For those with long memories, news that the Quality Care Commission tried to cover up an investigation into the death of babies at a hospital trust in Morecambe Bay is not the first sign of a culture of secrecy in the NHS.
After the inquiry into poor care in Staffordshire a number of stories hit the media where whistleblowers claimed to have been dismissed for expressing concerns about poor care. One former chief executive of United Lincolnshire Hospitals NHS Trust claimed to have been ‘gagged’ when he left. In a poll of physicians asking whether their employer encouraged staff to report poor care only 3 out 230 said ‘yes’.
There is plenty of evidence of a culture of secrecy in the NHS – a reluctance to admit mistakes and a failure to tell patients when things have gone wrong. The government has done no more than pay lip service to the need for a ‘duty of candour’ on hospital staff to admit mistakes. Despite a manifesto commitment it proposes only to require a duty on private service providers to tell the commissioning body about mistakes. It does not require them to tell patients – the people most concerned.
Should we be surprised? The reality is that despite a moral duty to admit mistakes and the value of doing so in shedding light on where practice should change, hospitals have a strong financial incentive not to. Foundation Trust status gives hospitals the ability to generate substantial private income. But Trusts can only get Foundation Trust status if they meet certain performance criteria. Admitting that mistakes have taken place and carrying out Serious Untoward Incident Investigations make the task harder. Morecambe Bay’s application for Foundation Trust status had been suspended because of serious untoward incidents.
The experience of our clinical negligence team is that some hospitals face up to some mistakes. We are often surprised by how detailed, thorough and self-critical Serious Untoward Incident Reports can be. They are also of particular value when they identify what needs to change to avoid mistakes in the future. But we are more often faced with organisations which are reluctant to admit mistakes and may actually mislead patients. Even once we are involved, have carried out a careful investigation and obtained expert evidence establishing negligence, the NHS Litigation Authority often fights cases it cannot win. So whilst we see some signs of greater candour in the NHS they are few and far between. With strong financial incentives to make performance look good and without an enforceable duty of candour on hospital staff things are unlikely to improve.