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Exclusive: 'Crediting' nurses who admit mistakes could improve safety

  • 12 Comments

Nurses and midwives who admit to their mistakes could receive less severe sanctions when their case is reviewed by a Nursing and Midwifery Council panel, the health secretary has suggested.

As part of a series of new measures announced this week to improve safety and learning from mistakes in the NHS, Jeremy Hunt said nurses should now receive “credit” from the NMC for being honest about errors during tribunals.

Speaking at the inaugural Global Patient Safety Summit in London, he said that under changes to NMC guidance, when NHS staff admit 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”.

“Nurses and other health professionals need to know that they will get credit for being open and honest, and the government is committed to legal reform that would allow professional regulators more flexibility to resolve cases without stressful tribunals, where professionals have admitted their mistake,” he told delegates.

The health secretary later told Nursing Times the NHS needed to “move away from the idea that there are going to be automatic professional consequences” if people admit to a “human mistake”.

In an exclusive interview, he said: “Obviously where there is gross negligence, where someone is grossly incompetent, where there is wilful harm, then of course there must be consequences.

“But the vast majority of the time we are talking about is simple mistakes where the priority is to learn from them, and that means we need to create an open culture where people are supported to speak up,” he said.

“Nurses and other health professionals need to know that they will get credit for being open and honest”

Jeremy Hunt

Mr Hunt said he had met with both the NMC and the doctors’ regulator the General Medical Council – which will also recognise honesty during tribunals – to discuss how the NHS can improve how it learns from mistakes.

“They have independently concluded the way they will do that is by giving people credit in tribunals for openness and transparency,” he said, adding that it was more than simply “a pat on the back”.

The NMC was asked for further details about how the credit process would work for applying reduced sanctions during tribunals.

In an earlier statement responding to Mr Hunt’s speech, NMC chief executive and registrar Jackie Smith highlighted that it introduced guidance last year on ‘duty of candour’ so healthcare professionals “fully understand their individual responsibilities to speak up, apologise and take action if things go wrong”.

In a subsequent statement for Nursing Times, Ms Smith added: “We launched the duty of candour with the GMC a year ago and set out the clear expectation that nurses and midwives should be open and honest when things go wrong.

“This is embedded in the code. We have advised our fitness to practise team that they should take account of those who apologise and show insight, when deciding what the appropriate outcome should be,” he said. “This has been in place now for over a year.”

Health secretary’s new measures to improve NHS safety and transparency

  • Creation of the independent Healthcare Safety Investigation Branch
  • legal protection, so called “safe spaces”, for staff giving information following a hospital mistake
  • from April 2018, expert medical examiners will independently review and confirm cause of all deaths
  • NHS Improvement to publish first annual “learning from mistakes league” to rank openness and transparency among trusts
  • Changes to General Medical Council and Nursing and Midwifery Council guidance so when NHS staff are honest about mistakes and apologise, a professional tribunal gives them credit
  • NHS Improvement to ask all trusts to publish a charter for openness and transparency so staff have clear expectations of how they will be treated if they witness clinical errors
  • NHS England will work with the Royal College of Physicians to develop a standardised method for reviewing the records of patients who have died in hospital
  • England to become first country to publish estimates for every hospital trust of avoidable mortality rates
  • 12 Comments

Readers' comments (12)

  • What is this issue all about? It was always emphasised during training that any mistake has to be reported to the physician In charge so it can be addressed as swiftly as possible if any further action is required and accurately documented with any actions in the patient's notes and passed on at report so any further necessary observations of the patient can be made and, depending on its seriousness, reported to the nursing management and the patient or their representative if appropriate. This is fairly obvious for the safety of the patient and to safeguard the person who made the error and anyone else involved. It also helps to prevent all sorts of complications later on where there are sequelae and details are not clearly remembered.

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  • This is corporate nonsense to keep continuous improvement lingo in action so they can dismantle the NHS further. So you could read it if your innocent and don't admit guilt to highly subjective processes they will punish you further because you didn't go along with the dogma of continuous improvement. So yet again the nurse gets the blame if they admit the environment, setting and management are the issue. Way to go Jeremy but you don't fool us.

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  • It's being honest to admit you were severely understaffed and hadn't had a break all day, which led to you making the error, right?

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  • Yet another constant psychological assault on nurses in the name of performance measured on the person rather than the setting people are placed in. The civil servants worked it out with hostile performance approaches based on time and now the nurses need to work it out. This to me isn't about what nurses are doing wrong, this is about government forging dependency on stressful improvement via dependency on false improvement. The lean care agenda only has one interest cost saving via eventual lean deletism of staff based on platauing performance and that will come. The NMC will only have so much tolerance (and that will come), but this also evades cost of improving the environment and puts false emphasis on blaming nurses. This is just a cheap way of hiding a crisis and nurses, including me are working it out. High numbers of staff, good support and care are not going to come by giving nurses a NMC get out from not blaming poor funded settings.

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  • Wonder how much "credit" Mr Hunt is due by now for all his mistakes. Come on now Jeremy, you just have to admit them...

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  • 15 MARCH, 2016 12:14 PM

    Our managerial response to that was it is up to you to organise your work better! Easier and quicker to pass the blame than do anything about any underlying problems!

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  • I think Mr Hunt is aware there is and going to be a massive shortage of nurses, his speech about not reacting about the current situation is to justify the cuts in the nursing workforce and undermining a serious situation, which he is misinformed or choices to be, by non clinical advisors. I

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  • mr hunt only offers credit to banks

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  • ANONYMOUS16 MARCH, 2016 10:48 AM

    Not yet woken up to the fact there is a very serious shortage of nurses? A few short term measures have been taken at great cost and financial waste to try and fill some gaps by recruiting from abroad and from agencies.

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  • Many nurses befor the NMC are not guilty of anything. They have, as I did reported abuse, cover up, dangerous staffing, poor nutrition, neglect and a number of other things to CQC & safeguarding units.
    Vindictive employers then refer the 'trouble maker' to the NMC on trumped charges & make false allegations against them.
    The NMC simply take the allegations and without investigating anything find them guilty and subject them to sanctions.
    On Facebook there is a page for these nurses, NMC-Nurses and Midwives CONDEMNED where they can join a group of nurses who have or are going through this unjust process which can last years. There is no censorship and all we ask is confidentiality. The 1st AGM of the group meets up next week.

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