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The Duty of Candour is a legal duty on hospital, community and mental health trusts to inform and apologise to patients if there have been mistakes in their care that have led to significant harm. All NHS provider bodies registered with the CQC have to comply with the Duty of Candour.
Candour can include:
The statutory duty of candour is triggered by:
It can arise in any circumstances, for example:
It can include any or all of the following:
Clinical staff may worry that being open with patients may compromise the ability to deal with a claim if one is subsequently made by the patient. In reality candour is all about sharing accurate information with patients and should be encouraged. The facts are the facts and staff should be encouraged and supported to help patients understand what has happened to them.
Saying sorry when things go wrong is vital for the patient, their family and carers as well as to support learning and improve safety.
Verbal apologies are essential because they allow face-to-face contact between the patient, their family and carers and the healthcare team. This should be given as soon as staff are aware an incident has occurred. A written apology, which clearly states the healthcare organisation is sorry for the suffering and distress resulting from the incident must also be given.
Information about a patient safety incident must be given to patients and their families in a truthful and open manner by an appropriately nominated person. Staff may be unclear about who should talk to patients when things go wrong and what they should say; there is a fear that they might upset the patient, say the wrong things, make the situation worse and admit liability. Having a local policy that sets out the process of communication with patients and raising awareness about this will provide staff with confidence to communicate effectively.
The local policy should state who is the most appropriate member of staff to give both verbal and written apologies to patients and their families; the decision should consider seniority, relationship to the patient, experience and expertise. Most healthcare provision is through multidisciplinary teams so any local policy on openness should apply to all staff that have key roles in the patient’s care.
Poor communication may make it more likely that the patient will pursue a complaint or claim. It is important not to delay giving a meaningful apology for any reason, including where there is a formal complaint or claim.
It is also essential that any information given is based solely on the facts known at the time. Healthcare professionals should explain that new information may emerge as an investigation is undertaken, and that patients, their families and carers will be kept up to date with the progress of an investigation.
Saying sorry is not an admission of legal liability; it is the right thing to do.
The NHSR is not an insurer and will not withhold cover for a claim because an apology or explanation has been given.
Healthcare organisations must create an environment in which all staff, whether directly employed or independent contractors of NHS care, are encouraged to report patient safety incidents. Staff should feel supported throughout the investigation process because they too may have been traumatised by being involved.
Sometimes patients can suffer significant harm. In these circumstances the member(s) of staff involved may find it hard to participate in the discussion with the patient and their family. Every case needs to be considered individually, balancing the needs of the patient and their family with those of the healthcare professional concerned.
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