Department of Health and Social Care

Openness and transparency

A common culture of serving and protecting patients and of rooting out poor practice will not spread throughout the system without insisting on openness, transparency and candour everywhere in it.

Robert Francis, 2013.

One of the overriding lessons from the inquiry is the need for a consistent culture of openness and candour in the NHS. The health and care system must move away from previous closed and defensive responses to mistakes. It must recognise the importance of being transparent about mistakes so that errors can be addressed and lessons learnt.

All organisations have areas of excellence as well as weakness. It is important to be honest and open about those weaknesses, within organisations and with the public.

It is a basic and just expectation of the public that organisations are open, honest and transparent about their performance standards, about the rights of patients and about what happened, and why, if things go wrong. This is the only way to begin to restore full public trust in the NHS.

Important actions in this area include:

  • transparent, monthly reporting of ward-by-ward staffing levels and other safety measures
  • all hospitals to clearly set out how patients and their families can raise concerns or complain, with independent support available from NHS complaints advocacy services, Healthwatch or alternative organisations
  • quarterly reporting of complaints data and lessons learned by trusts, with the Ombudsman to significantly increase the number of cases considered
  • a statutory duty of candour on providers, and professional duty of candour on individuals, through changes to professional codes
  • the Care Quality Commission and NHS England will develop a dedicated hospital safety website for the public which will draw together up to date information on all the factors, for which robust data is available, that impact of the safety of care
  • a government intention to legislate, at the earliest available opportunity, on wilful neglect of patients, so that those responsible for the worst failures in care are held accountable
  • trusts will be liable if they have not been open with a patient – the NHS Litigation Authority will continue to make full payments on successful claims, but will have the discretion to make the trust partly liable


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