Hospital incentives are harming the NHS, warns US expert Don Berwick

The dominance of hospitals is a threat to the future improvement of NHS care, according to the US healthcare expert reviewing the Francis Report.

Don Berwick: aims to make 'zero harm' a reality in the NHS (photo: Solent News)
Don Berwick: aims to make 'zero harm' a reality in the NHS (photo: Solent News)

Professor Don Berwick was appointed by prime minister David Cameron to lead a task force to ‘make zero harm a reality’ following the failings at Mid Staffordshire NHS Foundation Trust.

Prof Berwick said the team of experts had ‘complete licence’ to make any recommendations they saw fit, in a lecture on leadership at the King’s Fund think tank in London this week.

He explained the Triple Aim theory that has driven his work on improving healthcare systems around the world over the past two decades – seeking to deliver better health, better care, and reduced costs.

But he said the threats to achieving these goals in the UK were similar to those facing the US healthcare system, one of which was the dominant position of hospitals.

‘From what I have seen over the years, you have structural problems. Your hospitals, despite repeated attempts to give power to primary care and keep people in their homes, are very much under incentive to keep busy and they do not have an incentive to build the continuity that we need.’

But he said that restructuring was not the answer – collaboration was the key to improving healthcare.

‘It’s well intended, but you continually restructure as if you can somehow find the correct number of agencies. But that’s not going to work, that’s not the way to get there.’

Patient-centred services were vital, he said. In Mid Staffordshire, cost pressures became paramount and ‘everyone forgot’ to turn to the patient as the focus of care.

And he called on the healthcare professions, or ‘the guilds’, to unite around the Triple Aim objectives, saying that the RCS, RCP and BMA were ‘not in the game’.

Professor Berwick, a paediatrician by background and the son of a rural GP, is a lecturer in healthcare policy at Harvard Medical School.

He was president and CEO of the Institute for Healthcare Improvement, which he co-founded in 1991, until President Obama appointed him head of the Centers for Medicare and Medicaid Services in July 2010, providing state-funded access to health services for disadvantaged groups.

He was forced to resign in December 2011, at the height of the Obama healthcare reforms debate, when it became clear that Republicans would block the confirmation of his appointment partly due to his open admiration of the NHS.

Read our profile of Professor Don Berwick

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