Social Care Column: Duty of Candour

The Duty of Candour is a statutory (legal) duty to be open and honest with patients (service users), or their families, when something goes wrong that appears to have caused or could lead to significant harm in the future. It applies to all health and social care organisations registered with the regulator, the Care Quality Commission (CQC) in England.

The importance of being open and honest

When the Duty of Candour regulation came into force, I remember personally welcoming the Care Quality Commission enforcing action on any provider that was not being open and honest. It took me right back to my early days of working in social care of how incidents were covered up and how that made me feel. I would be left with a guilty feeling and I would sit at home feeling I had let down the people I was supporting by not speaking up.

For me personally, I have never understood why as a provider, manager or leader in the sector we would ever want to hide or not disclose something. We are taught from such a young age the importance of telling the truth. After all, we are human, don’t we all make mistakes? Part of life is making mistakes and learning from them. Surely if a mistake is thoroughly investigated, the lessons learnt and actions put into place to prevent it from happening again, will make the delivery of care safer and more person-centred in the longer term.

Being honest and admitting when an incident or accident has occurred will only lead to an increase in trust from the staff teams we manage, the people we support and the families and friends of those in care. For me personally, communication is key.

Communication is key

To be open and honest requires you to put the person you are supporting in the centre and ensuring everyone involved in their care knows exactly what is happening, what is meant to happen and when something does not go to plan. When something goes wrong, however small, we should be honest and reflect on why it did not work.

It is important to remember that when thinking of something going wrong, it doesn’t have to be something really big or bad, it could just be that someone’s favourite mug broke or that they cut themselves with a knife whilst being supported to cut some vegetables. When you open up about these small incidents, you will increase the respect and trust between your teams and the families. If something bigger should happen they will know that you will be honest with them about what it was and what you are doing about it.

Relatives want to know you are learning and preventing something from happening again and for a provider, there are simple steps to do this. The first is saying sorry and explaining in full detail what has happened, being clear in what can be done to deal with the harm caused, thoroughly investigating and finalising what will be done to prevent someone else from being harmed in the future.

Influencing change from within

I often wonder if the legislation should go further. At present, the duty only applies to organisations rather than individuals, but it states staff should cooperate to make sure the organisational obligation is met. However, if you are new to the sector and you are working for an organisation that has a closed culture, how would you know what is expected of you?

Check out the below as a starting point for how to make your organisation more open and honest.

Saying sorry

Service users expect to be told three things as part of an apology:

1. What happened
2. What can be done to deal with any harm caused
3. What will be done to prevent someone else from being harmed.

I believe that being open and honest and honouring our Duty of Candour will lead to increased staff wellbeing, happiness amongst service users, and peace of mind for their loved ones.