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CQC chief executive backs wider duty of candour

The chief executive of the Care Quality Commission has thrown his weight behind a wider definition of the government’s planned statutory duty of candour.

Speaking at the regulator’s board meeting, chief executive David Behan said he supported a duty which applied to cases where “serious” harm had been caused to patients, and not just incidents which resulted in death or “severe” harm.

Mr Behan said “being on the side of patients” had led him to back “a much more comprehensive reporting policy…consistent with serious [harm]”.

A statutory duty of candour obliging healthcare organisations to be open with patients about mistakes that may have impacted their health, was a key recommendation of the Francis inquiry into poor care at Stafford Hospital.

The duty was formally accepted by the health secretary, Jeremy Hunt, in the government’s response to the inquiry last month.

The government originally intended for the duty to be limited to “severe harm” – when a patient had been killed or left permanently disabled, arguing a more expansive reporting requirement could inundate organisations with unnecessary bureaucracy.  

The Department of Health is set to consult on the duty – and the central question of what threshold of harm should be applied to it – in January next year.

The CQC has estimated there are about 11,000 incidents of severe harm per year, and potentially up to 100,000 incidents which could count as serious harm, although there may be significant underreporting of both.

In board papers released last week, Mr Behan had written that “it would be presumptive [for the] CQC to form a view on the appropriate threshold” before the consultation.

However, Mr Behan said he had been persuaded to change his position by the reaction to its initial decision from groups campaigning for a wider duty of candour, such as the charity Action Against Medical Accidents (AvMA).

“I’ve had email correspondence… with Peter Walsh [AvMA chief executive], who’s saying ‘you need to say what you think’, so… my recommendation to the board is CQC should adopt a position which takes a more comprehensive view and we should go for serious harm,” he said.

When asked by HSJ whether the CQC would formally back this threshold during the DH consultation, Mr Behan replied: “Yes… I hope it’s unambiguously clear.”  

Last week, five organisations representing patients and NHS whistleblowers wrote to Mr Hunt demanding the duty of candour not be limited to severe harm, arguing it would legitimise cover ups of incidents which in most people’s minds would be serious.

In addition to AvMA, the groups were Cure the NHS, National Voices, Patients First, and the Healthwatch and Patient Involvement Association.

As well as consulting on the duty, the DH has commissioned David Dalton, chief executive of Salford Royal Foundation Trust, and Norman Williams, president of the Royal College of Surgeons, to review the duty’s scope.

Readers' comments (2)

  • Incidentally, it is not just the chief executive who confirmed that including moderate harm within the remit of the Duty of Candour was the preference - it was the Board as a whole. As CQC will be responsible for enforcing the duty I do hope that their view will be given the weight it deserves. I have not heard any credible argument foe limiting the scope of the duty of candour - has anyone?

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  • I fully support this provided we remove 'Blame culture and have 'fair and open' culture' supportive and learning culture' and CQC, Monitor and regulators must stop punishing staff for genuine mistakes. Of course we must do everything to prevent harm but doctors and nurses are simply human beings and they will make mistakes and if we start punishing them for genuine mistakes then there won't be anyone left to look after patients. Accountability is a must.

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