The Berwick Review - my conclusions.

I would summarise the Berwick Review like this;

Problems happen in all health organisations, including the NHS which is probably the finest and most idealistic of them all. To honour the victims, we should endeavour to ensure that it never happens again.

‘Zero harm’ is an impossible dream but we can work towards it, if only we can change the culture.

The NHS should be a learning organisation and work as a team.

No more fear, no more blame.

Put patient safety first.

Hmmmmm. Am I being really cynical?

How about this –

The ‘Liverpool Care Pathway’ was intended to ease the terminally ill into death gently, by withdrawing food and hydration at the very end, following careful discussions and planning with the patient, their relatives and carers.

In fact, the government offered a financial inducement to hospitals to put as many terminally ill people as possible on that ‘pathway’.

Meanwhile the managers had closed so many wards that they were desperate for the beds.

The discussions didn’t happen, consent wasn’t bothered with. People were put on the ‘pathway’ too early. It became involuntary euthanasia, with a financial bonus and a free bed every time a patient got put on the ‘pathway’.

Real, live human beings were treated terribly.

Good, decent people felt obliged to defend it.

After a number of years, another scandal and another report – and it is going to be quietly scrapped.

So it isn’t the ‘culture’, its government, lack of resources, bad management and too much pressure.

 

What is missing in the report?

1) Bad management.

Starting at the very top, the NHS has been badly managed by people with no clinical knowledge who were either second rate civil servants or failed private sector managers. Their main achievement has been laying off workers, closing wards, shutting hospitals and paying themselves very well.

2) The clinical harm in hospitals is mainly caused by a tiny minority of doctors and nurses who are either lazy or incompetent. Usually a mixture of the two. They leach off their colleagues because, unfortunately, they are shielded by workmates who cover for them.

3) There is an atmosphere of fear in the NHS – not fear of being caught out for incompetence but fear of questioning management orthodoxy.

4) There is no democratic control – for patients, staff or local authorities. Who pays for it all? Who does it belong to? Who does all the work?

5) Too much of the NHS is in private hands, people with vested interests, making money.

G.P.’s, Opticians, Pharmacists, Dentists are all in private, profit making business for themselves. They are subcontracted by the state to do medical work on our behalf and very profitable it is too.

Increasingly, peripheral work like cleaning, maintenance, testing and analysis has been subcontracted to profit making multi-nationals.

The Pharmaceutical industry makes Billions out of our NHS and puts little back in.

6) Bullying is normal.

Consultants bully junior doctors and nurses.

Nurses bully care assistants.

Managers bully consultants.

Racism and sexism are everywhere.

7) The ‘Never Events’ say it all, a list of things that should never happen in a hospital, because there are systems (like check lists) in place to prevent them. Yet they go on happening.

 

I’m going to stop there for the moment, I’m going to develop my own plan for the NHS over the next few weeks.

I’ve got a backlog of research I need to write up, but these days finding the ability to concentrate is harder for me. Here’s a taste;

I’m going to review the front runners for the job of Chief Executive of NHS England, now that there will be a vacancy. I think I’ll do my own countdown of undesirables – in reverse order of course.

I’ve been taking a little look at ‘The Foundation Trust Network’ – that’s interesting.

And there’s a lot more besides.

And your comments are always welcome.

Neil Harris

(a don’t stop till you drop production)

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