Errors should be investigated in a no blame culture

IT’S always interesting to see the priorities of government in a new legislative session as recently announced by the First Minister.

Inevitably it is the health-related legislation which will be of most interest to doctors and, of course, a large proportion of patients too.

A new independent body for patient voices is a good idea in theory but will leave many people wondering how it will link with the current supportive organisations for patients, the Community Health Councils.

A seamless and accessible route for patients to make suggestions to – as well as complain about – the NHS is vital for an open service, and we at BMA Cymru Wales eagerly await details of the new scheme.

I sincerely hope that in the reorganisation we don’t lose the vital local links to people’s healthcare.

The headline proposal around a statutory duty of candour to apply to the health service is something the BMA strongly supports and we’ve called for this over a number of years.

Most patients might reasonably expect that they should already have a right to be told when things go wrong, and certainly doctors are under a clear professional obligation to be honest and candid with patients about their care.

Nevertheless, the current blame culture where health bodies often seem to deflect responsibility for errors and poor outcomes to individuals, together with recent very high profile criminal prosecutions of doctors, nurses and other health professionals, has led to a climate of fear over admitting mistakes.

This may sound like just closing ranks and an admission of human nature, but in fact the current climate is hugely dangerous for patients.

The only way to improve safety is to learn from every mistake, minor or major, and a duty of candour is of course an essential part of this. Every time opportunities to learn are missed the next patient is at risk of suffering the same harm.

Candour is only one part of the problem. The second is an appreciation (as in the airline industry) that almost all imperfections in the system are a combination of small errors, omissions and inefficiencies right across the system, and we have to try and eradicate these one at a time.

If we have a culture where identifying these risks in the system is positively incentivised and encouraged then we have a real chance to improve patient safety for all our sakes.

The first thing that is needed to support a duty of candour is an absolute obligation on health boards and NHS trusts to investigate all errors in a no blame culture, seeking to develop safeguards to prevent repetition. This must be integral to any legislation.

In tandem with the duty of candour, the Welsh Government want a duty of quality to apply to health and social care organisations.

In addition, doctors feel that there also needs to be prioritisation of staff governance, safe staff levels, preventing bullying, protecting whistleblowers and ensuring adequate occupational health provision to properly care for the carers.

If the new programme truly delivers on all these aims it will be immensely positive for the Welsh NHS and all our citizens, but it will require real commitment to get it right.

■ Dr David Bailey is from the British Medical Association (BMA) in Wales