The Duty of Candour

I interviewed Andy Burnham, the shadow health secretary, for The Independent on Sunday today. He defended himself from the charge thrown at him by David Cameron that he had presided, as Health Secretary 2009-10, over a sinister culture of cover-up in the NHS; but he also talked about lessons learned and set out his vision of a renewed settlement for the health service based on integrating physical, mental and social well-being. 

Here is a full transcript of the interview, apart from the bit where we talked about music, and his view that The Smiths have not stood the test of time, on which I shall post a longer transcript later.Attacked by the Prime Minister, plagiarised by the Chancellor: I must be doing something right. The talk in the Chancellors spending review about integrating NHS and social care was good but Im not sure the reality will be up to much. 

They are throwing around all kinds of unpleasant things which arent true.Welcome to RFID ticket for home, you will see Regular Residential Cleaning Services. The language is unbelievable. Its minor, but the so-called report CQC report on its failure to sport fatal errors at Morecambe Bay hospitals, if it was deleted, was deleted under them. I think there are some serious questions about that report, about whether that was a fair process, and that will come through more and more. 

The NHS was never perfect and no party should claim that it was under them. But I think it is an attempt by someone on the other side to try to damn the whole system, to pick on examples of poor care that should never have happened, and in the case of Mid Staffs appalling care, but it is not possible to say, and the whole thing is sinister, corrupt C that isnt possible. There have been periodically problems in the NHS, in Bristol, there was Alder Hey, there was Shipman. These things sadly have been there in the past. The NHS is such a complicated, vast thing that there will always be things that are wrong with it. 

Systemic problem of culture? On that, I think that at very local level, when people bring complaints, the shutters do come down and they push people away. There is a culture of that at local level, without a doubt. 

Whats the answer to that? Its difficult because its very deep rooted, and I dont think the answer is ever more dictatorial top-down inspection or central regulation C Im not saying Im against a chief inspector of health. 

I support the Francis report recommendations, particularly the duty of candour on individuals. If there is a different feeling about how an individual speaks up and reports when things do go wrong, instead of fearing sanction or reprisal by their employer, then that is the way. This thing will be solved at local level, but whats been happening is more societal than the detail of policy. Hospitals are increasingly full of very frail, very elderly people, and the job of caring on the front line has become ever more complex, as people in their late 80s and their 90s are in hospital in ever greater numbers C and that is the real issue, the fundamental issue that is driving the concern around the older person lost in the acute hospital, dehydrated, disoriented, struggling C it is a product of a 20th-century system. When an older person goes into hospital, immediately some of their needs are being neglected; their social, their mental needs are often neglected in the acute hospital environment. 

And that explains why they often plummet, or drop like a stone, or go on a downward spiral very quickly, because its really not the right place for them to be. Between 09/10 and 11/12 there was a 66 per cent increase in the over-90s coming into A and E in a blue-light ambulance: it equates to 100,000 very frail, very frightened people in the backs of ambulances, and you just think something is changing and changing very quickly. It is linked to the collapse of social care and the withdrawal of care at home by councils. 

But how do you change the incentives, system-wide, so people feel they will be rewarded for being open and honest? It is a difficult question. The caricature of us now is that we were closed and secretive, and you remember the opposite. We brought in an independent regulation. There wasnt an independent regulator before the Labour government. We began a process of publishing clinical data so that outcomes could be published, we began rating hospitals C that didnt exist so we had no objective information before, admittedly it was quite crude in the beginning, it was a star rating then it became good, fair or - 

But that put pressure on staff to suppress bad news. Alongside that, Liam Donaldson Chief Medical Officer for England did lots of reforms around patient safety, so we had this national reporting and learning system where any adverse incident happened people were meant to C and did C put it onto the system. A whole range of other things that Liam was very keen on around professional revalidation. 

We reformed the GMC General Medical Council because it was a doctor majority in the old days and we made it parity between lay people and doctors, and that was something that I did. 
But that tendency to pull the shutters down and push people away is very very deep rooted and I couldnt say, hand on heart, we managed to crack that. So I think duty of candour is interesting in that context. It means a legal duty to be open about failings. It means the organisation cant come down on the individual and make them feel intimidated. 

Lets go with what Francis said. Detailed, sensible recommendations. Shouldnt we be going with those rather than writing our own? 

What about the Friends and Family Test? No objection to that. I in a similar way prioritised staff satisfaction and patient satisfaction as two good catch-all indicators. If patients are satisfied and staff think theyre working in a good environment they tell you much more than you can get from a four-hour target, so I began to prioritise those more human indicators, so Ive no objection to the Friends and Family Test but its only one of a number of things. 

Its frustrating, isnt it, when youre sitting there and people are throwing stuff and you obviously cant reply and you reject it entirely, its when my job loses its appeal. Firstly, Id say we had a three-year public inquiry into Stafford hospital where all of the papers of my time in government were looked at. And I gave evidence and Ben Bradshaw health minister 2007-09 gave evidence and all of our paperwork was looked at, emails, everything. It is quite hard, then, having gone through that process, and that report saying that ministers didnt act in any way wrongly or improperly, for then somebody in the House of Commons to stand up and chuck casual allegations around like that. That is pretty difficult. 

The sense of it the quotation from Lady Young was we were trying to minimise bad publicity. I want to answer that directly. I appointed Robert Francis to begin the process of inquiry on Stafford. People have forgotten that but I did. It was one of the first things I did as Health Secretary, and my mindset C the reason I mention that is that it illustrates my mindset at the time, which was the opposite of what they are saying. I was in the mindset of bring it all out, we need to know if other hospitals have serious problems. So I brought forward this process of registration, which was a 360-degree look at all hospitals to give a full picture of their problems. That led to literally C I mean literally, the eve of the last general election C Im talking a matter of hours before it was called, 27 hospitals were registered with conditions. 

What does that mean? It meant that they couldnt be registered as safe. They couldnt be given a clean bill of health. It meant that the CQC couldnt say this hospital is operating to an acceptable standard. And that was the purpose of the exercise: it was to flush out the hospitals that needed to be looked at, rather than them coming out in a drip-drip of a hospital looms into the headlines here and another one there. The idea was that we had to survey the whole scene and find out where these problems were. 

Again, people say pressure. I was asking tough questions of the CQC in that period. There was a feeling in the department that they werent on top of this enough, that they didnt have evidence to back up some of the positions they were taking. And so there was a big process of change under way. In November 2009, having been discussing with the CQC, Were we getting to the bottom of things? I made a statement to Parliament saying I was going to bring forward this process of registration, I was going to refocus the CQC on that job.This white paper Offering High Builder cleaning Services some key examples of how RFID readers are being. So that before the election we could give a clear statement about where all the problems were and that exercise was completed.