Recommendation 173

Organisations and staff must be honest, open and truthful

Every healthcare organisation and everyone working for them must be honest, open and truthful in all their dealings with patients and the public, and organisational and personal interests must never be allowed to outweigh the duty to be honest, open and truthful.

Promoting honesty, openness and transparency, and instilling a culture that values compassion, dignity and the highest quality of care is one the key responsibilities of the Department of Health as part of its role in championing improvement and innovation in health. In Patients First and Foremost, the government’s initial response to the public inquiry, leaders of health and social care organisations signed up to a statement of common purpose that included reaffirming their commitment to putting patients first before the interest of their organisations and to uphold the value that patients are best served where there is a culture of candour, openness, honesty and acceptance of challenge. In A new start – Consultation on changes to the way CQC regulates, inspects and monitors care, the Care Quality Commission proposed a framework for inspection which includes a judgement of organisations based on their ability to promote an open, fair and transparent culture. Openness and honesty is already a requirement in healthcare professionals’ codes of practice and the principles and the NHS Constitution already emphasises the importance of honesty and openness. The Education Outcomes Framework and in turn, the Mandate for Health Education England also identifies recruitment, education, training and development that are consistent with the values and behaviours identified in the NHS Constitution as a key deliverable.


The Department of Health and the wider health and care system remains committed to being transparent and open about the safety and quality of services. The public now has a single authorative view about the quality and safety of healthcare services. From April 2014, the Care Quality Commission began rating hospitals’ quality of care in bands ranging from outstanding to inadequate and the full roll out of ratings for hospitals, and ratings for social care and GPs began to be used from October 2014. The NHS in England is also the first health system in the world to measure its commitment to an ‘open and honest reporting’ on a national scale. And there has been a push to achieve an unprecedented level of transparency. Patient safety information is now on NHS Choices together with information about infection control and cleanliness, whether patients are assessed for risk of blood clots, how trusts perform on whether their staff would recommend the trust, how they respond to patient safety alerts and ward-by-ward level information about nursing and midwifery staff levels. The Consultant Outcomes Publication began with ten national clinical audits in June 2013 and this has now increased to 12 specialties. Over 99 % of consultants have agreed or not objected to information regarding their practice being published. The statutory duty of candour announced in November 2013 came into force for NHS trusts from November 2014 and will come into force for all other organisations from April 2015.

The latest results of the NHS Staff Survey show that overall, 85% (86% in 2012) of all staff felt encouraged by their organisation to report errors, near misses and incidents. Only 14% of all staff felt that reporting of errors would lead to punishment or blaming of those involved. The Nuffield Trust survey of NHS acute trusts one year post the Francis Report found that many of the themes from the Francis Inquiry Report, including the importance of openness, staffing levels and a patient-centered culture, have resonated with leaders of the hospitals