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Practice comment

'An honest culture is enough to protect both patients and staff'

The discovery and investigation of patient abuse in Mid Staffordshire has made this a critical time for the NHS. Action is needed to prevent this from happening again.

One recommendation of the Francis report is that a duty of candour is made law. The government has started with an institutional duty of candour in last week’s response, but has hinted individual duty of candour could be on the cards. Being open and honest is no longer enough. Truthfulness and transparency must be reinforced.

Under this duty, anyone coming to harm through healthcare would have to be told what happened, regardless of whether a complaint had been made. Trusts would have to report the truth to the public. Nurses would have to highlight dangerous conditions and expose poor practice.

To secure such a culture of transparency, communication has to be sincere and honest. Improving relationships between professional groups and across hierarchies is vital. Too often nurses, doctors and other groups close ranks and do not collaborate. This transfers to the bedside -leaving the patient in the dark.

Errors could no longer be concealed by omission of fact. Breaching the duty of candour would be a criminal offence. Disciplinary measures are likely to increase if poor practice is exposed. Litigation against trusts would also increase. What protection would there be for nurses who spoke candidly?

When a defendant stands up in court and swears to tell “the truth, the whole truth and nothing but the truth”, they are being judged on their candour as well as their crime. Cooperation with investigations is taken into account during sentencing. Candid witnesses are also protected so they can give their testimony. Anonymous reporting could provide such protection for whistleblowers.

But support must be in place for those with the humility and the courage to admit they were wrong, if lessons are to be learnt.

If cutting red tape is the priority, a duty of candour should not be made law. The burden of caring is heavy enough. Instead, improve openness and fairness in the NHS. Show people that if you are genuinely transparent you have nothing to hide and nothing to fear. Being open and honest is part of the Nursing and Midwifery Council code and much has been done to secure truthfulness in safety reporting.

The changes that the duty of candour would bring might seem necessary in the wake of the Francis report. Better communication of problems could have saved lives. Routine reporting of errors can only have a positive effect in a no-blame culture. NT

Samuel Holden is clinical research nurse, Guy’s and St Thomas’ Foundation Trust

While we acknowledge Mr Holden’s concerns about a duty of candour, Nursing Times believes it is essential for an open NHS. Such a duty would apply to all NHS employees so would protect frontline staff who raise concerns from bullying and will compel management to respond. Sign our Speak out Safely petition.

Readers' comments (2)

  • I agree with your fine goal, but I doubt that law would automatically change much. We need systems to clearly document such candor, with confirmation pt received & underdstood it. A robust whistleblower protection & reward system might also help. Otherwise informal suppression of candor would likely persist, as do many illegal acts.

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  • Cultural vlalue is very important in nursing intervention, but it must be a spirituality of nurse-pastien relation in each nurse's doing.
    Please, give us a method to plant the cultural value for students of the Nurse

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