…or if you prefer, lets be open and honest. It is now two years since the publication of the Francis Report, in the short and pithy (sarcasm already; sorry!) executive summary of 125 pages, the words Transparent and Transparency are used, nay unashamedly hammered home at least 27 times…and if you are inclined to read the full set of all three documents you will find the “T words” are used approx. 200 times; thank goodness for the word search facilities in Adobe. Its as if Robert Francis and his colleagues recognized that one of the problems leading to the scandal at Mid Staffs was a lack of Transparency; that’s just a hunch on my part.
So two years on, what has happened as a result of the Francis report? In reality not a lot, and lets be honest, not a lot was ever going to really happen as a result of a report that contained 290 (two hundred and ninety recommendations) I mean, talk about the need for prioritizing and clarity; just where were people expected to make a start? NHS boardrooms would have been full of confused executives playing pin the tail on the recommendations or placing their hands in buckets of recommendation slips to draw them out one at a time like raffle tickets. But thankfully, logic of a kind prevailed, and ultimately, in a move that could only ever make sense in the Public Sector, an American called Don Berwick was asked to lead and coordinate a group of interested parties to create a further report that would try and make sense of the first report. And in fairness the Berwick Report was readable and useful. But where were we, yes, we were talking about what happened as a result of the Francis report and I said not a lot, and what I mean by that is not a lot that the average healthcare user would notice…but fear not dear reader, because in the dark Satanic Mills of the Public Sector, the rusty old machinery of bureaucracy that is housed in the department of value prevention and energy sapping has been oiled up and has been steadily whirring away. And the result is, wait for it, drum roll please, that’s right, the result is some more legislation…ta da, step forth “The Duty of Candour”
Candour, its an interesting word, in essence it means being open and honest. It strikes me as a significant admission of failure that the NHS is seen as being in need of legislation to ensure that it behaves openly and honestly with the people it serves and who pay for it to exist. At this point you’d be right to call me naive if you think I mean that everyone in the NHS is already open, honest, cuddly and benign; they’re not…my family has the T-Shirt and it can still itch badly. My point is that you won’t achieve honesty and openness using legislation and as Homer Simpson might say, I’m no legal expert, but it strikes me that every time some new legislation is implemented that is designed to “help things get better”, it has a horrible habit of backfiring spectacularly and the reporting required to comply with it quickly becomes an industry in its own right. The Duty of Candour, on the face of it, would seem to be no exception to this; and when you think about the “success” of previous legislative interventions, why should it be?
Part of the Duty of Candour is something called the Fit and Proper Persons Test, an element of which is the requirement for people in positions of responsibility to demonstrate that they acted upon valid information that they might have received. Experience suggests that the implementing of such legislation will simply lead organisations to close down the mechanisms through which they allow themselves to hear anything that might cause discomfort, pushing their fingers ever further into their ears whilst running away from those in the Public Sector playground who may utter unwanted words shouting, “I can’t hear you, I can’t hear you”.
If we in the NHS have reached a place where we feel that openness and honesty are behaviours to be enforced and not qualities to be celebrated then we are at risk of losing our way, and as Emile Durkheim famously observed, “when mores are sufficient, laws are unnecessary; when mores are insufficient, laws are unenforceable.”