The “old days” where clinical errors were not disclosed must give way to an environment that allows staff to be trained and supported in “admitting, reporting and learning fully from mistakes”, according to an independent review for the government.
The review – by Salford Royal Foundation Trust chief executive Sir David Dalton and Royal College of Surgeons of England president Norman Williams – recommended all staff should be trained in how to disclose incidents to patients and their families and apologise “where appropriate”.
If the recommendations of the government-commissioned review are adopted, NHS organisations will also be required to tell patients about all but the most minor patient safety incidents under a new statutory “duty of candour”.
Based on current levels of incident reporting to the National Reporting and Learning System, this would mean trusts owning up to almost 100,000 incidents every year.
“If the NHS embraces this new culture and takes it seriously this could be the basis of a profound change”
Sir David said: “If the NHS embraces this new culture and takes it seriously – thinking about all the things you would need to put in place to make a reality of candour – this could be the basis of a profound change to the ways in which organisations and staff interact with patients.”
The government announced plans for a statutory duty of candour on organisations registered with the Care Quality Commission in its response to the Francis report last year.
Robert Francis QC recommended the duty should only apply in cases of death or serious harm. However, following pressure from patient groups, the government agreed to look again at what the threshold should be.
Sir David and Professor Williams concluded the threshold should also include “moderate harm”. This extends the number of incidents likely to be covered by the duty from 11,000 to 96,000.
Under the proposals, all cases involving death or moderate or severe harm would be classed as “significant” and would sit alongside a “low harm” and “no harm” incidents categories.
The duty of candour is one of the 11 fundamental standards being introduced in the wake of the Francis report.
“It is now up to trust boards and managers to lead by example”
The Royal College of Nursing said the review had “rightly focussed” on the importance of organisations creating a culture where staff were supported to be open when things go wrong.
RCN chief executive and general secretary Peter Carter said: “Healthcare is inherently risky and sometimes things will go wrong. When this happens patients deserve an open and honest discussion with staff, and to know that lessons will be learnt.”
He added: “We also support the recommendation that the duty of candour should apply to all cases of ‘significant harm’, and not just cases which result in serious permanent injury or death.
“This is an important and useful report and it is now up to trust boards and managers to lead by example and ensure their organisation has a culture which is good for staff and good for patients,” he said.
Don Redding, director of policy at the patient group National Voices, welcomed the findings of the review.
“The key advance is that the definition of ‘significant’ should include what are currently classified as incidents of ‘moderate’ harm but which are significant to patients – the original plan was to limit to the duty to fatal cases or those causing the most severe permanent disability,” he said.
“We also welcome recommendations that staff should have training and support in taking this forward,” he added.
This week marked the first anniversary of the Speak Out Safely campaign, which Nursing Times is running to increase protection for staff who raise concerns.
One of the campaign’s aims is for a duty of candour to be introduced covering both organisations and individuals.