Duty of candour guidelines put ‘honesty’ at heart of healthcare

Doctors, nurses and midwives have been told to be ‘open’ and ‘honest’ about mistakes with their patients, as part of draft guidance released today. 

Developed by the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC), the document aims to set out a common standard which will apply to doctors, nurses and midwives when they deal with things that go wrong in patient care. 

The proposals cover the need to learn from ‘near misses’ as well as when something goes wrong and a patient is harmed. There is also advice on apologising to patients and those close to them. 

As part of an attempt to change the culture in the NHS, following the events at Mid-Staffs, Niall Dickson, chief executive of the GMC, stated that patients deserve a clear and honest explanation if something has gone wrong with their care. 

“This is why, for the first time, we are collaborating on this new joint guidance. It will ensure that doctors, nurses and midwives are working to a common standard and will know exactly what their responsibilities are,” he said. “But it will only be of any use if it makes sense in day-to-day practice and that is why we are now going to consult with patients and with doctors, nurses and midwives who deal with these issues on the clinical front line. We want to know if it is clear enough, covers everything it should and we would welcome ideas on how best to illustrate the guidance working in practice.” 

Secretary of state for health Jeremy Hunt who will be speaking at an event to mark the launch of the joint consultation this evening, stated that transparency and honesty when things go wrong are powerful tools to improve patient safety, and part of the continued culture change we are determined to see in the NHS.

“These new guidelines will complement the statutory duty of candour on organisations and help make the NHS safer than ever before,” he added. 

In response to the guidelines, the chair of the British Medical Association’s Council, Dr Mark Porter, said that NHS leaders need to commit to making the guidelines a practical reality and look forward to Sir Robert Francis' report on his review of 'Freedom to Speak up'. 

“When things go wrong the vast majority of doctors already apologise at the earliest opportunity as this is a key professional duty.  The General Medical Council proposals to support that duty may well be helpful in this process, however any suggestion of an enforced apology where there is a dispute over where fault lies would be inappropriate,” stated Dr Porter. 

“Apologies in these circumstances should be couched in those terms if we are to have a process that is truthful and appropriate.” 

Last month the GMC, NMC and six other professional healthcare regulators in the UK published a joint statement, setting out their commitment to a duty of candour for healthcare professionals. The consultation is open until 5 January 2015. The GMC and NMC aim to publish their new joint guidance in March 2015. 

Jackie Smith, the NMC’s chief executive, said: “The duty of candour will enhance public protection as it will nurture an open and constructive learning environment. This in turn will support healthcare professionals who wish to raise concerns.” 

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