The Berwick Report has to be the most exasperating, annoying report I have ever read. I know... to criticise anything that 'The Don' says or does or writes is to risk the disapprobation of his thousands of acolytes here and across the galaxy. A scintilla of misgiving brings the roof in! A hint of disapproval invites an inbox of green ink invective. To question 'The Don' is like passing wind at a funeral.
But... this is still the most aggravating report. The Don's rationale is not very different from the report he wrote for Ara Darzi in 2008. It is full of nuance and has to be read, properly. Most won't bother, some will claim they have and the charlatans will have plenty of ambiguity to hide their motives in. Prepare for the Berwick PowerPoint onslaught.
This report is like a rare and beautiful masterpiece reproduced on a greetings card. Clever, but not like the real thing. Berwick mesmerises us. This is not a report it is mood music, a colour chart, a selection of textures that belong in a designer home in mid-town Manhattan. Belmont or Bamford. Bristol 300 East 56 Street. This is a sound track to life but not the script.
In truth, I love it. Who could resist Berwick's love letters to NHS staff and the 'people of England' (Yes really! Annex B, page 39+). An arrogance? A foible? A conceit? A sincere Billet-Doux? His acolytes will forgive this excess. His critics will seize on Berwick's chutzpah
In truth, also, I hate it. I hate its lack of grit and traction. Failure to take on the real issues; the front line of care that has become the ragged edge of what we do, desperately hoping Berwick would arbitrate an end to their struggle. He stokes them and whispers sweet nothings. But, nothing is what the front-line is left with. This is Berwick minus cojones.
Why won't Berwick say what common sense tells us; mandated staff to patient ratios are the key to safe care. Duck-shoving the issue to NICE puts a solution years away, when finances are driving down staff numbers right now. Why does Berwick talk of investing in training when training budgets are being slashed. Why does The Don duck the issues? The system is crying out for the confusion between the CQC and Monitor to be put out of our misery. Their walled-garden arrogance pushes safe care further and further from our reach into the hands of lawyers and inspectors. Why create permission to delay, obfuscate and do nothing?
Why flirt with ideas? Berwick's team; the teenage girls dancing around their handbags at a youth club disco. They don't have the confidence to Tango and tangle with real issues, Rhumba and rumble with the vested interests to really change the NHS.
This is a soft focus report that the hard heads of the finance department will park. This is intricately written when plain speaking was called for. The DH will have an army of their brightest and best ready; dissecting, slicing and dicing. They will roll it up with the 209 recommendations of the second Francis Report, parcel it up with the 18 recommendations of his first report and mix it up with the thoughts, still to be published, of the Clwyd report. Something unrecognisable will emerge.
This was The Don's biggest challenge. Sad to say he has failed. His report is full of everything we know to be wrong but falls short of the remedies well all know to be right. He has tried to be too clever by half and the result is a report that only half deals with the solutions.
If only he had said; protect the front line fund it properly, protect it fiercely, mandate its staffing and make it fun to work there. If only he had said make all Board members apply and qualify for a license to hold public office. If only he had said regulate HCAs. If only he had said dump the lunacy of Monitor and the CQC. If only he had said be honest about the money thing and how to get more for no more. If only he had said reorganisation has got you into this mess and you won't reorganise your way out of it but you can unpick it, carefully. If only...
If only he... if only....
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