‘Duty of Candour’ with a Nurse’s hat on!

28 Jan 2021

What difficult times we are just emerging from. A time when our Health Service has been absolutely stretched to the limit. It was during this awful time that the first prosecution was brought against an NHS Trust for a breach in the `Duty of Candour` regulation following a patient`s death in 2017. The Care Quality Commission (CQC) brought the prosecution because a Plymouth hospital failed to tell a patient`s family the facts surrounding her death after a failed procedure and did not apologise in a timely manner.

Sadly there have been times in the past, and still are, when healthcare professionals and organisations have not been open and honest with patients and families about areas of their care that could cause harm and distress, or things have gone wrong and harm has occurred.

Since the publication of a report into the Mid Staffordshire NHS Foundation Trust Public Enquiry in 2013 (the Francis Report), and similar investigations in both Scotland and Wales, things have gradually started to change. Healthcare regulators have put in place an obligation for healthcare professionals and organisations to tell patients openly and honestly that something has gone wrong. This is not just hospitals. This culture of openness and honesty is applicable in all healthcare settings, to all professionals, and this also applies in other professional areas, such as law. This regulation is known as the ‘Duty of Candour’.

Healthcare professionals must:

  • Tell the patient (or family, carer, advocate where appropriate) when something has gone wrong as soon as possible
  • Offer an appropriate remedy or support to put matters right (if possible); and
  • Explain fully to the patient (or family, carer, advocate where appropriate) the short and long-term effects of what has happened

And the following must occur:

  • A full and frank apology must be offered and written
  • The patient (or family, carer, advocate where appropriate) must be provided with support after the incident and must be included in the incident investigation.

Healthcare professionals must also be open and honest with their colleagues, employers and relevant organisations, and take part in reviews and investigations when requested. They must also be open and honest with their regulators, raising concerns where appropriate, and must support and encourage each other to be open and honest, and not stop someone from raising concerns.

For some working in healthcare, particularly those with many years’ experience, this is a very different concept and has been a big culture change within healthcare environments. Many times I have seen something vague written in medical records about a conversation but there are no specific details and no apologies at all. We are yet to see if this approach to honesty has been totally embedded in healthcare culture. The Professional Standards Authority for Health and Social Care is continually monitoring compliance with this regulation, as are many regulating authorities. Education and training is vital and will always need to be a focus in a culture of learning and improvement.

Acknowledging system failures and ensuring proper funding for a safe NHS is fundamental to everyone’s health and wellbeing. We will have to wait to see how this last year will impact and hopefully influence that.

As a patient, family, carer or advocate you may well be invited to a meeting as part of an organisations ‘Duty of Candour’ process. Why not ask for a meeting? You may feel relieved discussions are taking place, you have the opportunity to ask questions and hopefully get answers, but it can also create a sense of anger and a need to take things further. Your solicitor may ask you about these meetings and request to see any documentation you have been given. If you approach us to look into making a Personal Injury / Clinical Negligence claim this information could help us establish what has occurred and potentially move things forward.

Author

Alison Hutchings

Medical Records Nurse Assessor