News -‘Urgent’ call for CQC to improve regulation of duty of candour laws

“Urgent” improvements to the way inspectors assess compliance with the new duty of candour law have been called for, following analysis that revealed the Care Quality Commission is failing to provide adequate details on the regulations in a quarter of its reports on hospitals.

Patient charity Action against Medical Accidents found that from a sample of 90 CQC reports from hospital inspections in 2015, 7% did not refer to the law at all and 19% were “superficial” in how they dealt with the regulations.

The law was introduced in November 2014 following a recommendation by the 2013 Francis report into care failings at the former Mid Staffordshire Foundation Trust.

It places a legal duty on hospital, community and mental health trusts – and more recently GPs and all other providers registered with the CQC – to inform and apologise to patients if there have been mistakes in their care that have led to significant harm.

“Having fought so hard to get a statutory duty of candour, we are deeply disappointed about how the CQC has regulated this so far”

Peter Walsh

Action against Medical Accidents said it was “disappointed” and “surprised” that in the first year of the law’s introduction the CQC had taken an inconsistent and superficial approach to its assessment.

It said it was “totally unacceptable” that six inspections “paid no attention at all to the duty of candour”. The charity called for “urgent” improvements to the way the CQC regulated duty of candour regulations.

It made a series of recommendations including that the CQC use a more robust and consistent method of assessing compliance with the candour law, as well as more in-depth analysis of why organisations may not be adhering to the regulations and suggestions for improvement.

“We still believe the duty of candour is potentially the biggest breakthrough in patient safety and patient rights in modern times, but we have always said that its success will depend to a large extent not only on the goodwill of providers, but on robust regulation by the CQC,” said Peter Walsh.

Professor Edward Baker, CQC deputy chief inspector of hospitals, said: “From these early inspections we identified the need for a more systematic approach to inspecting how well organisations are embedding the duty as part of their broader approach to learning from incidents and supporting people who use services and their families.

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Relevant training: Using Empathy to Help Resolve Complaints 

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“Three out of four investigations by hospitals into complaints that patients suffered avoidable injury or death fail to identify serious failings in care, leaving distraught families in the dark.” Julie Mellor Parliamentary Health Ombudsman, Dec 2015

Description: A one-day course for ideal for those working with families raising an initial concern or following the official complaints procedure. Delegates will develop the confidence to handle such conversations with empathy, understanding and consistency. Staff will develop skills to implement openness, honesty and transparency and prevent prolonged psychological harm as stated in the Duty of Candour.

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Blog – Does being emotionally strong and aware always make it easy to handle difficult emotions and conflict? Is failing sometimes good?

So I asked myself to quickly write down 5 things I know about myself for sure……and here they are:

#1 I have believed in and studied empathy and emotional development passionately

#2 I have had to explain the death of a parent to a 4 year old and listen to her distress.

#3 I have felt grief that overwhelmed me when I lost a 15 year old child.

#4 I am very honest with myself, emotionally developed, know myself well with good empathy skills.

#5 I am passionate about supporting healthcare professionals and complaints teams to understand how the use of empathy will help in their interactions with patients and families. 

So knowing these 5 things, especially #5 you would think that I always handle conflict and difficult emotions amazingly well, never ‘failing’….right???? …..WRONG.

funny.pho.to_half_robot_face_mask (1)You see being emotionally strong, being emotionally developed, and having understood, cultivated and practised well my ability in empathy, benefits me with good insight and skills,  but it does not make me a robot, logical, detached and unfailingly objective – heaven forbid! In fact, it probably makes me the total opposite of a robot. AND YES that really is an image of me transformed on an android website!

At 47 now, I still have many situations that will still evoke an emotion in me, that will make me shout, cry, panic, get defensive and often aid3758-728px-Walk-Away-from-a-Fight-Step-7momentarily want to bolt or walk off from the situation because I can’t handle it.   Reactions that most people experience, unless they are a sociopath (whether they admit it to themselves or not).

Trained in counselling and imparting knowledge to other professionals, I have sometimes spent time expecting myself not to have these reactions. To always ‘be in control’ and when I haven’t been, I have been left feeling like a failure and indeed a fraud. ‘how can you help others when you, yourself Carolyn, have not succeeded at handling that situation better’?  

But of course, the answer is, that is exactly why I can help people, because I experience and importantly, acknowledge these emotions. The good and the not so good. It is exactly why I know I have emotional strength because I still feel emotions after going through very difficult things and am not an empty shell. I can draw upon emotions from being sat by the side of a river when I lost a child, to being the outrageous life and soul of a party (and everything else in between)!! It’s what I am so passionate about in my training, being human beings in the room together. Being brave enough to be open, honest and transparent (anyone having been to my training or seen me speak at a conference will know that to be the case!!). Working with the Duty of Candour (Openness and honesty when things go wrong) and preventing prolonged psychological harm, dictates to me on an ethical and moral level, as a professional, that part of the learning process needs to be that I, as the person conducting the training,  needs to emulate the ethos and requirements of the information I am imparting.

Human brain AMYGDALA - cross section
Human brain AMYGDALA – cross section

Emotions guide us and are our internal radar – The Amygdala in the brain. They used to help us survive thousands of years ago by feeling fear of danger and although we still live in a dangerous world sometimes, our emotions protect us in other ways. They can of course hinder us too however and that is why the key to emotions is not to not have them or suppress them, but to understand them, learn from them, manage them and work with them alongside your intellect.

Our emotions with intellect can help us understand and empathise with another in a way that intellect alone can’t. and YES we can develop this! Our emotions and intellect can help us learn the discipline of feeling someone else’s emotions and to be able to respond to this, without being so overwhelmed that you take on their pain. This is true human connectedness. And it is a felt process.

But this takes practice and continual development. It requires you to stay in an enquiring mind and ask why?? Why do I feel that? Why might they feel that? What is the best action?

What is important to say is that….

It’s NOT about getting it right all the time. That is impossible.

It’s NOT about being responsible for someone else’s behaviour and emotions

It is about valuing and understanding your own emotions though and in doing so bringing the unconscious into the conscious and always learning. 

Murray-wins_wimble_2611142bFor those tennis fans out there that watched Murray win his 2nd Wimbledon Final, if he should he never win it again, does that mean that his finally tuned attributes of physicality, emotion and conviction that he worked on to secure such an achievement, never really existed? Or will never exist again? No of course not. They may change, but he will be developing them and learning all the time. He will celebrate and learn from his successes and hopefully celebrate and learn from his failures (even though that never feels as nice!) He will continue to be equipped with expertise and experience to teach and coach tennis students, even if he can no longer compete with the top ranking players of the world. He may not always get the outcome he hopes for, but he will be developing himself nevertheless. 

So when you are committed to emotional development (as I am) and being the best version of yourself you can be, I believe that part of that learning curve is acknowledging that you will not always get it right and you will sometimes fail. But in failing….another thing I know for sure, is that you are being pushed. You are being stretched. You are being forced to face tough emotions, and create emotional learning that consequentially place you in a great position to think about it, analyse it, learn from it and guess what, develop into that great, imperfect, but honest human being and not that robot.Carolyn

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