EDITORIAL
Editor in Chief Ian Peate Editor/Associate Publisher Julie Smith [email protected] Chief Subeditor Sarah Kahn [email protected] Subeditors Daniel Davies [email protected] Vicqui Stuart-Jones [email protected] Commissioning Editor Sue Woodward Group Classified Director Rachel McElhinney [email protected] Circulation Director Sally Boettcher [email protected] Commercial Manager Andrew Iafrati [email protected] MedEd Manager Tracy Cowan [email protected] Classified Sales Executive Harry Nolan Production Manager Jon Redmayne Production Assistant Larry Oakes Editorial Make-up Kyri Apostolou Publisher Anthony Kerr Chief Executive Officer Ben Allen UK PERSONAL SUBSCRIPTION RATES
Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£43 £169 £178 £303 £427
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Email: [email protected] Websites: www.britishjournalofnursing.com
© MA Healthcare Ltd, 2014. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. The British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: iStockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
British Journal of Nursing, 2014, Vol 23, No 16
Lies, damned lies, and statistics
T
he media’s extensive coverage of poor individual or team practices culminating in deliberate or unintentional harm to patients or relatives continues unabated. Indeed, at the Royal College of Nursing (RCN) Congress, Sir Robert Francis recounted repugnant stories told to him during the Francis Inquiry. Those people receiving care under the NHS have the right to elective pre-planned consultant-led care within 18 weeks of being referred for treatment, unless they opt to wait longer, or it is clinically appropriate to do so. There were 19.1 million referrals to hospitals in England in 2012–13, costing around £16 billion (National Audit Office, 2014). During checks, the National Audit Office identified inconsistencies in the way Trusts measure waiting times, as well as errors in the waiting times recorded. In the aftermath of the Mid Staffordshire NHS Foundation Trust Public Inquiry, the NHS has a duty to be honest about mistakes as part of a revamp of the system. There has been a call for a statutory duty of candour on hospitals, GPs and other organisations where mistakes were made that resulted in significant harm, with the aim of putting patients at the heart of the NHS. An analysis of reporting incidents shows that 29 out of 141 NHS trusts in England are failing to register the expected number of safety incidents (National Audit Office, 2014) and are likely to be covering up their mistakes. It was discovered earlier this year that some NHS trusts were influencing data related to waiting-list figures (this is not the first time). These further revelations show that there are some trusts that have not been open with their reporting, which will do little to instil confidence in patients and nurses. Making the NHS in England more open and honest about mistakes is a requirement that was made by the Mid Staffordshire Inquiry. However, when the government made its official response to the inquiry last year, the issue of candour did not receive its full backing. There were concerns that it could lead to more legal action being taken. Instead, the government set up a review and the president of the Royal College of Surgeons (RCS) and the chief executive of Salford Royal NHS Foundation Trust Hospital were asked by the Secretary of State for Health to take the lead on a review of two proposals that would enhance candour in the NHS. This concerned whether the threshold for the new statutory duty of candour should be set at the level of death and serious injury—or death, serious injury and moderate harm (the definition of moderate levels of harm includes pressure ulcers), and
how the NHS Litigation Authority might encourage candour by seeking compensation from trusts in those cases where they have not been candid with a patient or their family. The RCS (2014) suggests that, put simply, candour means the quality of being open and honest; that patients should be well-informed about all aspects of their care and treatment; and that all staff have a duty to be open and honest with patients and their families. It follows therefore that care organisations (NHS, social services and the independent sector) should promote and sustain a culture that supports staff in being candid. It is acknowledged that the provision of care and treatment are not risk-free and that errors do happen, be they because of systems or human failures.The duty of candour on organisations—note that the duty is on organisations, not individual practitioners—requires them to ensure that patients, and if appropriate their families, are told openly and honestly about unforeseen errors that cause a patient harm above a pre-set threshold.This is a tall order, particularly when the recent findings from the National Audit Office are openly and honestly telling us that some organisations are far from open and honest. A website will be made available that will allow the public to view the performance of individual hospitals based on measures such as safe staffing levels and infection rates. This website will also reveal those trusts that have a poor rating for open and honest reporting. The question has to be asked, however, whether the data that will appear on the website are to be believed or not. In fact, we might ask the same question of the data that appear on white boards on each ward telling patients (and nurses) the number of nurses and healthcare assistants who should be on duty, and how many there actually are so that they can see when they are understaffed, with the aim of giving greater openness on how hospitals are doing to make sure wards are properly staffed. To be candid, I will be looking at that data with considerable caution. BJN
Ian Peate
Editor in Chief British Journal of Nursing
National Audit Office (2014) NHS Waiting Times for Elective Care in England. TSO, London Royal College of Surgeons (RCS) (2014) Building a culture of candour. A review of the threshold for the duty of candour and of the incentives for care organisations to be candid. RCS/NHS, London
879
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on November 29, 2015. For personal use only. No other uses without permission. . All rights reserved.
