Duty of candour

Being open with you is not simply about meeting a legal requirement. It is about treating you with honesty, compassion and respect.

When something has gone wrong with your care, you can expect us to:

• speak to you as soon as we reasonably can 
• explain what we know about what has happened
• say sorry
• be honest about anything we do not yet know
• listen to what the experience has been like for you
• give you the opportunity to ask questions and tell us what matters to you
• explain what will happen next
• involve you in any learning response as much, or as little, as you would like

We know that different people need different things after something has gone wrong. Some people want to understand everything in detail; others need time before they are ready to talk about what happened.

We will ask you what would be most helpful to you and how you would prefer us to keep in touch.

You can have a relative, friend, carer or another person you trust with you during conversations with us.

Sometimes the most important thing we can say is simply that we are sorry.

An apology should be sincere and acknowledge what has happened and the impact it has had on you. We should not wait until every question has been answered before saying sorry or speaking openly with you.

If we do not yet understand exactly what happened, we will say so. We will tell you what we know at the time and explain what we are going to do next.

Saying sorry is not the same as accepting that someone has been negligent or that the Trust is legally liable. NHS Resolution is clear that an apology is not an admission of liability.

Saying sorry is about acknowledging your experience and responding to it with honesty and compassion.

When something has gone wrong, it is natural to want to understand what happened.

NUH follows the NHS Patient Safety Incident Response Framework (PSIRF). This means we consider what has happened and decide what response will be most helpful and proportionate.

This will not always mean carrying out a formal investigation.

Sometimes a detailed Patient Safety Incident Investigation will be needed. 

Sometimes another approach will help us understand what happened and identify opportunities to make care safer. There may also be occasions where the work to improve care is already underway.

Whatever response is appropriate, our commitment to being open and honest with you does not change.

We will explain what is happening and what you can expect.

Healthcare is complex, and things rarely happen because of one action or one person.

When we try to understand a patient safety incident, we look beyond individual actions to understand the circumstances in which care was provided. This can include the systems and processes people were working with, equipment and technology, staffing, workload, the environment and communication.

We also want to understand what happened from your point of view.

You may have seen, heard or experienced things that cannot be understood from your healthcare record alone. You may also have questions that are different from the questions we would otherwise ask.

We will give you an opportunity to share your experience and tell us the questions that matter to you.

The purpose is to understand what happened, to answer your questions, learn and identify where we can make care safer.

There are two related duties of candour.

The Professional Duty of Candour requires healthcare professionals to be open and honest when something goes wrong with treatment or care that causes, or has the potential to cause, harm or distress.

At NUH, we expect openness and honesty from everyone involved in delivering care.

There is also a Statutory Duty of Candour. This is a legal duty placed on healthcare organisations and applies when particular criteria set out in Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 are met.

If the Statutory Duty of Candour applies to what has happened, we will explain this to you. There are some additional things we are legally required to do, including providing particular information in writing.

But you do not need to understand the legal definitions or work out which duty applies before asking us questions.

Our responsibility to be open and honest with you is wider than the legal threshold.

If something has gone wrong, or you are worried that it might have, we want you to feel able to talk to us about it.