Duty of candour

24 Jul 2018

7 out of 10 complaints to the NHS mention poor communication and medical staff not explaining what went wrong.  Since the introduction of the duty of candour in November 2014 for clinical trusts and April 2015 for other care providers, this is a statistic that ought to be improving. The key to learning from a mistake is being honest about it.   The airline industry transformed its safety record by changing its culture to encourage feedback and review accidents openly in order to avoid similar tragedies happening in future.  The duty of candour encourages an open, transparent approach to medical accidents. However, with the number of clinical negligence claims on the rise, it would seem that the cultural shift required to create an environment where mistakes are acknowledged and addressed still has some way to go.

What is the duty of candour?

When mistakes in medical care happen, the duty of candour sets out clear criteria for how medical staff and institutions should respond.  The duty of candour demands openness and transparency in the event of a “notifiable safety incident”.  The definition of this is different depending on the organisation involved:

  • In the case of an NHS body (trust, foundation trust etc.) – a notifiable safety incident is defined as something unintended or unexpected in the patient’s care that, in the reasonable opinion of a healthcare professional, could result in or appears to have resulted in:
    • Their death (not relating to natural progression of an illness or condition)
    • Them suffering severe or moderate harm, or prolonged psychological harm
  • In the case of a non-NHS body (GP, independent practitioner) – a notifiable safety incident is defined as something unintended or unexpected occurring in the care of a patient that, in the reasonable opinion of a healthcare professional, appears to have resulted in:
    • Their death (not relating to natural progression of an illness or condition)
    • Impairment of sensory, motor or intellectual function, lasting or likely to last for 28 days
    • Changes to the structure of the body (e.g. amputation)
    • Prolonged pain or psychological harm (for at least 28 days)
    • Shortening of life expectancy
    • The need for treatment to prevent death or the above adverse outcomes

In the event of a “notifiable safety incident”, medical staff involved in the care of the patient are required to provide them with an explanation, offer an apology and keep a written record of the notification to the patient.  They should provide reasonable support and written notes detailing further enquiries etc.

How our experts get involved:

Our medical experts are pain consultants with a lot of experience of diagnosing and  treating patients with over 90 different pain conditions as practicing clinicians in both the NHS and private practice.  Their medico legal reports provide an expert opinion of the condition and prognosis of a claimant and an opinion  on causation. They take into account the medical history of the claimant and whether there is anything in their history which may have contributed to their condition, as well as advising on treatment options.