18 Sep 2013

More calls for candour as NHS whistleblower hounded from UK

On a monthly basis, it seems,  there is a response to the Francis Inquiry report into Mid Staffs.

Almost all of them begin with an acknowledgement of the importance of the report itself.  The Royal College of Nursing, indeed, today describes it as a ‘watershed moment’.  All of them agree there is a clear need for change.

So today the health select committee has published its response which has highlighted two important issues: transparency, honesty and openness about care quality – or lack of; and staffing levels.


On the first, they appear to have rejected the idea that there should be a statutory duty of candour to ensure that concerns about care quality and mistakes are brought out into the open.

Instead they say that the NHS needs to be an organisation in which open dialogue about care quality is part of the natural culture of the organisation and not a duty which only arises in cases of service failure.

This will disappoint patient organisations such as Action Against Medical Accidents (AvMA), which have long argued that a statutory duty of candour is essential against a long history of failures in service and care delivery being hidden or ignored, and of the staff who try to speak up being harrassed, sacked and sometimes gagged.

The health select committee goes on to say that the NHS standard contract imposes a duty of candour on all NHS providers.

I spent an hour yesterday speaking to a consultant who tried to rise concerns at a well-known hospital and who was hounded from his job.  He has now been forced to work abroad.

It was a heartbreaking discussion, not least because England has lost (I hope temporarily) an eminent, highly-trained specialist with a swathe of international awards behind him, to another country.  And it was heartbreaking because it revealed, once again, that enormous – and I mean enormous – sums of money have been spent on getting him out of his much-loved post.

He has refused a pay out because he did not want to take any taxpayers money.  But there are many in similar positions who do not have that luxury because they have mortgages to pay and families to support to support.

The health committee is absolutely right that candour should be embedded into the fabric of the NHS.  But they do not set out how you can actually change the entire culture of the NHS which actively encourages people to keep their heads down and avert their eyes from disaster.

On staffing, they suggest hospitals publish ward staffing levels daily.  They say patients, regulators and NHS bosses must be able to see how many nurses are working every day and how that compares with the number who should be on duty.

The Chief Nursing Officer is apparently preparing to issue guidance but has so far rejected the idea for minimum ratios to be made compulsory as happens in some US and Australian states.

The argument against is that it would encourage hospitals to stick to the bare minimum when in an ideal world there would be more staff.

The argument for it is laid bare in the Times today when its own survey shows that 43 per cent of wards have a staffing level lower than one nurse per eight patients.

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