Editor in Chief Ian Peate Editor/Associate Publisher Julie Smith [email protected] Chief Subeditor Sarah Kahn [email protected] Subeditors Daniel Davies [email protected] Vicqui Stuart-Jones [email protected] Commissioning Editor Sue Woodward Group Classified Director Rachel McElhinney [email protected] Circulation Director Sally Boettcher [email protected] Commercial Manager Andrew Iafrati [email protected] MedEd Manager Tracy Cowan [email protected] Classified Sales Executive Harry Nolan Production Manager Jon Redmayne Production Assistant Larry Oakes Editorial Make-up Kyri Apostolou Publisher Anthony Kerr Chief Executive Officer Ben Allen UK PERSONAL SUBSCRIPTION RATES
Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£43 £169 £178 £303 £427
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Email: [email protected] Websites: www.britishjournalofnursing.com
© MA Healthcare Ltd, 2014. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. The British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: iStockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
British Journal of Nursing, 2014, Vol 23, No 16
Lies, damned lies, and statistics
T
he media’s extensive coverage of poor individual or team practices culminating in deliberate or unintentional harm to patients or relatives continues unabated. Indeed, at the Royal College of Nursing (RCN) Congress, Sir Robert Francis recounted repugnant stories told to him during the Francis Inquiry. Those people receiving care under the NHS have the right to elective pre-planned consultant-led care within 18 weeks of being referred for treatment, unless they opt to wait longer, or it is clinically appropriate to do so. There were 19.1 million referrals to hospitals in England in 2012–13, costing around £16 billion (National Audit Office, 2014). During checks, the National Audit Office identified inconsistencies in the way Trusts measure waiting times, as well as errors in the waiting times recorded. In the aftermath of the Mid Staffordshire NHS Foundation Trust Public Inquiry, the NHS has a duty to be honest about mistakes as part of a revamp of the system. There has been a call for a statutory duty of candour on hospitals, GPs and other organisations where mistakes were made that resulted in significant harm, with the aim of putting patients at the heart of the NHS. An analysis of reporting incidents shows that 29 out of 141 NHS trusts in England are failing to register the expected number of safety incidents (National Audit Office, 2014) and are likely to be covering up their mistakes. It was discovered earlier this year that some NHS trusts were influencing data related to waiting-list figures (this is not the first time). These further revelations show that there are some trusts that have not been open with their reporting, which will do little to instil confidence in patients and nurses. Making the NHS in England more open and honest about mistakes is a requirement that was made by the Mid Staffordshire Inquiry. However, when the government made its official response to the inquiry last year, the issue of candour did not receive its full backing. There were concerns that it could lead to more legal action being taken. Instead, the government set up a review and the president of the Royal College of Surgeons (RCS) and the chief executive of Salford Royal NHS Foundation Trust Hospital were asked by the Secretary of State for Health to take the lead on a review of two proposals that would enhance candour in the NHS. This concerned whether the threshold for the new statutory duty of candour should be set at the level of death and serious injury—or death, serious injury and moderate harm (the definition of moderate levels of harm includes pressure ulcers), and
how the NHS Litigation Authority might encourage candour by seeking compensation from trusts in those cases where they have not been candid with a patient or their family. The RCS (2014) suggests that, put simply, candour means the quality of being open and honest; that patients should be well-informed about all aspects of their care and treatment; and that all staff have a duty to be open and honest with patients and their families. It follows therefore that care organisations (NHS, social services and the independent sector) should promote and sustain a culture that supports staff in being candid. It is acknowledged that the provision of care and treatment are not risk-free and that errors do happen, be they because of systems or human failures.The duty of candour on organisations—note that the duty is on organisations, not individual practitioners—requires them to ensure that patients, and if appropriate their families, are told openly and honestly about unforeseen errors that cause a patient harm above a pre-set threshold.This is a tall order, particularly when the recent findings from the National Audit Office are openly and honestly telling us that some organisations are far from open and honest. A website will be made available that will allow the public to view the performance of individual hospitals based on measures such as safe staffing levels and infection rates. This website will also reveal those trusts that have a poor rating for open and honest reporting. The question has to be asked, however, whether the data that will appear on the website are to be believed or not. In fact, we might ask the same question of the data that appear on white boards on each ward telling patients (and nurses) the number of nurses and healthcare assistants who should be on duty, and how many there actually are so that they can see when they are understaffed, with the aim of giving greater openness on how hospitals are doing to make sure wards are properly staffed. To be candid, I will be looking at that data with considerable caution. BJN
Ian Peate
Editor in Chief British Journal of Nursing
National Audit Office (2014) NHS Waiting Times for Elective Care in England. TSO, London Royal College of Surgeons (RCS) (2014) Building a culture of candour. A review of the threshold for the duty of candour and of the incentives for care organisations to be candid. RCS/NHS, London
879
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on November 29, 2015. For personal use only. No other uses without permission. . All rights reserved.
