A duty of candour

Ah, the NHS. Hit them when they’re down. It’s not enough that this eternal, infernal winter is driving sickness to horrible new levels. Now nurses will have to train in basic care (I thought they already knew all that) and it looks like there will be a new legal duty of candour imposed on NHS service providers.

As to what a “duty of candour” actually means, the nuts and bolts are to be worked through in due course, but the spectrum is rather wide. At one end there could be a legal obligation on individual health workers to tell the truth and blow the whistle, enforceable by criminal sanctions. On the other end, NHS service providers could be required to sign an undertaking to promote honesty and own up to mistakes, enforceable under the existing provisions of contract law. As with Leveson, the odds are the Government’s going to take the easy option, the “light” option (although they claim they are still looking seriously at the more draconian measures). Unlike in the case of Leveson, however, this might well be the right result, because what needs to change is a culture of cover-up, and one of the best ways to go about making that change is to start at the top, with the management. A few weeks ago in another post (here) I wrote this:

As for the second person, we can start by teaching managers everywhere, in every form of public and private service, that their first duty isn’t to their company or department or their team or their colleagues or the bottom line or the project. It’s to society.

It’s a shame management can’t just be told to tell the truth, but it’s not a perfect world, and in the world we have maybe the best way to make people concentrate on doing the right thing is to hit them in the pocket if they don’t.

In the same post I wrote about how good it would be if blowing the whistle became the cultural norm. There will always be people looking to cut corners and do the wrong thing. If they know their colleagues are watching them they might decide that spending their working lives looking over their shoulders making sure they haven’t been spotted just isn’t worth it. But my guess is that putting the fear of god into each and every NHS employee by threatening them with who-knows-what if they don’t report anything they suspect as wrong-doing will lead to mass over-reporting, a culture of fear, and ultimately a backlash and the complete discrediting of whistle-blowing.

So it’s obvious which way the law should go on this, right? Hit management with the bottom line rather than employees with the police state. But with a Government reeling over accusations it went soft on press regulation, there’s always a risk they’ll see this as an opportunity to show their hard side. And of course the NHS is already a write-off, politically-speaking, for the coalition. The vast majority of NHS employees are going to vote Labour at the next election whatever the Government does in this particle case. And they don’t own the newspapers to scare Cameron and co into going easier on them. There might be some short-term gain, politically, in pushing the hard line on candour. I hope it doesn’t come to that, but with politicians, you never know.


Liked this? Take a look at the opening chapter from the soon-to-be-published Without Due Care here.


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