Learning and acting: some suggestions for ministers

Sitting listening to Don Berwick launch his report at the King's Fund yesterday, I noticed it had these words in its title: 'a promise to learn – a commitment to act'. Don was as compelling and inspirational to listen to as ever he has been. I am sure that each of us in his audience was prepared there and then to commit to both learn and act. Indeed, I would go so far as to say it is everyone’s duty in the NHS to put reducing harm at the top of our agendas and to act accordingly.

But what about the government? To be blunt, I fear ministers have not yet learnt and I heard no commitment to act. While they’ve said they’ll respond to the Francis Inquiry and the Berwick review in the autumn, in the absence of any coherent response so far, let me make some suggestions for ministers to reflect on during their summer holidays.

At the report’s launch, Don told us that, in order for a healthcare system to improve, action was needed on three equally important fronts. First, there needed to be strong assurance and regulatory mechanisms in place. Second, what he termed a 'learning system' needed to be built, enabling individuals to be trained and developed in the practice of improvement and for institutions to participate in collaborative learning. Third, was the need for continued exploration of ways of doing things better, what he called 'invention'.

Don went on to warn that politicians were very often only interested in the first of these. Strong regulatory action and building ever more defensive assurance processes appealed to the media. It sold newspapers. It showed that politicians were tough, courageous and forthright. It cut through complex matters with simple, understandable actions. But it was insufficient. Action in the other two equally important areas was necessary.

Yet the Secretary of State's brief remarks at the launch did indeed concentrate solely on regulatory action. The creation of the chief inspector of hospitals had been the most important action government had taken since publication of the Francis Report, Jeremy Hunt said. The absence of any commitment to create a 'learning system', or to explore ways the NHS can focus on constant improvement, was deeply worrying. The secretary of state needs to be urgently thinking about how he will take forward the report's recommendations in these two areas if he’s really serious about improving patient safety.

What can the government do to enable skills and capacity building for improvement in the NHS? How can we invest in building the science of improvement? These are the questions Jeremy Hunt must reflect on in advance of the government’s response in the autumn.

Don also told us that the actions and behaviours of top leaders, including politicians, were of critical importance in building the right safety culture. 'Only when reducing harm becomes the agenda of the leaders will staff follow', he warned. The secretary of state must remember that he too is a leader. His role is crucial in helping to set the right tone of debate about the NHS, free from blame, and allowing people working in healthcare to feel supported and safe to learn from their mistakes. His leadership is vital to culture change in the NHS: the buck stops with him and cannot simply be passed to frontline staff. The recent political spat over the Keogh report illustrates the damage that can be done by politicians and the media making merry with statistics and focusing their energies on the blame game – this is not leading by example.

The Berwick report deserves the full attention and backing of the secretary of state as well as senior NHS leaders. Anything short of this is a disservice to the NHS and those who rely on it. Here at the Foundation, we will continue to champion the recommendations in this report as we believe it sets out a blueprint for a safer NHS.

Stephen is Chief Executive of the Health Foundation