Obama’s Ex-Medicare Head Tells U.K. How to Fix the NHS

The U.K. should resist relying too heavily on targets or taking criminal action against workers to address shortcomings in its National Health Service, a panel headed by former U.S. Medicare chief Don Berwick said today.

The 17-member National Advisory Group, which U.K. Prime Minister David Cameron directed the Harvard-trained doctor to assemble after a probe found “appalling” care in a local health system, said the NHS should recognize that it needs “wide systemic change” to make patient safety a top priority. The group also recommended that the NHS provide sufficient staff, involve patients more and become more transparent.

“When the pursuit of targets becomes, for whatever reason, the overriding priority, the people who work in that system may focus too narrowly,” the panel said. “Goals in the form of such targets can have an important role en route to progress, but should never displace the primary goal of better care.”

Berwick’s team spent five months assembling the 46-page report. Their conclusions about targets run counter to practices established in the NHS more than a decade ago when the Labour Party-led government sought to improve access to care by requiring the NHS to treat patients within specified timeframes.

They also rejected a call by lawyer Robert Francis, whose investigation of the Mid-Staffordshire health system in central England prompted Cameron’s appointment of Berwick, to impose a “duty of candor” on NHS employees who discovered unsafe conditions. Francis found that substandard care had led to hundreds of deaths there between 2005 and 2009 and said he had uncovered an attitude which tolerated poor care.

‘Defensive Documentation’

“We do not subscribe to an automatic ‘duty of candor’ where patients are told about every error or near miss, as this will lead to defensive documentation and large bureaucratic overhead that distracts from patient care,” the National Advisory Group said in its report.

The panel said existing professional behavior codes require health-care workers to report what they believe or suspect about serious incidents to their employers, though the government should create a new category of offense to penalize leaders for “willful or reckless neglect or mistreatment applicable to both organizations and individuals.”

Criminal sanctions should be used only in exceptional circumstances and should be similar to those provided in the Mental Capacity Act 2005, they said. People convicted under that law can be fined or imprisoned up to five years.

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