What can Don Berwick do for the NHS?

US healthcare expert Don Berwick has been asked to help enforce the Francis report. Colin Cooper outlines what GPs can expect.

When the prime minister announced in parliament last month that he had invited Don Berwick to make 'zero harm' a reality in the NHS, he seemed to think everyone would know who he was talking about.

It was just a fleeting mention - apparently Professor Berwick had advised President Obama on the matter - and could easily have been dismissed as a quick PR fix for the Mid Staffordshire report.

But for those GPs who are aware of the Harvard professor's work, that swift name-check may well have brought with it a renewed sense of hope for the future of the NHS.

The son of a GP

In particular, anyone who heard his speech at the RCGP's 2008 conference in Bournemouth will remember colleagues weeping as he spoke about growing up as the son of a rural GP in Connecticut - and, of course, the standing ovation he received afterwards.

Professor Steve Field, then chairman of the college and now deputy medical director at the NHS Commissioning Board, is effusive in his praise: 'Don is a wonderful, wonderful human being. He has a brain the size of a planet and wonderful values and communication skills.'

Professor Berwick, a paediatrician by background, was president and chief executive of the Institute for Healthcare Improvement at the time he made the speech.

His recollections of his father's selfless professionalism, and the community that treated him like royalty, touched on the essence of general practice.

'Some say doctors and patients should now be partners in care,' he told the conference.

'Not so, I think. In my view, we doctors are not our patients' partners; we are guests in our patients' lives.'

It was these values that prompted Professor Berwick to co-found the institute in 1991, a not-for-profit organisation dedicated to optimising healthcare delivery systems around the world, through professional development programmes and working directly with healthcare facilities and governments.

The overriding aim of the Massachusetts based organisation is to ensure that 'everyone should get the best care and health possible'.

But it was this altruism that caused problems for Professor Berwick when President Obama appointed him as head of the Centers for Medicare and Medicaid Services in July 2010, providing state-funded access to healthcare services for disadvantaged groups.

Professor Berwick was forced to resign in December 2011, at the height of the Obama healthcare reforms debate, when it became clear that Republicans would block confirmation of his appointment.

Admiration for NHS

They were particularly displeased with his open admiration for the NHS. He had received an honorary knighthood from the Queen in 2005 for his services to UK healthcare and was invited to speak at the NHS 60th anniversary celebrations in July 2008, where he declared the NHS was 'one of the astounding human endeavours of modern times'.

He said the UK had taken the difficult decision to promise healthcare as a human right. 'It's easier in the United States because we do not promise healthcare as a human right. In America, people ask, "How can healthcare be a human right? We can't afford it."

'As a result, almost 50 million Americans, one in seven, do not have health insurance. Here, you make it harder for yourselves, because you don't make that excuse. You cap your healthcare budget and make the political and economic choices you need to make to keep affordability within reach.'1

But he does not see the NHS as a finished product: 'No one in their right mind would expect that to be easy. No wonder that, even at 60, the NHS seems still immature, adolescent, searching.'

The Francis report testifies to that. And perhaps David Cameron is right to seek an 'outsider' to help NHS managers. Though in many ways, as Professor Field points out, Professor Berwick is very much an insider.

'Don understands the privilege of getting into the innermost secrets of the human being sitting in front of you, often knowing more about the patient than their wife or family. That's general practice at its core.

'In all of the reforms, we must not do anything to disrupt that interaction. What we must do is build on it, and ensure we treat everyone with the same compassion and dignity.'


1. Berwick DM. A transatlantic review of the NHS at 60. BMJ 2008; 337: a838.

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