In her guest blog, Sarah Seddon talks about the Duty of Candour and how it's affected her personal life.
How do you explain the Duty of Candour to three young children? Most healthcare professionals would not expect to find themselves presented with this conundrum, however it’s exactly the position in which I found myself when my children needed to understand why their parents were so distraught around six months after their baby brother had died.
After a lot of thought, I began to realise that it’s actually a very simple concept: the Duty of Candour is about telling the truth and owning up when things go wrong (then doing everything you can to put it right). It now shapes my parenting practice as well as my pharmacy practice: everyone is human and we all make mistakes – if they are genuine mistakes, we should not be judged for them and should apologise and use the undesirable situation to implement change so that the same thing doesn’t happen again in future. This can be applied to a child breaking a picture frame or damaging someone else’s toy; it can be applied to an adolescent who forgets to include a friend on a social media post leading to upset within the friendship group…… and it can be applied to a healthcare professional who makes a mistake after which a baby is stillborn.
As a healthcare professional, I’m very aware of the principles of the Duty of Candour, however there is nothing like personal experience to bring something to the forefront of your mind.
Integral to professionalism is the commitment to try your absolute best for every patient, to work within your limits and to speak up if something does not feel safe or right. Occasionally despite this, something will go wrong and a professional must have the skills, knowledge, self-awareness and humanity to accept what has happened, to own their mistakes and obtain appropriate, timely support both for themselves and their patient and/or patient’s family. The patient must be given the opportunity to understand what has occurred, to process it, to ask questions and to be supported in whatever ways are necessary. The professional should have the support of their employers and their regulators to enable them to feel safe to tell the truth and apologise in an environment which supports patient safety, working together and learning from errors rather than encouraging blame, concealment and punishment.
When things go wrong in healthcare it is horrendously distressing for the patient and their family who find themselves in an extremely vulnerable situation and experience the sudden devastating realisation that there is no safety net for them and they can no longer rely on what they had previously believed to be absolute certainty. Their trust is destroyed. It is also a horrific time for the healthcare professionals involved: they have turned up to work to do their best, yet are now questioning their ability, their skills – sometimes their entire career. Everyone is in this terrible situation together and (in my opinion), the only way out of it is to be open and honest and work together compassionately to establish what happened, how it came to happen and how it could be prevented from happening again. The healthcare professionals and their employers must take the lead on this. My healthcare professional did not. I can only attempt to guess why not: all I can imagine is that she was terrified of her employer and of her regulators and to her it felt like the best (or ‘least-worst’) option at the time. But she had a duty of candour and she contravened it. My NHS Trust instigated a ‘Serious Incident’ investigation into the death of my son but did not tell me that the investigation was happening and did not ask me for my input. They did not inform me that my care had not met their usual standards. They had a duty of candour and they contravened it.
The amount of damage that this lack of candour caused has been immense and the repercussions have snowballed to my entire family and friendship group, causing much more damage than the initial mistake. As a harmed patient, I was not initially angry at the individuals involved. All I needed was to be informed of what was happening, I needed a sensitive, accurate and timely investigation, an apology (not an admission of blame) and a commitment to making demonstrable changes so that another family would not end up in the same situation in future. I needed to be included in decisions as an equal partner so that I could start to regain some trust, some dignity and some control (all of which had been stripped from me).
Instead – I was subjected to ‘official’ documentation of what had happened which was written without my knowledge, was full of inaccuracies, insensitive, blaming language and insinuations about me as a person. The lack of apology made me begin to feel as though I deserved what had happened to me, the excessive additional investigations required me to continually re-live my son’s stillbirth and a referral to the regulator culminated in a Fitness to Practise hearing where I was cross examined as a witness on all the details of my baby’s death as though I were guilty of something. This went on for two years and could have been avoided if duty of candour had been implemented appropriately. During this time, I should have been coming to terms with the death of my baby, but instead was being made to feel more and more vulnerable and inconsequential.
In addition to the individual registrants and their employing organisations who have a legal (and professional) Duty of Candour, each healthcare regulator has the enormous responsibility of ensuring that the people on their register (and those organisations who employ them) take this responsibility seriously. It must be embedded in initial education and training requirements for all professionals, a mandatory part of revalidation and the message should be re-enforced at all opportunities. Regulators should take an uncompromising approach in cases where Duty of Candour has not been applied but they must also commit to positively supporting candour and not penalising registrants for speaking up, telling the truth, apologising or participating in mediation with families. These actions should be actively encouraged. In my experience, healthcare professionals are still very much afraid of their regulators – they are afraid to tell the truth and this culture of fear needs to change so that processes can become less adversarial and less damaging. Only then can the public truly trust that the regulators are doing their job in ensuring safe, effective and compassionate care for all. Healthcare is nothing without trust and trust cannot be achieved without candour. Making an isolated mistake will not bring a profession into disrepute. Being dishonest about that mistake is another matter.
It’s simple: in the words of my four-year olds: 'we need to tell the truth when things go wrong'.