Findings of the call for evidence on statutory duty of candour (Department of Health and Social Care, 26 November 2024)

Summary

This report presents the findings of a call for evidence on the statutory duty of candour for healthcare providers, conducted by the Department of Health and Social Care between 16 April and 29 May 2024. In essence, the duty places a direct obligation upon trusts to be open and honest with patients and service users, and their families, when something goes wrong that appears to have caused or could lead to moderate harm or worse in the future (known as a ‘notifiable safety incident’).

Content

Key findings from the call for evidence included:

• 2 in 5 respondents (40%) thought the purpose of the statutory duty of candour is clear and well understood. Some commented that the duty has become a tick-box exercise, with staff and providers going through the motions to fulfil the duty, and not demonstrating compassion, for example through the use of standard templates and wording in letters to patients and/or service users which appear impersonal.
• Over half of respondents (54%) did not think staff working for health and social care providers know of and understand the duty’s requirements. Respondents felt that application of the duty is inconsistent and open to (mis)interpretation. This may be due to confusion between organisational and professional duty of candour, variations in staff interpretation of criteria for triggering a notifiable safety incident, and some groups having less knowledge of the duty, such as non-clinical, new or agency staff.
• Less than 1 in 4 respondents said that the duty is correctly complied with when a notifiable safety incident occurs (23%). Some felt staff are reticent about complying with the duty for fear that it admits fault and liability and leaves them open to blame. Others reported instances where staff were empathetic and aimed to follow the process, but senior management did not support them, and they feared not being protected if considered a ‘whistleblower’. Some respondents also believed there to be a culture of covering up incidents, falsification of records and dismissal of complaints.
• Respondents were divided in their assessment of provider engagement with 94% of patients or service users disagreeing that providers engage meaningfully and compassionately with those affected after a notifiable safety incident, compared to 27% of health or care professionals.
• Some patients and service users do not understand their rights. Specifically, their rights to access documents and receive an apology or response from a healthcare provider, and what they can do if they feel their case meets the criteria, but communication has been inadequate, or processes not followed.
• Generally, respondents who were patients, service users, family members or caregivers were more critical of the duty and its application, compared to health and/or care professionals and organisations.