By Steven Swinford, Senior Political Correspondent
10:00PM GMT 12 Jan 2014
Doctors and nurses should be more open and honest when things go wrong and “say sorry” to patients to help win back trust in the NHS, the health secretary has said.
New guidance sent to every hospital in England and Wales suggests staff are reluctant to apologise because they fear admitting legal liability or making the situation worse.
However, the recommendations for doctors and nurses make clear that “saying sorry is the right thing to do” in all circumstances when there are failures of patient care.
Jeremy Hunt, the Health Secretary, told The Telegraph he wants to end the “closed and defensive culture” which had developed in parts of the NHS under Labour.
He said: “We want to see an open NHS culture that focuses on safety and learns when things go wrong.
“Saying sorry and supporting patients and their families when they have experienced harm is a really important part of this. It’s great to see staff being supported to do the right thing.
“Sadly, under the last Government a closed and defensive culture developed in parts of the NHS. We are transforming this culture through a new transparency drive in our hospitals.”
Last year Sir David Nicholson, the outgoing head of NHS England, said the health service has developed a culture of denial and defensiveness when it comes to dealing with complaints from patients.
The concerns have been heightened by a series of care scandals where thousands of patients have been subjected to appalling and unnecessary suffering.
The most high profile was Mid Staffordshire NHS Foundation Trust, where 1,200 patients died unnecessarily and many more were “failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.”
A further 11 trusts have been put into special measures after an official investigation raised concerns over their high mortality rates.
To address the concerns the NHS Litigation Authority, the body which oversees claims made against the health service, has produced a four-page leaflet for staff entitled “saying sorry”.
It recommends that staff should make face-to-face apologies to patients “as soon as staff are aware an incident has occurred”.
Patients should subsequently be given a written apology which “clearly states the healthcare organisation is sorry for suffering and distress resulting from the incident”.
The NHS Litigation Authority says that it is not like a car insurer, which can “withhold a claim because an apology or explanation has been given”. “Saying sorry is not an admission of legal liability”, the leaflet says. “It is the right thing to do.”
Catherine Dixon, chief executive of the NHS Litigation Authority, said: “Saying sorry is the human and moral thing to do, we won’t say we’re not going to cover you because you’ve said sorry.
“In cases where people perhaps bring a claim out of frustration, because they don’t feel that they’ve been given an explanation or that their complaints have been heard, an apology may make them less likely to pursue an action.
“We actively support organisations being open, transparent and candid with their patients. We have seen some cases where that hasn’t happened in the NHS. It’s important that we create and support the right culture. It can win back people’s trust.”
Mrs Dixon said that the NHS is this year facing a 20 per cent rise in claims against medical staff to around 12,000.
More than £22billion – equivalent to about a fifth of the health service’s annual budget – has been set aside to pay compensation to thousands of people harmed by poor care. The size of the liabilities has almost doubled in five years.
However, the leaflet suggests that by apologising, patients may be less inclined to sue. It states: “Poor communication may make it more likely that the patient will pursue a complaint or claim.
“It is important not to delay giving a meaningful apology for any reason. It is also essential that any information given is based solely on the facts known at the time.
“Healthcare professionals should expect explain that new information may emerge as an investigation is undertaken, and that patients, their families and carers will be kept up to date with the progress of the investigation.”
In response to the Francis inquiry into care failings at Stafford hospital, Mr Hunt introduced a “statutory duty of candour” meaning families must be informed if errors in treatment cause death or serious injury.
More than £1.2 million has been paid out to 120 victims of poor care at Mid Staffordshire Foundation trust, in the largest ever group claim against the NHS.
However, ministers have limited the scope of the laws to hospitals and organisations rather than individuals, saying they fear it could increase a “blame culture” within the NHS.