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283WH<br />
Candour in Health Care<br />
1 DECEMBER 2010<br />
Candour in Health Care<br />
284WH<br />
[Liz Kendall]<br />
the hon. Member for Poole (Mr Syms)—“get at the<br />
truth”, which, so often, is the start of the healing<br />
process.<br />
Last week, I went to a meeting at the University<br />
Hospitals Leicester NHS Trust with two of my constituents,<br />
Mr and Mrs Harkisan-Hall, who lost their son in the<br />
hospital’s neo-natal unit. It was only at the coroner’s<br />
inquiry that they found out that the two qualified<br />
nurses on the unit were both on a break at the same<br />
time, leaving a nursery nurse in charge of very vulnerable<br />
children. They felt that they had to battle to get that<br />
information, and they still have not seen the full reports<br />
of what the staff said. Like them, I believe that that is<br />
unacceptable.<br />
Mr Syms: The hon. Lady makes a good point. One<br />
point that I meant to make was that if people do not<br />
hear what has happened, coroners can find it difficult to<br />
determine how someone has died. If people are not<br />
honest about what has happened to a particular individual,<br />
coroners do not have the full information.<br />
Liz Kendall: In this particular case, interviews were<br />
conducted with the two qualified nurses. The trust did<br />
not read both transcripts together and did not see that<br />
both nurses were on a break at the same time. People<br />
are astonished that such simple things happen, and it is<br />
vital that we learn from this process.<br />
Before I go on to talk about the duty of candour, I<br />
want to discuss two concerns about the Government’s<br />
policy in relation to patient safety. It is important that<br />
hon. Members do not look just at the duty of candour<br />
in isolation from what is going on in the rest of the<br />
NHS, including on patient safety. My first concern is<br />
the Department of Health’s decision to abolish the<br />
National Patient Safety Agency and to move responsibility<br />
for this issue to the new national NHS Commissioning<br />
Board. T<strong>here</strong> are real concerns about whether the<br />
board will have the necessary skills, experience and time<br />
to focus on such a vital issue when it will also be<br />
responsible for setting NHS outcomes, assessing whether<br />
GP consortiums are delivering on those outcomes,<br />
commissioning a whole range of specialist services and<br />
managing contracts for all primary medical services.<br />
That is a huge agenda for any board, even without<br />
adding responsibility for patient safety.<br />
Will the Minister tell us what resources and how<br />
many staff from the NPSA will be transferred to the<br />
NHS Commissioning Board? Which NPSA activities<br />
will the board take on? For example, will NPSA continue<br />
to publish patient safety alerts and bulletins and other<br />
guidance to identify key problems and help spread best<br />
practice? Will it also run workshops with leads for<br />
patient safety in individual providers, such as those I<br />
was involved with in the Ambulance Service Network?<br />
Will the national Patient Safety First Campaign, which<br />
was launched last year, and the annual patient safety<br />
week, which was held early this month, have the staff<br />
and resources to continue?<br />
My second concern relates to the Government’s<br />
reorganisation of the NHS and fact that the service<br />
needs to make efficiency savings worth some £20 billion<br />
over the next three years, as the NHS chief executive<br />
said. The first report on adverse incidents in the NHS<br />
was drawn up by Sir Liam Donaldson in 2000. Its key<br />
recommendation was that the NHS must be open and<br />
honest and learn from its experiences. To do that, the<br />
NHS must become, as the report’s title suggests, “An<br />
organisation with a memory”. But the Government<br />
plan to abolish many of the very organisations that<br />
have worked hard to build this memory and understanding<br />
of how to improve patient safety.<br />
If the NHS has to make efficiency savings worth<br />
some £20 billion, t<strong>here</strong> will inevitably be job losses and<br />
posts frozen, some of which could include those staff<br />
who have worked hard to learn lessons from the mistakes<br />
that have been made in the NHS. How will the Minister<br />
ensure that the NHS retains its “memory” on patient<br />
safety when PCTs and strategic health authorities are<br />
being abolished, new GP consortiums are being established,<br />
community services are being transferred to different<br />
providers and staff posts are being frozen and reduced?<br />
In particular, what steps has she taken to ensure that<br />
managers and front-line staff who have knowledge and<br />
expertise in patient safety are retained in the NHS at a<br />
time when the Government want to cut management<br />
costs by 45% and make efficiency savings of £20 billion?<br />
Finally, I want to talk about the duty of candour. As<br />
hon. Members have said, the introduction of a statutory<br />
duty of candour was first recommended by Sir Liam<br />
Donaldson in his 2003 report, “Making Amends”. I<br />
agree with hon. Members that t<strong>here</strong> is a strong case to<br />
look again at this issue, as a Health Committee report<br />
recommended in 2009.<br />
I think that it was the hon. Member for Carshalton<br />
and Wallington who said that too often the debate is<br />
split between those who want a statutory duty of candour<br />
and those who think the NHS should instead focus on<br />
creating a culture of candour. Of course, changing the<br />
practice of individual staff and organisations does not<br />
require legislation, but I think that we can see from<br />
existing laws, such as those that helped to reduce drinkdriving,<br />
those that introduced the smoking ban and<br />
others, that legislation often plays a vital role in changing<br />
culture and behaviour.<br />
Some professional bodies are concerned that a duty<br />
of candour would make it less likely that incidents<br />
would be reported. I am not convinced that that would<br />
be the case, particularly if the duty is combined with an:<br />
“exemption from disciplinary action for those reporting adverse<br />
events or medical errors—except w<strong>here</strong> t<strong>here</strong> is a criminal offence<br />
or w<strong>here</strong> it would not be safe for the professional to continue to<br />
treat patients”.<br />
That was the recommendation of Sir Liam Donaldson<br />
back in 2003.<br />
Others question whether a statutory duty could be<br />
imposed when it might be difficult to specify or enforce<br />
sanctions. That concern has not prevented other parts<br />
of the world from introducing legal duties, including<br />
some US states, Sweden, France and Denmark. It is<br />
also worth noting that the Equality Act 2010, which<br />
was introduced by the last Government, imposes a<br />
number of legal duties on public bodies to consider the<br />
impact of their policies and decisions on different groups,<br />
without specifying what the sanctions will be if those<br />
duties are not complied with.<br />
The final argument against a statutory duty of candour<br />
is that patients might end up trusting professionals less,<br />
because they have to report a mistake rather than