Monthly article November 2019

written this month by Graham Webster, Vice Chairman

This last week it has been exposed that the Royal Cornwall Hospitals NHS Trust has been fined a total of £16,250 for 13 separate breaches of the NHS Statutory Duty of Candour.

The Care Quality Commission, the quality watchdog, issued the £1,250 penalty notices to the Trust after it failed to be open with patients or apologise after an incident of significant harm.

The fixed penalty notices were linked to 7 separate safety incidents between September 2016 and October 2017, where the duty of candour regulation had not been followed.

In each case, the Trust failed to notify the patient or their family of the facts available as soon as reasonably possible.

The incidents included medication errors, delays in diagnosis and missed opportunities to investigate a patient’s deteriorating condition.

The watchdog’s actions follow criticism of its handling of the duty of candour after an analysis by the charity Action Against Medical Accidents concluded the CQC could not be relied on to enforce the rules.

Duty of candour regulations were brought in following the Mid Staffordshire care scandal and require a trust to be honest with patients after a mistake has led to harm. Patients should receive an apology and details of what happened following an investigation.

West Cornwall HeathWatch understand that CQC inspectors have since followed up matters with the Trust, which also required evidence of the steps taken to strengthen the processes in place to ensure compliance with the duty of candour in the future.

The CQC’s Chief Inspector of Hospitals Ted Baker has said “Under the duty of candour, all providers are required to be open with patients or their families when something goes wrong that appears to have caused significant harm. Where CQC find evidence that this hasn’t happened, we will take action, as we have done against the Royal Cornwall Hospitals Trust. The Trust’s new leadership team have provided evidence of the action taken to ensure that their legal responsibilities under duty of candour are now being consistently fulfilled.”

Actions taken included new staff training, duty of candour champions and board level oversight of compliance with the law.

Bernadette George, the Trust’s Director of Integrated Governance has said “The Trust fully accept the Care Quality Commission’s findings which reflect a time when our organisation was not as open as it should have been. Whilst incidents were being investigated and lessons learned, we were not always sharing full details with patients and families in the way we should have done. This was simply not good enough. The size of the fine and the CQC’s decision not to pursue a prosecution show that it considers we have moved forward and it is satisfied we are now properly fulfilling our duty of candour responsibilities.”

West Cornwall HealthWatch has long campaigned for NHS organisations in Cornwall and the Isles of Scilly to be open, honest and transparent with patients and their families, particularly when something has gone wrong that appears to have caused significant harm. We welcome the Care Quality Commission’s action in this case and under the new leadership team at the Trust, hope the action taken represents a wakeup call at all levels of the organisation that their duty of candour responsibilities are not to be taken lightly.