here - United Kingdom Parliament
here - United Kingdom Parliament
here - United Kingdom Parliament
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
269WH<br />
1 DECEMBER 2010 Candour in Health Care<br />
270WH<br />
Westminster Hall<br />
Wednesday 1 December 2010<br />
[MR JAMES GRAY in the Chair]<br />
Candour in Health Care<br />
Motion made, and Question proposed, That the sitting<br />
be now adjourned.—(Jeremy Wright.)<br />
9.30 am<br />
Mr Robert Syms (Poole) (Con): It is a pleasure to<br />
serve under your chairmanship, Mr Gray. I start with<br />
an apology: I cannot possibly do justice in this debate to<br />
all those who have suffered as a result of mistakes made<br />
by the national health service. I know that a lot of<br />
people are paying attention to this debate, and I will do<br />
my best to make the case for a duty of candour in health<br />
care, particularly a statutory duty. That would be progress.<br />
In the House, if an hon. Member makes a mistake,<br />
however outrageous, everybody thinks that it is fair<br />
enough as long as they apologise quickly. I want to put<br />
forward the arguments for why honesty is the best<br />
policy and why it is best to acknowledge that mistakes<br />
are made in medicine and in the health service. That is<br />
part of the medical process. If people inform relatives,<br />
put their hands up and say, “We made a mistake”, that<br />
is a far better way to proceed than what seems to have<br />
happened in the past.<br />
I would like to thank Peter Walsh from Action against<br />
Medical Accidents for assisting me as I prepared for<br />
this debate. Over the next few weeks, Ministers are due<br />
to decide on their preferred option for honouring a<br />
commitment to require openness when things go wrong<br />
in health care. During the 2010 general election, the<br />
Liberal Democrat manifesto stated:<br />
“We will: require hospitals to be open about mistakes, and<br />
always tell patients if something has gone wrong.”<br />
I do not often quote from the Liberal Democrat manifesto,<br />
but it is probably important to do so under current<br />
circumstances and the coalition. That pledge was also<br />
included in the coalition programme for government:<br />
“We will enable patients to rate hospitals and doctors according<br />
to the quality of care they received, and we will require hospitals<br />
to be open about mistakes and always tell patients if something<br />
has gone wrong.”<br />
That has clearly been lifted from the Liberal Democrat<br />
manifesto. The White Paper, “Liberating the NHS”,<br />
stated:<br />
“We will enable patients to rate hospitals and doctors according<br />
to the quality of care they received, and we will require hospitals<br />
to be open about mistakes and always tell patients if something<br />
has gone wrong.”<br />
That shows consistency running from the original Liberal<br />
Democrat manifesto to the coalition programme for<br />
government and the White Paper produced by the<br />
Department of Health.<br />
Those commitments have been widely interpreted<br />
and welcomed as going some way towards the introduction<br />
of a statutory duty of candour in health care. Such a<br />
move has been advocated for many years by patient<br />
groups and others, including the ex-chief medical officer,<br />
Sir Liam Donaldson. Recently, Ministers have made it<br />
clear that as well as the possible introduction of an<br />
explicit statutory duty of candour, they are also considering<br />
not altering or adding to the statutory regulations, but<br />
merely issuing new or refreshed guidance to existing<br />
regulations contained in the Care Quality Commission<br />
(Registration) Regulations 2009.<br />
It is implied that that is more likely to be the favoured<br />
option because t<strong>here</strong> is an extreme reluctance to add<br />
or alter statutory regulation. I will speak about those<br />
two options, with a view to encouraging support for the<br />
introduction of a statutory duty of candour. Action<br />
against Medical Accidents has campaigned on that<br />
matter for a number of years, and representatives from<br />
that charity met with a Health Minister to try to put<br />
forward their case about the right way to proceed.<br />
Put simply, the situation is unacceptable. It comes as<br />
a shock to most people, particularly patients and members<br />
of the public, to know that health care organisations<br />
are in breach of no rules and will face no sanctions if<br />
they cover something up or decide not to inform a<br />
patient—or, in the case of a fatality, their relatives—that<br />
something went wrong during an operation or health<br />
care.<br />
Probably more by accident than design, the current<br />
system tolerates cover-ups and denials. People ask how<br />
that can happen in a modern, ethical health service, and<br />
the vast majority of people would agree that honesty<br />
with patients and their relatives is a moral and ethical<br />
requirement. T<strong>here</strong> is an abundance of guidance on the<br />
issue, and best practice dictates that honesty, or being<br />
open, is the only course of action.<br />
We know that t<strong>here</strong> are a million incidents in the<br />
national health service each year, about half of which<br />
cause some harm. Within those cases, t<strong>here</strong> are many<br />
serious incidents, so it is a large problem. When something<br />
goes wrong, most people want someone to explain what<br />
happened to their relative, mother, father or daughter.<br />
In part, such behaviour is part of the professional code<br />
for individual doctors and nurses, and is recognised as a<br />
central component of an open and fair patient safety<br />
culture. However, the failure to be open and honest<br />
when things go wrong is not uncommon.<br />
Although many trusts or PCTs do act openly, a<br />
significant minority tell patients nothing. Something<br />
must be done to provide parents and relatives with<br />
a flow of information and an honest approach. Patients<br />
and their families are unfairly denied crucial information<br />
about what happened during their health care procedure,<br />
and they may never learn the truth. If they do, they are<br />
often deeply traumatised by the initial dishonest response<br />
to something going wrong. It is not unusual to find<br />
people who have spent decades campaigning under<br />
difficult circumstances to find out what happened to<br />
one of their relatives.<br />
If patients suspect that something has gone wrong<br />
but have to fight to get the truth, they lose all confidence<br />
in the health care system and are more likely to take<br />
legal and disciplinary action. The NHS and health care<br />
organisations have failed to develop a learning culture<br />
and the ability to learn from errors and make things<br />
safer. Instead, they have developed a culture of defence<br />
or denial; they do not want to see themselves in the<br />
newspapers.<br />
The situation in England became even worse when<br />
the previous Government introduced the Care Quality<br />
Commission (Registration) Regulations 2009, which came