What is duty of candour?

DISCLAIMER:  First things first.  This is not official guidance.  It is duty of candour as I understand it.


There is a new “Duty of Candour” requirement.

“Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress).”

(joint statement issued in October 2014 by the GOsC and other regulators)

Find the official GOsC page on duty of candour here.

As of October 2015 there is a new “Duty of Candour” requirement.   How it works and how we will be informed is a work in progress.

The gist of it is that if something goes awry in practice we must

      • tell the patient when something has gone wrong
      • apologise to the patient
      • offer an appropriate remedy or support to put matters right (if possible)
      • explain fully to the patient the short and long term effects of what has happened

In certain cases you might need to deal with the patient’s advocate, carer or family, for example if the patient is a child, but the same duty applies.

The duty is one of openness and honesty, not only with the patient but also with the regulator.

It’s a bit more than just admitting to a mistake when someone complains.  It means that even if there is no complaint, if you think you did something wrong, you proactively tell the patient.

How and why did this duty arise?

To understand what this is for and why this has arisen, does the phrase Mid-Staffs Hospital Scandal ring any bells with you?  I’m sure you’ve heard the phrase at least.  After between 400 and 1200 patients were believed to have died due to poor care at Stafford Hospital over a four(ish) year period, the phrase ‘mid-Staffs’ became a byword for NHS negligence. This spawned a series of inquiries, one of which was the Francis Inquiry.  His report (2013) included a recommendation for a duty of candour with patients and their families when harm has been caused.  He realised that the general cover-up and failure to admit mistakes when something has gone wrong only makes things much worse.   The GOsC with other regulators agreed something that worked in an osteopathic setting in 2014, and that is to admit, apologise, explain and try to redress what has gone wrong.

This sounds eminently more sensible than denial, obfuscation and the refusal to accept responsibility which might be the knee jerk reaction to a mistake, and I am almost relieved to have a formal obligation to be honest, rather than be in a situation where I wonder whether I should admit failings or not.

Years, though, of being told that insurance companies don’t want you to admit causing a car crash even when it’s bleedingly obvious that you drove straight into the car parked in front of you, has made some people unsure about the legal implications of candour.  It was thought that the duty of candour might conflict with the requirements of Professional Indemnity Insurance, but that has been found not to be a problem.

Apparently saying sorry is not necessarily an admission of liability.  And the tide is going in the direction of patients’ rights to be listened to and apologised to if appropriate.