The Nursing and Midwifery Council will in future “credit” nurses who are honest about mistakes, and there will be legal “safe spaces” for staff offering information about errors, the government has announced.
They form part of a raft of measures designed to improve safety and transparency in the NHS, due to be outlined by health secretary Jeremy Hunt over the next two days at a major conference in London.
“It is a scandal that every week there are potentially 150 avoidable deaths in our hospitals”
Mr Hunt will announce “ambitious plans” to improve safety and transparency on Thursday at the inaugural Global Patient Safety Summit, said the Department of Health.
The conference brings together ministers and expert clinicians, including World Health Organization director general Margaret Chan.
The health secretary will outline the role of the new independent Healthcare Safety Investigation Branch, which has been asked to initially focus on maternity and neonatal mortality before moving on to other areas of clinical activity.
Mr Hunt will also outline plans by the government to legislate to bring in protection for anyone giving information following an error – confirming a report earlier this week by Nursing Times.
These so-called “safe spaces” will legally protect those co-operating with investigations in a move to help clinicians to speak up and bring new openness to the NHS.
Families will get the full truth faster, staff the support and protection to speak out and the NHS will become better at learning when things go wrong and acting upon it, said the DH.
In addition, he will note changes to guidance by the General Medical Council and the NMC on openness among the professions they regulate.
“It is up to us all to make the need for whistleblowing and secrecy a thing of the past”
Under the changes, when NHS staff are honest about mistakes and apologise, a professional tribunal “will give them credit for that, just as failing to do so is likely to incur a serious sanction”, said the DH.
Meanwhile, the new regulator NHS Improvement will publish an annual “learning from mistakes league”, identifying the level of openness and transparency among trusts.
The first such table will reveal that 120 organisations were rated as “outstanding” or “good”, while 78 had “significant concerns” and 32 had a “poor reporting culture”, said the DH.
Hunt to set out plans to end NHS ‘cover up culture’
The regulator will also ask all trusts to publish a “charter for openness and transparency”, so staff can have clear expectations of how they will be treated if they witness clinical errors.
In addition, Mr Hunt is set to announce plans for a nationwide medical examiner service.
It will mean all deaths in England and Wales will be investigated by an independent medical examiner in an effort to improve patient safety and tackle inaccurate death certification.
The new role will see approximately 300 senior doctors appointed to review the causes of all deaths from April 2018. The examiners will have the ability to refer deaths to a coroner and it is hoped their work will make it easier to spot trends in deaths and tackle clinical governance problems.
Medical examiners will also be able to liaise with relatives and potentially investigate any concerns they may have about the care their loved one received.
The idea was first recommended by Dame Janet Smith following her public inquiry into serial killer Harold Shipman. It was also supported by recommendations from Sir Robert Francis after the Mid Staffordshire public inquiry and Dr Bill Kirkup’s investigation into failures at Morecambe Bay.
Hunt to set out plans to end NHS ‘cover up culture’
Early pilots, which examined 27,000 deaths since 2008, found one in four hospital death certificates were inaccurate and one in five causes of death were wrong. In 10% of cases the underlying cause of death was changed after the medical examiner’s investigation.
The pilots also revealed wider patient safety benefits, including the identification of a cluster of post-operative deaths due to an infection that had not been spotted by hospital staff.
In another case, a failure of nursing staff to conduct patient observations was found by the medical examiner leading to a review of nurse staffing and education.
Mr Hunt will tell the conference: “A huge amount of progress has been made in improving our safety culture following the tragic events at Mid Staffs. [But] it is a scandal that every week there are potentially 150 avoidable deaths in our hospitals.
“It is up to us all to make the need for whistleblowing and secrecy a thing of the past as we reform the NHS and its values and move from blaming to learning,” he will say.
In response, NMC chief executive and registrar Jackie Smith said: “When things go wrong, it’s right that patients should expect a face to face explanation and apology from the doctors, nurses and midwives treating them.
“This is why, together with the GMC, we introduced guidance on the professional duty of candour so that healthcare professionals fully understand their individual responsibilities to speak up, apologise and take action if things go wrong,” she noted.
“In addition to the duty of candour guidance, we have already advised our fitness to practise panels, when deciding on an appropriate outcome, that they should take account of whether someone has admitted their mistake and apologised,” said Ms Smith.