Duty of Candour

From 1 October 2014 health providers have a duty of candour to their patients.Final regulations for the NHS have been published here.

The regualtion also applies to adult social care providers of regulated activities from April 2015 and the guidance can be found here

The distinction between NHS providers and regulated care providers is significant because the duty is triggered at a different threshold depending upon the provider. Although all providers owe their service users a general duty of openness and transparency, the duty of candour is triggered when a ‘notifiable safety incident’ occurs. There are separate definitions of ‘notifiable safety incident’ for health providers and care providers. In both cases, the CQC will enforce the duty and failure to meet the duty is an offence punishable by fine.

What triggers the Duty of Candour?


Social Care Providers

A safety incident is an unintended or unexpected incident, which is suspected to have occurred to a service user during the provision of a regulated activity and that could result in or appears to have resulted in harm to the service user. A notifiable safety incident in the care setting is a safety incident which results in the following types of harm to the service user:

  • death of the service user, where the death relates to the incident rather than the natural course of the service user’s illness or underlying condition or
  • permanent (lasting for a continuous period of at least 28 days) impairment of sensory, motor or cognitive functions or 
  • prolonged pain or psychological harm lasting (or expected to last) at least 28 days; or 
  • changes the structure of the body; or
  • shortens life expectancy or
  • requires medical treatment in order to prevent any of the above.

Healthcare providers

A notifiable safety incident is a safety incident which results in the following types of harm to the service user: 

  • death of the service user, where the death relates to the incident rather than the natural course of the service user’s illness or underlying condition or
  • a moderate increase in treatment such as a return to surgery, an unplanned re-admission, a prolonged episode of care, extra time in hospital or as an outpatient, cancelling of treatment, or transfer to another treatment area (such as intensive care) or
  • a significant but not permanent harm or
  • prolonged psychological harm lasting at least 28 days or
  •  a permanent lessening of bodily, sensory, motor, physiologic or intellectual functions, including the removal of the wrong limb or organ or brain damage

How does the Duty of Candour work?

If a Notifiable Safety Incident occurs a registered person must notify a relevant person that the incident has occurred and provide the relevant person with all information directly relating to the incident and provide reasonable support to the relevant person in relation to the incident.

Who is a Registered Person?

A registered person is the service provider of a registered activity or the registered manager of that activity.

Who’s a Relevant Person?

A relevant person is a service user or, where the service user is not competent to make a decision in relation to their care or treatment, a person lawfully acting on their behalf.

What should the notice contain?

The notice should be given in person by one or more representatives of the service provider. It should be recorded in writing and provide a truthful account of all the facts the service provider knows about the incident at that time. It should also advise and if possible agree with the relevant person what further enquiries into the incident are appropriate. It must include an apology. It must be followed in writing by a notification covering the facts of the incident, the enquires available or undertaken and the apology.

This summary report was taken from the inital CQC guidance. For specific information reference should always be made to the latest veriosn of Regulation 20 Duty of Candour on the CQC website to ensure any relevant updates to the regualtions can be noted.