Proposals to Introduce a Statutory Duty of Candour for Health and Social Care Services: Consultation Analysis

4 Ensuring Staff Have The Required Support, Knowledge And Skills (Q2)

4.1 The consultation proposed that the statutory duty of candour should include an organisational requirement to ensure that staff involved in disclosable events have the necessary support, knowledge and skills. Respondents were asked for their views on this proposal:

Question 2: Do you agree that the organisational duty of candour encompass the requirement that adequate provision be in place to ensure that staff have the support, knowledge and skill required?

4.2 Altogether, 97 respondents replied to Question 2. Table 4.1 shows there was near unanimous agreement with this proposal, with 98% of respondents agreeing and just 1% disagreeing. One respondent made comments that neither agreed nor disagreed with the proposal.

Table 4.1: Q2 - Do you agree that the organisational duty of candour encompass the requirement that adequate provision be in place to ensure that staff have the support, knowledge and skill required?

Type of respondent	Yes		No		Other		Total
	n	%	n	%	n	%	n	%
NHS	23	100%	-	0%	-	0%	23	100%
Third sector	22	100%	-	0%	-	0%	22	100%
Professional associations, support agencies and trade unions	13	93%	-	0%	1	7%	14	100%
Local government organisations	10	100%	-	0%	-	0%	10	100%
Scrutiny / regulatory bodies	8	100%	-	0%	-	0%	8	100%
Partnership bodies	6	86%	1	14%	-	0%	7	100%
Other organisational respondents	6	100%	-	0%	-	0%	6	100%
Individual respondents	7	100%	-	0%	-	0%	7	100%
Total	95	98%	1	1%	1	1%	97	100%

Percentages do not all total 100% due to rounding.

4.3 In total, 83 respondents made comments at Question 2, and the views of these respondents are explored in more detail below.

4.4 The consultation paper referred to (i) support for staff involved in a disclosable event (i.e. the original adverse event) as well as (ii) training, supervision and support for those involved in the disclosure process (i.e. the process of disclosing to those harmed by the original adverse event), and respondents discussed both of these situations in their comments.

Reasons for supporting the requirement

4.5 There was a clear consensus among respondents that it was 'essential' or 'vital' to the successful implementation of the legislation that staff had the necessary knowledge, skills and support, and that organisations should be responsible for providing this. Respondents also agreed that training and support were necessary for staff to be able to perform effectively and act confidently in dealing with adverse and disclosable events. It was also argued by some that, without adequate training and support for the staff involved, the introduction of a duty of candour could do more harm than good.

4.6 Respondents made the following points:

• Being involved in an adverse event could be a cause of anxiety and it was important that appropriate support was provided to safeguard staff welfare and to ensure the full benefit of organisational learning was achieved.
• Disclosing adverse events to patients / service users and their families involved dealing with difficult situations and placed particular demands on staff in terms of communication skills (verbal and written) if their duties were to be carried out sensitively and effectively.

4.7 Respondents emphasised the importance of organisation-wide awareness raising in connection with the new duty and development of a common understanding of what the duty entailed for all those working in the health and social care sector.

Comments on the wider organisational culture

4.8 Respondents saw training and support for staff as intrinsically linked to the issue of organisational culture. It was argued that successful implementation of the legislation could only be achieved if organisations were seen to value and support staff in being candid. This required a commitment, by management and throughout the organisation, to honesty, transparency, openness and learning, with appropriate governance arrangements in place.

4.9 Training and support services were seen as important in promoting cultural values of openness and transparency, and helping staff perceive the duty of candour as a positive contribution to that culture. They were not, however, seen as sufficient in isolation.

Comments on training

4.10 Respondents also agreed on the need for good quality training for staff. There was a view that this should be developed at a national level as a way of supporting consistency (Scottish Social Services Council and NHS Education for Scotland were both highlighted as having a potential role), and that multi-agency delivery of training might be helpful in developing an integrated approach. Respondents identified a range of ways in which training might be delivered, including through written guidance and information covering policies and procedures, online learning resources, and intensive experiential training for those seeking to acquire advanced communication skills.

4.11 Respondents also provided specific comments on training requirements (as opposed to support) focusing on what might be covered in training and who would need to receive training, as discussed below.

Issues to be covered in training

4.12 Respondents saw training as fulfilling several functions including: (i) disseminating information about the duty of candour; (ii) ensuring staff understood what the duty entailed for organisations and individual staff members, and how it related to their professional responsibilities; (iii) training staff in the procedures to be followed; and (iv) equipping people with the verbal and written communication skills and confidence required for disclosing incidents to service users and families and preparing reports and apologies. The need for specialist skills to deal effectively with particular groups such as children and young people and those with mental and cognitive disorders was also noted.

Staff requiring training

4.13 Respondents took a wide view on who would require training. It was argued that anyone within the organisation could potentially be involved in or be witness to a disclosable event and should therefore be aware of the duty and the related procedures, and the support available. Thus, training should be provided to board members and senior leaders as well as managers, frontline staff of all professions, and ancillary and support staff. Training for volunteers was also mentioned by some respondents. There was a suggestion that training should be mandatory for all staff.

Comments on support for staff

4.14 Although respondents often talked generally about the importance of a supportive organisational culture to the successful implementation of the duty of candour, there were also comments which outlined specific types of support that should be available to staff who were involved in disclosable events. These included counselling, occupation health services and trade union support. It was seen as important that the support needs of staff were recognised at an organisational level through the adequate resourcing of appropriate services.

Implementing the requirement

4.15 A key concern for respondents in implementing the requirement related to resources, both in terms of time and money. There was a strongly expressed view that the extent and nature of training and support required could have significant resource implications for organisations, particularly at a time of budgetary constraint. Respondents identified costs relating to the development and delivery of the training and support itself; development of related guidance; review of existing arrangements; and staff time in attending training. It was noted that the provision of training would not be a one-off event but would need to be sustained and funded on an ongoing basis.

4.16 While the predominant view was that implementation would require significant training and support to be put in place, there was also a less commonly expressed view that meeting these requirements would have a more limited impact on organisations. Respondents commented that many staff already had relevant skills, that training was already provided, and that the new requirement would be able to build on existing arrangements for dealing with adverse events.

4.17 More generally, implementing the requirement was seen as an issue for smaller organisations. Respondents particularly queried the feasibility of community-based professionals such as GPs, dentists and pharmacists operating in small or single-handed practices meeting the requirement.

Views of those who did not agree with the requirement

4.18 The two respondents who did not agree with the proposal (one disagreed in response to the tick-box question and one expressed mixed views in their comments) did not disagree with the benefit of training and support per se, but thought that existing arrangements were sufficient or that efforts should focus on the more fundamental issue of developing a culture of openness and trust.