here - United Kingdom Parliament

285WH
Candour in Health Care
1 DECEMBER 2010
Candour in Health Care
286WH
because they want to. I think that the far greater risk for
doctor-patient trust is the perception, and too often the
reality, that professionals do not tell patients when
things go wrong. I know that if a mistake was made in
my own care, or in the care of one of my family or
friends, I would want to know—and indeed I believe
that I have the right to know.
To conclude, I think that the NHS has made important
progress on improving patient safety and it has started
to try to change its culture, to become more open and
honest. However, the evidence shows and hon. Members
have clearly demonstrated in this debate that the NHS is
still not as open as it should be, not only with its own
staff, but—crucially—with patients. The abolition of
the NPSA, the huge reorganisation that the NHS is
about to undergo and the future cuts in numbers of
staff actually make a stronger case for having a duty of
candour in place.
The White Paper, “Liberating the NHS”, says that
the Government will:
“require hospitals to be open about mistakes and always tell the
patient when something has gone wrong”.
It also says that that requirement will be implemented
by summer 2011. So I just want to ask the Minister to
clarify if that means that the Government are proposing
a statutory duty of candour? Also, will she now agree to
bring together patient groups, professional bodies, experts
on the duty of candour in this country and abroad, as
well as those who represent NHS trusts—such as the
NHS Confederation—to discuss how we can all best
move forward on this vital issue?
10.34 am
The Parliamentary Under-Secretary of State for Health
(Anne Milton): Thank you very much, Mr Gray. It is a
pleasure to serve under your chairmanship for the first
time. I also want to congratulate my hon. Friend the
Member for Poole (Mr Syms) on securing this debate.
As Chairman of the Regulatory Reform Committee, he
is no doubt acutely aware of some of the issues that
exist around regulation, not least those that exist around
the duty of candour. His humility and recognition of
the impossible task that we face here today—to truly
reflect the pain and suffering of those who have suffered
as a result of medical harm—does him considerable
credit.
We take candour and openness in the NHS extremely
seriously. Everybody does, because it is a vital issue. As
anyone who has ever been treated knows, a health care
system is not just about how quickly someone is seen or
how quickly their stitches come out; it is also about
trust. Trust is fundamental—between patients, the patient’s
family and health care professionals—and we must do
everything we can to ensure that that trust is upheld.
As the hon. Gentleman may be aware, one of the
early references to a statutory “duty of candour” was
included in “Making Amends”, a 2003 report, which I
know hon. Members have referred to. It was a consultation
paper from the then chief medical officer, Liam Donaldson,
and it set out proposals for reforming the approach to
clinical negligence in the NHS, suggesting
“a duty of candour requiring clinicians and health service managers
to inform patients about actions which have resulted in harm”.
The paper also proposed to foster an environment of
openness and honesty among all NHS staff; it encouraged
“integrity”, which is a word that we perhaps do not use
often enough, and it proposed exempting those who
report adverse events or medical errors from disciplinary
action, unless there are serious extenuating circumstances.
It is a key belief of the coalition, and I would hope all
Members of the House, that the focus should be on the
performance of the organisation rather than on penalising
individuals who bring matters of concern out into the
open. The hon. Member for Southport (Dr Pugh) has
already mentioned whistleblowing. I think that the point
is that this debate is not necessarily about the protection
of whistleblowers or a right to whistleblow; it is perhaps
about a duty to whistleblow.
It is important to note the good work that is currently
being done to promote candour. The previous Government
should be congratulated for providing staff with advice
and support to help them to communicate with patients,
their families and carers following harmful incidents.
The Health Act 2009 requires all NHS organisations to
be aware of the NHS constitution, which places a duty
on NHS staff to acknowledge mistakes, apologise for
them, explain what happened and put things right. The
professional codes of practice for doctors and nurses
contain a similar duty.
As somebody who trained as a nurse and worked in
the NHS for 25 years, I think that professional codes of
practice and professional standards are not talked about
often enough. We look for someone to blame: we look
for the organisation to blame; we look for the board to
blame, and we look for the chief executive to blame.
What we do not talk about is individual professional
standards and I feel particularly strongly that we need
to do everything that we can to raise those standards
right up.
The National Patient Safety Agency has been running
its own campaign to promote candour in the NHS, as
the hon. Member for Leicester West (Liz Kendall) said.
That campaign, entitled “Being Open”, is a long-term
process rather than a short-term push. It encourages
the provision of verbal and written apologies to patients,
their families and carers; it promotes continual
communication with those involved in incidents, and it
requires thorough record-keeping of all “Being Open”
discussions and documents.
However, we all know that still more needs to be
done, as hon. Members have said and as I know myself
from my own constituency casework; I have a number
of people who have continually fought to try to get the
truth about what happened to their relatives. The recent
White Paper, “Liberating the NHS”, states that
“we will require hospitals to be open about mistakes, and always
tell patients if something has gone wrong”.
It is quite simple: we expect the NHS to admit to errors;
apologise to those affected, and ensure that lessons are
learned to prevent errors from being repeated.
In one year, the NPSA receives notification of more
than one million incidents. Most of those incidents
result in no harm and we welcome the high level of
reporting. However, the incidents that result in harm
obviously cause distress and anguish for the patients
and families involved. In those cases, it is even more
important that the lessons are learned and that organisations
are open with those who have been affected.
Dr Pugh: I want to ask about the future of the NPSA.
If it is going to be brought within the national
commissioning body, will a Chinese wall be established