“You must be open and honest with patients if things go wrong. If a patient under your care has suffered harm or distress, you should: A. put matters right if that is possible; B. offer an apology; C. explain fully and promptly what has happened and the likely short-term and long-term effects.” (GMC Good Medical Practice, paragraph 55)
I am very glad that the Secretary of State has listened to reason and dropped plans for doctors to have a legal duty of candour to report poor care.
This requirement is already clearly defined by the GMC in GMP, and further enforced in the guidance, Raising and acting on concerns about patient safety (GMC March 2012). It is incumbent on all doctors to take this very seriously. But inevitably the various campaigning groups are furious preferring a big legal stick to hit us with.
Unfortunately they miss the obvious. If a doctor is behaving professionally then he or she will be conscientious in following the guidance. But if they are not behaving professionally or if there are other external pressures then they are unlikely to comply, even if there is a big legal stick!
When mistakes are made or things go wrong the natural human instinct is to cover up; this is as old as human nature. In the Garden of Eden, after things went wrong with the serpent, the story states that Adam and Eve came suddenly to the realisation that they were naked i.e. exposed. They then proceeded to cover their nakedness with fig leaves to try to hide their shame from God – a rather futile exercise! Whether or not you believe the Bible the psychology is spot on.
If doctors are found to be covering up, and the MPTS Fitness to Practise panel decision reports make very salutary reading, the consequences may be very severe indeed.
I know I am always banging on about targets and how much I hate them but command and control target-driven performance management does not work – it merely drives dysfunction and cheating into the system. And what is the point of putting a numerical value on a system (e.g. the four hour A&E target) when it has no relationship to actual outcomes? “A time measure should only be used where time is critical to the purpose”.* The outcomes for a visit to A&E are many and varied; how long you spend in the place is largely irrelevant to this.
St Paul in his thoughtful and eloquent letter to the Church in Rome sums up the problem perfectly.
In essence he states that a law or target, whether it is human or divine, can define the requirements, boundaries and limits of behaviour. It may also, to some extent, reduce and control wrongdoing. But what it cannot do is make people good; that requires a change of heart. The thirty miles per hour speed limit is a perfect example. We all know what the law states, but which one of us does not regularly exceed this provided there is no speed camera or policeman watching.
In the current NHS climate cover ups will continue, and individuals and organisations will search frantically for fig leaves when they are about to be exposed. Surely there must be a better way?
* J Seddon, Freedom from Command and Control, VanguardConsulting Ltd.