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Exclusive: duty of candour will not work unless it applies to staff, says Francis


Plans to introduce a statutory “duty of candour” on NHS providers will not work on its own and will leave patients at risk, according to Robert Francis QC.

The barrister, who led the public inquiry into the care failings at Mid Staffordshire Foundation Trust, said a similar duty should also apply to staff and without it organisations risked missing potential patient safety warning signs.

Mr Francis recommended in his inquiry report that individual clinicians should be required to tell their manager about any incident where a patient experienced serious avoidable harm or death. Their employer would then be required to tell the patient or their relatives, and provide information and an explanation.

Clinicians would not be required to tell patients directly and any information “conveyed under the statutory duty of candour” would not be used against them in criminal or civil legal action.

Nursing Times’ Speak out Safely campaign is calling for a duty of candour in-line with Mr Francis’ recommendations, which would cover both organisations and individuals.

However, the government has so far said it would only impose a duty of candour on NHS organisations, which it plans to do so through new powers given to the Care Quality Commission.

In response, Mr Francis said: “The bit that is missing from the jigsaw would seem to be getting the employees to tell their employer about things that have happened.”

He said an organisation could only comply with a statutory duty of candour “if it is told by its employees what has been going on”.

Asked if he thought a lack of a duty on individuals put patients at risk and meant warning signs could be missed, he said: “I think it does both.”

Mr Francis also reiterated his belief that it should be made a criminal offence for anyone to “wilfully obstruct” a member of staff from complying with a statutory duty of candour.

He said this would prevent bullying or pressure from colleagues and managers to stop staff from speaking up, and would give better protection for those prepared to speak up.

“What we are talking about is something so important and so demonstrated not to occur sufficiently that we need to back it up with statutory laws,” he told Nursing Times.


Are you able to Speak Out Safely? Sign our petition to put pressure on your trust to support an open and transparent NHS.

On Tuesday 14th May we will be hosting a Twitter discussion on Robert Francis’s comments. Join us at 1pm. Just follow #NTtwitchat and include this hashtag in your tweets to join the debate.


Readers' comments (4)

  • Yes But

    I DO LIKE Francis !

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  • I support what Francis is recommending but it seems to me that the biggest hurdle here is the lack of trust and the 'fear / blame' mentality presently pervading the NHS.

    Bottom line ... if a duty of candour protected individuals as well as organisations would it be enough for individuals to trust that they would be supported? There's a big difference between not being held legally responsible and feeling supported in your workplace.

    I'm not questionning that nurses have to find the courage to report failings ... it is imperative that they do. But words and laws don't help an individual who may feel marginalised and afraid.

    Using only legislation and threats of punishment to tackle these issues adds yet another layer of fear and blame to the existing culture. The NHS has to wake up to the reality that although the most expensive resource nurses are also the most valuable. It is vital that for any new initiative to work every single nurse has to feel that he/she matters.

    Resources have to be made available to start to rebuild the confidence, self-esteem and trust of all nurses within the organisation.

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  • michael stone

    Lynne Healy | 14-May-2013 10:39 am

    Yes -staff who raise issues (not this personal grudge stuff !), must be certain they will not be bullied.

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  • A lot of good comments here and i think there is the making of a good concept here to protect those who do have genuine concerns. I would also like it to have a element that will protect those that are subject to the grudge stuff, as this behaviour should be punished and some standards put in place for conduct between healthcare staff. This doesnt mean just nurses it means Doctors and all other fractions of the care team, in the way they treat each other, as if we cant respect and treat each other properly, then what chance have the patients got of even the basic care and respect. The standared a lot of professionals give is excellent, so why should they have their hard work and efforts sabatarged by the rough ellements of our profession, there's no room for them in care so lets oust them out. It's got to start at the bottom and also radiate from the top too.

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