Gaslighting patients and rapid reviews

The Health Secretary, Wes Streeting has recently announced a rapid review of obstetric and neonatal care concentrating on 10 or 11 Trusts which have been in the headlines as a result of failings in provision and care.  In his comments he has indicated that women feel that they are being gaslit, ignored and misled when they raise legitimate concerns about what has happened to them at hospital.  This in fact echoes what the Patient Care Commissioner, Ms Hughes said a year ago noting the significant difficulties with the way that women in particular were treated within the obstetric and midwifery units.

The review is a rapid review of trusts which appear to have the most failings but may not actually represent all of the trusts with significant failings.  What it is, is an attempt to find out what is happening with obstetric care.

As a clinical negligence practitioner, unfortunately misleading and gaslighting claimants/patients is not restricted to the field of obstetrics but there is no doubt that the experience of most lawyers would be that women suffer more of this than men .

The duty of candour finally came in, in 2014.  It is a duty that the labour government wishes to extend to other areas of professional life and it would be difficult to argue against that.  The experience however, on the ground for individuals can be slightly different from that which it had been perhaps anticipated.  Some of the more recent cases of obstetric problems have occurred after the  introduction of the duty of candour.  There may be a number of reasons for this, not least of which perhaps financial but that does not justify what has happened in these cases.

The problem with the duty of candour is that excellent practitioners would always have been fair and honest with their patients when something was in error.  The duty of candour does not encourage necessarily the trusts to take the same approach.  Ideally, they can be fined but the reality is the fines are  relatively small and easily forgotten.  It is not clear whether financial penalties are the answer in any event.  However, if there is no punishment regarding the failure to provide a full and transparent answer on issues then there is no reason for the trust to do so.

It is not just within Trusts that this occurs.  I have dealt with cases where a second trust has discovered a significant failing but didn’t report this to the client with disastrous effects because of the delay in diagnosis. It would have been hoped perhaps that by now the duty of candour would have prevented such events but actually that is not quite the case.

It remains the case that the vast majority of people who pursue a clinical negligence case, one of their primary motivations is that they want to know what has happened and why.  Yes, these claims have a monetary value, clearly.  Yes, they may need those funds for improving the quality of their life going forward and of course no amount of funds can compensate for the situation that they may find themselves in.  However, much of the trauma of clinical negligence would be removed if the defendants, if the NHS simply chose to do proper investigations, provide proper analyses and reports and admit fault when it is found.  Some do but not all.

Though court waiting times in terms of progressing a case have returned to normal (which is slow but not almost stopped), claimants are still waiting 2, 3, 4 years for a proper answer to what has happened to them.

The duty of candour needs to be enforced.  The duty of candour needs to have proper weight behind it that is meaningful.  Arguing that an organisation can be fined for a breach is no use if the fines do not come or are relatively minimal.

If there is to be a change in culture, there has to be encouragement and penalty. If there is to be a proper working duty of candour and indeed if it is to be extended to other organisations in other spheres, then it needs to have some proper backing and it needs to be an essential part of the governance of the NHS and organisations with all that that entails.  Until such time as the duty of candour is made a real weapon in obtaining the truth, until the time that women are entitled to expect a proper detailed response, then the concept remains desirable but not functioning properly.

Wes Streeting is to be commended for his review but the culture of misinformation, of gaslighting, of failing to inform properly has to stop and the review must tackle that issue.  These are not just matters of funding and resources.  They are a matter of giving, in particular, women but in general patients proper respect. That may require a good deal more than a review and a little enforced duty of candour.

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