Health and social care professionals have long held the duty to practice in the best interests of the service user. it is increasingly evident, that the CQC, https://www.cqc.org.uk/guidance-providers/all-services/regulation-20-duty-candour, are becoming more interested in how providers exercise the duty of candour than they have been previously – of course some of this can be demonstrated using digital care management software as we will discuss.
The Duty of Candour, as identified on the CQC website, helps providers understand the legislation part of what our Duty of Care is and helps us further understand some of what it means to act in the service users best interests.
What is candour?
The Francis’ report, https://www.england.nhs.uk/2014/02/the-francis-report/, defines candour as:
What this demonstrates is the need for the social care professional to be proactive in the offering of information to service users when harm may have occurred. This is about openness and is defined in the Francis’ report as:
Not only does the duty of candour exhort social care professionals to volunteer information honestly with the affected individual and perhaps their legal representatives, but as Francis again identifies:
This places a further burden of proof on the registered manager who needs to be aware not only of any incidences of poor care or poor care outcomes, reporting these to the affected service user or their guardians, they also need to consider how they will share this information with regulators and fellow health care providers – that is in terms of the notifications which are one element the CQC are looking at when they inspect care providers.
You might have identified that the duty of candour, as it applies to health and social care providers was a result of a number of observations made in the Francis report into the shortcomings in care at the Mid-Staffordshire NHS trust.
One good example is recommendation 181 which identified the need for their to be:
on healthcare providers who believe or suspect that treatment or care provided by it to a patient has caused death or serious injury to a patient to inform that patient or other duly authorised person as soon as is practicable of that fact and thereafter to provide such information and explanation as the patient reasonably may request;
on registered medical practitioners and registered nurses and other registered professionals who believe or suspect that treatment or care provided to a patient by or on behalf of any healthcare provider by which they are employed has caused death or serious injury to the patient to report their belief or suspicion to their employer as soon as is reasonably practicable.”
Practically speaking, the Duty of candour requires the registered manager not only to be open and honest in their dealing with service users and their families, but to create a culture of care in their service which is open, and honest.
Open and honest cultures don’t seek to apportion blame every time something happens, rather they are learning cultures which take the learning from incidents and accidents, compliments and complaints and use these as “lessons learnt” (which is a topic we will return to at a later date).
In essence, the duty of candour is one of the activities which underpins person-centred care. That is it recognises the service user as central to care and is open and honest with them when care falls short of the standard they should expect.
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 20 identifies what the Duty of Candour regulations require from the registered manager that is:
- Registered persons must act in an open and transparent way with relevant persons in relation to care and treatment provided to service users in carrying on a regulated activity.
- As soon as reasonably practicable after becoming aware that a notifiable safety incident has occurred a registered person must—
- notify the relevant person that the incident has occurred in accordance with paragraph (3), and
- provide reasonable support to the relevant person in relation to the incident, including when giving such notification.
- The notification to be given under paragraph (2)(a) must—
- be given in person by one or more representatives of the registered person,
- provide an account, which to the best of the registered person’s knowledge is true, of all the facts the registered person knows about the incident as at the date of the notification,
- advise the relevant person what further enquiries into the incident the registered person believes are appropriate,
- include an apology, and
- be recorded in a written record which is kept securely by the registered person.
The CQC guidance on the duty of candour identifies some strategies you might like to consider for your service:
- Promote a culture encouraging candour, openness and honesty at all levels
- Have policies and procedures in place to support the culture, see: https://www.careis.net/features/
- Ensure staff follow the policies
- Tackle bullying and harassment
- Have a system to identify and deal with possible breaches of the duty of candour
- Ensure staff understand their responsibilities in relation to the duty of candour
- Ensure staff are supported to exercise the duty of candour
- Treat allegations seriously
While these look like good management, which they are, these strategies also underpin compliance with the duty of candour.
A failure to comply with the duty of candour requirements means, under Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 20, that the CQC can move directly to prosecution without first serving a Warning Notice.
The duty of candour is one of the tolls to aid social care providers in the provision of services which can truly be said to be in the service users best interests and as such instead of seeing the duty of candour as a chore, registered managers should see it as a blueprint for good practice and embrace what it in its entirety in their services.
Using digital care management software like CAREis, https://www.careis.net/, can help in a number of ways for example:
- Providing access to policies which are compliant
- Enabling access to care plans for service users and their legal representatives
- Recording incidents and accidents and the actions plans, including candour, which result from them
- Recording audits, including of care, which identify when care has fallen short.