This week a BBC Panorama documentary revealed that some NHS trusts had not made public patient safety reports that had been written about their services.
The BBC received 80 reports and found that just 16 were in the public domain. Only 26 were shared with regulators.
In this article we look at the relationship between the NHS and transparency when it comes to problems with the medical services it provides, and the overriding principle of honesty which is supposed to govern the actions of trusts.
What is the ‘Duty of Candour’ and why is patient safety at the core of it?
The duty of candour is a statutory (legal) duty for NHS bodies to be open and honest with patients, or their carer or families, when something goes wrong that appears to have caused or could lead to significant harm in the future. This applies also to all health and social care organisation registered with the regulator, the Care Quality (CQC) Commission in England and was introduced in 2014 for NHS Bodies and April 2015 for all other organisations.
What does the ‘duty of candour’ cover?
There is an over-arching responsibility on the health and social care organisations to be open and transparent with the patient/their family. This statutory duty was introduced so that an organisation must tell you/your family about any incident where the care or treatment received may have gone wrong and appears to have caused harm, or it may have potential to result in significant harm in the future.
When will you be informed about an incident?
When something does go wrong, healthcare professionals must tell the patient (or their carer or family) what has happened with as much information as possible. This should happen as soon as reasonably practical after the incident is known about and should include as follows:
- Apology
- Followed by a written account and an apology
- Next steps: for example, safety measures that will be put in place
- Where you can get support
- Be kept up to date about an investigation and its outcome
How is the incident reported?
Since the introduction of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the NHS bodies have been legally required to act in an ‘open and transparent’ way with a patient or their family/carer if there is a ‘notifiable safety incident.’ These incidents can be unintended or intended that could result in, or appear to have resulted in:
- Death (not due to the ordinary course of the patient’s illness or condition);
- Moderate harm (e.g return to surgery, unplanned re-admission to hospital or extra time in hospital);
- Severe harm (described as a permanent lessening of bodily, sensory, motor, physiological or intellectual function. This includes, for instance, amputation, organ damage, brain damage and other serious harm);
- Prolonged psychological harm.
Patients must be told of such incidents regardless of whether anyone is at fault- it is the NHS bodies ‘duty’ to do so. A patient’s safety should be of paramount importance. The emphasis should be on being open with you if there is any doubt.
Organisations do not legally have to tell you about incidents that cause a ‘low level of harm’ or ‘near misses’ but it is good practice for them to be ‘open and transparent’ and to learn from all incidents.
What if an organisation fails to comply with the duty of candour?
If any organisation registered with the CQC fails to comply with the duty of candour, they could face regulatory action from the CQC and, in the most serious or persistent cases, even criminal prosecution.
