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‘Significant harm’ should trigger NHS candour

A new legal duty for openness by NHS organisations when mistakes have been made is unnecessary, a defence body warns.

A review – Building a Culture of Candour – by Sir David Dalton, Salford Royal’s CEO, and Professor Norman Williams, the RCS president, recommends that the threshold for telling patients when things go wrong should be where there has been ‘significant harm’.

It would encompass moderate and serious harm and death as currently defined by National Reporting and Learning System criteria for categorising patient safety incidents.

But the MDU says that to avoid confusion, the threshold should mirror doctors’ current professional duties, and any new legal duty needs to be clearly understood by doctors and patients.

Dr Michael Devlin, Head of Professional Standards and Liaison at the MDU, said: “We do not see the need for a statutory duty of candour on organisations like hospitals and GP practices, because doctors already have a clear ethical duty to tell patients when things go wrong, to apologise, and to put matters right where that is possible.

“However, if such a duty was introduced, the threshold for telling patients when things go wrong should mirror the professional duties that already apply and are understood by doctors. This would have the advantage of clarity and simplicity as doctors would not have to spend any time trying to work out if an incident had reached the threshold.”

The review, commissioned by the Health Secretary in the wake of Mid Staffs, says candour cannot be an ‘add on’ or a matter of compliance; it can only be effective as part of a wider commitment to safety, learning and improvement.

This will require a considerable commitment to supporting staff through induction, training, and processes of review and implies inculcating a ‘just culture’ focused on learning and improvement and avoiding the temptations of defensiveness and blame.

The review recommends that the levels and accuracy of reporting patient safety incidents are improved so that this information is used as the basis for organisational learning and not for criticism of individuals.

It says the ‘audit loop’ needs closing with lessons learned being spread and applied into practice and publicly reported on.

The focus of any sanctions on organisations found to be in breach of the duty should have impact on the provider’s reputation, it finds.

It says national organisations, like the NHS Litigation Authority, the Care Quality Commission and NHS England, should share intelligence about breaches of the duty of candour; incentivise candid behaviour by organisations through co-ordinated action; and, levy any financial sanctions on organisations who fail to be candid.

The MDU’s advice to doctor members remains unchanged and includes: following GMC advice in telling patients when things go wrong and a patient is harmed or distressed; putting matters right, if that is possible; offering an apology; and explain fully and promptly what has happened and the likely short-term and long-term effects.

The defence body also advises that doctors should be familiar with and follow their organisation’s reporting procedures for patient safety incidents.

Read the review.

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One Response to “‘Significant harm’ should trigger NHS candour”

  1. Malcolm Morrison says:

    Well said Dr Devlin! We don’t need MORE law in medicine – there is too much already! Professional ethics already define what should be done and when.

    The problem with ‘Mid Staffs’ was that ‘management’ was allowed to impose a ‘culture’ where financial targets took priority over clinical care – and those who tried to ‘speak out’ against it were ‘silenced’!

    It is the duty of ALL doctors to draw attention to situations where patients are put in danger or where their care is jeopardised.

    Maybe it would ‘concentrate the minds’ of LAY people (particularly CEOs and Trust Chairmen) if they were held PERSONALLY responsible for any failing of their ‘systems’!

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