Crackdown on mistreating NHS staff ‘could backfire’

PLANS for a criminal crackdown on NHS staff who mis-treat patients in Scotland could backfire and result in more mistakes being covered up, nursing and medical leaders have warned.

Doctors have claimed that patient care may be damaged if a culture of “over prescribing and over-treating” emerges in an attempt to guard against any threat of prosecution.

The British Medical Association (BMA) and Royal College of Nursing (RCN) will set out their concerns when they appear before Holyrood’s health committee this week.

The proposed shake-up comes after the Stafford Hospital scandal south of the Border, which saw sub-standard care lead to the deaths of hundreds more patients than expected. The Scottish Government’s Health Bill, currently going through Holyrood, is aimed at avoiding a repeat north of the Border.

The plans also include a proposed “duty of candour” on NHS staff so that any incident or “near miss” is reported in order to learn from it and improve the service.

But RCN chiefs warn that the proposed new criminal offence of wilful neglect or ill-treatment may have the 
“opposite effect to the intended”.

“There is a significant risk that the threat of criminal proceedings against an individual will encourage organisations, staff, patients, their families and carers, to ‘look for someone to blame’,” the body states in a submission to MSPs. This could halt any moves, either by individuals or organisations, towards greater openness when something goes wrong in health care. We know that greater openness enhances patient safety.

“We believe that the existing criminal and civil law or professional sanctions for addressing neglect or ill-treatment, when applied properly, can deal with any serious failings in health care 
delivery.”

The existing justice and professional regulatory bodies, including the Nursing and Midwifery Council (NMC) and General Medical Council (GMC) can already deal with cases of deliberate neglect or mistreatment when they arise.

A recent NHS survey found most staff do not challenge how things are done and the prospect of a criminal crackdown will only compound this, the RCN submission adds.

“Staff will be less open and less honest when things go wrong out of fear that they may expose themselves or their colleagues,” it goes on.

The BMA said that doctors can already be subject to “multiple investigations” over one incident, and adding a criminal offence would not provide “any additional protection for patients”.

And there are also concerns about the impact of possible criminal prosecution on the “clinical decision making” of doctors.

“Any mechanism which incentivises doctors to err on the side of caution to protect themselves by over-prescribing or over-treating will not be in the best interest of the patient, wider population or in the quest to achieve a sustainable healthcare system,” it states.

“We are concerned that the new offence of wilful neglect and ill-treatment may contradict the duty of candour provisions in the bill.

“If a reportable patient safety incident occurs then health professionals need to be confident they can offer an apology without fear of criminal proceedings.”

The BMA also warns that the proposed legislation could stop people coming forward to report mistakes.

“The development of a culture where open and transparent reporting is the norm requires employers to establish clear, no-blame incident reporting systems from which to learn and improve.

“The threat or over-use of criminal prosecution seems likely to deter the development of such a culture, and to deter information sharing at the “near miss” level.

“Again, clear guidelines defining the grounds for prosecution would need to be set out to ensure that medical professionals were not deterred from reporting cases of neglect.”