NHS England, Monitor and the NHS Trust Development Authority have advised that this information is not held centrally.

In the context of hospitals currently declaring major incidents, this refers to an emergency situation where particular facilities or resources are under pressure and special arrangements are required to maintain the delivery of some services. It would be for the organisation that had declared the emergency to de-escalate it, in line with its incident response plan.

The use of major incidents has been part of the National Health Service planning process since 2005, and they have been declared in every year since then.

There is no central definition but a major incident in a hospital might be called in:

- times of severe pressure such as winter periods or an infectious disease outbreak; and

- a period of particular local pressure such as dealing with a road traffic accident.

The Department has committed to simplify and modernise professional regulation legislation. However, the professional duty of candour can be strengthened without such changes to legislation and the professional regulators are developing new guidance to make clear professionals' responsibility to report “near misses” for errors that could have led to death or serious injury, as well as actual harm. They will review their professional codes to bring them into line with this guidance. They will also be reviewing their guidance to panels taking decisions on professional misconduct to ensure they take proper account of whether or not professionals have raised concerns promptly.

The Nursing and Midwifery Council and General Medical Council are beginning work straight away, working with the other professional regulators, on the strengthened guidance covering the professional duty of candour and we expect that it will be ready for consultation early next year and in place towards the end of 2014.

It is intended that the statutory duty of candour on providers registered by the Care Quality Commission will also come into force towards the end of 2014.

Ministers keep the issue of professional regulation under regular review and the Department has frequent contact with the professional regulators.

We accept the findings of Robert Francis QC’s public inquiry, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, February 2013, that at every level of the healthcare system, there was a failure to put the needs and safety of patients first, and to act on the warning signs that there were significant problems at the Trust.

However, we believe that the Trust Board were ultimately accountable for the poor standards of care delivered under their management. As the Inquiry stated, “the Trust prioritised its finances and its Foundation Trust application over its quality of care”.

On November 19, the Government published its full response to the Inquiry, Hard Truths: the Journey to Putting Patients First, November 2013. A copy has already been placed in the Library. The measures set out in this will together put in place the action needed to revitalise the culture of the National Health Service around a consistent focus on the needs of the patients it serves.

This includes:

— A robust inspection regime, with physical inspection by experts, considering whether services are safe, effective, caring, responsive to people’s needs and well-led;

— A new failure regime based on quality as well as finance, which will allow much swifter intervention to put things right;

— Monthly transparency on staffing levels, falls, pressure sores, complaints and other key indicators which will provide a smoke alarm locally and nationally, if things are not right;

— A new criminal offence of providing certain types of false or misleading information and a new statutory duty of candour which will set clear expectations around openness and honesty;

— A fit and proper persons test for Board directors, so that those responsible for failures in care are prevented from working elsewhere in the system; and

— Where breaches of the new fundamental standards take place, the Care Quality Commission will ultimately have the powers to prosecute and there will be much stronger accountability for managers—for quality as well as finance.

The right way to meet the objective of enhanced candour by individuals is by strengthened references to candour in professional regulation. This will include being candid with patients when mistakes occur whether serious or not, and reporting “near misses” for errors that could have led to death or serious injury, as well as actual harm. Alongside this, the organisational duty of candour will drive a more open culture throughout organisations, including its staff.