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Doctors must be more open over mistakes, says government

Doctors will be required to be more open about patient safety incidents under a professional duty proposed by the government.

careIn its response to the public inquiry into failings at the Mid Staffordshire NHS Foundation Trust, the government has stressed its determination to make ‘more openness, greater accountability and a relentless focus on safety … the cornerstones of an NHS which puts compassion at its heart’.

The BMA is supporting the move, having successfully urged the government not to introduce a statutory duty of candour for individuals.

The association also backed moves to ensure adequate staffing levels on all wards across England.


Patient care first

BMA council chair Mark Porter said: ‘Patient safety should always be paramount, which is why safe staffing levels should always be set in accordance with the best available evidence and with a dynamic consideration of patients’ needs at any one time.

‘We are also pleased that the government has heeded the BMA’s warnings over the introduction of a statutory duty of candour for individuals, instead strengthening the professional duty that already exists.

‘It is vital that organisations actively listen to their staff and take on their concerns.’

The Department of Health will consult on its proposals that all NHS organisations and professional staff must be open with patients when things go wrong, whether the incident is serious or not.


Honesty paramount

The GMC and other professional regulators will introduce a new explicit and consistent duty of candour for doctors and health professionals, making it a requirement to be open with patients and families about all avoidable harm.

The guidance will also make clear that obstructing colleagues in being candid will be a breach of their professional codes. Speaking up quickly may also be considered to be a mitigating factor in a conduct hearing.

The government says the moves are inspired by normal practice in the airline industry and will help foster an NHS culture in which reporting and learning from mistakes is the norm.

If a hospital is not open with patients and their families, its indemnity cover for a compensation claim in connection with that incident could be reduced or removed. The government says this would give a strong financial incentive to hospitals to be open about patient safety incidents.


Taking responsibility

Other changes to the NHS will include:

  • Safe staffing. From next April, all hospitals in England will publish staffing levels on a ward-by-ward basis, together with the percentage of shifts meeting safe staffing guidelines
  • A new national safety website will publish all the information relevant to safety in every hospital in the country on a monthly basis
  • Every hospital patient should have the names of a responsible consultant and nurse above their beds. There will be a named accountable clinician for out-of-hospital care for all vulnerable older people, as part of the latest GP contract
  • A new criminal offence for wilful neglect.

A new ‘fit and proper person’s test’, which will enable the Care Quality Commission to bar unsuitable senior managers who have failed in the past from taking up individual posts elsewhere in the system.


Focus on staff levels

Dr Porter added: ‘Centrally imposed, mandatory staffing levels would be difficult to implement as they fail to recognise that not every patient is the same and, as such, safe levels will vary from time to time across hospitals.

‘The government is right to want to deal with this through a combination of evidence-based guidance, rigorous governance, transparency and openness.’

However, the association has doubts about whether extending wilful neglect as a criminal offence will help change the NHS culture in a positive way.

Dr Porter pointed out there were already criminal sanctions in place to hold healthcare workers, including doctors, to account.

Mid Staffordshire public inquiry chair Robert Francis QC made 290 recommendations to ensure such failings never happened again. The government has accepted 281 of the recommendations, including 57 in principle and 20 in part.

The government response, published today, also incorporates its response to five expert independent reports, commissioned following the Francis report.

Progress against the report as a whole will be reported to Parliament on an annual basis to ensure rapid progress in delivering the recommendations.

Read Mid Staffordshire NHS Foundation Trust public inquiry: government response

Read about the BMA's response to the Francis inquiry

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