Duty of candour

The requirement to undertake duty of candour came from The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 20.

Duty of candour is an open and transparent conversation with people who use services in general and in relation to care and treatment. This is a contractual, legal and professional obligation of Trusts and their staff.

The principles of the Duty of Candour Regulation (20) set out specific requirements that include

informing people about an incident, providing reasonable support, providing truthful

information and an apology. The principles are to help and support openly and fairly, without blame or recriminations.

This has been developed following the Frances Report (February 2013) after the Mid Staffordshire enquiry. This means we must demonstrate that our care includes:

Openness: Enabling concerns and complaints to be raised freely without fear and for questions to be answered. Transparency: Allowing information regarding the truth about performance and outcomes to be shared with staff, patients, the public and regulators. Candour: Any patient harmed by the provision of a healthcare service is informed of the fact and an appropriate remedy offered, regardless of whether a complaint has been made or a question asked about it.

Duty of candour means we are being open with patients and service users following an incident and doing this promptly, fully, honestly and compassionately. This process requires that we give an apology to patients and their carers when things go wrong, in an honest manner.

The expectations of staff to patients and carers when a patient safety incident leads to a moderate, severe harm or death incident is that we acknowledge a mistake, apologise, explain what happened and identify learning so that it does not happen again.

Once an incident is identified and reported, prompt clinical care is initiated to prevent further harm. Upon assessment of the severity of harm, if confirmed as being moderate or above, a lead for duty of candour will be identified. There are five stages to duty of candour and these are:

I. Initiate a being open process, by notifying the relevant patient or carer in person that an incident II. Provide an account, which to the best of the health service body’s knowledge is true, of all the facts the registered person knows about the incident at the time of the notification.

III. Include an apology which expresses sorrow or regret in respect of the incident.

IV. Identify what further enquiries into the incident will be undertaken; respond to questions openly and truthfully. Agree the process for keeping the patient or carer updated on a regular basis. If the person does not wish to communicate, their wishes must be respected and a record kept.

V. Document all information and conversations in the formal records. Share the findings of the investigation with the patient or their representative, including all learning and actions being taken.

Staff may be concerned that by giving an apology, it means that they or the Trust is admitting liability. This is incorrect and an apology is not an admission of liability. The executive lead for being open is Fay Gilder, medical director, supported by Sharon McNally, director of nursing, midwifery and allied health professionals. Our nonexecutive director for being open is Helen Glenister. Dr Fay Gilder, The executive lead for being open is Dr Fay Gilder, medical director, supported by Sharon McNally, director of nursing, midwifery and allied health professionals. Our non-executive director for being open is Helen Glenister.

Background information: The CQC made their first prosecution for a breach of the duty of candour regulations in October 2020 for a Trust where there was a failure to disclose a failed clinical procedure (endoscopy in this case) and did not offer the patient an apology. The trust was fined £12,565.