Don Berwick’s admiration of the U.K. National Health Service didn’t help him among U.S. Senate Republicans when President Barack Obama needed someone to revamp the Medicare health insurance program three years ago. It didn’t hurt him this year when U.K. Prime Minister David Cameron needed someone to recommend remedies for the NHS.
Cameron appointed the Harvard-trained pediatrician to advise him about making the NHS as harm-free as possible in response to lawyer Robert Francis’s 13 million-pound ($19.8 million) probe of the Mid-Staffordshire health system in central England. Francis found “appalling” care had led to hundreds of deaths there between 2005 and 2009, and he made 290 recommendations.
Berwick’s team of U.S. and U.K. specialists met in London last week. They have until July to report to Cameron and Secretary of State for HealthJeremy Hunt about “quickly and efficiently” making the health system safer for patients.
“It could change the whole of the NHS and that’s what we’ve got to hope for,” said Julie Bailey, who started pressure group Cure the NHS. “At the moment, the expectation is that patients are harmed and that’s got to change.”
Bailey’s 86-year-old mother died at Stafford Hospital in 2007 after a routine hernia operation. Francis looked at the experiences of more than 900 patients and their families, most of whom complained about their treatment. He found a 96-year-old woman was left lying in her own feces, another died because she wasn’t given insulin and others were left to drink from flower vases after staff ignored requests for water.
“My inquiries uncovered an attitude which tolerated poor care of them on the basis that there was nothing that could be done about it and even more often on the basis that it was the same as everywhere else,” Francis said at a conference in London April 17.
Substandard care wasn’t confined to Mid-Staffordshire, he said. Nor has it gone away. As recently as the 2011-2012 fiscal year, more than 200 people died of bedsores in NHS hospitals, 70 had operations on the wrong body part and 161 had instruments and swabs left inside them during surgery, Hunt told 400 people whom Berwick’s committee invited to offer opinions at London’s Excel Centre on April 16.
Berwick’s task is potentially daunting. The medical system, run by the Department of Health, is England’s largest employer with more than 1.4 million workers and accounts for about 109 billion pounds of the U.K.’s budget.
“We’re aiming for a cogent set of actionable recommendations to the department and the government to accelerate progress toward major improvements in safety and quality,” Berwick said in an interview in London.
His success or failure could have lasting implications for the NHS and for Cameron, whose Conservative Party trails the Labour Party in polls. A general election is set for May 2015.
As Obama’s administrator of Medicare and Medicaid for 17 months in 2010 and 2011, Berwick said he oversaw about 5,000 employees and a budget of $820 billion. His tenure at the agency was a limited recess appointment because Obama couldn’t muster enough Senate support to confirm his appointment. Republican senators objected to Berwick having extolled the benefits of the U.K.’s taxpayer-funded universal health system.
Berwick will decide whether to pursue the Democratic nomination and run for governor of his home state of Massachusetts after incumbent Democrat Deval Patrick steps down in 2014.
Berwick said he is considering, “if I were governor, could I help, could I get elected and could I weather the rigors of a campaign?” Lucian Leape, a professor at the Harvard School of Public Health and member of Berwick’s advisory group, said he expects his long-time colleague will seek the post.
Correcting flaws in some aspects of the U.K. health system’s culture is one of their group’s greatest challenges, Leape said.
“The elephant in the room is how the staff were treated,” Leape said. “If they were overworked, or under pressure, it’s no surprise that everything would go wrong.”
Navigating the subtleties of British culture may prove another obstacle for Berwick. Though he holds an honorary knighthood from Queen Elizabeth II for his past work with the NHS, he’s an American who hasn’t had to personally depend on the U.K. health system.
Many Britons wouldn’t send a steak back to the restaurant kitchen if it wasn’t cooked to their liking, Francis said, much less raise a ruckus over medical care even though the consequences might be serious.
“There is that British, rather than American, habit of not wishing to make a fuss,” Francis said. “People are afraid of complaining.”
Among Francis’s recommendations are stronger governance and that a “duty of candor” be required of every NHS worker, with criminal penalties for those who don’t report unsafe conditions. Leape, who said that criminalizing health workers’ behavior creates fear that squelches openness, predicted the duty of candor may be contentious among panel members.
Leape said Berwick can bring the panel to a consensus. Whatever they report to Cameron and Hunt must then be implemented, from hospital executive suites to wards.
“We don’t need another report with 290 recommendations,” said Liam Donaldson, the former Chief Medical Officer for England and the World Health Organization’s envoy for patient safety. “It needs to be a short letter of advice.”
Senior ward housekeeper Stephen Parkinson, who works at an Oxford hospital and heard Berwick speak last week, said it may be hardest to have an impact on the thousands of workers at his level where there is absenteeism, routine use of temporary staff and a lack of motivation.
“I’m at the rock face,” Parkinson said. “This is too far removed from what I do day-to-day.”
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