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MPs insist on freedom to raise patient safety concerns

Doctors and other healthcare professionals must feel free to raise honestly held patient safety concerns without fear of retribution, MPs have insisted.

Houses of ParliamentIt is up to healthcare providers to enable this culture of openness, which would allow issues of genuine concern to be raised and ‘make the role of the whistleblower redundant’, the Commons health select committee has declared.

The committee has been examining the recommendations made by Mid Staffordshire NHS Foundation Trust public inquiry chair Robert Francis QC.

Its report, After Francis: Making a Difference, published today, says disciplinary procedures, professional standards hearings and employment tribunals are ‘not appropriate forums for honestly held concerns about patient safety and care quality to be discussed’.


End culture of fear

The report adds: ‘Providers of health and care services, and their regulators, should be open and transparent.

‘Any “gagging” clause in an agreement with such an organisation which has the effect of inhibiting the free discussion of issues of patient safety and care quality is unlawful, and no NHS body should seek to enforce any such agreement in a way which inhibits the free discussion of such issues.’

The recommendations chime with ongoing BMA work on NHS culture and whistleblowing.

BMA council chair Mark Porter told a fringe meeting at the Liberal Democrat party conference yesterday that doctors needed to work in ‘a culture in which they are not punished for speaking out with good intentions’.

He said: ‘If we are asking why doctors do not always speak out, we should look to the examples of the doctors who have expressed serious concerns about care and found themselves ostracised, suspended or excluded, threatened or dismissed … Too many doctors report working in an organisation where fear of consequence is never far away.’


Clear professional duties

Select committee chair Stephen Dorrell (pictured below) said the NHS needed to be an organisation in which an open dialogue about care quality was part of the natural culture, not a duty which only arose in cases of service failure.

stephen dorrellHe said: ‘Robert Francis made 290 recommendations in his report, but in truth they boil down to just one – that the culture of “doing the system’s business” is pervasive in parts of the NHS and has to change.’

Mr Dorrell said the clinical professionals already had ‘clear personal duties’ in their professional codes and it was the responsibility of the healthcare regulators to ensure these duties are reflected in practice.

In the report, the committee says it regrets the continued delay in implementing death certification reforms, first proposed after serial killer GP Harold Shipman’s activities were uncovered.

The reforms would see independent medical examiners recording the cause of death on death certificates rather than the examining doctor. The government plans to implement the new system next October.

The select committee urges the government to ensure this timetable does not slip further.


Further evaluation

The report also proposes:

  • NHS care providers should provide data on staffing levels at ward level on a daily basis in a format which allows easy comparison against benchmarks
  • Breaches of the proposed fundamental standards of patient care in NHS providers should be treated seriously and investigated thoroughly, but with regulatory consequences that are proportionate and focus on analysis and remedy of adverse circumstances that led to a breach
  • Examining the response of the GMC to Mr Francis’s recommendations during the annual accountability hearings the select committee holds with the regulator.

The health select committee will continue to monitor and evaluate the government’s response to the Mid Staffordshire inquiry recommendations.

Read After Francis: Making a Difference

Read about the BMA culture project