Norman Lamb MP writes… Improving patient safety in the NHS

Nurse jokes with patientBack in 2012, an independent study of NHS case notes from hospitals concluded that in about 2.3% of hospital deaths there was strong evidence that death could have been prevented. In practice, this equates to around 6,300 preventable deaths in hospitals every year.

This is a shocking statistic. As Liberal Democrats, we should never fall into the trap of talking down the NHS – our health and care services do fantastic work day after day savings lives and providing excellent care.  But we must also be willing to confront fallings: every preventable death is one too many, and a tragedy.

When fatal mistakes happen, we would all say that there should, of course, be complete openness with loved ones. And the same principle should apply when a patient is harmed. But too often we hear stories of families battling to get to the truth. Sometimes clinicians close ranks. Sometimes hospital managers fear damage to their reputation. This has to be confronted.

In our 2010 Manifesto, the Liberal Democrats committed to creating a statutory Duty of Candour for hospitals, placing them under a legal duty to own up when serious mistakes are made. And Robert Francis, in his report on the lessons to be learnt from the horrors of Mid Staffordshire, also called for a statutory Duty of Candour.

I’m really pleased that the Government accepted this recommendation. Now we are consulting on whether the duty of candour should include all ‘significant harm’, covering all health and social care organisations.

In government, the Liberal Democrats have been committed to delivering better care, so everyone can be confident that they will be properly looked after by our health and care system in their moment of need.  At the heart of building confidence in our system is the need for a real culture shift towards complete openness and transparency, and a commitment to learning from mistakes.  This week we have made a significant step forwards in delivering on that.

Across the country, NHS trusts are being asked to “Sign up to Safety”, setting out publicly an ambitious plan to reduce avoidable harm over the next three years.  In return, the NHS Litigation Authority, which indemnifies NHS Trusts against legal action, will reduce the premiums paid by those organisations which are implementing their plans successfully.   Every year the NHS spends over £1.3bn on legal claims, and this plan aims to free up as much of that money as possible so it can be reinvested in providing better care.

Crucially, though, this plan won’t just apply to acute hospitals.  I was determined that mental health and community care trusts were also involved – mistakes in these organisations have every bit as devastating effect on individuals and families.

As a Liberal Democrat minister, my preference has always been for encouraging local areas to find local solutions for delivering better care.  Different areas have different needs, and I am glad that this new initiative will not be imposed top-down from Whitehall, but will be about supporting each NHS Trust to develop their own approach to reducing mistakes.

This new approach has the potential to make a massive difference to the thousands of families. Every mistake avoided through an obsessive focus on safety is worth it. And the lesson I learnt on a visit to the brilliant not-for-profit integrated care organisation, Intermountain Health in Utah, is that creating a really strong culture of safety saves lives, reduces harm to patients but also reduces cost so money can be reinvested in care.

In government the Liberal Democrats are working to deliver better care, building a fairer society, and reducing preventable harm is an essential  step in achieving this.

* Norman Lamb is MP for North Norfolk and was Liberal Democrat Minister of State at the Department of Health until May 2015. He now chairs the Science and Technology Select Committee

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  • A ‘Duty of Candour’ is just the sort of thing that sounds good in Westminster but doesn’t necessarily travel well. It could be made to work but I think it needs some additional angles.

    Lack of candour – which one might reasonably suppose is the problem addressed by the ‘Duty’ – doesn’t appear to be the problem. There are plenty of people in the NHS who are dedicated professionals with a real passion to deliver the best possible care yet when they are driven to become whistle-blowers by the systems inability to correct bad practices they are too often persecuted, subjected trumped-up disciplinary procedures or gagged with substantial pay-offs.

    So what is a junior member of a team supposed to do under the Duty of Candour if/when he/she observes something wrong and senior members of the team or the hospital administration refuse to address the problem? It seems they will be dammed if they do speak up and dammed if they don’t. That’s not a good result.

    Have the Duty of Candour by all means but add some conditions for the hospital management:
    1. Any past gagging agreements with whistle-blowers are to be unilaterally waived by the NHS side. If there is a serious intent to promote candour there can be no objection to revealing what they were trying to expose to the light however belated. The whistle-blowers should of course keep their money since it may have been spent.
    2. Make it illegal for NHS boards to pay legal costs or gagging pay-offs with any such future costs to be surcharged to the board members on a joint and several basis. That will concentrate minds!

  • Having recently watched my father, in my opinion, becoming one of those 2.3% preventable deaths in hospital I welcome anything that might improve patient safety. However, he was failed not by anyone making a major mistake that might fall within the ambit of Duty of Candour, but by simple failures of organisation and care. He was admitted to hospital on a Friday evening, which meant no proper assessment of his condition until the doctors returned in full strength on the Monday. He had special dietary needs, but because he was moved several times in the days after he was admitted his meals never reached him, so he was left without food. His bed was soaked several times by a leaking drip which was undetected throughout the night by nursing staff. The buzzer to summon staff was placed on the floor at night so that he couldn’t reach it. The last thing I want to do is to “talk down the NHS” – I want to be able to believe that our health and care services are doing fantastic work (which, incidentally, is what they are paid for) – but my observations suggest that too often they are not Yes, there are people who are doing their job properly, and I see no reason to unduly reverence them for that , which it seems we as consumers of health care are supposed to do, but there are also far too many people in the health service who are lazy and incompetent, and who evince little sign of caring about the people in their charge

  • Stephen Donnelly 27th Mar '14 - 9:28pm

    The problem with this is that we supported the Lansley Bill which has put commissioning of services partly in to the hands of conflicted groups of local GPs, and in the case of specialised services, unaccountable and inexperienced national bodies.

    Patients do not feature in the commissioning arrangements, and hospital clinicians have been sidelined. It is impossible to run an organisation the size of the NHS by centralised command and control. Hospital doctors and nurses are not best managed by legislation and threats.

    We are all aware that ‘something needed to be done’. This is something, but it is not what was needed. I fear we have been very naive in giving unquestioned support to a Tory agenda that generates tough sounding headlines about patient care, whilst dismantling the NHS without a mandate.

  • So would the duty of candor extend to, say, release of the Health and Social care act risk register?

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