NHS: Be Candid - Be fit!
Published 28 November 2014
From 27 November, all NHS providers must comply with the new statutory Duty of Candour and also the Fit and Proper Person Test for 'Directors or equivalents'. Both fall under the new Care Quality Commission mandatory requirements for provider registration - both covering all 5 key domains in sections under the new era. NHS bodies should urgently:
- Recognise the steps needed for compliance against both new requirements;
- Ensure implementation to deliver both – one outward facing, one internal;
- Raise awareness and communicate on candour as a mandatory cultural evolution.
Well over a year in the making, Duty of Candour today hits the statute books via commencement of the CQC regulations sitting beneath the Care Act 2014. Compliance is mandatory – candour is no longer a 'nice to have'. It has to be demonstrably present in the provider's approach and culture. Failing to comply presents a significant risk of expedited enforcement activity by the CQC, particularly following routine or triggered inspections. This applies from today. It will therefore have significant bearing on how NHS providers' service provision is governed.
The above is the 'stick' – but the true 'carrot' in this initiative is patient safety and learning from incidents. Candour relies on incidents being recognised, and with more robust and accurate incident reporting, will come the imperative to investigate and learn from those incidents. The NHS has become familiar with this through the NHS commissioning contract, with heavy financial penalty for breach, however today's new law takes the requirement one stage further, with a prescribed process for holding those honest conversations with patients when things go wrong and harm is caused.
From board to bedside, the issue of Duty of Candour has been considered for months in the sector – some have approached it with confidence, on the basis they have long since embraced 'Being Open' and are culturally robust, others are more wary of how to deliver it, often because the complexity of services provided across multi-facteted, multi-partnered health and social care provision in the UK renders the concept of assurance as to compliance 'out there' in the service, is daunting. Our national team of specialists have been presenting to Board and Clinical teams over the last 3 months on the impact of candour, building to today's commencement, and whilst this has come round quickly for some, others are well on the way to effect real change within the patient experience, staff engagement, learning from incidents and compliance.
The first step is to ensure your board absolutely recognises the importance of getting candour right, not only at patient contact level, but throughout the organisation. Thereafter (or in parallel) a sustained programme of training and awareness raising is essential, to make the necessary cultural shift, supported by demonstrable commitment to this agenda. This can then be underpinned by clear messages in policy updates, contracts and HR approaches. In particular, the management of board meetings and the flow of information into and out of the boardroom will require attention to ensure it is both valid, but also suitably authored to ensure the confidentiality of individuals.
One of the most striking comments in the CQC guidance on Candour is their expectation that organisations will regard a breach of the duty of candour requirement as so significant, that it merits referral to the GMC or NMC if a registered individual is the cause. This demonstrates the CQC's focus on candour, and all registered providers in the NHS can expect upcoming inspections to consider this specifically, as well as direct scrutiny and tracking in the event of notifiable incidents.
Candour is not something to fear – but equally it is not something that will happen without significant leadership within NHS providers. Our Governance Advisory Practice team are providing support and guidance to those organisation who are already ahead of the game.