fun. It’s a big business, not a cure for cancer’

Donatella Versace at New York Fashion Week
The fall of Rome? Cash-strapped Italy accused of selling its soul to the highest bidder

The fall of Rome?

Italy's fears that corporate-sponsored restoration projects will lead to the Disneyfication of its cultural heritage
Glasgow girl made good

Glasgow girl made good

Kelly Macdonald was a waitress when she made Trainspotting. Now she’s taking Manhattan
Sequins ahoy as Strictly Come Dancing takes to the floor once more

Sequins ahoy as Strictly takes to the floor once more

Judy Murray, Frankie Bridge and co paired with dance partners
Wearable trainers and other sporty looks

Wearable trainers and other sporty looks

Alexander Wang pumps it up at New York Fashion Week
The landscape of my imagination

The landscape of my imagination

Author Kate Mosse on the place that taught her to tell stories