here - United Kingdom Parliament

283WH
Candour in Health Care
1 DECEMBER 2010
Candour in Health Care
284WH
[Liz Kendall]
the hon. Member for Poole (Mr Syms)—“get at the
truth”, which, so often, is the start of the healing
process.
Last week, I went to a meeting at the University
Hospitals Leicester NHS Trust with two of my constituents,
Mr and Mrs Harkisan-Hall, who lost their son in the
hospital’s neo-natal unit. It was only at the coroner’s
inquiry that they found out that the two qualified
nurses on the unit were both on a break at the same
time, leaving a nursery nurse in charge of very vulnerable
children. They felt that they had to battle to get that
information, and they still have not seen the full reports
of what the staff said. Like them, I believe that that is
unacceptable.
Mr Syms: The hon. Lady makes a good point. One
point that I meant to make was that if people do not
hear what has happened, coroners can find it difficult to
determine how someone has died. If people are not
honest about what has happened to a particular individual,
coroners do not have the full information.
Liz Kendall: In this particular case, interviews were
conducted with the two qualified nurses. The trust did
not read both transcripts together and did not see that
both nurses were on a break at the same time. People
are astonished that such simple things happen, and it is
vital that we learn from this process.
Before I go on to talk about the duty of candour, I
want to discuss two concerns about the Government’s
policy in relation to patient safety. It is important that
hon. Members do not look just at the duty of candour
in isolation from what is going on in the rest of the
NHS, including on patient safety. My first concern is
the Department of Health’s decision to abolish the
National Patient Safety Agency and to move responsibility
for this issue to the new national NHS Commissioning
Board. There are real concerns about whether the
board will have the necessary skills, experience and time
to focus on such a vital issue when it will also be
responsible for setting NHS outcomes, assessing whether
GP consortiums are delivering on those outcomes,
commissioning a whole range of specialist services and
managing contracts for all primary medical services.
That is a huge agenda for any board, even without
adding responsibility for patient safety.
Will the Minister tell us what resources and how
many staff from the NPSA will be transferred to the
NHS Commissioning Board? Which NPSA activities
will the board take on? For example, will NPSA continue
to publish patient safety alerts and bulletins and other
guidance to identify key problems and help spread best
practice? Will it also run workshops with leads for
patient safety in individual providers, such as those I
was involved with in the Ambulance Service Network?
Will the national Patient Safety First Campaign, which
was launched last year, and the annual patient safety
week, which was held early this month, have the staff
and resources to continue?
My second concern relates to the Government’s
reorganisation of the NHS and fact that the service
needs to make efficiency savings worth some £20 billion
over the next three years, as the NHS chief executive
said. The first report on adverse incidents in the NHS
was drawn up by Sir Liam Donaldson in 2000. Its key
recommendation was that the NHS must be open and
honest and learn from its experiences. To do that, the
NHS must become, as the report’s title suggests, “An
organisation with a memory”. But the Government
plan to abolish many of the very organisations that
have worked hard to build this memory and understanding
of how to improve patient safety.
If the NHS has to make efficiency savings worth
some £20 billion, there will inevitably be job losses and
posts frozen, some of which could include those staff
who have worked hard to learn lessons from the mistakes
that have been made in the NHS. How will the Minister
ensure that the NHS retains its “memory” on patient
safety when PCTs and strategic health authorities are
being abolished, new GP consortiums are being established,
community services are being transferred to different
providers and staff posts are being frozen and reduced?
In particular, what steps has she taken to ensure that
managers and front-line staff who have knowledge and
expertise in patient safety are retained in the NHS at a
time when the Government want to cut management
costs by 45% and make efficiency savings of £20 billion?
Finally, I want to talk about the duty of candour. As
hon. Members have said, the introduction of a statutory
duty of candour was first recommended by Sir Liam
Donaldson in his 2003 report, “Making Amends”. I
agree with hon. Members that there is a strong case to
look again at this issue, as a Health Committee report
recommended in 2009.
I think that it was the hon. Member for Carshalton
and Wallington who said that too often the debate is
split between those who want a statutory duty of candour
and those who think the NHS should instead focus on
creating a culture of candour. Of course, changing the
practice of individual staff and organisations does not
require legislation, but I think that we can see from
existing laws, such as those that helped to reduce drinkdriving,
those that introduced the smoking ban and
others, that legislation often plays a vital role in changing
culture and behaviour.
Some professional bodies are concerned that a duty
of candour would make it less likely that incidents
would be reported. I am not convinced that that would
be the case, particularly if the duty is combined with an:
“exemption from disciplinary action for those reporting adverse
events or medical errors—except where there is a criminal offence
or where it would not be safe for the professional to continue to
treat patients”.
That was the recommendation of Sir Liam Donaldson
back in 2003.
Others question whether a statutory duty could be
imposed when it might be difficult to specify or enforce
sanctions. That concern has not prevented other parts
of the world from introducing legal duties, including
some US states, Sweden, France and Denmark. It is
also worth noting that the Equality Act 2010, which
was introduced by the last Government, imposes a
number of legal duties on public bodies to consider the
impact of their policies and decisions on different groups,
without specifying what the sanctions will be if those
duties are not complied with.
The final argument against a statutory duty of candour
is that patients might end up trusting professionals less,
because they have to report a mistake rather than