What is the Duty of Candour policy in the UK?

To comply with the Duty of Candour, healthcare providers must adopt an approach of openness and transparency with their patients, particularly when something goes wrong with their care or treatment.

When errors occur, patients and their families can expect to be informed honestly about what happened, what can be done to deal with any harm caused and what will be done to prevent a recurrence to someone else.

Professional Duty of Candour

Every health and care professional must be open and honest with patients and people in their care when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress. This is an individual duty on each health care provider.

Role of professional bodies in enforcing the duty

Regulators of specific healthcare professions oversee the professional duty of candour. These include:

• The General Medical Council (GMC)
• The Nursing and Midwifery Council (NCM)
• The General Dental Council (GDC)

Failure to adhere to the duty of candour may result in disciplinary action being taken.

Examples of professional duty in practice

As soon as the professional realises something has gone wrong with the care of a patient, they should:

• speak to the patient or family members face-to-face
• provide a true account of what has happened, allowing time for any questions
• say sorry – this is always the right thing to do and is not an admission of liability
• take action to put things right where possible
• document the incident and actions taken in writing

Statutory Duty of Candour

This duty applies to the organisations that provide healthcare services. It is a legal obligation on organisations to be open and transparent with people using their services in relation to their treatment or care.

This duty is set out under Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Key elements of the statutory duty

The statutory duty is triggered by a “notifiable safety incident” which is an unintended or unexpected incident that occurred during the provision of care or treatment that could or appears to have resulted in the following outcomes: (in the reasonable opinion of the healthcare professional)

• Death that is directly related to the incident
• Severe harm
• Moderate harm (harm that requires a moderate increase in treatment and significant but not permanent harm)
• Prolonged psychological harm (continuous period of psychological harm for 28 days)

When something qualifies as a notifiable safety incident, a conversation must begin with the patient who was harmed, or their family, as soon as is reasonably practicable. The healthcare provider should:

• Tell the patient face-to-face that a notifiable safety incident has taken place
• Say sorry
• Provide a true account of what happened and explain what further investigations may take place
• Follow up by providing this information and the apology in writing and providing updates
• Keep a written record of all communications and meetings

They should offer the patient practical support, such as providing an interpreter if needed, and emotional support such as counselling.

Consequences of failing to comply with the duty

It is an offence for a Care Quality Commission (CQC) regulated organisation to fail to comply with the duty. Failure can result in enforcement activity ranging from warning or requirement notices to criminal prosecutions.

The difference between statutory and professional Duty of Candour

The statutory duty of candour applies to organisations rather than individuals and covers all providers regulated by the CQC.

The professional duty of candour is an individual duty that applies to all registered healthcare professionals.

The statutory duty also contains specific requirements for notifiable safety incidents.

NHS Employers have responded to the consultation on the regulation of NHS managers welcoming the introduction of a new professional duty of candour on NHS leaders.