Overview of consultation

Between December 2024 and March 2025, the Northern Ireland Department of Health undertook a consultation on the introduction of a Being Open Framework in Northern Ireland. More information can be found at the government's consultation page.

MPS submission

Section 1: Understanding Openness and Culture

These questions focus on how organisations can create a culture where being open and honest is the norm (further information is provided in Section 3 of the ‘Being Open Framework’).

Q1: The framework looks at openness at three levels:

• Routine openness: Being honest in everyday care and communication.
• Learning from mistakes: Reflecting on errors to improve and avoid repeating them.
• When things go wrong: Clear communication and accountability when harm is caused.

Do you think these levels are helpful and appropriate?

• Yes
• No

Q2: The framework focuses on three areas of culture in an organisation:

• Infrastructure (e.g., policies and systems to support openness).
• Behaviours (e.g., how staff interact and communicate).
• Beliefs and stories (e.g., shared values and lessons from the past).

Do you think it’s helpful to also focus on three areas?

• Yes
• No

Comments:

In our view, focusing on these areas is helpful to fostering openness within healthcare organisations. However, we would like to reiterate that whilst a focus on everyday communication, learning and incident response is important, and infrastructure, behaviours and beliefs are important in changing organisational culture, any framework must support adequate training, meaningful communication and the promotion of learning rather than blame or fear of regulatory consequences.

Section 2: Supporting openness in everyday care

These questions focus on how organisations can make honesty and openness a natural part of daily care (further information is provided in Section 2, Section 3.3.1 and Section 7).

Q3: To support staff in being open it is proposed that organisations:

• Provide regular training for staff to promote openness.
• Share real-life examples of openness and what was learned.
• Recognise and celebrate examples of good practice in being open.
• Provide supervision that is supportive of openness.

Do you agree with these will help staff be open and honest every day?

• Yes
• No

Comments:

The success of these measures relies on their proper implementation and support.

Regular training is essential to embedding an honest and open culture. From our experience, training around openness and statutory duties in other jurisdictions has been inconsistent; this has added to the lack of clarity around the process and policy. A good example of adequate and ringfenced training is within NHS Scotland, where the Government ensured an online training module and plentiful resources were available on the new guidance and duties.

Section 3: Openness with a focus on learning

These questions focus on how organisations learn from experience to improve care and avoid future harm (further information is provided in Sections 2 and 3).

Q4: To improve learning it is proposed that organisations should:

• Encourage staff to talk openly about mistakes without fear of unfair retribution.
• Understand the circumstances that may contribute to failures and mistakes.
• Share lessons across teams to improve safety and care.
• Make improvements visible to the public, so people know what has changed.

Do you agree that these will improve learning from experience?

• Yes
• No

Comments:

Staff must feel safe discussing mistakes or incidents without fear of blame. Codifying ethical principles into legislation can create a defensive culture. Under potential statutory duties, conversations when things go wrong or mistakes occur can focus on responsibility, blame or failures, as opposed to learning and genuinely open conversations with patients.

Section 4: Openness when things go wrong

These questions focus on when things go wrong, and how organisations and their staff handle these situations with openness, compassion, and clear communication (further information is provided in Section 3).

Q5: When things go wrong, it is proposed that organisations immediately:

• Inform patients and families as soon as possible after an incident.
• Offer apologies and explanations early.
• Provide emotional or therapeutic support to all those affected (patients; carers; staff).

Do you agree with the proposals for when things go wrong?

• Yes
• No

Q6: For all involved in serious incidents, it is proposed that they have:

• Timely access to information about the incident.
• Regular updates on progress and outcomes of any investigations.
• Counselling or emotional support as and when needed for all involved.
• Debriefs to discuss what happened and how to improve.

Do you think all involved in serious incidents should receive support?

• Yes
• No

Comments:

Support for staff involved in incidents should be properly signposted and freely available, no matter the time of an incident. Timely access to information, regular updates and debriefing opportunities are crucial, so both potential distress on healthcare professionals is minimised, and a culture of transparency and learning is encouraged.

In the draft framework (p.17), the Compensation Act 2006 is referred through the ‘Saying sorry’ guidance from NHS Resolution. Section 2 of the Compensation Act 2006 states that an apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty. However, we would like to flag that this section of the Act does not extend to Northern Ireland. This, and the onward implications, should be a consideration of the consultation team when outlining requirements of individual clinicians, especially in the event of statutory duties in this area.

