The Department of Health in Northern Ireland is consulting on policy proposals to enact a statutory duty of candour in Northern Ireland. This follows recommendations from an Inquiry into hyponatraemia-related deaths.
The statutory duty of candour has already been enacted by legislation in the rest of the UK and the SoR is a longstanding champion of the principle of a duty of candour. However, we believe that experience shows the duty is most evidently exercised in cultures where staff feel secure and are supported in admitting when something has gone wrong.
We are therefore inevitably concerned by the Northern Ireland Executive’s proposal to make failing to exercise a duty of candour a criminal offence.
SoR’s Northern Ireland national officer Leandre Archer explained: ‘Professionals don’t work in isolation and are impacted by organisational culture – positively and negatively. We know from inquiries and inspectorate reports when things have gone wrong it has often been because staff did not feel they could safely say or challenge systematic and cultural barriers to safe patient care.
‘So while we support the duty of candour and efforts to promote its use, we are concerned by how the department is proposing to do this here. Individualising looks like a crude attempt to play a blame game. Criminalising individuals has the potential to make people more insecure and could be counter-productive.’
The SoR is asking Northern Ireland members to share their views to inform a formal collective submission by 29 July 2021. Please email [email protected]. Members can also consider responding directly to the consultation as individuals. The consultation closes on 2 August 2021. Members may also want to write to their MP or MLA. Contact details at: MLA Contact Details
What is a duty of candour?
In recent years there has been increasing emphasis on honesty and transparency in healthcare – particularly following a number of public inquiries into patient care failures. Any culture of secrecy or cover-up in healthcare is to be challenged, which has led to a focus on making ‘candour’ in healthcare mandatory.
Candour has been defined by the Professional Standards Authority as ‘being open and transparent when something has gone wrong’. Currently, radiographers in NI are only affected by a professional duty of candour.
This duty is reflected in the Health and Care Professions Council’s standards of conduct, performance and ethics at Standard 8: Be open when things go wrong and in the SoR’s code of conduct 2.1: You must work within current legal, ethical, professional and governance frameworks pertaining to your occupational role and the sector in which you work.
A statutory duty of candour would create a legal responsibility for all healthcare organisations and individual staff to be honest when things go wrong. This duty would not just apply to being open and honest with patients but also to the need to be open and honest within organisations in reporting adverse incidents or near misses that may have led to harm.
This statutory duty has already been implemented in England, Scotland and Wales although there is a major difference to what they are considering in NI. In the other countries there are no individual criminal sanctions if the health professional does not provide information to the patient in relation to the near miss or serious incident - only an organisation can be penalised by the statutory duty.
As radiographers, we have robust systems in place to report near misses and incidents of harm to patients. Currently the ethos in NI is one where our members feel supported and able to report and communicate near misses or incidences of harm in their respective organisations. The implementation of the QSI in NI has also reinforced and standardised policies across trusts protecting both patients and staff.
Summary of the options presented in the duty of candour consultation:
- Implement the recommendations as written in the O’Hara report. Report of the Inquiry into Hyponatraemia related Deaths (ihrdni.org).
- Introduce a statutory individual Duty of Candour which would include a series of requirements in law that have to be adhered to by staff within its scope. Breach of these requirements would constitute a criminal offence.
- Alternative proposal (A) Statutory Duty of Candour without criminal sanction for breach.
- Alternative proposal (B) Statutory individual Duty of Candour without criminal sanctions for breach and separate criminal offence for withholding information destroying or tampering with information or providing false or misleading information.
The Department of Health also proposes the development and implementation of a ‘Being open framework’. Guidance would be developed at the following levels:
- Routine openness
- Openness to promote learning
- Candour when significant harm has been done or something has gone wrong which has caused death.