Health Minister Pledges Introduction of Duty of Candour

Health Minister Mike Nesbitt has committed to implementing an organisational duty of candour, aiming to enhance transparency within Northern Ireland’s healthcare system. This initiative follows recommendations from several public inquiries over the past two decades, which arose from instances of cover-up or significant failures by medical personnel. A duty of candour mandates staff to be open and transparent with patients and their families when errors occur in patient care. Mr. Nesbitt highlighted that Northern Ireland is currently the sole region of the UK without an organisational duty of candour. He expressed his aspiration to introduce legislation for this measure before the current mandate concludes, provided the Northern Ireland legislative agenda allows. The Minister made these remarks at the Northern Ireland Assembly, following an Alliance Party motion that advocated for the necessity of a duty of candour in the healthcare sector. He stated, “It is a vital issue. It is one that must be addressed by my department, yes, but also by this assembly, and by the health and social care sector at large.” He further elaborated, “Any legislative change needs to be very clear, and that is to reduce patient harm, and support a culture where openness and honesty are at the centre of the services we provide.” Mr. Nesbitt also acknowledged, “In the vast majority of cases, openness and honesty, as well as a relentless commitment to patients and their safety, is evident in every ward and through every service in Northern Ireland.” The Alliance Party commented that “while the overwhelming majority of staff are committed to the highest standards of care, a statutory duty of candour will play a vital role in identifying and addressing cases of abuse, negligence and failings in health and social care settings.” Alliance assembly member Paula Bradshaw conveyed “sheer frustration” that seven years after the Hyponatraemia Inquiry, “we are no further forward.” The Hyponatraemia Inquiry, which spanned 14 years, investigated the deaths of five children in Northern Ireland. It was highly critical of a health service it characterized as “self-regulating and unmonitored.” The Alliance Party clarified that its motion did not include “criminal sanctions,” believing that further discussion on this aspect was required. The British Medical Association (BMA) has deemed the concept of criminal sanctions impractical, asserting that the Department of Health made an error in a 2021 consultation by linking sanctions with the duty of candour in the same statement. DUP assembly member Diane Dodds questioned the practical feasibility of a duty of candour, considering the daily risks faced by healthcare workers. She noted the inherent complexity and significant risks in modern medicine, where not every procedure guarantees a successful outcome. Her party colleague, Paul Frew, indicated that if the Department of Health fails to introduce an individual duty of candour, he intends to present a private members’ bill to the assembly to enact it into law. Sinn Féin’s Pat Sheehan clarified that a duty of candour with criminal sanctions is not intended to penalize individual healthcare staff for genuine mistakes, but rather to focus on “ensuring there is a culture of transparency” and combating any “culture of cover-up.” SDLP MLA Colin McGrath informed the assembly that a cultural shift is necessary within the health system, enabling those who “witness failings feel that they can speak truth to power”. However, he expressed concern that the motion under debate “might inhibit that need for a change in culture.” He concluded, “The process which the proposers are taking today, of an individual duty of candour, of organisational duty of candour, of criminal sanctions for all and then rolling them all in together, I feel, could just lead us to poor policy.”