Why a culture of fear and blame won't fix the NHS Berwick is right to emphasise that errors are not the same as misconduct and need a different approach to best reduce the chance of them reoccurring. Transparency is essential at every level if staff, patients and carers alike are going to be free to discuss concerns about safety and put things right. But transparency simply does not happen when blame is the preferred tool for change. This is yet another report which stressed that gagging clauses can have no place. My own view is that it is unacceptable that they remain written into the code of conduct for the Health Secretary's own parliamentary aides. That matters, as a culture of secrecy has always percolated down with damaging effects throughout our healthcare system with a tendency for inconvenient data or complaints to be massaged or ignored. The Berwick Review makes clear that responsibility for safety needs to be clear and simple because when everyone is responsible, no one is responsible. The goal of an NHS that first does no harm is laudable but that will take investment in staffing and training without any prospect of further increases in the overall budget. The challenge as ever will be for politicians of all colours to stop the blame game around reconfigurations, as without them there will be nothing to fund the changes that are desperately required to improve education and staffing. The importance of leadership throughout the system is stressed in this as in every other report and inquiry. That requires presence, visibility and leadership of the culture change through commitment, encouragement and compassion. Leaders are the role models for change and need to maintain direct contact with the front line. There is also a responsibility for opinion formers including the media and politicians to engage in honest debate rather than irresponsible or alarmist reporting. That will be a particular challenge as the deliberate mishandling of this data is one of the greatest threats to improving transparency and reducing the variation in standards of care and safety across the NHS. If staff are withholding poor data for fear of reprisals or misreporting then ultimately it will be patients who pay the price for poor practice. It is in all our interests to see a mature and honest debate about variation in healthcare and the need for reconfigurations, be that changes to children's heart surgery or local A&E departments. Politicians and the press shout the loudest for culture change but could become the greatest threats to a truly open and learning culture in our NHS. Dr Sarah Wollaston is the Conservative MP for Totnes. She is a member of the Health Select Committee