Being open - The Duty of Candour when things go wrong

What is the Duty of Candour?

We always want to give the best and safest treatment and care. However occasionally things go wrong.

When something goes wrong with someone's treatment or care and this causes harm or death, health professionals have a duty to tell people the truth.

This is called the Duty of Candour. ‘Candour’ means ‘openness’ or ‘honesty’.

If something has happened resulting in harm or loss of life, we call this a ‘patient safety event’ or ‘incident’.

What does Duty of Candour mean?

The Duty of Candour means we must:

Tell the person (s) affected when harm has happened. (If a patient has died, this may be the family or carer.)
Talk to patients (and if appropriate, carers and families) to try to understand what went wrong.
Give you the opportinuity to be involved in any review or investigation; for example telling us what you think happened and asking questions you would like answered.
Give you all relevant information.
Be open and honest about the cause of any incident and apologise.
Write to tell you what happened; and what will be done or has been done to prevent or reduce the risk of it happening again to another patient.

What happens after a patient safety event?

We are committed to talking to patients/carers at a very early stage to understand what has happened.
One of the clinical team will offer to meet with you. This will usually be the consultant or nurse looking after the patient.
We realise this may be a difficult and distressing time. A friend or relative can come to this meeting with you.
You may prefer to talk in another place away from the hospital or care setting.
At the meeting, we will tell you what we know about what happened at this point.
We will try and answer any questions you may have.

Review of care

We always look into (review) all reported patient safety events to understand what has happened and what we might need to chance or improve to reduce the risk of it happening again.

In some cases, we carry out a more detailed review. This is called an 'investigation' or a 'patient safety review'. The purpose is to identify:

factors which caused or contributed to the incident;
how we can prevent it happening again;
any procedures, practices or policies that may need to be changed or improved.

What does a patient safety review involve?

We will look at the patient's clinical records. We will also talk to staff involved in the patient's care.
We will invite you, your relatives/carers to be involved in this review and we will ask how much you wish to be involved.
You can be involved by sharing your insights and opinions and asking questions.
An investigation can take weeks or months. We will keep you informed of our progress along the way.
We will share the findings of any review with you when it is complete.

A Patient Safety Review is not intended to find out the physical cause of death or to blame an individual or hold an organisation to account. There are other procedures for this when needed.

How does the Duty of Candour help?

When a patient comes to any harm or dies unexpectedly, it can have devastating emotional and physical effects on the patient, their families and carers. It is also very distressing for the staff involved.

People often say that they cope much better once they get an apology and understand what went wrong.

Sharing your experience and insights can also help us find ways to stop the same thing happening to someone else.

Family Liaison Service

If someone close to you has died unexpectedly, you may be contacted by a Family Liasion Officer, who works in the Family Liaison Service. They can support you during the patient safety review.