The blame game: Threatening nurses with criminal liability is wrong The effect will be to continue the blame game that got the NHS into this mess in the first place. The vilification of staff at failing hospital trusts has fostered the secretive, bullying culture that has prevailed in too many institutions where the welfare of patients has been forgotten. These plans defy the report that David Cameron commissioned in the wake of the Francis report. That was the Berwick report - the work of renowned expert on patient safety, Don Berwick, published in August - which warned that the search for scapegoats in the NHS must end and be replaced by a new culture of openness which encouraged organisations to learn from mistakes. "NHS staff are not to blame - in the vast majority of cases it is systems, procedures, conditions, environment and constraints they face that lead to patient safety problems," the report said. At the report's launch Jeremy Hunt, the Secretary of State for Health, denied that he had blamed staff, insisting that his comments had been about the structures that prevented hospital staff from exercising their compassion and concern for patients. That has been forgotten now. Berwick's report said that only in very rare instances was there wilful neglect and abuse, and a new criminal offence should be introduced to deal with these specific cases. But for the Government to place this at the centre of its response undermines Berwick's key message. He called for a change of culture across the NHS to support, not blame, staff in order to empower them. Ministers have been driven to show they will crack down hard on staff who step out of line, reinforcing the culture of fear that Berwick identified as so corrosive of high standards of care and humanity in the NHS. Nobody who understands the NHS could support this latest intervention. Nurses need a supportive environment in which to learn, not the threat of jail if they commit an error.