Debate contribution: Statutory Duty of Candour

Debate contribution by Ms Paula Bradshaw on 11 November 2024.

MLA

Ms Paula Bradshaw

Party at the time

Alliance Party

Date

11 November 2024

Type

Debate contribution

Business

Private Members' Business

Heading

Statutory Duty of Candour

Assembly identifier

Official Report component 4668005

Read the official Assembly record

Text

Thank you very much, Madam Principal Deputy Speaker. I thank the Members for their contributions this afternoon. I very much concur with the Minister that there has been a passionate debate. That is because we all care so much about the issue and, as elected representatives, have heard the stories of the victims and survivors, many of whom are in the Public Gallery. The fundamentals are simple: victims have rights. Those who suffered ruined and incomplete lives because of a scandal or disaster need to be central to the response to that scandal or disaster. Work needs to be undertaken to ensure that such scandals or disasters do not occur, and Alan Chambers highlighted that. My colleague Nuala McAllister outlined some of the scandals. Sadly, the list of scandals and disasters this century alone makes for grim reading; they have had a significant human cost. We had the hyponatraemia inquiry, and I pay tribute to Alan and Jennifer Roberts for their courageous work over the years. I very much appreciate Pat Sheehan's outline of their story; I do not know how you remembered it all, Pat. We heard the family's story again, and what they have had to go through is harrowing. We have also had the Muckamore Abbey Hospital inquiry. That is another inquiry that the Department of Health was reluctant to establish, but it is under way, and some of the information coming out of it is deeply disturbing. We pay tribute to Dawn Jones and her late husband, Councillor Mervyn Jones, for the support that they gave to their son Timmy, who was an inpatient at Muckamore Abbey. We have had the independent neurology inquiry and seen the sterling work of Colin Armstrong, who has been fighting on behalf of the families of the deceased. Of course, there was also the infected blood inquiry, and Nigel Hamilton and his late brother were stalwarts in the campaign for truth, justice and accountability in that space. We have seen a series of individual cases of negligence. The payouts for negligence average £40 million per year in Northern Ireland. I should have highlighted — it is on my list — that Diane Dodds raised the cervical smear test failings in the Southern Health and Social Care Trust. We could stand here all day and recite the scandals, but there are so many inquiries into scandals and disasters that the Department of Health even has an inquiries implementation programme management board. Remarkably, it is made up entirely of departmental appointees. We know that victims are looking for truth, justice and accountability, so you have to question how they could have faith in such a board. As Jonathan Buckley highlighted, the families, many of whom have campaigned for decades for the truth about their loved one's case, need to have faith in whatever processes are taken forward. By way of example, let us look at some of the findings of the independent neurology inquiry, which should truly shock us. It found that there was a lack of prioritisation of patient safety to the extent that trusts had audit committees but not patient safety committees. My colleague Nuala McAllister raised that issue. It found that intervention is required where there is clear evidence of poor performance and malpractice, yet no such intervention occurred in the case of Dr Watt. It specified — we should note it clearly — that intervention is required where there is reason to suspect that patient safety is at risk. In other words, the burden of proof is not the same as it is in a court of law; it is on the balance of probability based on the evidence. It found that opportunities to stop harm being caused to patients were missed. Even when it was evident that harm had been caused, the authorities focused on trying to reduce the financial burden that would arise rather than on accepting liability and trying to learn from it. That issue came up today. Those whose focus was not on patient safety or on trying to learn from the process that led to appalling harm are, in some cases, on a board that is supposedly implementing the changes based on those very findings. Incredibly, even after all that, authorities were subsequently called out in court for conspiring to enable Dr Watt to escape due process by allowing a voluntary erasure. Another aspect of patient safety that Members will be aware of relates to the SAI process. Incredibly, when we turn to any of the inquiries and look at the review of systems and processes of learning that were carried out on behalf of the Department by the RQIA and an expert panel, some of whom came from outside Northern Ireland, we see that it gets even worse. The panel specifically found that, in over a decade of serious adverse incident reviews, which started in their current form in 2009, not a single review had delivered any improvement. The panel found that the procedure for serious adverse incident reviews had never met the requirements of the statutory duty of personal public involvement set out in the Health and Social Care (Reform) Act 2009, did not provide for reasonable application of the principles of SAI review practice; did not deliver significant independence of the chairs; did not provide for the formulation of evidence-based recommendations or for the design of action plans that would enhance the safety and quality of healthcare; and did not produce readable reports. It did not end there. The panel further noted that the SAI procedure focused too much on timescale rather than on standards; did not have regional standards on patient rights; lacked regional patient safety training; failed to provide clear competencies that were required for those leading reviews; delivered insufficient independent advocacy for patients and their families; and struggled because time was taken up, in some cases, with reviews that were not necessary. That is purely shocking. The outcome is that we simply can no longer trust those responsible to put the needs of victims first. There are simply too many instances of patient safety not being the absolute priority. Indeed, in many cases, those instances are systemic.

Go ahead.

Exactly. I touched on that a bit. Thank you for that. It is perhaps small wonder that, when Justice O'Hara made his first recommendation for a statutory duty of candour, those who had overseen the system that did not prioritise patient safety decided to kick for touch, persuading the then Health Minister to ignore that absolutely critical recommendation and instead pursue the Being Open framework. That is still incomplete six years on, and we hear today that it will go out to consultation. We just need to get on with those pieces of work.

I welcome Paul Frew's contribution, in which he talked with passion about introducing a private Member's Bill. So many times in the Chamber, unfortunately, it is up to individuals, rather than the responsible Minister, to introduce the legislation that is required.

Go ahead.

Thank you for that clarification. The public have grown tired of scandal after scandal and disaster after disaster, as the Chair of the Health Committee, Liz Kimmins, highlighted. They, rightly, no longer trust a system that refuses even to engage with clear recommendations for improvement and putting patient safety first. That is why a statutory duty of candour is necessary, otherwise there is no prospect of restoring patient confidence. The interests of victims must be put first when we look back, and the interest of patient safety must be put first when we look forward. The motion is drafted as it is for a reason. Among the prime beneficiaries of a statutory, legally enforceable duty of candour will be the overwhelming majority of HSC staff. My colleague Danny Donnelly highlighted that. We recognise and really appreciate that they are committed to the highest standards of care and to the oath of working in consort with patients. If we identify cases of abuse, we will identify those responsible. If we address negligence, those committed to higher standards will themselves be able to have more faith in the system within which they work. If we can address the public with candour about the care and services that they receive, the bond between HSC staff and those for whom they care will be strengthened. I appreciate the Minister's contribution. I hope that he introduces his legislation shortly, and we will work with him on it.

1,411 words. Text as published by the Northern Ireland Assembly.

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