Risk new openness rule will lead to greater silence
New rules ordering NHS organisations to tell patients when their safety or care has been put at risk could conversely lead to fewer incidents being reported by nurses and frontline staff, it has emerged.
The Department of Health announced last week that from April 2013 NHS providers will be contractually required to tell patients when mistakes happen, under what is described as a “duty of candour”.
Health minister Dr Dan Poulter said the change would “boost transparency and openness”.
However, the government’s own impact assessment of the rule change warned there was a “theoretical risk” that it would in fact lead to staff speaking up less than they do now.
It stated: “Admitting to making a mistake or being involved in an error or incident is difficult at the best of times. It is much more difficult when admitting involvement in an incident to the very person who has been harmed or someone who cares about the person who has been harmed.”
Staff “may be even more likely [than at present] to decide the risk of the consequences to them personally, outweigh the positive benefits of reporting the incident”, the risk assessment warned.
It added: “Put simply, the more punishments that are associated with an error or incident, the more likely a person is not to report it at all – therefore not only does the patient not get told, the incident may not even be reported.
“This could have knock-on effects on learning, improvement and ultimately the safety of healthcare.”
The DH has said it was difficult to quantify the risk and stressed the duty rested on the organisation, rather than the clinician, and consequences would be for the trust and chief executives.
Chris Cox, head of legal services at the Royal College of Nursing, said: “The real issue here is around the culture of the organisation.
“If you have a culture of no blame and not picking on the individual, the people will volunteer information. But if you have a culture of singling out the individual when things go wrong, then you will push these problems even more underground.”
He added: “It is critically important that nurses speak up, it is a requirement of their professional code. They must have the courage to speak up when things are going wrong.”