Duty of Candour.
The team at Swift Management have seen an increase in the number of providers that are finding themselves in difficulty with the regulators when it comes to Regulation 20 – Duty of Candour.
The regulation aims to ensure that providers are open and transparent with people that use the service concerning the care and treatment they receive. Any health or social care provider must promote a culture of openness and honesty.
The introduction of Regulation 20 was a direct result of a recommendation made in the Francis Inquiry relating to Mid Staffordshire NHS Foundation Trust. The recommendation is related to the introduction of a statutory duty of candour.
The basis of the recommendation was: Openness – enabling concerns and complaints to be raised without fear. Transparency – Allowing information to be passed truthfully about performance and outcomes to be shared with all concerned, including the public and regulators. Candour – Where a person is harmed in the provision of health and social care, they are informed of the facts, and an appropriate remedy is offered, regardless of whether a complaint has been made or questions being asked.
There are several steps providers should follow to meet the requirements of Regulation 20 – Duty of Candour; to do this, the provider should:
- Ensure it acts in an open and transparent way with relevant persons about care and treatment provided to people who use services in carrying on a regulated
- Tell the relevant person, in person, as soon as reasonably practicable after becoming aware that a notifiable safety incident has occurred, and provide support to them concerning the incident, including when giving the
- Provide an account of the incident which, to the best of the provider’s knowledge, is true of all the facts the body knows about the incident as of the date of the
- Advise the relevant person what further enquiries the provider believes are appropriate
- Offer an
- Follow up the apology by giving the same information in writing and updating the inquiries.
- Keep a written record of all communication with the relevant
A vital part of the duty of candour is the apology. Many people feel that to make an apology is admitting fault or an admission of liability. In some instances, the lack of an apology infuriates and pushes people to take legal action and, therefore, escalates an issue to another level.
It is important to remember that saying sorry is: Always the right thing to do; it is not admitting liability. It acknowledges that something could have been done differently or better. Saying sorry is the first step to learning from an incident and stopping it from happening again.
What incidents should be reported under regulation 20? This dilemma is probably the most frequently asked question. This is defined as a “Notifiable safety incident” and is a specific term specified in the “duty of candour regulation”, but it should not be confused with other types of statutory reporting under the health and social care act.
A notifiable safety incident must meet all 3 of the following criteria:
- It must have been unintended or unexpected.
- It must have occurred during the provision of a CQC regulated activity.
- In the reasonable opinion of a health or social care professional, it already has or might result in death or severe or moderate harm to the person receiving care. Defining levels of harm can be subjective, but the typical definitions of levels of harm are:
Harm that requires a moderate increase in treatment and significant, but not permanent, harm.
A permanent lessening of bodily, sensory, motor, physiologic or intellectual functions, including removal of the wrong limb or organ or brain damage, is related directly to the incident and not related to the natural course of the service user’s illness or illness underlying condition.
Moderate increase in treatment
An unplanned return to surgery, an unplanned re-admission, a prolonged episode of care, extra time in hospital or as an outpatient, cancelling of treatment, or transfer to another treatment area (such as intensive care)
Pain which a service user has experienced, or is likely to experience, for a continuous period of at least 28 days.
Prolonged psychological harm
Psychological harm which a service user has experienced, or is likely to experience, for a continuous period of at least 28 days.
Duty of Candour and lessons learned are critical factors in achieving an excellent well-led service. They can be something that can be inadvertently overlooked when an incident occurs, and everyone is trying their best to resolve the issue or investigate what happened. The team at Swift Management Services are happy to assist in supporting the Duty of Candour Process or independently analysing an incident. We follow the nationally recognised process of Root Cause Analysis process. We are happy to provide reports that can be used to conclude the duty of candour process and help providers improve or review standards of care delivery.
For further information about our service, please contact us for an informal discussion.