BMJ research found that 20% of doctors have had direct experience of incompetence, but 16% of those who reported colleagues were told their own careers could be jeopardised. Photograph: Pulse Picture Library/PA
“I’m afraid there’s been a complication …..” words that no patient or their family ever wishes to hear in hospital. But what matters in the end is the truth and it’s getting there that can prove difficult.
NHS staff act no differently to those in the wider society. Sometimes bad things happen with terrible consequences. Yet, despite the excellent calibre of its professionals, the NHS has a culture of blame which all too often limits openness and honesty with colleagues and patients.
It is concerning that the BMJ’s Quality & Safety journal this week reported that 20% of doctors have had direct experience of an incompetent colleague. According to the BMA, 16% of doctors who had reported colleagues were told their own careers may be affected. Where do these statistics leave the patient?
The term whistleblowing is filled with negative connotations. The language itself smacks of telling tales and playground politics. It is no wonder that a fear of retribution causes substandard care to go unreported.
Earlier this year, the Department of Health issued a consultation paper on new expectations and commitments around whistleblowing. The NHS has made significant strides over the years to encourage a culture of transparency, but there is still a long way to go. To my mind, the inherent conflict of interest between protecting the NHS (or practitioner), versus protecting the public (or patient), when something has gone badly wrong, is at the heart of the difficulty in reducing the risks of future inadequate care.
Let’s start with the Hippocratic Oath – the pledge doctors take to put patients first. This should be synonymous with a duty of candour. If, instead of simply empowering NHS staff to speak out without fear of victimisation, the DoH’s whistleblowing proposals came with a duty extending to every employee to report their own wrongdoing; this subtle cultural shift could have far reaching consequences.
Reporting currently focuses on ‘others’ rather than ‘self’, yet this is perverse. Why should a doctor or nurse have a greater duty in relation to reporting their colleagues’ behaviour than the duty they have to discharge in relation to themselves? Medical professionals are human – they recognise as much as the next person when their own standards have fallen short. Yet only when held to a standard of personal accountability through this proposed cultural shift, will more NHS employees have the courage to admit that the service they personally provided fell short.
This duty of candour would have noticeable cost-effectiveness too. There is plenty of evidence that good practice helps reduce cost to the public purse of legitimate yet costly compensation claims. In my own experience, where excellent practitioners admit their error to a patient, or their family, straight away, it reduces the likelihood of legal complaints. These professionals manage to retain the respect and trust of the family affected, in spite of the error, because of their openness and honesty. This shows excellent clinical leadership and aids swift resolution of incidents that are distressing for NHS staff and patients alike. Sadly, such behaviour is notably rare.
Sometimes, the law of ‘tort’ is the correct tool for delivering solutions where, despite the best efforts of committed people, things have gone wrong in a way that is avoidable and accountable. In clinical negligence claims, there is a tough legal test applied to the facts of clinical error and an objective decision is reached on whether the standard of care has been breached and what consequences flow from any breach. Rare is the patient or relative who relishes having to bring such a claim.
Ultimately I’d like to see an ethos in which the NHS learns from avoidable mistakes or ‘near misses’ through a cultural recognition of the duty of individual responsibility. A self-administered shot of self-esteem across the NHS would do wonders. This, coupled with a programme of recertification and peer review for doctors to ensure good clinical standards, would mean improved patient safety and NHS staff being instilled with a justifiable sense of pride.
• Ross Brain is a partner and clinical negligence expert at law firm Kingsley Napley
Sources : Guardian-Health