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Student nurses need duty to speak out ‘ingrained’ in training, says Hunt


Speaking out about mistakes should be “ingrained” in the training of student nurses and doctors, health secretary Jeremy Hunt has said.

He said the government did not go far enough last year in its initial response to the Francis report to emphasise the importance of training students to be open about errors they make.

But Mr Hunt said that the Department of Health was now investigating how to address this. “We need to ingrain speaking out into the training of new doctors and nurses,” he said.

“We are working with training bodies to work this out – and it is quite challenging because we are trying to train new doctors and nurses to do something different to their elders and betters when they join their first hospital or clinical organisation, and the natural instinct is to do things the same way your superiors do,” said Mr Hunt.

“We are trying to train new doctors and nurses to do something different to their elders and betters”

Jeremy Hunt

His comments came at the launch of draft joint guidance by the Nursing and Midwifery Council and General Medical Council on the responsibility of individual staff to be honest with patients, colleagues and employers when an incident occurs which did, or could have, harmed a patient.

These joint proposals on the so-called “duty of candour” for each healthcare worker include guidelines around apologising to patients and learning from mistakes so as to avoid similar problems in the future.

When questioned about the lack of a system to train registered clinicians in how to learn from their mistakes, Mr Hunt acknowledged that a “better system for spreading learning” was required.


Student nurses need duty to speak out ‘ingrained’ in training

He said the launch of the draft guidance – which is out for consultation until 5 January 2015 – represented an “unbelievably significant” first step towards creating a culture in the health service which makes it easier for workers to speak out and learn from mistakes.

“If we get this right we will truly be the first country in the world across the health economy to say we are going to create a culture of openness, transparency and learning,” he told an audience of healthcare professionals and organisations at St Thomas’ Hospital in London last night.

“This could be a moment when the NHS blazes a trail in the 21st century about safety and healthcare,” he said.

The introduction of a legal duty of candour on both individuals and NHS organisations was recommended by the Francis report in February 2013.

It was also one of the aims of Nursing TimesSpeak Out Safely campaign.

The government agreed to introduce a legal duty on organisations, but not on individuals, instead asking regulators to beef up existing requirements for candour in professional codes.


Readers' comments (11)

  • michael stone

    Hunt is partly right - but the culture of honesty and openness, also needs to be present within management.

    Commenting with others in The Times yesterday (page 9), Mark Porter of the BMA commented that "problems were often the result of an oppressive culture and poor systems created by bosses" and he objects to medics apologising for things they beleive were down to other people.

    I wonder if politicians are ever going to be honest about their mistakes while still in office - I've not seen much evidence of that.

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  • more rubbish from the stone front.

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  • Oh sorry, we're rather busy discussing the application of poultices and the life cycle of the leech (sorry didn't mean to remark on some politicians).
    We really do not need statements of the blindingly obvious.
    Can we have some candour about the limitations of political initiatives that are style over substance and do little to illuminate intentions.

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  • I know I keep banging on about toxic management culture, but it does need addressing.

    My first introduction as to what happens when you do speak out came as a student nurse in 1986 (hear that Mr Hunt? We knew about this stuff even then) at a large mental hospital. Several of us reported concerns about standards of care on one ward(the stuff we didn't report was even worse, but we couldn't substantiate it). Our concerns came to the ear of the then DNS, who was given to profuse public statements about how good his hospital was...He didn't want to know anything about the substance of our concerns. He only wanted to know our names...The only name let slip to him later found themselves in front of the UKCC (as was) on some trumped up charge with the main witnesses against them being cronies of the DNS...

    Now, Mr Hunt, what are you going to do to sort out the Augean stable that is NHS management culture, so that clinicians feel safe raising concerns?

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  • I Remember as a young staff nurse making a significant drug error, mixing up two patients. My first instinct was to go to the charge nurse and inform them. The doctor was called, the patient observed for adverse effects and I was given a metaphorical wrap on the knuckles, being left in no doubt that I had to be more careful but also feeling fully supported by the team.

    I was able to talk freely about it with colleagues and it kept everyone on their toes.

    Fast forward a few years and a colleague made a similar mistake and ended up going through a full disciplinary procedure.

    Now, tell me again about how this encourages people to admi their mistakes?

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  • Another politician who suffers from the 'I must make my hands appear to be bigger than the rest of me, then waft them about furiously, in the hope that what I don't know about much will be overlooked'.

    We notice, and turn the telly off. Shame on the Nursing Times for posting a picture that already makes the person look irrelevant. In the era of high-res., close-up pics and much gesticulation, the trick to appearing relevant and interesting is to not be as dull as the current vacuous trend.

    Nursing Times could start by using a smaller, above the arms photo, to avoid prejudicing the reader into thinking before reading that there is nothing being said. Leave us to conclude that without the help of the image.

    What a dull world to have the dim podium-lovers let-loose.

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  • This idea is so far from reality. On my last placement all the hospital Practice Education Facilitators were off sick for the duration, I saw not one person from the university and was sent a mere text message from a stranger saying, "hope you're enjoying your placement." I was not, and I didn't know who to tell. I've heard stories of a couple of other student nurses describing bad mentor practice to tutors but the outcome was nightmarish. Tutors would talk to placement staff making it clear that a who had voiced concern and then leave that student in the aforementioned placement for 9 weeks with the same mentor, ensuring that they were treated as a complete pariah.
    They instilled the 6 Cs into us at uni but what is actually in place to support our 'courage' except fancy alliterative slogans and motivational speeches?

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  • how about the likes of mr hunt making apologies about mistakes or is he so perfect he never makes any. silly man

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  • I don't think Nursing Times chose a picture to lead the reader to think he is irrelevant by posting a picture of him with big hands? I suspect they just chose a picture because it was of Hunt, and I suspect that there is nothing more to it than that. The world is not all cynical! Read the piece and make your mind up, it's a photo of Hunt, you don't need to look at his arms or hands to know if he's relevant to you or not. He's the health secretary!!!!!!!

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  • michael stone

    It is interesting that Sir Robert Francis has just commented that in fitness to practise investigations, the wider 'working enviroment' needs to be considered as well (put simply, was the problem really caused by what I might call 'management diktat' or by a chronic shortage of resources).

    There is a disturbing tendency, for people to call for EVERYONE ELSE to be 'honest and transparent', but to see themselves [and their role] as being some sort of 'special case, and 'exempt''.

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