It's been a long nine months for the NHS since the Francis report was published. As if the terrible and unnecessary suffering at Mid-staffs wasn't enough, numerous other scandals have come to light all across the country, continuing to damage the reputation of what we like to think of as a national treasure.
But perhaps there is light at the end of the tunnel? Any day now we expect the Government's formal response to the Inquiry. More importantly we will get to hear what the Secretary of State has to say about the 290 recommendations outlined by Robert Francis and find out how he intends to fix what feels like 'a broken health and social care service'.
Whatever the response, it's a fairly certain bet the major focus will be around the need for culture change, a shift away from corporate and professional self-interest to the needs of health and care consumers. Easier said than done. Which is why this change needs every bit of help it can get, including some underpinning by statutory legislation enforcing openness and honesty.
You would be forgiven for assuming that honesty would be found in spades in a sector which is fundamentally about caring for people. Yet it is the surprising lack of openness that has led to isolated incidents spiralling out of control and causing more serious and more widespread failures.
Take the latest scandal to hit the papers. Initially it seemed as though the shocking falsifying of cancer records at Colchester General had affected 22 patients. Now the press are reporting that it could be much higher and the hospital has been put into special measures. We are told this is all because of a culture of bullying right up to senior management, used to hide the fact that the hospital was struggling to meet its targets. Ultimately we will only know once the various assurance reviews have been completed exactly how many people were put at risk.
As a Colchester resident and a former non-executive board member of the hospital trust, I am deeply troubled by this and fully understand the concerns of local people. My family have been patients of the hospital in the past, indeed my son had excellent care there for minor surgery only last week. But if any of us are unlucky enough to need cancer treatment in the future, I want to know that we are in safe hands.
I joined the board in 2010 to help improve patient experiences and clinical outcomes for my community, I left to take up my role as Chair of the Healthwatch England, the national consumer champion for health and social, in August 2012. During my time with the trust, issues were identified and raised with the Board around the failure to meet screening targets for specific cancers and measures were put in place to address these, but the whistleblowing and internal investigations into data quality and alleged bullying were never brought to the attention of the board.
In the end it took the courage and persistence of a small number of staff to bring their concerns to the attention to the regulators. If it hadn't been for the strong moral compass guiding these individuals who knows how long the hospital could have continued to cover-up its cancer failings.
This case shows just how important it is for hospital staff, and other health and social care professionals, to be able to raise concerns with regulators, inspectors, and indeed their local Healthwatch, but they shouldn't have had to go this far. A legal duty of candour binding health and social care professionals to act in an open and honest way at all times would help to ensure that such issues are dealt with internally before reaching crisis point.
The Secretary of State has recognised the importance of candour and we expect this to feature in the Government's response. We think there must be a statutory duty of candour for all situations and one that applies to individuals as well as organisations. This may seem tough but we already know the professional codes of conduct have failed to prevent poor care, so why would anything less than a statutory duty make any difference. Statutory legislation would send a signal to the system that could fundamentally alter the way it deals with incidents of poor care.
Interestingly, in the case of Colchester, the CQC has passed its report on to the police, the first time it has decided to do so following an investigation. This means that those involved could face criminal prosecution and a possible custodial sentence. Criminal sanctions send out a strong message about the seriousness of violations and they need to be available as a tool to reinforce the message of honesty. But they should not be applied in every instance. It is crucial that such strong sanctions are not used to create a climate of fear.
The whole purpose of the duty of candour is to create a system that is more open, transparent and honest. Those that commit the most serious breaches of care must face the consequences but we need everyone else to feel confident about reporting their concerns and that they will be protected if they decide to blow the whistle. The Government's imminent response needs to establish the right mix of checks and balances to create a system where honesty is always the best policy.