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289WH<br />
Candour in Health Care<br />
1 DECEMBER 2010<br />
Candour in Health Care<br />
290WH<br />
mentioned his constituents the Byes and the Powells,<br />
who have campaigned endlessly for the truth and continue<br />
to campaign. I pay tribute to all the people, some of<br />
whom we do not know about, who use their own tragic<br />
circumstances to ensure that the same thing does not<br />
happen to others. Their efforts should never be<br />
underestimated.<br />
Tom Brake: The Minister said that the NHS sometimes<br />
adopts an aggressive stance. I remind her of my question<br />
to her about the possible impact of withdrawing legal<br />
aid in clinical negligence cases. Often, families use such<br />
cases as a way of trying to secure an apology because<br />
one has not been forthcoming. If that option is not<br />
available to them, it reinforces the need for a duty of<br />
candour.<br />
Anne Milton: The hon. Gentleman pre-empts me by a<br />
second; I was about to come to legal aid. My experience<br />
is that even with legal aid, the courts are rarely an<br />
option for most people. Allowing discretion on the<br />
reporting of near misses would, I fear, open another<br />
minefield beyond which people could hide, as he also<br />
mentioned.<br />
I have certainly brokered meetings between NHS<br />
organisations and my constituents to try to bring them<br />
together and make the NHS organisations stop feeling<br />
so defensive. I have been an advocate for people in my<br />
constituency just so they could hear what happened. I<br />
should think that many hon. Members rely on personal<br />
relationships, particularly within hospital trusts, for<br />
such purposes. Maybe they know a supportive medical<br />
director to whom they can say, “Look, this family, this<br />
couple or these relatives just want to know what happened;<br />
this isn’t going to go anyw<strong>here</strong>.” That is a leap of faith.<br />
The NHS organisation has to say, “Fair enough”. When<br />
that happens, closure can follow.<br />
The hon. Member for Southport rightly pointed out<br />
that accidents occur across the NHS and mentioned, in<br />
particular, the failure to diagnose in general practice.<br />
That is an ongoing, rumbling issue that I hear about not<br />
only as a constituency MP, but as a Minister. I thank<br />
him for recognising that the solution to getting to a<br />
situation w<strong>here</strong> we have effective measures in place to<br />
ensure candour is a dilemma. It is not an easy decision.<br />
He is also right to point out that the NHS is not alone in<br />
protecting itself. My goodness me, we know a lot of<br />
professions that close their doors when one of their<br />
members is under attack—the legal profession is one.<br />
People just want the truth, but sadly the shutters go<br />
down and the doors close, and closure cannot be achieved.<br />
Mr Syms: I am pleased with the way the Minister is<br />
responding to the debate and recognise that a statutory<br />
duty of candour is one of a range of measures that the<br />
Government are considering. However, if they decide<br />
not to take that route initially, it is important that they<br />
do not rule it out, because the culture change that is<br />
needed might not come about as a result of what they<br />
are doing, but we will still need to get t<strong>here</strong> at some<br />
point. I still think that a statutory duty of candour<br />
would be the biggest and most successful leap towards<br />
that goal—the hon. Member for Carshalton and Wallington<br />
made a good point on that—but even if the Government<br />
choose not to go t<strong>here</strong>, they should not rule it out,<br />
because I think that ultimately that is w<strong>here</strong> we will<br />
end up.<br />
Anne Milton: I thank my hon. Friend for his intervention<br />
and am sure that the report of this debate will aid<br />
people in making their decisions on the matter.<br />
On the point raised by the hon. Member for Carshalton<br />
and Wallington on legal aid, I understand that the<br />
Ministry of Justice proposal on restructuring and refocusing<br />
the scope of legal aid is currently out for consultation.<br />
T<strong>here</strong> will still be an exceptional funding route for those<br />
not eligible for legal aid, but he might want to raise that<br />
specific point with the MOJ because it is important.<br />
The hon. Member for Southport rightly picked up on<br />
the fact that we included in the White Paper the principle<br />
of “No decision should about me, without me”, and<br />
that probably needs to be extended to situation w<strong>here</strong><br />
harm happens.<br />
A few Members mentioned international precedents,<br />
but we must be slightly careful, because what happens<br />
abroad cannot necessarily be transported to this country.<br />
Those precedents tell us that t<strong>here</strong> can be problems in<br />
adopting a statutory duty of candour. It can be difficult<br />
to measure success and, t<strong>here</strong>fore, find any evidence of<br />
w<strong>here</strong> success or failure has occurred. We must also be<br />
mindful of the differing health care and legislative<br />
environments that exist around the world when looking<br />
at international examples. In Pennsylvania, for example,<br />
we have been told that a complicated set of requirements<br />
makes enforcing its version of a statutory duty particularly<br />
problematic.<br />
In conclusion, t<strong>here</strong> are complex issues at play in<br />
relation to a statutory duty of candour, and views are<br />
held on both sides of the argument for and against such<br />
a duty. What we can say, as has been documented in the<br />
White Paper, is that we are absolutely set on achieving<br />
that change in culture to achieve openness and candour<br />
in the NHS and all organisations that provide care. We<br />
are exploring those complex issues carefully. The culture<br />
of secrecy and denial is a disease that needs to be cured,<br />
but to do so we need to understand and treat its causes<br />
at their source, rather than simply treating the symptoms<br />
with an ineffective plaster.<br />
As my hon. Friend the Member for Poole stated, the<br />
start of the healing process is about learning the truth.<br />
The Government will need to decide how we can provide<br />
the environment, with or without legislation, in which<br />
the truth can come out immediately—in a timely fashion—<br />
and openly. We need inspirational leadership and highly<br />
developed management skills in our NHS leaders to<br />
create that change in culture to create an open atmosp<strong>here</strong><br />
among staff, not the closed culture that we have seen.<br />
We need a culture that replaces the fear of the consequences<br />
of openness with the courage to recognise that openness,<br />
honesty and truth will, ultimately, not only give families<br />
what they need to heal their wounds and achieve closure,<br />
but allow staff to learn from their mistakes, raise their<br />
standards and raise the bar on their professional standards.<br />
The Government will consider all that when making<br />
the decision, but Members should rest assured that<br />
everything that has been said today and all the effort to<br />
highlight the issue will be taken in account to ensure<br />
that we get the right system in place to give people what<br />
works.<br />
10.55 am<br />
Sitting suspended.