CQC Report: Failings in the way the NHS reports and investigates patient deaths
At the end of 2016, the CQC published a report following an large scale review into deaths of patients in acute community and mental health care at NHS Trusts across the UK. Although the report centres around deaths of the elderly and with acute mental health needs, the findings are relevant throughout the NHS.
Candour and accountability
The statutory duty of candour introduced in 2014 requires that Trusts should give explanations and make full and frank apologies to patients when they have experienced poor care. Research shows that patients who feel listened to and supported are less likely to pursue litigation. In a climate where costs of litigation are under heavy scrutiny and criticism, compliance with the duty of candour provisions would appear sensible.
Unfortunately, the report indicates that this is rarely the case. Families are often left in the dark when a patient dies; unsure of where to find answers and have a poor experience of reviews and investigations. They are not always treated with sensitivity and feel overwhelmingly that the Trust is trying to 'delay, deny, and defend'. Furthermore, the quality of investigations has been criticised – those appointed to lead them are often untrained, the communication is poor and there is often confusion about timelines and guidance.
Unsurprisingly, the involvement of the patient and their family, features centrally in the recommendations. The report calls for Trusts to treat the family with sensitivity, to make full and honest apologies and to listen to their concerns. The family should be 'meaningfully involved' in investigations.
One of the report's valuable recommendations is that Trusts employees should have 'protected time' to carry out their investigations. Time-pressure on staff in the NHS is commonplace. Families would welcome this if they can see it will result in full land frank investigations.
Learning and adapting is paramount to best practice. Trusts need to learn from their mistakes, both clinically and administratively. Training should be cascaded throughout agencies, allowing a seamless multi-disciplinary approach. A fair amount of criticism is directed at the various agencies failing to communicate effectively.
The findings of the report are in no way surprising or ground-breaking; and the recommendations are largely common sense. Changing the culture is imperative and it is hoped that the abundance of research urging Trusts to communicate with families meaningfully, will infiltrate.
Both Trusts and their patients would benefit enormously, both psychologically and in financial terms, from a simple shift in attitudes.
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