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281WH
Candour in Health Care
1 DECEMBER 2010
Candour in Health Care
282WH
among the parties as to the merits of that legislation.
The idea was that complaint costs would reduce if we
had an open policy of admitting errors, patients
surrendering none of their legal rights but simply being
given the apology and the explanation that they wanted.
As the hon. Member for Poole said, people who wish
to pursue a complaint against the NHS if they believe
that their treatment has gone wrong are not looking for
money. They are looking not only for an explanation
and an apology; they are looking for an assurance that
whatever happened to them or their relative will not
happen to others.
Prior to the NHS Redress Act 2006, we looked hard
at the costs of litigation in the NHS. Yes, it cost the
NHS a lot of money; and, yes, something could have
been done to reduce it. The really depressing thing,
however, was that the bulk of the money went into the
lawyers’ pockets on either side. The NHS is not about
helping to boost lawyers’ profits.
The 2006 Act seemed to offer an alternative to litigation,
which everyone would support, but the nagging fear in
the Department of Health was that it would become
a platform for litigation—that if someone admitted a
fault it might be a sound basis for taking legal action.
Are those fears well grounded? I believe that we do not
precisely know, but we all have our own feelings on the
subject. People cite the Michigan case in the United
States, where they went outright for a duty of candour,
and litigation costs to the health service have declined.
The duty of candour is not something that can be
piloted, and once it has been done one cannot withdraw
it. To go ahead with it is almost an act of faith. I am
very keen on the concept of evidence-led policy, but I
see evidence-led policy debates taking place in the
Department of Health. If we go ahead with a statutory
duty of candour—and I firmly believe that we should—it
will be a statement about what sort of NHS we want.
I conclude by quoting Sir Liam Donaldson, the former
chief medical officer for England. He said,
“To err is human, to cover up is unforgivable”.
Regardless of the risks, I doubt whether the Government
want to do what is unforgivable.
10.19 am
Liz Kendall (Leicester West) (Lab): It is a pleasure to
serve under your chairmanship, Mr Gray. Every 36
hours, NHS services are used by some 1 million people,
the vast majority of whom receive safe and effective
care. None the less, as in every other health care system
in the world, not all care in the NHS is as safe as it could
be, and too many patients are harmed by it, sometimes
seriously and even fatally.
Modern health services are delivered in a highly
complex, often pressurised, environment, and involve
the care of many vulnerable and seriously ill patients.
More than any other environment in which risks occur,
health care is reliant on people taking difficult decisions
that rely on judgments that are not always straightforward
or clear cut. In such circumstances, things can and do
go wrong. Sometimes, as I know from my own experience,
the consequences can be very serious for the patient,
their family and their carers.
Patients and their families have a right to know if
something has gone wrong, to get an explanation of
what has happened and to receive an apology and,
if appropriate, compensation. As hon. Members have
mentioned, it is also vital that professionals and NHS
organisations learn lessons from mistakes to improve
care for patients and, wherever possible, to save taxpayers’
money by reducing the cost to the NHS from clinical
negligence claims.
During the past decade, important progress has been
made on improving patient safety in the NHS. Last
year, the Health Committee’s report on patient safety
acknowledged that the previous Government became
one of the first in the world to make it a priority to
address patient safety across the whole health care
system. A unified system for reporting incidents and
learning from them was introduced, and it was centred
on the national reporting and learning system and the
National Patient Safety Agency. The creation of this
system was, in a large part, down to the pioneering
work of Sir Liam Donaldson, and I should like to pay
tribute to him for his work on this vital issue.
Since the establishment of the data reporting system,
the number of reported incidents has increased significantly,
which is a good thing. At the last count, more than
3 million incidents had been reported, ranging from
very minor incidents to the more serious ones. The
NPSA has worked hard to improve patient safety, both
nationally and within individual NHS trusts. I personally
experienced such work when I was director of the
Ambulance Service Network at the NHS Confederation.
We set up a programme of work, with patient safety
leads in ambulance service trusts, front-line paramedics,
PCT commissioners of ambulance services and the
NPSA to identify the particular areas of care where
mistakes were being made—it is often in the handover
period—and to share best practice to prevent such
mistakes.
I question some of the comments that have been
made this morning about managers wanting to cover up
problems. In my experience, both managers and
professionals have difficulties in blowing the whistle on
their colleagues. I just want to put it on the record that
the ones that I have worked with have wanted to be
open and to learn the lessons.
My experience has shown me that the NHS needs to
do more to improve patient safety. As identified by the
Health Committee’s report and Ara Darzi’s next stage
review, there is still huge under-reporting across the
system, because, as hon. Members have said, there is
too often a “blame culture” in the NHS.
I agree with the hon. Member for Carshalton and
Wallington (Tom Brake) that this is not just an issue
about hospitals. Primary care, which accounts for 95%
of patient contacts with the NHS, accounts for only
0.25% of reported incidents. Although substantial progress
has been made, patient safety is still not always a top
priority for NHS boards. Most importantly, patients
still too often feel that the NHS is not genuinely open
and honest with them when a mistake is made.
In 2005, the National Audit Office’s 2005 report, “A
safer place for patients” found that only 25% of NHS
trusts routinely inform patients when an incident has
taken place, and an astonishing 6% admit to never
informing patients. Like other hon. Members, I have
seen such practice in my own constituency. Patients feel
that mistakes are not promptly or openly admitted to
and they have to battle the system to—in the words of