Care Quality Commission told it “must improve” on duty of candour

Published: 5 Aug 2016

Action against Medical Accidents today publishes its report on how the Care Quality Commission (CQC) has been regulating the statutory duty of candour – Regulating the duty of candour: a report on CQC inspections and regulation of the duty of candour.

The study shows that CQC inspections of NHS trusts in 2015 were very inconsistent and often superficial in how they assessed compliance with the duty, and that even where they identified there was non-compliance, there was little or no evidence that the CQC was taking steps to ensure that NHS trusts improved. It was also found that the CQC could not identify a single example where they had taken action over an alleged individual breach of the duty reported to it, and had no system in place to monitor these.

AvMA is calling on the CQC to make urgent improvements to how it regulates the duty of candour and makes several recommendations to that end.

The study analysed 90 reports on CQC inspections of NHS trusts carried out in 2015, and responses to a Freedom of Information Act request made to the CQC. Key findings include:

  • 23 (26%) of the inspection reports were either superficial in how they dealt with the duty of candour or did not refer to it at all
  • 6 (7%) of the reports did not refer to the duty of candour at all
  • 34 (38%) of the reports contained criticism of how a trust was implementing the duty of candour, but only 14 of these went on to make a recommendation to improve
  • Even where recommendations had been made to improve, the CQC could not provide a single example of a trust having responded about the action they would take to improve
  • The CQC did not know how many individual reports of potential non-compliance it had received from members of the public or other external sources, or whether the CQC had looked into any of these

AvMA chief executive Peter Walsh said:

“Having fought so hard to get a statutory duty of candour, we are deeply disappointed about how the CQC has regulated this so far. We still believe the duty of candour is potentially the biggest breakthrough in patient safety and patient rights in modern times, but we have always said that its success will depend to a large extent not only on the goodwill of providers, but on robust regulation by the CQC.

“The public have a right to expect that the CQC gives this fundamental standard the priority it deserves, and for it to be seen to be doing so, if we are to move from a situation where dishonesty and cover ups are simply frowned upon to one where they are no longer tolerated.

“We are grateful for the CQC’s co-operation and acknowledge that since this study was carried out they have made some improvements to the way they cover duty of candour in their inspections, but we need to see much more. That said, we are encouraged that there are signs that some providers are implementing the duty of candour well and sense that it is beginning to make a positive difference across England.

“We look forward to working with the CQC and providers to make sure that the duty of candour reaps its full potential. We are particularly grateful to Hannah Blythe who devoted so much time voluntarily to conduct this study for us.”

The absence of a statutory duty of candour was first exposed in 1996 during the civil case of Robbie Powell who died as a consequence of medical negligence in 1990.

Will Powell, father of Robbie Powell who has campaigned tirelessly for decades for a genuine duty of candour (“Robbie’s Law”) said: “It is disappointing that after two decades of campaigning for a statutory duty of candour, with AvMA, it would appear that the current legislation has done little, if anything, to ensure honesty in the NHS following medical errors. What is needed, in my view, is a free standing legal duty of candour for all healthcare professionals (Robbie’s Law). The same law should apply to all public servants including our Members of Parliament.”

The full report is available here.