Section 5: Duty of Candour to support Openness

These questions relate to the proposals for the introduction of a statutory organisational and individual Duty of Candour.

Q7: Do you think that the introduction of a statutory organisational Duty of Candour would support organisations in their development of a more open culture?

• Yes
• No

Q8: Do you think that the introduction of a statutory individual Duty of Candour would support individuals to be more open?

• Yes
• No

Q9: Do you think that including a “Duty of Candour” clause in staff contracts will improve openness?

• Yes
• No

Comments:

It is MPS’ long-held belief that legislating ethical principles, such as is the case with Duty of Candour, can end up being counterproductive to the development of an open learning culture in healthcare. We fully support the intention behind such proposals but are concerned that legislating ethical principles risks creating a culture of compliance rather than genuine openness.

From our experience, doctors understand the morality of duty of candour; they are keen to apologise and explain when things go wrong and go a long way in carrying out their duties towards a culture of openness. However, duties of notification and legal requirements can often distract from the original objective of ensuring openness with patients and learning from mistakes.

In addition, the multidisciplinary nature of modern healthcare, with various healthcare professionals, teams and specialists contributing to patient care, also adds further complexity. Individuals will likely have different perspectives on incidents, and this divergence can lead to inconsistent interpretations of when the duty of candour applies. As a result of this, it is our view that statutory duty of candour should not be imposed upon individual clinicians.

Instead of additional, statutory measures, we recommend that a culture of openness should be encouraged through appropriate and adequate training, strong leadership, and organisational support. By approaching openness this way, healthcare professionals are more likely to feel safe to be candid without fear of retribution or disciplinary/regulatory action.

Section 6: Leadership and oversight to promote Openness

These questions consider the role of leaders in promoting and monitoring openness (further information is provided in Section 4).

Q10: Should Boards of organisations and Chief Executives, through their Board Patient Safety and Quality Committee, be held responsible for creating an open culture?

• Yes
• No

Q11: Proposals for monitoring openness in organisations

• Organisations should report and publish regularly on their progress in being open.
• Organisations should be held accountable for supporting openness by the Department of Health and regulators.
• Independent audits should assess whether organisations are meeting openness standards.

Do you agree with the proposals to monitor openness?

• Yes
• No

Q12: Would the introduction of an Independent Patient Safety Commissioner improve openness and patient safety? (Further information is provided in Section 6.2).

• Yes
• No

Comments:

Introducing an Independent Patient Safety Commissioner could be useful in focusing aims and monitoring of patient safety. In our opinion, such a role would need to have clear scope and responsibility, as well as guidelines on how they would work with others, including healthcare professionals, to achieve their aims.

Section 7: Training and education to support openness

These questions focus on the training and support that is needed to help staff understand how to be open and honest in different situations (further information is provided in Sections 7 and 8).

Q13: Organisations should support and train staff in being open in different situations so they can:

• Be open and honest in everyday care.
• Learn from mistakes and failures to share lessons.
• Support patients and families when things go wrong.

Do you think all staff should be trained for these purposes?

• Yes
• No

Q14: Organisations should provide support and train staff at different times using a range of training methods

• Training for openness at induction and as refresher training for all staff.
• Provision of a range of different opportunities for learning such as online or in person.
• Provision of support through mentorship, coaching and supervision.
• Learning provided in way appropriate to the staff role and the most effective training method.

Do you think all staff should be trained for in these ways? 

• Yes
• No

Comments:

As previously discussed, training should be standardised, readily available and regularly updated and reviewed. Ringfenced funding for training on openness should also be secured. Again, we reiterate that training provision in other jurisdictions is patchy and not accessible to healthcare professionals across the entirety of organisations/healthcare providers. Employees should receive continuous, ongoing training and guidance as well as support.

About MPS

MPS is the world’s leading protection organisation for doctors, dentists and healthcare professionals with more than 300,000 members around the world. 

Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.

MPS is not an insurance company. We are a mutual non-for-profit organisation and the benefits of membership of MPS are discretionary as set out in the Memorandum of Articles of Association.

Contact

Should you require further information about any aspects of our response to this consultation, please do not hesitate to contact us.

Megan Bennett
Policy and Public Affairs Manager
[email protected]