Editorial

Clin Risk 2008;14:108
doi:10.1258/cr.2008.080021
© 2008 Royal Society of Medicine

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Peter Walsh, Chief Executive


AvMA


Recent events have brought into even sharper focus the needfor the NHS to adopt a robust and coherent position on the needto be open and honest with patients and their families whenthings go wrong (and an excuse for me to return to the subjectwhich is so close to AvMA’s heart).

Since the Kennedy report into the Bristol Royal Infirmary tragedies,which made the term ‘no blame culture’ a commonphrase in discussions around improving patient safety, the Departmentof Health and the NHS has shown improved insight into what isactually desired. I do not believe it was ever Sir Ian Kennedy’sintention to suggest a literal ‘no blame’ culture,but more to move to a culture which is less focused on blamingor punishing individuals for their part in what is usually awider organizational or systems failure. The National PatientSafety Agency (NPSA), following prompting from AvMA and others,adopted the more acceptable phrase ‘open and fair’culture. Words are important in defining a desired culture.The ‘no blame’ terminology has led some people tobelieve that it might be acceptable if, say, a clinician reportsan incident to the national reporting system, for the injuredpatient or their family not to be informed. This would of coursebe completely contrary to the codes of the General Medical Counciland other health professional regulators, which require opennesswith patients when things go wrong. The NPSA has issued goodguidance on ‘Being Open’ which is unequivocal thatpatients need full and open explanations and apologies. TheDepartment of Health published ‘Safety First’ in2006 which for once did not talk about ‘no blame culture’and refreshingly acknowledged the need to address the ‘cultureof denial’ in the NHS. In August 2007 the NHS LitigationAuthority (NHSLA) issued another circular to NHS bodies as ‘Apologiesand Explanations’.

So what is the problem? The NHSLA circular, while well intentioned, is an example of how far we still have to go. It defines apologies as ‘an expression of regret … to sympathize with the patient or the patient’s relatives and to express sorrow or regret at the outcome’. Of course, as far as this goes, it is a perfectly desirable and humane approach. However, expressions of regret which are not put in context can actually add insult to injury. How would you feel if an organization which you believed had caused the death of your child through its own negligence simply expressed regret for the outcome and sympathy for you? The circular does go on to encourage explanations, including information on what lessons have been learnt, which is commendable. However, much of the circular’s good intentions are undone by one sentence in it which qualified the explanations that should be given:

‘Care needs to be taken in the dissemination of explanations so as to avoid future litigation risks, but for the avoidance of any doubt NHSLA will not take action against any NHS body or any clinician seeking NHS indemnity, on the basis of factual explanation offered in good faith before litigation is in train.’

 

What will leap out for any member of NHS staff with responsibilitiesin this area is the first half of this sentence. Why shouldcare be taken so as to avoid future litigation risks? Surely,the explanations and information given should be complete andfactual, even if it directly increases the risk of litigation?Our hope and understanding is that this is what NHSLA meantto say, and our relations with them are constructive enoughto give us some confidence that the harm done by the unfortunatewording can be put right. However, it is very indicative ofthe mind-set and culture which remain widespread in the NHS.Add to this the fact that there is still resistance on behalfof the Department of Health or Healthcare Commission to makingthe excellent NPSA guidance on ‘Being Open’ anythingmore than ‘guidance’, and you will understand whythe promised land still seems a far-off place.





Forthcoming Events

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Forthcoming Events

Medico-Legal Issues Arising from General Practice

14 May 2008, Browns Courtrooms, London

AvMA Annual Charity Golf Day

26 June 2008, Mannings Heath Golf Club, Horsham, West Sussex

Annual Clinical Negligence Conference

27–28 June 2008, Hilton Brighton Metropole

Legal, Ethical & Clinical Issues in Dentistry

9 October 2008, Woburn House, London

AvMA & MPS present The Annual Legal & Ethical Issues in Healthcare Conference

26 November 2008, Woburn House, London

AvMA Christmas Drinks Reception

10 December 2008, London Aquarium

For full details on these events, please go to www.avma.org.uk, e-mail conferences{at}avma.org.uk, or call 020 8688 9555.

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