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269WH
1 DECEMBER 2010 Candour in Health Care
270WH
Westminster Hall
Wednesday 1 December 2010
[MR JAMES GRAY in the Chair]
Candour in Health Care
Motion made, and Question proposed, That the sitting
be now adjourned.—(Jeremy Wright.)
9.30 am
Mr Robert Syms (Poole) (Con): It is a pleasure to
serve under your chairmanship, Mr Gray. I start with
an apology: I cannot possibly do justice in this debate to
all those who have suffered as a result of mistakes made
by the national health service. I know that a lot of
people are paying attention to this debate, and I will do
my best to make the case for a duty of candour in health
care, particularly a statutory duty. That would be progress.
In the House, if an hon. Member makes a mistake,
however outrageous, everybody thinks that it is fair
enough as long as they apologise quickly. I want to put
forward the arguments for why honesty is the best
policy and why it is best to acknowledge that mistakes
are made in medicine and in the health service. That is
part of the medical process. If people inform relatives,
put their hands up and say, “We made a mistake”, that
is a far better way to proceed than what seems to have
happened in the past.
I would like to thank Peter Walsh from Action against
Medical Accidents for assisting me as I prepared for
this debate. Over the next few weeks, Ministers are due
to decide on their preferred option for honouring a
commitment to require openness when things go wrong
in health care. During the 2010 general election, the
Liberal Democrat manifesto stated:
“We will: require hospitals to be open about mistakes, and
always tell patients if something has gone wrong.”
I do not often quote from the Liberal Democrat manifesto,
but it is probably important to do so under current
circumstances and the coalition. That pledge was also
included in the coalition programme for government:
“We will enable patients to rate hospitals and doctors according
to the quality of care they received, and we will require hospitals
to be open about mistakes and always tell patients if something
has gone wrong.”
That has clearly been lifted from the Liberal Democrat
manifesto. The White Paper, “Liberating the NHS”,
stated:
“We will enable patients to rate hospitals and doctors according
to the quality of care they received, and we will require hospitals
to be open about mistakes and always tell patients if something
has gone wrong.”
That shows consistency running from the original Liberal
Democrat manifesto to the coalition programme for
government and the White Paper produced by the
Department of Health.
Those commitments have been widely interpreted
and welcomed as going some way towards the introduction
of a statutory duty of candour in health care. Such a
move has been advocated for many years by patient
groups and others, including the ex-chief medical officer,
Sir Liam Donaldson. Recently, Ministers have made it
clear that as well as the possible introduction of an
explicit statutory duty of candour, they are also considering
not altering or adding to the statutory regulations, but
merely issuing new or refreshed guidance to existing
regulations contained in the Care Quality Commission
(Registration) Regulations 2009.
It is implied that that is more likely to be the favoured
option because there is an extreme reluctance to add
or alter statutory regulation. I will speak about those
two options, with a view to encouraging support for the
introduction of a statutory duty of candour. Action
against Medical Accidents has campaigned on that
matter for a number of years, and representatives from
that charity met with a Health Minister to try to put
forward their case about the right way to proceed.
Put simply, the situation is unacceptable. It comes as
a shock to most people, particularly patients and members
of the public, to know that health care organisations
are in breach of no rules and will face no sanctions if
they cover something up or decide not to inform a
patient—or, in the case of a fatality, their relatives—that
something went wrong during an operation or health
care.
Probably more by accident than design, the current
system tolerates cover-ups and denials. People ask how
that can happen in a modern, ethical health service, and
the vast majority of people would agree that honesty
with patients and their relatives is a moral and ethical
requirement. There is an abundance of guidance on the
issue, and best practice dictates that honesty, or being
open, is the only course of action.
We know that there are a million incidents in the
national health service each year, about half of which
cause some harm. Within those cases, there are many
serious incidents, so it is a large problem. When something
goes wrong, most people want someone to explain what
happened to their relative, mother, father or daughter.
In part, such behaviour is part of the professional code
for individual doctors and nurses, and is recognised as a
central component of an open and fair patient safety
culture. However, the failure to be open and honest
when things go wrong is not uncommon.
Although many trusts or PCTs do act openly, a
significant minority tell patients nothing. Something
must be done to provide parents and relatives with
a flow of information and an honest approach. Patients
and their families are unfairly denied crucial information
about what happened during their health care procedure,
and they may never learn the truth. If they do, they are
often deeply traumatised by the initial dishonest response
to something going wrong. It is not unusual to find
people who have spent decades campaigning under
difficult circumstances to find out what happened to
one of their relatives.
If patients suspect that something has gone wrong
but have to fight to get the truth, they lose all confidence
in the health care system and are more likely to take
legal and disciplinary action. The NHS and health care
organisations have failed to develop a learning culture
and the ability to learn from errors and make things
safer. Instead, they have developed a culture of defence
or denial; they do not want to see themselves in the
newspapers.
The situation in England became even worse when
the previous Government introduced the Care Quality
Commission (Registration) Regulations 2009, which came