BMJ 2014;348:g2022 doi: 10.1136/bmj.g2022 (Published 7 March 2014)
Page 1 of 1
News
NEWS Hospitals and GPs must tell patients about incidents that cause “moderate” as well as “serious” harm, report says Clare Dyer BMJ
NHS healthcare providers in England should be obliged to tell patients of incidents that cause moderate harm, as well as those that result in serious harm or death, an expert review set up by the government has recommended.1
Jeremy Hunt, England’s health secretary, asked Norman Williams, president of the Royal College of Surgeons, and David Dalton, chief executive of Salford Royal NHS Foundation Trust, to look at how far the proposed new duty of candour should extend. A new obligation on organisations that provide care to tell patients when things go wrong was recommended by the public inquiry into systemic failures at Mid Staffordshire NHS Foundation Trust. Robert Francis QC’s report recommended that the duty should apply only to cases of serious harm or death,2 but patients’ groups lobbied for a more extensive duty.
Williams and Dalton said that the duty should apply to all cases of “significant” harm, which would correspond to the categories of moderate harm, severe harm, and death in the National Reporting and Learning System, which requires NHS providers to report adverse incidents. It would also cover harms currently reportable to the Care Quality Commission, the regulator of health and social care, and would include prolonged psychological harm.
It was “vital” that the duty apply to primary, community, and social care and not just to hospitals, said the authors of the review. To be effective, not just a duty but a culture of candour would be needed, with staff trained and supported to tell patients about unanticipated events and to apologise when appropriate. Patient safety incidents are known to be substantially underreported, and Williams and Dalton said that levels and accuracy of reporting must improve so that “information is used as the basis for organisational learning and not for criticism of individuals.” Organisations must “close the audit loop” by spreading and applying the lessons learnt and publicising them.
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Hunt also asked the review to consider sanctions to encourage organisations to be candid, including possible refusal by the NHS Litigation Authority to reimburse a hospital that breached its duty of candour if the incident later turned into a negligence claim. The review pointed out a number of disadvantages to this sanction and called for further consultation on the options. It said that the focus of any sanction should be the effect on the organisation’s reputation, which was likely to be a stronger force for change than adjustments to liability cover.
Williams said, “The evidence that we heard during the course of this review reaffirms what we already knew: that when things do go wrong, patients and their families want to be told honestly about what happened [and] how it might be corrected and [want] to know that it will not happen to someone else.
“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 their 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.” The patient safety charity Action against Medical Accidents welcomed the recommendation for a full duty of candour. Its chief executive, Peter Walsh, said, “It is unthinkable that the government will ignore this recommendation.” 1 2
Dalton D, Williams N. Building a culture of candour: a review of the threshold for the duty of candour and of the incentives for care organisations to be candid. Mar 2014. www. rcseng.ac.uk/policy/duty-of-candour-review. Dyer C. NHS must adopt a culture of “zero tolerance” for patient harm, Francis report says. BMJ 2013;346:f847.
Cite this as: BMJ 2014;348:g2022 © BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
News
NEWS Hospitals and GPs must tell patients about incidents that cause “moderate” as well as “serious” harm, report says Clare Dyer BMJ
NHS healthcare providers in England should be obliged to tell patients of incidents that cause moderate harm, as well as those that result in serious harm or death, an expert review set up by the government has recommended.1
Jeremy Hunt, England’s health secretary, asked Norman Williams, president of the Royal College of Surgeons, and David Dalton, chief executive of Salford Royal NHS Foundation Trust, to look at how far the proposed new duty of candour should extend. A new obligation on organisations that provide care to tell patients when things go wrong was recommended by the public inquiry into systemic failures at Mid Staffordshire NHS Foundation Trust. Robert Francis QC’s report recommended that the duty should apply only to cases of serious harm or death,2 but patients’ groups lobbied for a more extensive duty.
Williams and Dalton said that the duty should apply to all cases of “significant” harm, which would correspond to the categories of moderate harm, severe harm, and death in the National Reporting and Learning System, which requires NHS providers to report adverse incidents. It would also cover harms currently reportable to the Care Quality Commission, the regulator of health and social care, and would include prolonged psychological harm.
It was “vital” that the duty apply to primary, community, and social care and not just to hospitals, said the authors of the review. To be effective, not just a duty but a culture of candour would be needed, with staff trained and supported to tell patients about unanticipated events and to apologise when appropriate. Patient safety incidents are known to be substantially underreported, and Williams and Dalton said that levels and accuracy of reporting must improve so that “information is used as the basis for organisational learning and not for criticism of individuals.” Organisations must “close the audit loop” by spreading and applying the lessons learnt and publicising them.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Hunt also asked the review to consider sanctions to encourage organisations to be candid, including possible refusal by the NHS Litigation Authority to reimburse a hospital that breached its duty of candour if the incident later turned into a negligence claim. The review pointed out a number of disadvantages to this sanction and called for further consultation on the options. It said that the focus of any sanction should be the effect on the organisation’s reputation, which was likely to be a stronger force for change than adjustments to liability cover.
Williams said, “The evidence that we heard during the course of this review reaffirms what we already knew: that when things do go wrong, patients and their families want to be told honestly about what happened [and] how it might be corrected and [want] to know that it will not happen to someone else.
“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 their 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.” The patient safety charity Action against Medical Accidents welcomed the recommendation for a full duty of candour. Its chief executive, Peter Walsh, said, “It is unthinkable that the government will ignore this recommendation.” 1 2
Dalton D, Williams N. Building a culture of candour: a review of the threshold for the duty of candour and of the incentives for care organisations to be candid. Mar 2014. www. rcseng.ac.uk/policy/duty-of-candour-review. Dyer C. NHS must adopt a culture of “zero tolerance” for patient harm, Francis report says. BMJ 2013;346:f847.
Cite this as: BMJ 2014;348:g2022 © BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
