here - United Kingdom Parliament

289WH
Candour in Health Care
1 DECEMBER 2010
Candour in Health Care
290WH
mentioned his constituents the Byes and the Powells,
who have campaigned endlessly for the truth and continue
to campaign. I pay tribute to all the people, some of
whom we do not know about, who use their own tragic
circumstances to ensure that the same thing does not
happen to others. Their efforts should never be
underestimated.
Tom Brake: The Minister said that the NHS sometimes
adopts an aggressive stance. I remind her of my question
to her about the possible impact of withdrawing legal
aid in clinical negligence cases. Often, families use such
cases as a way of trying to secure an apology because
one has not been forthcoming. If that option is not
available to them, it reinforces the need for a duty of
candour.
Anne Milton: The hon. Gentleman pre-empts me by a
second; I was about to come to legal aid. My experience
is that even with legal aid, the courts are rarely an
option for most people. Allowing discretion on the
reporting of near misses would, I fear, open another
minefield beyond which people could hide, as he also
mentioned.
I have certainly brokered meetings between NHS
organisations and my constituents to try to bring them
together and make the NHS organisations stop feeling
so defensive. I have been an advocate for people in my
constituency just so they could hear what happened. I
should think that many hon. Members rely on personal
relationships, particularly within hospital trusts, for
such purposes. Maybe they know a supportive medical
director to whom they can say, “Look, this family, this
couple or these relatives just want to know what happened;
this isn’t going to go anywhere.” That is a leap of faith.
The NHS organisation has to say, “Fair enough”. When
that happens, closure can follow.
The hon. Member for Southport rightly pointed out
that accidents occur across the NHS and mentioned, in
particular, the failure to diagnose in general practice.
That is an ongoing, rumbling issue that I hear about not
only as a constituency MP, but as a Minister. I thank
him for recognising that the solution to getting to a
situation where we have effective measures in place to
ensure candour is a dilemma. It is not an easy decision.
He is also right to point out that the NHS is not alone in
protecting itself. My goodness me, we know a lot of
professions that close their doors when one of their
members is under attack—the legal profession is one.
People just want the truth, but sadly the shutters go
down and the doors close, and closure cannot be achieved.
Mr Syms: I am pleased with the way the Minister is
responding to the debate and recognise that a statutory
duty of candour is one of a range of measures that the
Government are considering. However, if they decide
not to take that route initially, it is important that they
do not rule it out, because the culture change that is
needed might not come about as a result of what they
are doing, but we will still need to get there at some
point. I still think that a statutory duty of candour
would be the biggest and most successful leap towards
that goal—the hon. Member for Carshalton and Wallington
made a good point on that—but even if the Government
choose not to go there, they should not rule it out,
because I think that ultimately that is where we will
end up.
Anne Milton: I thank my hon. Friend for his intervention
and am sure that the report of this debate will aid
people in making their decisions on the matter.
On the point raised by the hon. Member for Carshalton
and Wallington on legal aid, I understand that the
Ministry of Justice proposal on restructuring and refocusing
the scope of legal aid is currently out for consultation.
There will still be an exceptional funding route for those
not eligible for legal aid, but he might want to raise that
specific point with the MOJ because it is important.
The hon. Member for Southport rightly picked up on
the fact that we included in the White Paper the principle
of “No decision should about me, without me”, and
that probably needs to be extended to situation where
harm happens.
A few Members mentioned international precedents,
but we must be slightly careful, because what happens
abroad cannot necessarily be transported to this country.
Those precedents tell us that there can be problems in
adopting a statutory duty of candour. It can be difficult
to measure success and, therefore, find any evidence of
where success or failure has occurred. We must also be
mindful of the differing health care and legislative
environments that exist around the world when looking
at international examples. In Pennsylvania, for example,
we have been told that a complicated set of requirements
makes enforcing its version of a statutory duty particularly
problematic.
In conclusion, there are complex issues at play in
relation to a statutory duty of candour, and views are
held on both sides of the argument for and against such
a duty. What we can say, as has been documented in the
White Paper, is that we are absolutely set on achieving
that change in culture to achieve openness and candour
in the NHS and all organisations that provide care. We
are exploring those complex issues carefully. The culture
of secrecy and denial is a disease that needs to be cured,
but to do so we need to understand and treat its causes
at their source, rather than simply treating the symptoms
with an ineffective plaster.
As my hon. Friend the Member for Poole stated, the
start of the healing process is about learning the truth.
The Government will need to decide how we can provide
the environment, with or without legislation, in which
the truth can come out immediately—in a timely fashion—
and openly. We need inspirational leadership and highly
developed management skills in our NHS leaders to
create that change in culture to create an open atmosphere
among staff, not the closed culture that we have seen.
We need a culture that replaces the fear of the consequences
of openness with the courage to recognise that openness,
honesty and truth will, ultimately, not only give families
what they need to heal their wounds and achieve closure,
but allow staff to learn from their mistakes, raise their
standards and raise the bar on their professional standards.
The Government will consider all that when making
the decision, but Members should rest assured that
everything that has been said today and all the effort to
highlight the issue will be taken in account to ensure
that we get the right system in place to give people what
works.
10.55 am
Sitting suspended.