Tayside Complete Health
Duty of Candour Policy
Being Open, Honest and Transparent
Document Control
Title
Duty of Candour Policy
Author Jill Forbes, Clinical Services Manager
1 01.12.20 Draft Approved by Max Groome 1 02.12.20 Final
Lead Director:
Max Groome
Document Class Policy
Target Audience
Directors, all TCH staff and Clinicians with Practicing Privileges.
Distribution List:
Senior Management Team
All Practitioners
All TCH Staff
Issue Date: 14.08.24
Consulted with the following Directors Practice Manager
Education and Training will be provided by: Clinical Services Manager
Distribution Method: e-mail
Review Date: July 2027
Contact responsible for implementation and monitoring compliance: Clinical Services Manager
1. Introduction 2. Purpose 3. Scope
4. Definition of Harm
5. Culture of Candour
6. Saying Sorry
7. Encouraging a Learning Culture
8. Process for implementing Duty of Candour
9. Process for Monitoring Compliance and Effectiveness
10. Implementing Policy
11. Related Documents
12. Policy Review
1. Introduction
Candour is about being open, honest and transparent with patients if something goes wrong with their treatment or care that causes or has the potential to cause harm and distress. Duty of Candour is a contractual obligation that requires health care providers to implement and measure the principles of being open.
The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 (The Act) and The Duty of Candour Procedure (Scotland) Regulations 2018 (the Regulations) set out a new Duty of Candour.
The Act and the Regulations require organisations providing health services, care services and social work services in Scotland to follow a formalised procedure when there has been an unintended or unexpected incident that results in death or harm (or additional treatment is required to prevent injury that would result in death or harm).
The purpose of this new duty is to ensure that providers are open, honest, supportive and providing a person-centred approach.
All Healthcare Professionals have a Duty of Candour professional responsibility to be honest with patients when things go wrong. This is described in NMC and GMC The Professional Duty of Candour, and forms part of a joint statement from eight regulators of healthcare professionals in the UK.
The Duty of Candour, whether contractual, statutory or professional, rests on the same fundamental principle: being open, honest and transparent with patients in your care. Your professional Duty of Candour applies to all incidents. Tayside Complete Health (TCH) fully support the Duty of Candour and culture of candour as a prerequisite to improving patient safety and the quality of service user and carer experience. This is a process rather than a one off event.
This policy informs all TCH staff and clinicians with practising privileges of their roles and responsibilities relating to the Duty of Candour and culture of candour, it is about being open, honest and transparent with patients, carers and or families and giving an apology should something go wrong in the course of the care and treatment we provide that causes or has the potential to cause harm or distress.
This policy, as well as informing staff of their role in relation to Duty of Candour and culture of candour informs service users, relatives and carers of what they can expect from the professionals involved if something goes wrong with the care and treatment we provided.
2. Purpose
The purpose of this policy is to set out TCH’s expectation for all Healthcare Professionals and the contractual, statutory and professional responsibility to be honest with patients in their care if things go wrong. This policy has been developed to ensure simple and robust processes in respect to the implementation of DoC and to ensure that openness, transparency and candour are complied with.
3. Scope
This policy applies to all Health care staff working within Tayside Complete Health, including those with practising privileges and staff who work on a self-employed basis. There is a statutory Duty of Candour on registered healthcare professionals to inform their employer
where they believe or suspect that treatment has caused death or serious injury and it is a criminal offence for any registered medical practitioner, or nurse to fail to do so.
4. Definitions of Harm
A notifiable safety incident is categorised as:
• Moderate Harm: (short term harm) Where safety incidents are moderately serious in nature or consequence that lead to a moderate increase in treatment e.g. unplanned admission, prolonged epi Prolonged psychological harm (expected to last more than 28 days)
• Severe Harm: (permanent or long-term) Incidents that are serious in nature or consequence and may
• Catastrophic Harm: An unexpected death. The death must directly relate to the incident and not the natural course of the service users illness or underlying condition.
Duty of Candour applies to any unintended OR unexpected notifiable safety incident that could have or did lead to harm for anyone to who we provide care and treatment (regulated activity) to. In deciding if Duty of Candour applies the Healthcare Professional must consider whether the incident was an unintended OR unexpected incident (it can be either or both for Duty of Candour to apply). And that the incident occurred during the provision of a regulated activity that could result in or appears to have resulted in a notifiable safety incident.
The initial decision made at the time of the incident as to whether Duty of Candour processes should be applied must be based on the reasonable opinion of a Healthcare Professional in accordance with the information available to them at the time.
