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National Patient Safety Agency

NHS urged to say sorry when things go wrong - Wales

19 November 2009


The National Patient Safety Agency (NPSA) has today published strengthened guidelines for NHS organisations on Being open, which describe the importance of open and effective communication with patients.


The NPSA’s Being open framework provides a clear set of principles describing how NHS staff need to communicate with patients, their families and carers when something goes wrong.


The framework is supported by policy makers, professional bodies and litigation and indemnity bodies across England and Wales.


NPSA’s Chief Executive Martin Fletcher said: “Being open is the key to making even greater gains in patient safety.


“Discussing patient safety incidents promptly, fully and compassionately is the best way to support patients and staff when something does go wrong.  Evidence from other countries shows that by following the principles of Being open, formal complaints and litigation claims can also be reduced.”


The framework also describes how boards of NHS organisations need to embed the principles to ensure that a culture of openness, honesty and transparency is created across the NHS. 


Today’s strengthened framework has been produced by the NPSA after close collaboration with NHS doctors, nurses, pharmacists.


Mr Fletcher added that boards have a huge part to play.  He said: “Without strong leadership from boards, we simply will not succeed.  We are asking boards to ensure that they embed these principles within their organisations and lead the implementation of this guidance.


One of the requirements of the Patient Safety Alert is the need for NHS organisations to introduce senior clinical counsellors.  Their role will be to provide specialist advice and support to staff involved in safety incidents.


The Patient Safety Alert also details several other key requirements that NHS organisations should do.  These include:


  • effectively communicate with patients, their families and carers;

  • review and strengthen local policies to ensure they are aligned to the Being open framework;

  • make a board-level public commitment to implement the principles of Being open;

  • nominate leads responsible for implementing the local policy within the organisation;

  • identify senior clinical counsellors who will monitor and support fellow clinicians;

  • raise awareness and understanding of Being open amongst staff, patients and the public;

  • ensure Patient Advice and Liaison Services (PALS) and other staff have the information, skills and processes in place to effectively implement Being open.


NHS Chief Executive for Wales Paul Williams said: "Patient safety is central to the recently-introduced reforms to the NHS in Wales. It is now at the top of the agenda of the new Health Boards and NHS Trusts highlighting the importance I, and the Welsh Assembly Government, place on patient safety. It is important that staff feel supported to apologise to patients and have a positive attitude towards learning from errors. 


“The strengthening of Being Open directly complements both the work of the Putting Things Right project in Wales, which aims to introduce more effective ways of investigating mistakes and supporting the staff involved, as well as our 1,000 Lives Campaign, which aims to improve patient safety in Wales.”


As part of strengthening the implementation of Being open, the NPSA will be holding five webinar events for NHS staff - each addressed by a national or international expert in this field.


Peter Walsh, Chief Executive, Action against Medical Accidents (AvMA) said: “Being Open when things going wrong is the most important thing for patients and makes sense from everyone’s point of view. The Being Open training and materials make it easier to do what must be the hardest job that a health professional has to do.” 


John Bowles, Manager of the Welsh Risk Pool, said: “We understand why, historically, fear of the consequences may have made NHS organisations and their staff reluctant to apologise for adverse outcomes or explain why or how they have arisen.


“In Wales we have sought to explain that NHS bodies and their clinicians can , and in many cases should, provide apologies and explanations and that this would not compromise their NHS indemnity in any way. When it is clear that treatment should have been better or an adverse outcome prevented, the patient or, where appropriate, their relatives should receive a sincere and meaningful apology and an honest explanation.


“We believe that the quick action which can follow being open and honest and which may prevent a similar adverse outcome is more important than the defence of any potential claim.


“We, the Welsh Risk Pool and the Welsh Health Legal Services, wholeheartedly support the objectives of the NPSA and the Welsh Assembly Government in publishing the new Being open framework.”


More information about Being open.




Note to editors:


  1. Media enquiries to the NPSA Press Office:

Simon Morgan – 020 7927 9580 / simon.morgan@npsa.nhs.uk

Dinah Lartey – 020 7927 9351 / dinah.lartey@npsa.nhs.uk

Out of hours – 0788 411 5956


The National Patient Safety Agency is an Arm’s Length Body of the Department of Health. It encompasses three divisions; the National Research Ethics Service, the National Reporting and Learning Service and the National Clinical Assessment Service. Each has its own sphere of expertise to improve patient outcomes. The NPSA’s vision is to lead and contribute to improved, safe patient care by informing, supporting and influencing healthcare individuals and organisations. For more information visit: www.npsa.nhs.uk.


Comments from partners endorsing Being open


Tahir Mahmood, Vice President at the Royal College of Obstetricians and Gynaecologists (RCOG)

“Clinicians must ensure that their practice remains evidence-based and up to date. They should work towards a philosophy of “zero tolerance to patient harm”. However errors do occur and the NHS should promote an atmosphere of openness so that lessons can be learnt for future practice. Clinicians should feel confident and be open and honest with their patients to explain their error.


“By sharing the experiences learned from mistakes, we can not only genuinely reduce clinical errors but can also make clinical services safer in the future. For this to happen, every NHS organisation must strengthen its local clinical governance systems.


“The RCOG is fully supportive of NPSA’s Being Open policy as it will encourage the NHS Organisation to invest in developing environments which will be conducive to learning from mistakes and develop safer healthcare for patients.”


Professor Dinesh Bhugra, President of the Royal College of Psychiatrists (RCP)

“The Royal College of Psychiatrists is delighted to be once again endorsing the Being open guidance. Openness and honesty is absolutely essential in establishing good doctor-patient relationships. If things go wrong, service users and their families and carers deserve a timely explanation. High levels of openness can strengthen the doctor–patient relationship and foster mutual respect.”


Steve Jamieson, Head of Nursing at the Royal College of Nursing

“The Royal College of Nursing welcomes the NPSA’s Being open policy and Patient Safety Alert to the NHS.  Nurses are at the forefront of patient care and we would encourage nurses to follow this guidance. Nurses are skilled communicators and understand the importance of being open with patients when they are harmed. The Being open principles will help alleviate distress to those involved and reduce the number of complaints.”


Dr James Armstrong, Medico-legal adviser at the Medical Defence Union (MDU)

"It is occasionally suggested that medical defence organisations actively discourage our members from saying sorry. This is a myth and we welcome the opportunity to set the record straight. Doctors have an ethical obligation to offer an apology and an explanation if something has gone wrong and there is no legal reason not to do so.


"In fact, it is now enshrined in law in Section 2 of the The Compensation Act 2006 which says: ‘an apology, offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty’. In the MDU’s experience, an explanation and apology at an early stage can help reduce the risk of a complaint and is often all that a patient or a relative wants to hear.”


Dr Stephanie Bown, Director of Policy and Communications, at the Medical Protection Society (MPS)

“As a longstanding advocate of openness in healthcare, MPS is pleased to once again support the NPSA’s Being Open.  Time and time again surveys tell us that most patients who make complaints about medical errors just want to understand what happened and why.  Anyone can make mistakes and admitting them is morally ethically and professionally the right thing to do.  An environment of openness is one where adverse events and near misses are openly identified. 


“In our experience, a significant proportion of adverse incidents are avoidable and it has been proven that the underlying cause of the majority of adverse incidents in medicine is either systems failure, or a combination of systems failure and individual error.  Therefore, adverse event reporting is central to improving patient safety as it provides the opportunity to learn how to prevent the same thing happening again.”