UK government wants to expand duty of candour

BMJ 2013; 347 doi: (Published 20 November 2013) Cite this as: BMJ 2013;347:f6972
  1. Clare Dyer
  1. 1BMJ

The UK government may enlarge its proposed new statutory duty of candour for institutions providing NHS healthcare in England, after representations from patient safety campaigners.

Ministers are asking the advice of experts on whether hospitals should be required to tell patients or their relatives that something has gone wrong if the harm was only moderate. Campaigners criticised the original proposal for the duty to cover only cases of death or serious harm.

The rethink has emerged as the health secretary for England, Jeremy Hunt, unveiled the government’s response to the report of the public inquiry into failings at Mid Staffordshire NHS Foundation Trust.1 Hunt said that he had listened to campaigners such as Peter Walsh, chief executive of Action against Medical Accidents, but was also taking expert advice to try to ensure that there would be no unintended consequences if cases of moderate harm were included.

Robert Francis QC, who chaired the Mid Staffordshire inquiry, had recommended such a duty in cases only of death or serious harm. Francis, who joined ministers at a press briefing on the government’s response, said that he had been concerned that making the duty so wide might obstruct, rather than increase, candour.

Walsh said, “We are grateful to Mr Hunt for listening to our concerns and agreeing to reconsider this controversial policy, but frankly we are dismayed that he needs any more time to think about it.”

The government has accepted 281 of Francis’s 290 recommendations for a move to a culture of openness that puts patient safety first. Hunt said that ministers had been influenced by the example of the airline industry, which had created a culture “where the norm is to report.”

He announced that the government would consult on a proposal that a hospital trust that had not been open with a patient who then made a negligence claim could lose all or part of its indemnity cover for that claim, creating a strong financial incentive to be candid.

Alongside the government’s moves, the General Medical Council and other professional regulators plan to introduce a more “explicit and consistent” professional duty of candour. This would make clear the requirement to be open with patients and families about incidents of avoidable harm, whether the incident was serious or not, and about “near misses.”

If an incident did lead to fitness to practise proceedings by the GMC, speaking up quickly would be a mitigating factor at the conduct hearing.

New GMC guidance would also make it clear that obstructing colleagues in being candid was a breach of professional codes. Francis recommended that it be made a criminal offence for a doctor, nurse, or director of a healthcare organisation to fail to provide information to a patient or nearest relative, obstruct another in providing information, or make an untrue statement to a commissioner or regulator, but the government has decided not to follow this recommendation. It will, however, become a criminal offence for organisations, managers, or clinicians to wilfully neglect or mistreat patients.

Low numbers of nurses on wards were a major factor in the poor care of patients at Mid Staffordshire, the Francis inquiry found. But ministers have resisted calls for defined staffing ratios on wards, arguing that different types of ward needed different ratios and skills mixes.

The National Institute for Health and Care Excellence will review the evidence and give guidance on safe and efficient staffing levels. From next April all hospitals will publish staffing levels on a ward by ward basis, together with the proportion of shifts meeting safe staffing guidelines.

A new national safety website will publish all the information relevant to safety in every hospital in the country on a monthly basis.

Mark Porter, the BMA’s chairman of council, said, “Doctors play a vital leadership role across the NHS in driving forward change, and we hope that doctors will be given a real voice in helping to meet the challenges the NHS faces in becoming an organisation that truly listens to both its patients and staff.”


Cite this as: BMJ 2013;347:f6972


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