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Clinicians 'must say sorry for errors', says Hunt

Doctors and nurses should be honest when things go wrong and “say sorry” to patients, according to the health secretary.

New guidance has been issued to hospitals that Jeremy Hunt hopes will help end the “closed and defensive culture” in parts of the NHS.

“We want to see an open NHS culture that focuses on safety and learns when things go wrong,” he told the Daily Telegraph.

“Saying sorry and supporting patients and their families when they have experienced harm is a really important part of this. It’s great to see staff being supported to do the right thing.

“Sadly, under the last government a closed and defensive culture developed in parts of the NHS. We are transforming this culture through a new transparency drive in our hospitals.”

The guidance sent to every hospital in England and Wales by the NHS Litigation Authority suggests staff are reluctant to apologise because they fear admitting legal liability or making the situation worse.

However, the four-page leaflet makes clear that “saying sorry is the right thing to do” in all circumstances when there are failures of patient care.

“Poor communication may make it more likely that the patient will pursue a complaint or claim,” it says.

“It is important not to delay giving a meaningful apology for any reason. It is also essential that any information given is based solely on the facts known at the time.

“Healthcare professionals should expect explain that new information may emerge as an investigation is undertaken, and that patients, their families and carers will be kept up to date with the progress of the investigation.”

Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “The NHS Litigation Authority is right to remind NHS staff that it is ok to say sorry, however in too many trusts there is an organisational culture which makes staff feel like they will not be supported when they do this.

“The vast majority of NHS staff aim to provide the best possible care to every patient and when this does not happen they naturally want to apologise and learn from the experience,” he said.

“We now need leadership across the NHS to ensure that patients and relatives feel their concerns are taken seriously when things go wrong.”

 

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Readers' comments (8)

  • michael stone

    Hunt is of course right - especially about:

    “Poor communication may make it more likely that the patient will pursue a complaint or claim,” it says.

    Mind you, the goverment isn't 100% on message about being entirely open itself, is it ?

    And I think he was very cheeky, to blame the previous goverment for something I suspect has been going on almost forever ?

    And transparency for private providers as well !

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  • The NRLS brought guidance out in 2005 about commuincating effectively with patients when things go wrong - this evolved into the NPSA 'being open' guidance in 2009. So to suggest that previous governments fostered a 'closed and defensive culture' is frankly untrue. I absolutely agree with him that the NHS has to be open and transparent when things go wrong - just the party politics are so annoying!

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  • How very right of Mr Hunt... However, will he and his colleagues of all political preferences the, "Honourable Members" who sit in the Commons be prepared to do the same?

    Will they stand up and apologise for their fraudulent expenses, their false mandates which get them elected, their rewarding themselves with pay rises while freezing the wages of the electorate who pay their wages?

    It is our elected leaders who are causing and have caused the problems in the NHS. Not the health care professionals who have to work within the constraints of budgets set by cold blooded ministerial accountants who treat the service as a business.

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  • I agree with Roger Hudgson.

    Will managers who expose my patients to risks by poor staffing or inadequate equipment apologise?

    Will politicos with no sense of the harm they're doing apologise to NHS users who're being shortchanged to save their chums paying fair taxes?

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  • tinkerbell

    Roger Hodgson | 13-Jan-2014 7:56 pm
    Forester | 14-Jan-2014 10:22 am

    Agree.

    I have no qualms saying sorry, it's the only right thing to do, believe in honesty and transparency like all decent folk but these Janus faced hypocrites preaching about honesty ...............................must go before I swear.

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  • I have always worked in an environment with open dialogue which is the best way to learn and progress a career. If we made a mistake we apologised to the people concerned, put it in the notes and informed the team and a doctor if there was any risk to the patient. Such errors were dealt with immediately, or as soon as possible, and we never had any problems with it. any conflict or disagreement was dealt with in the same way so they usually remained at the level of those responsible for the difficulties and were resolved. If this was not the case we could discuss it with everybody concerned with the support of the floor manager. Only once an incident went higher up and thence to legal level because a patient complained about the care she was getting on a pt. satisfaction questionnaire. However, the case was dropped as we were able to explain that we had done all we could for this patient on a busy medical ward but she had mental health problems which we were not qualified for and were unable to accede to all of her personal wishes and extra demands she made on us and on our time to try and make her feel comfortable.

    It is hard to imagine how difficult, frustrating and unpleasant it must be to work in such an oppressive environment which can instill fear and put patients and staff alike at risk, although I have also had a little (already too much) experience of it from time to time and it prevents everybody from working to their full potential causing everybody to lose out. Let's hope that it is serious cultural issue which can quickly be resolved so that the focus can return entirely to the best patient care which is only possible if the wellbeing of the staff is assured.

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  • Of course Jeremy Hunt is right. But it is often the culture which is worked in that means that patients complain, rather than the "fault" always being with the clinician. He would do well to remember that clinicians are being asked to work with increasingly limited staff, time and resources and perhaps it is those who have made these decisions who should be apologising to the patients.

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  • George Kuchanny

    I agree with all the comments. Each highlights some of the real dangers of working in a closed Janus culture(good one Tinkerbell). A culture shockingly endemic within the NHS. So bad that an adverse event may be covered and inevitably lead to a cascade of incorrect diagnoses, interventions and withdrawal of 'futile' care. Outcome? Usually death. What for? Face saving, protection of 'reputation' and other frankly trivial concerns.

    The next statement may be an unpalatable truth for Anonymous 14-Jan-2014 9:18 pm to face but it must be stated nonetheless. As Donald Irvine said succinctly many years ago "We have to speak about the unspeakable". The unspeakable being that a patient damaged by a poor intervention is then deliberately made worse and dies as result. This happens when there are no staff shortages, equipment is no problem and time and resources are not stretched.

    Time to consider the effect of incompetence and culture. It can be very bad indeed.

    Delivery of care that is World Class funded and give fifth rate results.

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