NHS has come under scrutiny once again with allegations that the duty of candour, a legal requirement for healthcare professionals to be transparent with their patients when errors occur, is not functioning effectively. This criticism is brought forward by Bill Kirkup, a notable figure who has chaired several important investigations into preventable deaths within the NHS, including cases at Morecambe Bay NHS Trust and the Oxford paediatric cardiac surgery unit.
The Duty of Candour
The duty of candour was statutorily imposed following a high-profile public inquiry into the systemic failings at Mid Staffordshire NHS Trust, which concluded that many unnecessary deaths were the result of poor care. The aim was to create a culture of openness and honesty in the healthcare system, making it a legal duty for medical staff to disclose errors and apologize to patients and their families. However, according to Kirkup, this duty has not been as effective as intended.
During the launch of the Committee on Standards in Public Life’s report, Kirkup expressed his concerns: “I hear repeatedly people saying, ‘oh well, you’ve already got a duty of candour in the health service’. We have theoretically, but it does not work. It might work sometimes when the stakes aren’t too high, but when the stakes are high, it does not work.”
Case Study: Baby Ida Lock
To illustrate the shortcomings of the duty of candour, Kirkup referenced the case of baby Ida Lock. The tragic circumstances of Ida’s death highlight failures in medical care. She died of a brain injury in 2019 after midwives did not provide adequate medical attention. Ida’s mother, Sarah, mentioned in an inquest that staff questioned her honesty about her smoking habits despite her clear denials. Kirkup pointed out the disturbing fact that Ida was born at the Royal Lancaster Infirmary, a part of Morecambe Bay Trust – a trust that had already undergone a significant investigation in 2015.
Systemic Issues in the NHS
The recurring issues at the Morecambe Bay Trust indicate a systemic failure that has not been resolved despite prior interventions. Kirkup stressed that these issues demand continuous attention: “That’s why we need this more than anywhere in the health service. And that’s why, if anybody tells you we’ve got a duty of candour and it’s working, please, please don’t believe them.”
Though the duty of candour is binding on health and social care providers, there are calls for its broader implementation across all public authorities. Labour has made commitments to introduce a legal duty of candour for public authorities in their manifestos, aiming to extend accountability beyond the healthcare system.
The Hillsborough Law
The proposed Hillsborough Law is another facet of the push for transparency and accountability, designed to mandate criminal sanctions against those who lie about mistakes. Prime Minister Keir Starmer supported this law, especially after extensive campaigns by victims of the Hillsborough disaster, the infected blood scandal, and the Grenfell Tower fire. Yet, according to reports, the law has faced delays and dilution, much to the dissatisfaction of campaigners.
While discussions continue, the lack of implementation of the Hillsborough Law before the anniversary of the disaster signals a broader issue in enforcing recommendations from public inquiries. Recently, there have been considerations about creating an oversight body to ensure comprehensive implementation of inquiry recommendations, aiming to address such systemic issues within public institutions effectively.