An independent review has concluded that healthcare organisations, including hospitals and GP practices, need to embrace a new culture of candour so that patients and their families are told honestly about any harm that has been caused and what will be done to put it right,.
Health Secretary Jeremy Hunt asked Professor Norman Williams, president of the Royal College of Surgeons, and Sir David Dalton, chief executive at Salford Royal NHS Foundation Trust, to undertake a review on how to enhance candour in the NHS. The group was asked to examine the threshold at which a new statutory duty of candour should apply to organisations, and how they can be incentivised to be more open and honest. The central recommendation is that the old days, where errors were not disclosed, must give way to an environment that allows staff to be trained and supported in admitting errors, reporting them and learning from mistakes. The report states that being open is not an addon or a matter of compliance. Patients and their families want to know that when things do go wrong not only is every effort made to put them right for them, but every effort is made to prevent similar incidents happening again to somebody else. The group took evidence on a range of issues relating to candour and openness. The review was asked to look at whether the threshold for organisations reporting harm should be set to include moderate harm to patients, as well as death or serious injury. Healthcare professionals are already required to disclose harm to patients when things go wrong. The new duty of candour applies to providers of healthcare registered with the Care Quality Commission (CQC) and not to individuals. The review concluded that the new duty should include ‘moderate’ harm, as defined under the NHS’s existing National Learning and Reporting System (NRLS). This would include incidents that do not cause permanent harm, but which most patients would regard as ‘significant’ events. It recommends that a new category of ‘significant harm’, corresponding to the current ‘moderate, severe and death’ NRLS standards, should be created, with incidents notifiable to the CQC. This should be broadened to include prolonged psychological harm. The report also makes recommendations for what should happen when an organisation breaches its duty of candour. Prof Williams, said: “The evidence that we heard during the course of this review reaffirms that when things do go wrong, patients and their families want to be told honestly about what happened, how it might be corrected and to know that it will not happen to someone else. Medical care is inherently risky and staff are not infallible. Errors will always be made and clinical staff will always find themselves in the position of having to discuss harm, or potential harm, with a patient. “A willingness to be open with patients must also include honesty about organisational problems that may have contributed to harm, such as losing notes, problems with discharging patients or poor management of resources. What matters is for organisations to support staff to be honest about those errors, learn from them, apologise when it’s the right thing to do and then improve the care and treatment in order to minimise harm in the future.”
