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Duty of Candour : What is expected of doctors, nurses and midwives when mistakes are made?

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    A blog considering new guidelines for individual doctors, nurses and midwives to admit mistakes and offer apologies to patients at an early stage when something has gone wrong.

    By Joachim Stanley

Medical mistakes within the NHS and in private healthcare can happen and, from my experience, it is often the case that patients are only occasionally given an apology or an explanation as to why the mistake was made.

Since the introduction of the duty of candour, NHS and Private Health Organisations have been under a duty to admit to mistakes when they have been made and offer apologies to patients and their families. Under new guidance introduced in June 2015, individual doctors, nurses and midwives are provided with information to ensure they play their part in complying with the duty in their role on the ‘front line’ of patient care.

What is a ‘Duty of Candour’?

The duty of candour was introduced in November 2014 for NHS bodies and from April 2015 for other independent care providers and it outlines what should happen when something goes wrong with a patient’s treatment.  In summary it is a legal duty to apologise to patients if there have been mistakes in their care that have led to significant harm.

The responsibility for this fell on the NHS and Private Health Organisations. Since the introduction of the duty of candour there has been call to provide guidance to individual medical practitioners.

New Guidance

Guidance to individual doctors, nurses and midwives is now being introduced making it clear that staff should inform patients and/or their families when something has gone wrong, what health implications there are and that all this information should be communicated as soon as possible. As a result of this patients and their families should be given a face-to-face apology.

In particular, the guidance states that the professional should:

– speak to a patient, or those close to them, as soon as possible after they realise something has gone wrong with their care
– apologise to the patient, explaining what happened, what can be done if they have suffered harm and what will be done to prevent someone else being harmed in the future
– report errors at an early stage so that lessons can be learned quickly, and patients are protected from harm in the future.

The new guidance “Openness and honesty when things go wrong: the professional duty of candour” has been drafted by General Medical Council and the Nursing and Midwifery Council. It will apply to in excess of 950,000 doctors, nurses and midwives working in the UK.

Why this change was needed?

It was often the case that when mistakes were made patients were not offered apologies or explanations as to why they occurred. This often had the effect of making what was a very distressing and frustrating situation, even worse. It is argued that there was a culture of secrecy within the NHS and private health sector to ensure protection from claims being made against them.

It is hoped that the guidelines and guidance, being implemented, will promote a more open and honest process following mistakes. The benefit to this being that patients are aware of what went wrong and practitioners are able to learn from mistakes in an open and more positive forum. This should also have the effect of improving patient care in the long term.Importantly, the guidance also seeks to reassure staff by emphasising that apologising does not mean that they are expected to take personal responsibility for failures in treatment systems or the mistakes of colleagues, and does not imply any admission of liability if a subsequent compensation claim follows.

So many of my clients tell me that understanding what has happened to them or their loved one is as important as being compensated for the injuries and financial losses suffered and so I hope this new guidance will help patients and their families to understand why mistakes are made and provide them with the apologies they desperately seek, and at an early stage.

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