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Berwick report highlights nonsense of criminal sanctions in healthcare

By News team

Criminal sanctions for healthcare errors should be extremely rare, national patient safety advisers have recommended.

The Berwick report on patient safety, commissioned by the Government in the wake of the Francis inquiry, says it “makes no sense at all” to punish a person who makes an error. Criminal sanctions should be used mainly to deter wilful or reckless neglect or mistreatment, it advises. Staff should be free to state any concerns about patient safety without reprisal, and there is no place for compromise agreements (“gagging clauses”) in such cases, it adds.

“The report has clearly set out the importance of removing the toxic culture of fear to achieve safety and improvement … [and] that the tiny number of cases that involve wilful or reckless neglect or mistreatment deserve censure, but that errors are not misconduct and do not warrant punishment,” the Royal Pharmaceutical Society said in a statement.

Numark managing director John D’Arcy said the report’s stance “appears to be in full support of pharmacy’s campaign for decriminalising dispensing errors”.

The report sets out nine other recommendations, including a call to action over inadequate NHS staffing levels. It recommends that the National Institute for Health and Care Excellence should review available evidence to establish what staffing level and skill mix is needed to provide all types of NHS services safely, and to a high standard. Health Education England should ensure the required number of training places have been commissioned to meet future staffing requirements.

The report also criticises the current NHS regulatory system for being “bewildering in its complexity”, with an unsatisfactory tick-box approach to deciding whether standards are being met and unclear or non-existent lines of responsibility. “When so many are in charge, no one is,” the report warns.

It proposes several changes, and calls for an in-depth, independent review of the regulatory system to be completed by the end of 2017, once those changes have been operational for three years.

“The RPS agrees that a safer NHS will depend upon major cultural change, leadership and a learning culture across the system,” the Society said.

“We are pleased that much of our existing work on professional empowerment, just culture and quality systems resonates with the key messages within Professor Berwick’s report.”

English Pharmacy Board chairman David Branford added: “Don Berwick’s key recommendation for continual learning and improvement of patient care to be the top priority for the NHS is supported by our development of the RPS Faculty … [which] has been created to ensure individual pharmacists can be the ‘best they can be’ for patients.”

Mr D’Arcy said the report makes a valid point about the need to ensure adequate staffing levels, and this is true of pharmacy services. “But it is essential that the need for adequate staff is recognised in pharmacy funding against a backdrop of prescription volumes up 62 per cent over the last decade, a plethora of additional services and an increasing administrative burden.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2013.11124155

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