Wk4 The Duty Of Candour

Question 1

What is the Francis report ?

Answer 1

• A report produced into the Mid Staffs scandal
  
  • It is thought that between Jan 2005 and March 2009, 400 - 1200 excess deaths occurred at Stafford Hospital
• Robert Francis QC led a number of investigations and published a series of reports into what went wrong at the Mid Staffordshire NHS Trust

Question 2

What happened during the enquiry?

Answer 2

The first Francis Inquiry gathered evidence about what care was like at the hospital.

• missed or late pain medication
• verbal abuse of patients by staff
• patients unwashed for up to a month
• food and drink left out of patients reach
• poor hygiene - relatives removing used bandages and dressings from the floor and clean toilets themselves
• patients requests for help with toileting ignored, leaving them in soiled sheets sometimes for hours

Question 3

What was the mismanagement?

Answer 3

Chronically understaffed wards
Receptionists with no medical training triaging in A&E Inadequate training of staff
Junior doctors left to manage alone overnight
“Complete failure” of management to address serious problems, or monitor performance

Question 4

How did this happen?

Answer 4

“A chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care”
Staff were cut to meet financial targets to become a Foundation Trust Complaints were ignored
- there was a complaints procedure that was superficially followed - but none of the recommendations were ever implemented
A culture of fear, bullying and intimidation - staff did not feel able to speak up

No one, at any point, has suggested that the doctors or nurses at the Trust were any less competent than anywhere else
This was a failure to provide adequate care, and a failure to learn from mistakes Most complaints were about basic personal care - washing, feeding, hydration
- staff must have seen this happening
- it went unchallenged

Question 5

What were the consequences for patients?

Answer 5

Physical needs unmet
- dehydration, depletion of resources, poor healing, poor immune function
Emotional / social needs unmet - stress response
- altered neuroendocrine function, poor immune function, impaired wound healing

Question 6

How did it come to an end?

Answer 6

• Eventually the increased mortality flagged up in broader NHS systems
• Julie Bailey, whose mother died in Stafford Hospital, launched a campaign group ‘Cure the NHS’ to publicize failings at the Trust
• It became a national scandal and led to significant changes throughout the NHS

Question 7

What is the duty of candour?

Answer 7

• one outcome from Francis report
• be honest with your patients about mistakes or errors that have happened in their care

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 20
Organisations have a duty to :
● Inform people about the incident
● provide reasonable support
● provide truthful information
● provide an apology

Question 8

What is the GMC view that healthcare professionals must?

Answer 8

● tell the patient (or the patient’s advocate, carer or family) when something has gone wrong
● apologise
● offer an appropriate remedy or support to put matters right (if possible)
● explain fully to the patient the short and long term effects of what has happened.

Question 9

How were concerns allowed to be raised after?

Answer 9

‘Freedom to Speak Up’ - a further review into changing the culture of the NHS
Nationwide, over 30% of those who had raised a concern felt unsafe afterwards
“victimisation or fear of speaking up has no place in a well-run, humane and patient centred service”