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

7 Staffing And Other Resources (Q5)

7.1 The consultation paper invited views on the staffing and resources which would be required if a statutory duty of candour was introduced:

Question 5: What staffing and resources would be required to support effective arrangements for the disclosure of instances of harm?

7.2 Altogether, 84 respondents provided comments at Question 5. Those not responding tended to be organisations such as professional associations and scrutiny bodies which do not have a service delivery function.

General views on resource implications

7.3 Respondents frequently expressed concern about the potential resource implications of a statutory duty of candour. This issue was raised repeatedly across all the consultation questions, as well as in response to Question 5.

7.4 Respondents noted that health and social care organisations were already under financial pressure, and that there was little spare capacity within existing teams to take on additional duties. There was a concern that meeting the duty of candour requirements could impact on frontline services.

7.5 There was also, however, a less common view that the resource implications would be marginal, particularly beyond the initial set-up phase, and would be accommodated within existing budgets. Respondents who offered this view felt that: many of the activities envisaged as part of the duty of candour requirements were already undertaken within health and social care services; there was already substantial relevant experience and expertise within the health and care workforce so training requirements would be limited; and there was scope to make use existing mechanisms and systems.

7.6 A third, much less common view, was that the duty may in the longer term have a positive impact on costs as a result of a more open culture, reduced complaints, reduced legal claims, and service improvements achieved as a result of learning from disclosable events.

Uncertainties in considering staffing and resource implications

7.7 A key theme in the views put forward was the perceived difficulty in considering resource implications at this stage because of the number of 'unknown' factors and other influencing variables. These included:

• The detail of what would be required under the legislation: without this, respondents thought it was not possible to be sure about the types of activities that staff would have to undertake or that organisations would have to fund, or the extent of any flexibility in meeting the requirements.
• A clear definition of what would constitute a 'disclosable event': without this it was not possible for organisations to estimate the number of cases they may have to deal with or the potential demands on staff
• Official guidance or expectations relating to staffing arrangements
• The possible impact on insurance premiums, legal claims and compensation pay-outs.

7.8 In addition it was felt that all cases would be different, each requiring different staff and other input on a case by case basis.

7.9 Some respondents also highlighted the fact that the resource implications would vary depending on the type of organisation. In particular, the requirements could have a disproportionate impact on smaller organisations, given that larger organisations were more likely to already have access to relevant expertise and systems. Thus, smaller organisations may need support in developing practices to meet their obligations under the legislation. In addition, the resources put in place would have to be service-specific, and in large organisations, tailored to individual specialities and departments.

Involvement of non-frontline services

7.10 Although respondents generally commented on the resource implications for frontline services, some also highlighted costs for other organisations that might have a role in supporting the delivery of the duty of candour. These included NHS Education for Scotland and the Scottish Social Services Council in relation to training and education, and regulatory bodies such as the Care Inspectorate. It was also suggested that Adult Protection Committees might take a role in supporting and monitoring duty of candour activities. Therefore, resource implications would be dependent on how the roles of these organisations / groups were specified.

Suggestions for minimising costs

7.11 Respondents suggested ways of minimising resource implications through: providing an online system for reporting incidents; sharing resources and developing joint solutions for smaller organisations; using existing systems and processes where possible (e.g. linking with those already in place for responding to adverse events); and providing national guidance, training resources and reporting templates.

Specific staffing and resource requirements

7.12 The most common resource issues highlighted were in relation to staffing and staff training. However, respondents also discussed the potential cost of initial implementation activities; support services for service users and staff; and ongoing administrative costs. The main points raised are noted below.

Implementation activities

7.13 Respondents identified a range of set-up activities which would need to be undertaken and resourced if the legislation was introduced. These included reviewing and developing policies and procedures, producing information and guidance, developing and delivering training, and establishing IT systems.

Staffing

7.14 Respondents anticipated a wide range of staff contributing to meeting duty of candour obligations. These include: frontline clinical and service delivery staff, senior and supervisory staff and those at leadership level in organisations. There were suggestions that roles might include (at a senior-level) a duty of care 'lead'; a compliance officer; and a duty of candour 'champion'. The point was made that there would also be implications for backfilling posts where staff members were removed from normal duties to deal with adverse events.

Training

7.15 Most commonly respondents envisaged a combination of staff-wide and specialist training, but it was pointed out that training requirements would vary depending on whether a generic or specialist approach to duty of candour activities was adopted.

7.16 Respondents anticipated a significant requirement to invest in initial staff training to ensure that all employees were aware of the new duty and the roles and responsibilities associated with it. However, it was also thought that training would need to be provided on an ongoing (possibly annual) basis.

Support services

7.17 Views about the costs of providing support services have been covered in detail in earlier sections and are not repeated here. In summary, respondents thought that support for staff (e.g. trade union support, counselling and psychological services, occupational health services) and support for service users / patients and their families (e.g. counselling, advocacy, chaplaincy, independent medical advice) would need to be put in place.

Ongoing administrative support and other costs

7.18 Respondents noted the need for ongoing administrative support, particularly in relation to reporting. Other potential costs related to the needs for: (i) legal advice (i.e. regarding the development of apologies and responding to any subsequent claims made); (ii) communications support in publicising the new duty of candour; and (iii) accommodation for training and support sessions.