here - United Kingdom Parliament

273WH
Candour in Health Care
1 DECEMBER 2010
Candour in Health Care
274WH
given the number of clear statutory obligations already
spelt out in the regulations themselves, rather than
developed by supporting guidance.
Option 1 would not have anything like the same
impact as introducing a specific statutory duty, if it had
any impact at all. The Department of Health would be
trying to say, “This has always been the case, but we
didn’t realise it and didn’t think it was important enough
to make it clear.” That option would fail to deliver
positive opportunities for sending a clear, unequivocal
message about the importance of being open and would
fail to support a major culture change. It would not deal
with the bizarre situation whereby there has already
been, since April 2010, a statutory obligation to report
anonymously to the national incident reporting system
patient safety incidents that cause harm, but there is no
equal requirement to tell the patient or a relative. It
would send the message that being open with patients is
not important enough to justify a minor amendment to
the regulations.
Option 2, which I prefer and think should be given
serious consideration by the Government, is to introduce
a specific statutory duty by amending the existing CQC
registration regulations. That would send a clear,
unequivocal message about the importance of being
open, which would support and underpin other initiatives
to develop a more open and fair culture. It would be
enforceable. The CQC has confirmed that it would be
practical for it to enforce such a measure. Of course, it
would be a condition of registration with the CQC. It
would have real impact: boards and management could
not escape noticing the change or recognising the need
to comply. At the moment, even when doctors or nurses
want to be open with patients, sometimes the management
of PCTs or of hospitals are less keen. We must send a
clear message so that the whole organisation undergoes
a major culture change in how it deals with patients.
Option 2 would balance out the existing statutory
regulation where it is a statutory obligation to report
anonymously patient safety incidents that cause harm
but there is no equal requirement to tell the patient or a
relative. It would not add to the regulatory burden on
health care organisations, and I think that it would
enjoy public confidence, which is a very important thing
to have in this area. That option would be relatively
easy to achieve. The con is that it would require a
change in the regulations, so there would possibly be
some legislation.
In my opinion, option 2 is the best way to go. It is not
something that is supported only by a few oddbods;
such a change has the support of many people, including
many senior people in the medical profession. I know
that there are concerns about compensation and litigation,
but the evidence from the United States, where many
insurers now do insist on a more honest system, is that
when people receive an apology, they are less likely to
sue. When they find out what happened to their relative,
they accept that mistakes are sometimes made and they
are less likely to pursue lengthy and costly legal action.
People are sometimes pushed into legal action by the
sense of injustice that they feel when their relative has
undergone harm or perhaps died in the course of treatment.
They feel a sense of injustice and are then driven to take
that action. Of course, many of the costs to the NHS
are from the legal fees, not necessarily the money paid
out in compensation.
I shall go through a list of some of those who would
support a statutory duty of candour. I have already
mentioned Sir Liam Donaldson, the ex-chief medical
officer, who formally recommended a statutory duty in
2003. Harry Cayton, chair of the Council for Healthcare
Regulatory Excellence, has also supported such a duty.
The late Claire Rayner, who was a doughty campaigner
on behalf of patients, and a former nurse, supported it.
Professor Aidan Halligan, the former deputy chief medical
officer for England, who is currently chief of safety at
Brighton and Sussex University Hospitals NHS Trust,
is completely supportive of the proposal. There is also
Sir Graeme Catto, the immediate past president of the
General Medical Council; Sir Donald Irvine, a past
president of the GMC; Sally Taber, director of Independent
Healthcare Advisory Services; Cure the NHS; Patient
Concern; and Sufferers of Iatrogenic Neglect. There is
broad support in the LINks—local involvement
networks—organisation for the view that what has been
described is an important thing to do.
In recent years, we have become aware of a major
disaster at Stafford hospital. It has affected not one or
two people, but hundreds of them. Of course, it has
been the subject of much debate, many statements in
the House and a lot of real concern, but had there been
a statutory duty of candour, the management of Stafford
hospital would not have been able to get away with the
poor standards of treatment and nursing and the fact
that many hundreds of people lost their lives. Such a
duty is a very important and practical measure, and if
the NHS is to mean anything to the people of this
country, being open and honest with those who have
suffered as a result of what are sometimes unavoidable
accidents is the best way to proceed.
There are clear benefits to introducing a statutory
duty, and there is an historic opportunity in that regard.
I listened to my right hon. Friend the Secretary of State
talking over the weekend about more transparency.
Introducing such a duty would be a brave step, because
all the advice from people in the Department of Health
would be, “Careful, Minister. Don’t do anything that
might have long-term costs.”
However, in the modern age—an age of freedom of
information, when thousands of documents appear on
the internet—it is not unreasonable that a cornerstone
of the NHS in this century should be that people are
up-front and honest, and tell the truth when something
goes wrong. Things inevitably do go wrong—not necessarily
deliberately, but simply because that is the way of the
world and medical science. People can then understand
what has happened to their relatives.
As my constituent Mr Bye said, “The start of the
healing process after the loss of a loved one is to know
the truth of what happened.” It is a very poor thing if
Governments cannot tell the truth. One has to acknowledge
that truth has not always been the essential component
of the NHS that it should be. I propose that the Government
give serious consideration to a statutory duty of candour,
because that is the best protection for those who use the
health service and for higher standards. The best protection
is that all of us believe in honesty in public life.
9.50 am
Tom Brake (Carshalton and Wallington) (LD): It is a
pleasure to serve under your chairmanship this morning,
Mr Gray. I congratulate my hon. Friend the Member