Amongst the many initiatives, Professor Don Berwick, a veteran of the healthcare quality movement in the US and former adviser to President Obama, has been invited to report on ‘a whole system approach to make zero harm a reality in the NHS’ (1).
For over twenty years, Berwick has been a leader in the field of health improvement, looking at how services can improve to make care better, safer and more efficient. His work at the Institute of Health Improvement has made a major contribution to understanding quality and safety in health care.
At a recent lecture at the Kings Fund in London (2), Berwick suggested that the UK health and social care system, like the US system, needed radical solutions if we are to achieve ‘better care, better health and lower cost’. Besides the economic pressures, which are considerable, he talked about the public and the professions being ‘confused’ about what the future of health care delivery would look like. Patients and their carers worry that changes will mean a loss of services, and the professions are unsure about what kind of practice they will have in the future. At a political level, in the US at least, Berwick spoke of a loss of authentic dialogue about exactly what changes will deliver better outcomes.
A quietly spoken man with a powerful combination of conviction and experience, Berwick’s vision had a moral dimension – with a challenge to professionals to focus on the needs of the vulnerable in society. He suggested that, in the future, care must be less centred on hospitals, and be much more community based. He saw the future of care delivered in teams made up of individuals with ‘an expanding scope of practice’, able to meet the needs of local populations, using new technologies and advocating a new approach to involving service users in the decisions about their own care.
Berwick illustratated his vision with examples of innovative care in the US, many of these based on integrated teams, with little or no heirarchy, and much less doctor-focused than our current systems advocate. He said the first rule of change is to cooperate. The training of health care professionals must include ‘process improvement, courage, transparency and openess and above all cooperation’.
These are huge ideas, and huge challenges, but arguably they articulate what many people in the UK already recognise. When HCPC was established over 12 years ago, there was resistance to the idea of an integrated system of professional regulation – where all professions were subject to the same regulatory processes, one register, one fitness to practise process, shared standards and one Board with oversight of all.
Today, the HCPC is seen as an effective and efficient regulator of 16 health, psychological and social work professions. It may well be a model for the future which Berwick describes.
1) Department of Health (2013) Patients first and foremost: the intial government response to the Report of the mid Staffordshire NHS Foundation Trust Public Inquiry
2) Don Berwick (2013) The role of clinical leaders. Kings Fund lecture, 16 April 2013. www.kingsfund.org.uk