CQC issues first fine for breach of duty of candour
The Bradford Teaching Hospitals NHS Foundation Trust has been fined £1,250 by the Care Quality Commission
The Bradford Teaching Hospitals NHS Foundation Trust has been fined £1,250 by the Care Quality Commission (‘the CQC’) for failing to apologise to the family of a deceased baby within a reasonable time. This is the first time that the CQC has exercised its criminal enforcement powers in respect of a breach of the duty of candour. This could be a reflection of the intention of Ian Trenholm the new chief executive of the CQC in November to pursue more criminal sanctions, when he announced that he was reviewing 31 NHS Prosecutions and had hired ex military and civil police officers to review evidence.
The background to the case concerned the admission of a baby boy to the Bradford Royal Infirmary in July 2016. There were delays in diagnosis and missed opportunities to admit him to hospital and he subsequently died. There was no suggestion that the trust had withheld information. The trust recorded it as a notifiable safety incident for the purposes of regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 but the family were not informed and were not given an apology until October 2016.
The CQC has previously used its civil enforcement powers in the form of warning notices and requirement notices, and although it has the power to bring a prosecution, it took the view that a fixed penalty notice was proportionate in this case.
The CQC’s chief inspector of hospitals noted that the action taken against the hospital was not in relation to the care provided to the baby but to the fact that the hospital had been slow to inform the family about the delays in diagnosis and missed opportunities for admission. In response, a spokesperson for the hospital stated that they recognised that, despite informing the family of the notifiable incident, as they were required, the delay in offering the apology was unacceptable. The spokesperson continued that the hospital had in fact identified and reported this breach of the regulations to the CQC themselves, co-operated fully with the CQC investigation and accepted the fixed penalty. Following identification of the breach, the hospital amended its policy and put in place a major staff awareness campaign. It has not, it says, had any further breaches in respect of the duty of candour since then.
Conclusions and implications
The regulations around the duty of candour have been in force since the end of November 2014 and it is perhaps surprising that this is the first fine issued by the CQC in respect of breach of the duty. The size of the fine itself is comparatively small but the reputational damage is something which all providers would wish to avoid.
Nevertheless, the CQC’s action is a salutary lesson and it is to the credit of the hospital that it not only identified and reported the breach to the CQC, but actively took steps to change its policy and increase staff awareness once it became aware of the issue.
The fact that they have had no subsequent breaches is testimony to effective procedures and good staff training and we would urge all care providers to review both procedures around the duty of candour as well as staff awareness and understanding. The CQC has shown in this case that it will not hesitate to act when it is required and appropriate to do so.
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