Patient safety

NHS must embrace a culture of candour

Healthcare organisations across the UK must usher in a new culture of candour so that patients are informed when things go wrong.

This is according to an independent review, which recommended that the old days where errors were not disclosed must give way to an environment that allows staff to be trained and supported in admitting errors, reporting them and learning fully from mistakes.

The report – carried out by Professor Norman Williams, president of the Royal College of Surgeons, and Sir David Dalton, chief executive at Salford Royal NHS Foundation – states that the culture of candour is not simply an add-on or a matter of compliance.

“Patients and their families want to know that when things do go wrong not only is every effort made to put them right for them but every effort is made to prevent similar incidents happening again to somebody else,” the report states.

The group, set up in December 2013, was asked to examine the threshold at which a new statutory duty of candour should apply to organisations, and how they can be incentivised to be more open and honest.

The review was asked by the Secretary of State to look at whether the threshold for organisations reporting harm should be set to include moderate harm to patients, as well as death or serious injury.Healthcare professionals are already required by their professional codes to disclose harm to patients when things go wrong, however, the new duty of candour applies to providers of healthcare registered with the Care Quality Commission and not to individuals.

The review concluded that the new duty should include ‘moderate’ harm, as defined under the NHS’s existing National Learning and Reporting System (NRLS). This would include incidents that do not cause permanent harm, but which most patients would regard as ‘significant’ events.

The review also recommends that a new category of ‘significant harm’, corresponding to the current ‘moderate, severe and death’ NRLS standards, should be created, with incidents notifiable to the Care Quality Commission.

Professor Williams, said: “The evidence that we heard during the course of this review reaffirms what we already knew: that when things do go wrong, patients and their families want to be told honestly about what happened, how it might be corrected and to know that it will not happen to someone else.

“We hope that the review will play an important role in helping to create a culture of openness and honesty which always places the safety and needs of a patient above the reputation of an organisation.”

In response to the review, Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, stated that the report is‘important and useful’, but 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.

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