What is Duty of Candour?

The Duty of Candour is a legal requirement that ensures transparency in healthcare. Under this legislation, healthcare providers must be open and honest with patients when things go wrong, fostering an environment of accountability and trust.

What is the Duty of Candour?

Essentially, the Duty of Candour obligates healthcare providers to be transparent with people receiving care. They must inform and apologise to the relevant persons when they experience harm due to the care or treatment they have received. This includes explaining what happened, the potential effects, and what steps will be taken to prevent recurrence. It's a practice rooted in ethical integrity, aiming to bridge the gap between healthcare professionals and patients through trust and transparency.

It is important to note that apologising is not an admission of liability. NHS Resolution, the entity responsible for handling clinical negligence claims against the NHS, provides clear guidance through its 'Saying Sorry' leaflet. It confirms that offering an apology will not impact indemnity coverage.

CQC Regulation 20: Duty of Candour

Under the Nursing and Social Care Act 2008 Regulated Activities Regulations 2014, healthcare providers must follow Regulation 20 set by the Care Quality Commission (CQC). This directly relates to the Duty of Candour by establishing the obligations for healthcare providers regarding transparency and honesty in the event of safety incidents. It mandates healthcare organisations to be honest with patients about notifiable safety incidents, ensuring accountability and transparency in healthcare delivery.

CQC regulation 20 highlights the need for clear reporting and written records of such incidents, underscoring the importance of a systematic approach to handling adverse events.

Types of Duty of Candour

Duty of Candour is divided into two main types: Professional and Statutory. Both have similar aims: to ensure care providers maintain openness and transparency with their service users, irrespective of the occurrence of any incidents.

Professional Duty of Candour

Professional Duty of Candour emphasises the healthcare professional's responsibility to be honest with patients, including acknowledging mistakes and providing truthful explanations. It's supported by guidelines from professional bodies, such as the Nursing and Midwifery Council (NMC) and General Medical Council (GMC), stressing the importance of open communication and professional duties in healthcare settings.

Statutory Duty of Candour

Unlike the professional duty, the Statutory Duty of Candour is a legal requirement for healthcare organisations. It mandates a formal apology and disclosure to patients when unintended or unexpected harm occurs, ensuring that organisations maintain a culture of transparency and learning from mistakes.

Why is the Duty of Candour important?

The Duty of Candour legislation plays a crucial role in healthcare, creating a culture where reporting safety incidents paves the way for learning and growth. It gives patients the confidence that healthcare providers are dedicated to honesty, openness, and transparency, which, in turn, strengthens trust and enhances the quality of care. It also highlights the importance of professional integrity and the ethical duty towards honesty with patients, leading to a healthcare system that is more compassionate and understanding.

When to Apply Duty of Candour

The Duty of Candour is required when a notifiable safety incident happens. This includes any unexpected or unintended event that, in a healthcare professional's careful judgment, results in:

• The death of the service user, which is directly linked to the incident and not just the natural progression of an existing illness or condition.
• Serious, moderate, or minor harm or extended psychological distress to the service user.
• Any lasting impact on the service user's ability to see, move, think, or learn that is expected to continue for at least 28 days or more, affecting their sensory-motor or intellectual functions.
• Any changes to the physical appearance or structure of the service user's body.
• The service user is suffering from long-term pain or psychological harm.
• A decrease in the service user's expected lifespan.

Also, if there is a need for medical care to prevent the service user's death or deal with any of the issues listed above, the Duty of Candour comes into effect. This duty encourages healthcare professionals and organisations to communicate openly and take appropriate steps in response to these incidents.

Duty of Candour Training

Training is essential to implement the Duty of Candour effectively. This training, available through various online courses and training programmes, equips healthcare professionals with the knowledge and skills to fulfil their obligations under Regulation 20. It covers aspects such as identifying notifiable safety incidents, communicating openly with patients and families, and maintaining accurate and transparent records.

In response to the need for more comprehensive training, Flourish has developed a Duty of Candour eLearning course. Following the Care Quality Commission's (CQC) updated guidance from March 2021, this course specifically addresses the legal requirements and steps to take when moderate or severe harm occurs to a patient. It's an essential resource for health and social care workers, providing detailed insights into the Duty of Candour's application and the recent CQC updates.

Training in the Duty of Candour is not just about compliance; it's about nurturing a culture of safety, openness, and continuous improvement within healthcare settings. By embracing these values, healthcare professionals can ensure that they not only meet legal and professional standards but also provide care that is truly patient-centred and safe.