An incident of self-harm is not automatically Duty of Candour applicable, this will depend on whether there is an action, omission or mistake in the course of the patient’s care and treatment that has resulted in a notifiable safety incident.
5. A Culture of Candour (being honest, open and transparent)
The culture of candour role Healthcare Professionals must undertake when something has gone wrong with a patient’s care or treatment that has resulted in low harm or no harm.
• No harm: (near miss) A safety incident that had the potential to cause harm but was prevented resulting in no harm, loss or damage.
• Low Harm: (minimal harm) This reflects a safety incident that resulted in a minor or undesirable or no serious outcome.
Immediately if it has been recognised that something has gone wrong with the patient’s care and treatment, meet with the patient and where appropriate, the patient’s family, carer or advocate.
Explain what has happened and any effects they may experience and say you are sorry. Offer an appropriate remedy and or support to put the matter right (if possible) Ensure someone is available to give them emotional support.
Record in the patient’s record what has happened, who explained to the patient what had gone wrong and that an apology was made for the error, omission or mistake.
6. Saying sorry to the patient
Saying sorry does not mean that you are admitting legal liability for what has happened and does not constitute an admission of negligence. It is not expected that the staff involved in
explaining to the relevant person what has gone wrong and then making the apology is responsible for what has happened.
When saying sorry you will be expected to:
• Speak to the patient (relevant person) in person in a place and at a time when they are best able to understand and retain the information and has someone with them who can support them.
• Give the patient (relevant person) the information they want or need to know in a way that they can understand and avoid jargon.
• Take into account the patient (relevant person) may find receiving the information distressing and to carry this out in a considerate way, respecting their right to privacy and dignity.
• Say “I am sorry” rather than a general expression of regret about the incident on the company’s behalf
• Make sure the patient (relevant person) knows how to contact the clinic to ask additional questions
• Give information about Independent Advocacy, counselling and or details for other mechanisms of support
7. Encouraging a learning culture by reporting errors.
Being open, honest and candid relies on staff and your rigorous reporting of patient safety incidents. If something has gone wrong with the patient’s care and treatment it is vital that it is reported at an early stage so that lessons can be learnt. Patients must be protected from future harm and the Clinic’s Incident reporting policy should be followed
8. Process for Implementing Duty of Candour
All staff must ensure that any patient/service user safety incident is reported as soon as possible after making the patient/situation safe. · If the patient/service user has suffered an injury or clinical incident whilst receiving Care thought to be due to a lapse in care, that is of a level of harm moderate or above, the Clinical services manager/ relevant other must speak to the patient and offer an apology and explain the event will be investigated
Subsequently, should the event, upon investigation be found to be due to a lapse in care the DoC must be followed. The investigation officer will ask what specific questions the patient/service user wants answering, be a formal contact point and ask how they would like the investigation to be fed back to them e.g. via a meeting or by sending a copy of the investigation to them. This will be followed up with a letter sent to the patient/service user These letters must be attached to the Incident report under the corresponding incident.
If the patient/service user has suffered severe permanent disability or death or lacks capacity, DoC will be implemented by the investigating lead as a part of the serious incident process through the next of kin (NOK) or legal guardian (LG).
If the patient/service user does not wish to be part of the investigation or DoC process (the patient has capacity) then a letter confirming the discussion should be completed and sent. A copy should be attached to the health record. Similarly, if the patient/service user lacks capacity and the NOK or LG does not wish to be part of the investigation or DoC process then a letter confirming the discussion should be completed and sent. A copy should be attached to the health record
If the service user/carer is not satisfied with the outcome of the investigation they should be offered local resolution via further communications. However, it is the right of the patient/service user, should they wish to, to lodge a complaint via the normal processes.
If more clarity on a specific incident is needed re the harm level, outcome etc., then a meeting with the Director and Clinical Services Manager should be convened and the proceedings recorded and attached to the incident report.
All documentation sent to the service user/carer must be in a format which is easy to understand, free from medical jargon and acronyms.
9. Process for Monitoring Compliance and Effectiveness
Monitoring of the implementation of this policy will be through the Incident reporting system
10. Implementation
Dissemination will be led by the Clinical Services Manager to all staff via Team Brief’s, Tayside Complete Health’ s policies and procedures web page and via induction and staff training
11. Related documents and References.
• This document is to be read in conjunction with the Tayside Complete Health Incident reporting policy.
• Healthcare Improvement Scotland www.healthcareimprovementscotland.org
• Scottish Government Health Care Standards https://www.gov.scot/policies/healthcare-standards/duty-of-candour
12. Review
This Policy will be reviewed every three years (or sooner if new legislation, codes of practice or national standards are to be introduced)