By | 1 February, 2018

There have been a number of high profile cases where healthcare professionals and/or organisations have not been honest, when harm has occurred as a consequence of error or omission of care. This can have devastating consequences for the patient or their relatives and in many cases families have had to fight NHS organisations and take their claims through the courts. This seriously compromises the confidence that the public places in our health and social care services and also has a detrimental effect on the patient/clinician relationship that should be built on trust.

The Duty of Candour came into effect in November 2014 when organisations that are registered with the Care Quality Commission (CQC), were legally obliged to be open and honest with patients when things went wrong. This was in response to the Francis Report that reviewed the breakdown of care at Mid Staffordshire NHS Foundation Trust. It should be recognised that a number of pressure groups such as Action Against Medical Accidents (AvMA) had been campaigning for something similar for many years.

Professional Duty

There has always been a  ‘professional duty’ to be honest and truthful with patients. It could be argued that as there was already a professional requirement that a legal framework was not necessary. However, this did not protect patients or staff when things went wrong at Mid Staffordshire. The legal requirement of organisations to be open and honest should support staff to raise safety concerns without fear of reprisals within an organisation, something that was recognised as a significant contributing factor to poor care experienced at Mid Staffordshire. Since the implementation of the Duty of Candour, the Nursing and Midwifery and General Medical Council have issued joint guidance on the professional Duty of Candour.

Contractual requirements

There was also a contractual requirement for NHS organisations to be open and transparent when patient harm occurred within the ‘NHS Standard Contract’. This has now been strengthened by the inclusion of the Duty of Candour.

Statutory requirement

The Government’s decision to make the Duty of Candour a legal requirement for organisations, sends a clear message of expectation to health and social care providers. The introduction of the Duty of Candour was the first time it would be unlawful not to disclose an error that caused significant harm.

The CQC, as the regulator, has a responsibility to identify any sustained breaches of the duty, which could ultimately lead to criminal sanctions. AvMA recently conducted a review of the CQC’s inspections of NHS bodies, which took place throughout 2015. They concluded that many of the CQCs inspection reports showed an inconsistent, and at times, superficial approach to monitoring the Duty of Candour and made a number of recommendations to improve methods of monitoring.

It is important to understand that mandated processes and statutory requirements alone, will not improve a safety culture. It requires an organisation to fully embrace a commitment to safety, learning lessons and ultimately improving care as a result.

It is well recognised that when things go wrong, patients and their families expect three things:

  • To be told honestly what happened
  • What can be done to deal with the harm caused
  • To know what can prevent a recurrence to someone else

These expectations are the cornerstone of the Duty of Candour. Ultimately being open with patients and their relatives, when things go wrong, should feel like the right thing to do.

This is the first in a three-part weekly blog series by Elaine Spencer on the topic of Duty of Candour and the requirement for openness in the NHS. Subscribe for future blog posts by entering your email address above.

Relias releases its Duty of Candour e-learning course on 1st February 2018. To experience the course, and discover how it can help your healthcare staff, simply fill out the form below.

Elaine Spencer

Governing Body Equality and Diversity Lead, Safety & Quality Team at Brighton and Sussex University Hospital Trust

Elaine took up her post as a Governing Body Member at Dorset CCG in August 2016 with a focus on quality. She also fulfills the role of the Freedom to Speak up Guardian and is the Governing Body Equality and Diversity Lead. Elaine has most recently been working within the Safety & Quality Team at Brighton and Sussex University Hospital Trust investigating serious incidents and leading on the introduction and monitoring of the statutory Duty of Candour. Elaine has previously worked as a Consultant Nurse in Cardiology at Guys and St Thomas NHS Foundation Trust introducing and evaluating nurse-led services and as a Clinical Director of S&C Healthcare providing clinical and management services to the NHS. She has been involved in, designing, delivering and commissioning innovative services, including complex care pathways. Elaine has shared her knowledge and expertise widely as a public speaker, a lecturer and is widely published.


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