Report concludes that doctors should admit their mistakes

The conclusions of a report by the president of the Royal College of Surgeons (RCS) and an NHS trust chief executive will put pressure on the health secretary, Jeremy Hunt, to agree to a full ‘duty of candour’, which patients’ organisations have been demanding for some years.

The report from Professor Norman Williams of the RCS and Sir David Dalton, the chief executive of Salford Royal hospital states that ‘when things do go wrong, patients and their families expect three things: to be told honestly what happened, what can be done to deal with any harm caused, and to know what will be done to prevent a recurrence to someone else. Health and care organisations have a responsibility to ensure that all of these are reliably undertaken.’

The report of Robert Francis QC into failures at the Mid-Staffordshire NHS trust called for a duty of candour, which the health secretary supported, but tepidly, implying that is should only apply to the most serious cases, where somebody dies as a result of poor care.  Williams and Dalton were asked by Hunt to look at where the threshold for candour should be set and what incentives might be needed for hospitals, GP surgeries and other organisations to comply.

The report suggests that healthcare staff should be honest and open with patients and families in all cases where the level of harm is not considered to be ‘low’. There are too many definitions, they say, and they would like to see them brought into alignment.  In their view, there should be a statutory duty on NHS organisations to tell patients what has happened in cases classified by the Care Quality Commission as ‘moderate’ or ‘severe’, as well as those where the patient dies.

‘Candour is essential for patients and their families. It is the responsibility of professionals, care organisations and the national bodies that support them to ensure that they have in place, and can sustain, a culture of candour,’ says the report.

The patient safety charity Action against Medical Accidents (AvMA), which has led the fight for a statutory duty of candour, said Hunt must accept the recommendations.

‘All patients welcome the outcome of the review. It is unthinkable that the government will ignore this recommendation,’ its chief executive, Peter Walsh is quoted as saying.

‘A full duty of candour would probably be the biggest advance in patients’ rights and patient safety since the creation of the NHS. For decades, the NHS has frowned upon cover-ups but has been prepared to tolerate them. This will be an end to that.’

The Royal College of Nursing backed a candour requirement in cases of significant harm. ‘We have long felt that in many organisations there is still a culture of blame, fear and secrecy that makes it very hard for staff to admit when things have gone wrong and learn from mistakes,’ Dr Peter Carter, chief executive is quoted as saying.

‘Healthcare staff want to provide the best possible care to patients, and work hard to achieve this,” he added. “However, healthcare is inherently risky and sometimes things will go wrong. When this happens, patients deserve an open and honest discussion with staff, and to know that lessons will be learned.’