Will a duty of candour provoke a culture change in the NHS? Health and social care professionals must be able to speak out about failings within the NHS without fear of sanctions.
The recent Care Quality Commission (CQC) report which identified concerns about the quality of care in more than a quarter of the 161 acute NHS trusts, has once again highlighted the need for increased transparency surrounding hospital standards and a change in attitude towards whistleblowing.
The NHS watchdog's report has magnified many of the same issues identified by Professor Sir Bruce Keogh in his review earlier this year and this latest report reinforces his calls for increased transparency.
Wholesale change has been called for, but this can only occur if there is a genuine shift in attitudes among NHS staff. There needs to be a clearly communicated drive to identify and solve issues that have led to patients receiving sub-standard levels of care over a long period of time.
The conditions under which doctors and nurses are working are extremely difficult. While their primary objective will always be to deliver good patient care, their ability to do this can be compromised by the effects of budget cuts, target-setting cultures and managerial constraints.
By embracing transparency and a culture of openness, it will be possible to reverse the negative connotations that are associated with whistleblowing. No one is better placed to identify issues as they arise than NHS staff themselves. Encouraging staff to speak out will not only lead to a better quality of care for patients, but it will also give staff a renewed confidence that they are being supported in their daily responsibility to properly care for and treat patients.
NHS organisations have already been told in no uncertain terms that it is not acceptable to suppress complaints or attempt to hide sub-standard practices under the carpet. One of the recommendations made in Robert Francis QC's report on the failings of Mid-Staffordshire NHS trust is that there be a new "duty of candour". It was proposed in the report that this duty involves both a statutory obligation on the individual professional to inform an organisation of "relevant incidents", and a further statutory obligation on the healthcare provider organisation to inform the patient where they have or may have been harmed, irrespective of whether or not they have asked for this information. It was also recommended that it be a criminal offence for a health or social care worker at any level not to report "relevant incidents" to their employer.
There was a concern that a "relevant incident" may be too narrowly defined but nevertheless, in principle, placing a new requirement on NHS health and social care workers to report errors or bad practice is a step in the right direction. This is still very much ongoing and plans to include a statutory duty of candour in the health and social care bill were defeated in the House of Lords in February. It is understood, however, that the Department of Health is due to publish a draft duty of candour regulation for review as part of a consultation into the CQC's new registration requirements for healthcare providers.
The challenge will be to ensure that NHS health and social care workers feel able to speak out about failings without fear of sanctions or intimidation. Healthcare provider organisations must be ready to investigate and address any failings they find and communicate them clearly and openly to the patient. This massive cultural change must be embraced by all NHS providers and staff if it is to succeed in significantly reducing incidences of sub-standard patient care.
The recent reports are just starting points. Without a major shift in management's attitude towards "whistleblowing", it will be extremely difficult to see how the NHS is improving its standards of care and patients will continue to suffer as a result. An NHS that is rooted in openness, honesty and the general principle of being able to learn from its mistakes is vital.
Suzanne Trask is a clinical negligence expert and partner at Bolt Burdon Kemp. Guardian Professional
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