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MAKING formal apology letters a legal requirement when healthcare goes wrong will do little to improve transparency at Jersey’s hospital without a major cultural overhaul, experts have warned. Lodged by the Environment Minister in July and due for debate in November, the Draft Regulation of Care (Jersey) Amendment Law proposes a raft of new rules for how health and care services should be regulated in future – including introducing a statutory “duty of candour” for regulated health and care providers. If approved, the law would require services to be open and transparent with patients when something goes wrong, including offering a written apology. In a submission to the sub-panel of politicians formed to scrutinise these law changes, the Royal College of Physicians praised this “move towards greater transparency and intention to increase learning from serious incidents”. But the professional body warned that the measure would not succeed unless accompanied by wider reforms to the Island’s healthcare culture. The RCP said the duty of candour policy “needs to be introduced as part of a wider commitment to supporting and embedding a culture of safety, learning and improvement within healthcare services in Jersey”. The organisation drew parallels with England, where a similar legal requirement already exists, noting that research there has highlighted continuing problems with training, inconsistency and fear of blame. The RCP pointed to findings from a Department of Health and Social Care review showing that less than one-in-four respondents said that the duty is correctly complied with when a notifiable safety incident occurs. “Some felt staff are reticent about complying with the duty for fear that it admits fault and liability and leaves them open to blame,” it said. “Others reported instances where staff were empathetic and aimed to follow the process, but senior management did not support them.” The RCP warned that “similar issues could arise in the context of Jersey and if so, this would potentially limit the intended impact of the new duty”. The organisation added that “there must be a focus on steps to improve [organisational culture] alongside the introduction of a duty of candour, if the goals of increased reporting of and learning from patient safety incidents are to be achieved”. In his own separate submission, former Government of Jersey health advisor Professor Hugo Mascie-Taylor also cautioned that while greater transparency is desirable, legislation alone would not shift attitudes within the system. “In principle it is accepted that the greater the transparency then the better, both in terms of driving up safety and quality and in terms of being fair with patients,” he said. “This is largely a cultural issue and therefore any process which encourages a more open culture is a good thing.” However, Professor Mascie-Taylor said it was “probably unclear” whether the legal duty of candour would change behaviours on its own. “Frankly the extent to which it improves the current situation depends to a large extent on the political leadership and the willingness of many in the authority to be open,” he said. He recalled being told during his time advising Jersey that “there are no consequences” for those in powerful positions when things go wrong. “Whether or not this continues to be the case in the future again depends on whether or not the collective leadership is prepared to deal with issues in a robust way or whether they are not,” he said. Despite his concerns, Prof Mascie-Taylor welcomed efforts to drive improvement. “Jersey has so much to gain by creating positive cultural change,” he said.
