The Bureau is running an ongoing campaign for greater transparency. Here we put the NHS under the microscope
Lat year, the government said it would introduce a ‘duty of candour’ meaning patients will have to be told when errors have been made in their care.
This means healthcare providers will be contractually obliged to be open and transparent and admit mistakes.
But last month the Health Select Committee has called for the government’s pledge to be strengthened even further: in a report published without much fanfare it has called for the duty of candour to be a condition for licensing by the Care Quality Commission.
The Committee noted, however, that duties like these may not make a difference without culture change in the NHS.
Challenging a cover up culture
The case of Mid Staffordshire NHS Foundation Trust, that has been the very public subject of a public inquiry, illustrates just how hard it is to change a culture in which cover-ups and persecution of whistleblowers is the norm.
The Select Committee heard from several relatives of patients who died at Stafford Hospital, who had to go through great lengths to establish the truth about those deaths.
Their experiences reflect the Bureau’s own.
Last year the Bureau asked Stafford, using the Freedom of Information Act, about a patient who died in March 2010 after their large intestine was perforated during an endoscopy.
We wanted to know whether the patient’s family had been told that the death had been reported internally as a ‘serious untoward incident’ and whether the results of the investigation had been shared with them.
National guidance on openness and transparency in place at that time stated that relatives and patients are meant to be informed when a ‘SUI’ report is filed that relates to them.
But Manjit Obhrai, the trust’s medical director was unable to give an answer, as there was no record about whether or not the family was told.
‘At the time of this incident it was not trust policy to ensure families were informed when incidents were logged as an SUI,’ he said.
This was at a time when the trust was under intense public scrutiny, following a Healthcare Commission report in 2009 that found hundreds of unnecessary deaths may have occurred there.
Dr Obhrai said the trust now has systems in place to ensure all families are kept fully informed when an error has occurred. But the trust declined to answer FOI requests about the extent of transparency in further incidents.
And this year it refused to release a review by the Royal College of Surgeons of England that heavily criticized two surgeons’ management of several patients who died following surgery.
The Bureau is aware that at least one of the families concerned only found about the review’s existence from the local press.
The new duty of candour is a step in the right direction.
But whether or not it makes a real difference will depend on senior hospital managers changing their attitudes to patients – and journalists.
August 14th, 2011 at 7:05 pm (#)
Intreresting stuff. In my experience there are wide discrepancies in reporting arrangements for Serious Untoward Incidents across the NHS. Some Trusts are upfront and publish outline details in board papers – SUI’s now have to be discussed at Trust board level as part of their clinical governance arrangements – while most do not. Even asking for SUI details via FOI requests throws up wide variations in what Trusts are prepared to disclose (though with persistence, much information can be extracted). There are also wide discrepancies in the actual reporting arrangements for SUI’s – in my experience no two NHS Trusts handle or define them in the same way, although there is a standardised way in categorising SUIs (eg ‘unexpected death’ or ‘medication error’). The same applies to Strategic Health Authorities. Disclosure of SUI’s appears to be a very sensitive subject within the NHS – they are after all about when things go wrong and can be very embarassing and distressing. Yes, SUI data can be a goldmine for journalists but there is a real public interest in extracting this information. I would argue that transparency over SUI’s enhances the safety culture within the NHS and fosters greater public awareness of what really goes on inside our hospitals. Keep up the good work.
August 21st, 2011 at 2:47 pm (#)
Being open about the collapse of the paediatric service at XXXX in 2007 led to my victimisation by XXXXX; repeated calls for investigation of what looks like attempts to cover up the truth about the service, calls by senior consultants at XXXX for an investigation into the Trust treatment of whistleblowers but no action by the NHS.
This is symptomatic as far as I can see of the current NHS culture.
There is no reason for NHS managers to follow the duty of candour, as no-one seems to care. It takes persistence by families, caring MPs, and or staff and as a last resort journalists to obtain the truth.
(Editor: parts of this report have been redacted as names have been mentioned which could open us up to libel accusations).