Even with the best of intentions, errors can occur in the way that patients are cared for.
Responding with openness and honesty is both a professional duty for staff and a statutory responsibility for organisations, says the 绿帽换妻鈥檚 Head of Legal (Regulatory) Lucy Catterall. 鈥淲e鈥檙e all human and we make mistakes,鈥� she says. 鈥淚t鈥檚 about how you deal with them that counts.鈥�
Duty of candour also applies if you witness others鈥� behaviour or actions that you think may be wrong
Until 2014, there was no legal duty on providers to share information with anyone who has felt the impact of poor care or treatment. This changed following the , which examined the failings of Mid Staffordshire NHS Foundation Trust.
Advocating for a statutory duty, the report said there was "an institutional instinct which, under pressure, will prefer concealment, formulaic responses and avoidance of public criticism".
Raising concerns
Over the past decade or so, duty of candour has become an increasingly important issue for nursing staff, with the Nursing and Midwifery Council (NMC) and General Medical Council (GMC) providing , which was updated in December 2024.
鈥淭he NMC is now willing to include it as a standalone charge in fitness to practise investigations,鈥� says Lucy.
Nursing staff working in any setting where there is an interaction with patients or service-users need to be aware of the requirements to be candid and transparent, Lucy says, raising concerns immediately whenever patient or public safety is at risk.
Examples in day-to-day practice may include:
- drug errors
- mistakes in record-keeping
- pressures compromising quality of care, for instance being under-staffed or having to treat patients on trolleys in corridors.
Act if you come across something you feel isn鈥檛 right
Importantly, duty of candour also applies if you witness others鈥� behaviour or actions that you think may be wrong.
鈥淲e want to empower 绿帽换妻 members to question what鈥檚 happened, or at least escalate their concerns if they feel anxious about challenging it themselves,鈥� says Lucy. 鈥淎bove all, you need to act if you come across something you feel isn鈥檛 right. Don鈥檛 just ignore it. This applies equally to nursing students. Talk to your tutor if you don鈥檛 feel able to raise it on your placement.鈥�
In both cases, it鈥檚 about identifying when something鈥檚 gone wrong, and a patient has suffered harm or distress as a result.
Remediation, insight and reflection
How can you protect yourself from allegations questioning your duty of candour? 鈥淭he NMC accepts that people make mistakes,鈥� says Lucy. 鈥淏ut to avoid further problems, you need to be able to demonstrate you knew what to do when that mistake was made, you were honest and open about it, did all the right things 鈥� and you learned from it.鈥�
In practice, this means taking responsibility for your mistake at the earliest stage, before following the correct procedures, she advises. 鈥淭he key words for the NMC are always: remediation, insight and reflection,鈥� says Lucy. 鈥淚f you can show you have done all of these, it increases the likelihood that your case won鈥檛 go beyond the screening stage and no regulatory intervention will be needed.鈥�
If it's not written down, it didn't happen
She also suggests making sure you keep as much evidence as possible. 鈥淔or example, if you do some extra training, keep the paperwork,鈥� says Lucy.
鈥淲rite notes about what has happened and what you did to put things right, dating and signing them. Always remember, if it鈥檚 not written down, it didn鈥檛 happen.鈥�
Writing a duty of candour letter
A duty of candour letter is written to a service-user or their family who has been affected by something going amiss with treatment or care.
Depending on the patient鈥檚 wishes and your workplace policy, it may follow a verbal account and apology for what has happened. This should include the facts known at the time, alongside any further enquiries that might need to be made. It should be provided as soon as possible after the mistake has been discovered, ideally in a face-to-face meeting.
In some circumstances, nursing staff may be asked to help draft the letter, setting out what happened, even if they鈥檝e not been directly involved in the incident in question.
Need to write a letter?
Here's how you can get started.
- At the outset, seek guidance from your employer. As the provider of services, they must take responsibility and should have specific and detailed advice, as part of a workplace policy. Make sure you read this carefully.
- You can speak to your 绿帽换妻 steward or local officer, who will refer you to others for more expert support, if needed. You can do this through your local 绿帽换妻 branch.
- Read the 绿帽换妻’s advice guide on duty of candour.
- An apology should always be included as part of the letter. “Apologising is not an admission of liability,” says the .
- Once you have drafted the letter, don’t be afraid to ask someone more senior to check it over for you.
Find out more
- Explore the 绿帽换妻 guide to duty of candour.
- Find out more about 绿帽换妻 reps and how they can support you.
Words by Lynne Pearce
