Consultation on Proposals to Introduce a Statutory Duty of Candour for Health and Social Care Services

CHAPTER 2: Proposed requirements on organisations

5.1. The statutory duty of candour would apply to health and care services provided by NHS Boards, Local Authorities, all organisations providing services regulated by the Care Inspectorate, independent hospitals, independent hospices, General Practices, community pharmacies, dental practices and optometry practices. As this is an organisational duty, it would not apply to individuals providing services, for example, childminders.

5.2. The statutory duty will require that an organisation must act in an open and transparent way with people when things go wrong. It will outline the minimum requirements that must be in place to support the duty of candour and require that reports are made to describe the implementation of arrangements.

6. What would be required of organisations?

6.1. As soon as it is reasonably practicable after becoming aware that there has been adverse event resulting in harm, the organisation must ensure that the relevant person is notified that this has happened. This will involve the provision of a step by step account of the facts of what happened, including as much or as little information as the person has expressed their wish for.

6.2. If an organisation becomes aware of an event that has resulted in harm after a period of more than a month after the index event, the relevant person should also be provided with an explanation for the delay and the organisation should identify the actions necessary to improve systems for the monitoring and reporting of harm.

6.3. There must be an offer of reasonable support provided to the person harmed, relatives and staff who have been involved with the event. The person undertaking the disclosure may be different for each disclosure episode. It is recognised that this flexibility will be required to reflect the importance of existing relationships with care professionals and the diverse nature of scenarios across health and social care that will come within the scope of the duty.

6.4. The responsibility will rest with organisations to ensure that all staff who are asked to be involved with disclosure have access to the relevant training, supervision and support before, during and after their involvement with disclosure communications.

6.5. The notification that is made to the relevant person should be given personally by a suitably trained representative of the organisation and should include an account of all of the facts known at the time of disclosure and the plans for the event to be reviewed. It will be for the organisation to determine who is most appropriate to disclose the harm episode.

6.6. The relevant person must be informed of the further steps to be taken to review the event and be given the opportunity to have their questions considered by the review process.

6.7. The organisation must provide an apology and must confirm all of the actions taken in a written record. The contents of this will inform the regular public reports of disclosable events and organisational response to these.

6.8. The relevant person must also receive a written summary of the face to face meeting.

7. Reporting on Disclosure Arrangements

7.1. All organisations would be required to report publically on the nature of adverse incidents that have been disclosed to people and confirm that requirements of the organisational duty of candour have been met.

7.2. Organisations would also be required to report on the ways in which they have supported staff in the development and maintenance of the skills required to ensure respectful disclosure by staff who are required to be involved with this.

7.3. Organisations should also publish annually their policies and procedures to support openness and transparency, this must include the arrangements in place to support staff training and development in these advanced communication skills. These reports should be submitted to the relevant organisation (which will differ for each care provider).

7.4. Organisations would be required to ensure that they have arrangements in place to ensure that if any adverse event/incident is reported that this is considered and a decision made whether this is a disclosable event.

7.5. Organisations would also be required to include a summary in their reports of the support that is available to patients, families and staff following an disclosable event. They would also need to describe the provision to ensure that training and development support has been implemented to ensure best practice in disclosure.

7.6. Guidance will be produced to assist organisations in implementation of the organisational duty of candour, which will include resources to support the process of notification, staff support and public reporting.

7.7. In many cases the requirements of organisations (disclosure, support and reporting periodically) will already be in place through local procedures for handling complaints or responding to adverse events/significant events, thereby minimising additional administrative demands on organisations. For example, NHS Boards already receive and monitor reports from GP practices on complaints and significant events. Social care services already have procedures in place to report on harm in respect of children and vulnerable adults.

8. Summary of Organisational Requirements for Duty of Candour

• Identify instances when there has been an event resulting in physical or psychological harm.
• Report the occurrence of these instances in person to the relevant person.
• Apologise.
• Offer the opportunity to be involved in review of the events.
• Offer access to emotional and practical support following the event (to staff, patients and relatives).
• Confirm in writing the details of the personal discussion.
• Have arrangements to ensure that those involved with disclosure have the necessary knowledge and skill to undertake this work.
• Identify and inform relevant person of the learning that was identified following the disclosure and review of the adverse event.
• Report publically (according to an agreed frequency) on all 'disclosable events', including on details of the organisational training and support arrangements in place to deliver the organisational duty of candour. The learning and improvement actions arising from disclosable events would also be included.
• If there have been delays in being notified of an instance of harm, organisations should report on actions being taken to improve on monitoring and reporting arrangements.

Question 1: Do you agree that the arrangements that should be in place to support an organisational duty of candour should be specified in detail ?

Question 2: Should the organisational duty of candour encompass the requirement that adequate provision be in place to ensure that staff have the support, knowledge and skill required ?

Question 3a: Do you agree with the requirement for organisations to publically report on disclosures that have taken place ?

Question 3b Do you agree with the proposed requirements to ensure that people harmed are informed ?

Question 3c Do you agree with the proposed requirements to ensure that people are appropriately supported ?

Question 4: What do you think is an appropriate frequency for reporting ?

Question 5 : What staffing and resources that would be required to support effective arrangements for the disclose of instances of harm ?