The duty of candour: How to be open and transparent with the people you support

I have seen several managers in forums and networks say that during inspections, they were asked about the duty of candour. This is often followed by comments from others enquiring what the duty of candour is and what evidence they can provide for inspections. In this week's blog, I'm exploring the benefits and how you can evidence your service is open and transparent.  

What is the duty of candour?

Before we look at the benefits of the duty of candour and the steps to ensuring transparency in our services, we need to understand what it is. The duty of candour is a legal obligation that came into effect in November 2014 and requires health and social care providers to be open and transparent with the people receiving care.  

What are the benefits?

There are several benefits to being open and transparent, but my top five are:  

• It can promote trust and confidence in your organisation from the person being supported and from their family, friends and representatives. It has also been shown to improve public trust.  
• It encourages learning and improvement through reflection which can increase the safety and satisfaction of those we support through lessons learnt and putting steps into place to prevent something from happening again in the future.  
• As a provider, it ensures that you’re meeting your legal responsibilities which can prevent penalties, fines and poor practice.  
• It improves communication between you and the people you support, by involving the people you support in decision-making processes you can strengthen relationships and ensure person-led care.
• It improves the complaints process as the duty of candour requires you to respond to complaints promptly and honestly, with a clear explanation of what happened and the steps that will be taken.  

Evidencing the duty of candour

The duty of candour sounds confusing which is what leads to managers questioning how they evidence it. But as it’s a priority for all of us, here are some of my top tips:  

• Document all incidents (however small).
• Inform the person being supported and (with the person’s consent) their representatives of what happened, the potential of harm and the steps you have taken to address the situation.
• Document all correspondence with the people you support and those involved in their care. This can be a simple log which all staff have access to that contains the date, what was discussed, any agreements made and the time. It should include face-to-face meetings, emails, telephone calls, texts etc.
• Root cause analysis documents can evidence lessons learnt. The regulator will want to see that you have learnt from past mistakes to prevent them from happening again in the future.
• Monitoring outcomes should be the norm, but make sure to document and review them so stakeholders and the regulator know you are ensuring changes are embedded and if the change isn’t working, what you have done to address this.
• Training records should be maintained to evidence how you have upskilled your team in the duty of candour and the importance of being open and honest.  
• Team meeting agendas could contain lessons learnt and outcomes from investigations to inform and upskill the team. Remember GDPR and consent from the people you support.
• Ensure your policies and procedures are up to date and document when they were last reviewed.
• Questionnaires can be used as evidence to show how you are collating feedback. Utilise this data to take it to the next level and identify trends and areas for improvement.
• Demonstrate leadership from the top of the organisation down as this will instil a culture of openness and honesty within the organisation. Senior leaders should be visible and approachable and take a lessons learnt approach. Remember the regulator and families will speak to your staff and this kind of feedback is positive and reassuring to hear.
• Publish reports on incidents and accidents alongside the actions you took to learn from them and prevent similar happening in the future. Public reports evidence your commitment to transparency and improvement.  
• Employ an external person to audit your service quarterly and retain copies of their reports. If there are actions, ensure it clearly documents what you have done to address these. Employing someone external will also reassure others that you are meeting the requirements.  

By taking these steps, you can ensure you evidence how you’re meeting your duty of candour requirements and that you are open and transparent to the people you support, their families and representatives. You can read more on duty of candour on the CQC website.