The CQC standards of care outline that care providers must be open and transparent about the care and treatment they deliver to people. If something goes wrong, providers must tell you what happened, offer support and apologise. This is called Duty of Candour.
Although healthcare has always had a moral obligation to provide honesty when care went wrong, Duty of Candour has only been a legal requirement in the UK for a little over 6 years. The call for legislation arose following a case in Stafford where failings and safety concerns had not been addressed by staff.
Before Duty of Candour came into effect in November 2014, the NHS Standard Contract of 2013/2014 had outlined incidents needed to be reported when it constituted moderate or severe harm. These, however, were merely contractual obligations.
Adopting Duty of Candour as a legal requirement strengthened the obligation to offer clarity into incidents. The Duty of Candour offered a way to obligate care providers to bring openness and transparency. This change means that since 2014 it is illegal to not disclose care errors.
The Main Principals of Duty of Candour
The CQC is responsible for monitoring care providers and their adherence to Duty of Candour. If a provider does not adhere to the legislation as set out, the CQC can prosecute that party for a regulation breach. They can also take other regulatory actions.
Openness and Transparency to Relevant Persons
The first principal is providing openness and transparency to relevant persons if an incident occurs. Relevant persons could be the service user in question, but could also be a family member, carer or otherwise involved party.
Informing and Supporting
If an incident comes to light the care provider must inform the relevant person as soon as possible and offer support. The notification of incidents needs to be given in person, as well as be recorded in a written record. Copies of the correspondence need to be kept by the care provider.
The account given must be true and provide all the facts known to the representative. It must additionally include an apology.
To read up on the regulation in full, you can visit the CQC’s guide on Duty of Candour.
Duty of Candour and Supporting Staff
One cannot take action if one is not aware that an issue exists. Legal enforcement offers a good tool to realise a higher degree of transparency, but in practice it doesn’t immediately result into full disclosure.
To prevent situations such as that of Stafford, offering staff the support, training and freedom to disclose where cases go wrong and act accordingly is of high importance.
As the CQC states in the previously linked Duty of Candour guide: “Providers must promote a culture that encourages candour, openness and honesty at all levels”. With that in mind bullying due to adherence to Duty of Candour should be prevented. Appropriate training can help as well as a system that identifies potential incidents with a possible evaluation process.
Maintaining or improving quality in healthcare organisations in general can be a challenge. One of the key items is to stay organised and have complaints, PALS, incidents and risks stored and available for review and monitoring. Quality Portal offers a place to store and manage all this information within a quality team in primary and secondary care.
Other fundamental standard of care
Duty of Candour is 1 of 13 standards of care outlined by the CQC. Whenever dealing within this specific standard and legislation, one must remain aware of the other care standards. For instance, when apologising to a person as a care provider, you must treat them with dignity and respect and care providers must have good governance in place to meet the Duty of Candour requirement.