The Inquiry into Hyponatraemia-Related Deaths (IHRD) report was published in January 2018 following an inquiry into the deaths of five children in hospitals in Northern Ireland (NI). It concluded that the deaths were avoidable and that the culture of the Health and Social Care (HSC) service and arrangements in place to ensure the quality of services and behaviour of individuals had contributed to the deaths.
Justice O'Hara was appointed Chair of the IHRD Review and made 96 recommendations for HSC improvement, among which were the enactment of an organisational Duty of Candour and an individual Duty of Candour with criminal sanction for breach.
The Duty of Candour and Being Open workstream was established by the Department of Health to research and consult with stakeholders on these recommendations and to report their findings and recommendations to Minister for Health.
RCPCH NI has compiled this response, which has been approved by RCPCH Executive Committee and informed by a focused member survey in NI. It details the College position on the implementation of the proposed aspects of a statutory Duty of Candour in NI.
Organisational Duty of Candour
The RCPCH welcomes and acknowledges the utility of an organisational Duty of Candour. We assert that the staff support and training and reporting and monitoring proposals within the Department's consultation document will need to be robust and effective to achieve the stated aims.
We also welcome the proposal on the development of a ‘Being Open’ Framework. We support the stated purpose of the proposed Framework to viz. set out the mechanisms through which cultural change can be facilitated and the key principles of: routine openness; openness to promote learning; candour when harm or death has occurred; support for openness and candour; and the governance of openness and candour. The College’s full considerations are set out at Section 4 of the response, which can be downloaded below.
Individual Duty of Candour
The RCPCH does not believe that a statutory individual Duty of Candour, in any form, is necessary in addition to a new statutory organisational Duty of Candour and Being Open Framework. We note that paediatricians are already rigorously regulated by way of the professional, regulatory Duty of Candour placed upon them by the General Medical Council (GMC) as well as their employer.
We believe that an additional, individual duty would be cumbersome, duplicative, and disproportionate in terms of achieving the stated aims of implementing candour legislation. We also believe that an individual duty with criminal sanctions attached would have the potential to create fear and defensive practice. The College’s full considerations are detailed at Section 5 of the response, which can be downloaded below.
Voice of children and young people
Section 6 of the response covers the attitudes and attributes identified by children and young people which they stated are needed in order for information and communication to be effective and understood.
Under UN Convention on the Rights of the Child (UNCRC), children and young people would need to be effectively and meaningfully involved in the development of any implementation actions and their input sought for the purposes of training staff and organisations on how to communicate effectively.
We respond to a wide range of consultations to ensure that the College’s position, and ultimately children’s health, is represented. Members can get involved in current consultations by contacting the RCPCH Ireland team on firstname.lastname@example.org.