Duty of Candour

What is Duty of Candour

Cambridgeshire and Peterborough NHS Foundation Trust has always been committed to being open and honest with patients, families and carers when a patient safety incident has occurred, and want to support our staff in this process. Under the Care Quality Commission(CQC) Regulation 20 Duty of Candour, the Trust has a legal and moral responsibility to be open and honest when things go wrong.

What are the requirements?

There are times when something goes wrong with the care, support and treatment provided to service users. On those occasions, we should:

• Inform service users, families or carers in person of what has happened and offer an apology
• Provide a full and true account of all known facts
• Provide information about the investigation process
• Inform service users, families or carers of support mechanisms
• Share the findings of the investigation with the service user, family or carers
• Identify the cause of the incident
• Provide a written letter which confirms the information already provided, the results of any further investigation and an apology
• Answer questions the service user, families or carers may have
• Document in the patient's clinical records and incident form.

Why was Duty of Candour introduced?

In 2013, Robert QC published his report into failings at Mid-Staffordshire NHS Foundation Trust. One of his recommendations was for a statutory Duty of Candour. The Duty of Candour applies to all providers of healthcare who are registered with the CQC. 

What happens if an NHS organisation does not comply?

If an NHS organisation does not comply with the regulation, the organisation can be fined and the CQC has the power to prosecute the organisation.

What incidents are affected by Duty of Candour?

Duty of Candour starts when there has been a 'notifiable patient safety incident' involving a service user which includes:

• A death
• Moderate harm (short-term harm)
• Severe harm (permanent or long-term harm)
• Prolonged psychological harm

Moderate harm is when an incident has occurred causing significant but not permanent harm - for example, grade 3 pressure ulcer, or an inpatient self-harm that requires a transfer to an emergency department for treatment.

Severe harm is when an incident has occurred causing permanent and significant harm, for example, grade 4 pressure ulcer, or an inpatient self-harm resulting in anoxic brain damage.

Prolonged psychological harm is psychological harm experienced or is likely to be experienced for a continuous period of at least 28 days, for example, experiencing a traumatic catheter change resulting in hospitalisation and subsequently an acute episode of severe anxiety and depression.

What to do when a potential Duty of Candour incident is identified?

• As soon as practically possible an appropriate person must verbally apologise to the service user, family or carer that the incident has occurred.
• The Trust must make every reasonable attempt to contact the relevant person through all available means of communication. All attempts to contact the relevant person must be documented in the patient's clinical record and the incident form.
• If the relevant person does not wish to communicate with the provider, their wishes must be respected and a record of this must be kept.
• If the relevant person has died and there is nobody who can lawfully act on their behalf, a record of this should be kept.
• A formal written apology should be sent within 10 working days of the incident being reported.

Care Quality Commission (CQC) 

The CQC is the independent regulator of health and adult social care organisations in England and is responsible for monitoring compliance with standards such as the duty of candour. The CQC has legal powers to take action against organisations who do not comply.

T 03000 61 61 61 
www.cqc.org.uk 

You can find the full regulations and the CQC guidance for organisations on how to comply at: www.cqc.org.uk/duty-candour