NHS providers will be required to tell patients about all but the very least serious patient safety incidents under the new statutory duty of candour, if the recommendations of a government commissioned review are adopted into law.

Based on current levels of incident reporting to the National Reporting and Learning System this would mean providers owning up to almost 100,000 incidents every year. This is 85,000 more incidents than envisaged under Robert Francis QC’s original proposal for a duty of candour on organisations.

The review, by Salford Royal Foundation Trust chief executive Sir David Dalton and Royal College of Surgeons president Norman Williams, also recommends the definition of harm be extended to include prolonged psychological harm and emotional distress. It was published today.

It concludes that organisational reputation is a stronger driver of behaviour than financial sanctions and recommends this is where sanctions for breaching the duty should be focused.

The review also recommends all staff should be trained in how to disclose incidents to patients and their families and apologise “where appropriate”.

Sir David said: “If the NHS embraces this new culture and takes it seriously – thinking about all the things you would need to put in place to make a reality of candour – this could be the basis of a profound change to the ways in which organisations and staff interact with patients.”

The government announced plans for a statutory duty of candour on organisations registered with the Care Quality Commission in its response to the Francis report last year.

Robert Francis QC recommended the duty should only apply in cases of death or serious harm. However, following pressure from patients groups including Action Against Medical Accidents and National Voices, the government agreed to look again at what the threshold should be.

Sir David and Professor Williams concluded the threshold should also include moderate harm, under the definitions for reporting to the NRLS, which is the current national reporting system hosted by NHS England. This extends the number of incidents likely to be covered by the duty from 11,000 to 96,000.

Professor Williams said: “The evidence that we heard during the course of this review reaffirms what we already knew: that when things do go wrong, patients and their families want to be told honestly about what happened,  how it might be corrected  and to know that it will not happen to someone else.”

The duty of candour is one of the 11 fundamental standards being introduced in the wake of the Francis report.

The review said the CQC should look for “patterns in organisational behaviour rather than one-off breaches” of the duty, except in “stark cases”.  

It concluded while further consideration should be given to handing the NHS Litigation Authority power to fine trusts if they were not open with patients, reputational sanctions, such as removing board members or issuing warning notices would be more effective.

The review also proposes a new set of definitions which recognise that moderate harm, which can regularly last a long time, often “does not seem very moderate in reality”.

Under the proposals all cases involving death or moderate or severe harm would be classed as “significant” and would sit alongside a “low harm” and “no harm” incidents categories.

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