here - United Kingdom Parliament

277WH
Candour in Health Care
1 DECEMBER 2010
Candour in Health Care
278WH
Tom Brake: I thank my hon. Friend for his intervention,
and I entirely agree. A duty of candour must not be
restricted simply to hospitals, because, as he rightly
says, GPs in primary care and other health care providers
regrettably also make mistakes. A duty would need to
encompass more than simply hospitals, as was initially
proposed in the coalition agreement.
I entirely support the points that my hon. Friend the
Member for Poole made in opening the debate. There is
strong, overwhelming evidence in support of a duty of
candour. Guidance has not done the job, and a duty
of candour really would open up the system and make
sure that families and those who have suffered are, and
know they are, entitled to receive information about an
accident. That would make it much easier for them to
arrive at closure. Regrettably, under the current system,
people must all too often use great energy and perseverance
to extract with great difficulty information that they
should be entitled to from the outset.
10 am
Dr John Pugh (Southport) (LD): I thank the hon.
Member for Poole (Mr Syms) for introducing this important
and timely debate and for putting the Government’s
dilemma so succinctly and accurately. I also pay tribute
to my hon. Friend the Member for Carshalton and
Wallington (Tom Brake), who has done as much as
anybody in this place to raise the issues of a duty of
candour and patient rights.
I do not know whether anybody caught Ian Hislop’s
programme about do-gooders on the BBC this week,
but in it he described the creation of the journal The
Lancet. It was set up by a young doctor, who, among
other things, wished to expose some of the deficiencies
in the appalling surgical practices at that time. He was
greeted with wholesale acrimony from much of the
medical profession and he was successfully sued. That
shows that there is resistance in most businesses and
professions to acknowledging error.
In an excellent book published some time ago, the
sociologist Erving Goffman suggested that people in all
organisations—whether in health, business, teaching or
policing—have a vested interest in supporting their
colleagues, playing as part of a team and working
together to minimise the reputational loss that their
organisation can suffer. He analysed in particular detail
how that can happen in health services right across the
world, although it must be said that such things do not
always happen for bad reasons. People have duties of
loyalty to colleagues and a genuine concern for the
organisation to which they belong—for its reputation
and, where admitting to errors might seriously imperil
it, for its very survival.
People inside organisations often recognise that mistakes
will happen in their organisations. I have worked in the
teaching profession all my life, and I have not always
been very overt about my colleagues’ deficiencies, even
when that sometimes has involved people suffering from
alcoholic intoxication when they should not. There are
therefore circumstances in which people cover up. There
is also probably a belief in many organisations that the
internal resolution of problems is the best way to proceed.
However, there is a huge downside; confidence is
eroded by simply taking such a path. Worse still, false
confidence persists; in other words, there are palpable
and demonstrable errors in organisations, but nobody
finds out about them until it is too late. Errors remain
uncorrected, and poor performance is undeterred or, in
some cases, it worsens.
That is where the duty of candour fits in, because it
will, on a voluntary or simply a request basis, lessen the
problems. There is an enormous amount of evidence
not only that patients want the NHS to be candid with
them, but that the NHS finds it hard to be candid. The
Department of Health itself spoke of a culture of
denial in the NHS—denial about error and, more seriously,
about negligence.
No one believes that things will necessarily improve if
nothing is done. No willing provider entering the frame
will find it easier to be more candid than NHS organisations;
in fact, they might have other motives for covering up.
They might be answerable to others apart from members
of the public, such as shareholders and the like. There is
therefore a genuine concern to get things right.
Every Member of the House of Commons has probably
come across a case, or several cases, where they feel that
things have gone badly wrong. In my intervention on
my hon. Friend the Member for Carshalton and Wallington,
I mentioned primary care. A young man in my
constituency—he was a relative of a friend of my
daughter’s—went to his GP five times to complain of
listlessness, a lack of energy and so on. He was brushed
off with suggestions that he needed more rest and less
stress. He was told that he perhaps had glandular fever,
but no blood test was done. Eventually, when one was
done, it was discovered that he had late-stage leukaemia.
My children attended his funeral. That clearly was a
failing.
I am also familiar with the ongoing case in my
constituency of a TV soap star with a disabling condition
that was brought on by receiving the wrong diagnosis
and the wrong treatment. Similarly, I had the long-running
case of a lorry driver with severe hypertension who was
prescribed Viagra for other complaints, even though
Viagra increases blood pressure. The thought of a lorry
driver being prescribed a drug that can imperil not only
him but members of the public is quite disturbing.
A woman in my constituency was falsely diagnosed
with cancer and treated for it until, on the spur of the
moment, she decided to request a check of the X-rays.
Staff then found that the X-rays that they had been
using, and which they had assumed were correct, were
those of another person. That woman had spent a year
in absolutely harrowing circumstances. More disturbingly,
we do not know whose X-rays were assigned to her.
Presumably, that person was not given the treatment
that this woman was wrongly given.
Each of those cases leads to a prolonged complaints
procedure, involving the ombudsman and the Care
Quality Commission. In other cases, as other Members
have indicated, there have been accusations that records
have been altered. The whole process is inordinately
cumbersome and difficult. To some extent, it exists
because there is no candour where candour would
probably be the solution.
On top of that, there are the systemic failures—the
Mid Staffordshires, the Bristol heart babies and so on.
To be fair, the Government recognise that this all comes
with the territory of running the modern health service,
and they are, to some extent, endeavouring to deal with