As a clinician who was born and works in Wales, improving standards in our health service is not just professional, it is deeply personal. As a women’s health specialist, I naturally interpret national conversations in the context of my field, but the recent interview with Professor Donald Berwick on BBC One Politics Wales resonated far beyond any one speciality. His reflections are relevant across the entire spectrum of medicine: workforce wellbeing, innovation, and cultural change are challenges—and opportunities—that unite us all. Wales is well-positioned and has immense potential to lead as an example.
Wales stands at a critical crossroads in the future of health and care. The pressures facing the system—staff shortages, growing demand, financial difficulties and the aftermath of a global pandemic—are well documented. But according to Professor Donald Berwick, one of the world’s leading authorities on healthcare improvement, the real opportunity lies not in describing the problems, but in taking bold, values-led action to address them.
In a wide-ranging interview on BBC One Politics Wales with Nick Servini, Professor Donald Berwick delivered a clear and timely message: Wales has the tools, the ambition, and the values to become a global prototype for excellent healthcare, but only if it fully commits to culture change, learning, and innovation, underpinned by a long-term vision.
Berwick, a former adviser to President Obama and the founding president of the Institute for Healthcare Improvement, is no stranger to health system reform. He has worked with governments and health leaders around the world. Yet in Wales, he sees something unique: an NHS still committed to the founding principles of equity, universality, and care based on need, not ability to pay. Those principles, he argues, create a foundation on which world-class care can be built.
Workforce Support Is the Defining Challenge
But he was also frank about the risks facing the Welsh NHS. “There’s not enough support, not enough energy,” he said, identifying workforce wellbeing as one of the most immediate and significant challenges to the system’s resilience. The stress and exhaustion being felt by staff cannot be ignored or managed away. Instead, the workforce must be supported, encouraged, and—crucially—developed.
This means more than just recruitment or retention strategies. Berwick emphasised the need for meaningful investment in upskilling, professional development, and creating opportunities for clinical staff to innovate and lead change. In his view, supporting the workforce is not a luxury; it is a strategic necessity.
When staff feel valued, listened to, and empowered to improve care, performance follows. When they are subject to pressure, blame, and a lack of investment, systems stagnate.
Culture Change Over Command and Control
Berwick’s position is clear: improvement cannot be driven by fear or command. “Name and shame do not work,” he said. Drive improvement with a carrot, not a stick. Instead of top-down control, he calls for a shift to positive accountability, where health boards and clinicians are supported to learn from each other, to trial new ideas, and to share what works. The kind of “parochialism” that limits collaboration across regions must be challenged. “Variation” in quality or access across Wales is not inevitable, but we can learn from negative variation and thrive on the positive. But addressing it requires a cultural shift, not simply new metrics or performance targets. Nobody likes being talked down to, but everyone loves to be part of the bigger picture. We need to win hearts and minds; not feel we can’t change the status quo.
This is where Professor Berwick believes Wales has a unique opportunity. The scale of the country, its NHS and its ethos of collaboration make it the ideal setting to model the kind of joined-up, values-driven innovation that other nations aspire to.
Innovation Must Be Embedded, Not Occasional
Central to delivering this kind of transformation is the Bevan Commission, Wales’ leading independent health and care think tank. Berwick praised the Commission’s work in enabling and supporting frontline innovation through programmes like the Spread and Scale initiative, which helps teams turn successful local projects into scalable national solutions. We need to embrace innovation and new ways of doing things, looking not to reinvent the wheel but get on the cart.
He highlighted the importance of reducing “silly rules” and unnecessary bureaucracy that get in the way of improvement. But he also stressed that real change will only come if health boards are willing to learn from each other—and adopt models that are already proving effective.
Community Gynaecology as a Case in Point
One such model is the Enhanced Community Gynaecology Service project, developed in West Wales and now recognised as one of the Bevan Commission’s Adopt, Spread & Embed projects selected for national scaling. This initiative, designed to bring specialist gynaecology care into community settings, was selected for its originality, capacity to release secondary care resources, and its alignment with long-term system goals.
It reflects the wider Welsh Government commitment to Women’s Health Hubs, designed to offer joined-up, accessible care for women across the life course, particularly for those with complex or multiple needs. In doing so, it demonstrates the kind of innovation Berwick advocates: clinically led, patient-focused, and integrated.
Tipping point
Wales has a chance to change and be a leading example for healthcare systems across the world. It’s in our gift, all of us working in Wales, to make this happen, and we need to seize the moment and shine.
