Candour in healthcare: where next?

The report into the findings of the call for evidence on the statutory duty of candour for health and social care providers was published by the Department of Health and Social Care on 26 November 2024. 

The review forms part of a wider assessment of the duty to be open and transparent when things go wrong during the provision of care and treatment. Readers will recall that it was announced in the Government’s response to the Hillsborough Report this time last year.

It is published ahead of a final response to the review into the statutory duty of candour for health and social care providers in England. 

It also follows three key publications, including the final report of the Infected Blood Inquiry which calls for increased accountability, the King’s Speech which committed to bring forward legislation to establish a Hillsborough Law and the consultation on the regulation of NHS managers. 

Three emerging themes are identified from the survey covering:

• Culture of the health and care system.
• Inconsistency in understanding and applying the duty of candour.
• Training issues around the lack of it and the need for it.

Summary of the main findings

We outline the six findings set out in the survey based on just 261 responses.

1. Clarity and Understanding: Only 40% (2 in 5 respondents) believe the duty’s purpose is clear and well understood. Of that 45% of healthcare professionals believe it is clear whereas only 34% of service users believe that.  Some view it as a tick-box exercise, processing it merely to fulfil the duty, and not demonstrating compassion e.g. through use of standard letters and templates.
2. Knowledge Gaps: Over half of respondents feel that staff working for health and social care providers lack understanding of the duty’s requirements, leading to inconsistent application and (mis)interpretation. Some suggest that this may be due to confusion between the professional duty of candour and organisational duty, variations in the interpretation of the criteria for triggering a notifiable patient incident, with some groups have less awareness of the duty, such as agency and new staff.  
3. Compliance Issues: Less than 25% think the duty is correctly followed when a notifiable safety incident occurs, with fears of blame and a culture of cover-ups being significant barriers. Some reported cases where staff aimed to follow the process, but senior management did not support them and feared being considered a ‘whistleblower’.
4. Provider Engagement: There is a stark contrast in perceptions, with 94% of patients/service users feeling providers do not engage meaningfully after a notifiable safety incident, compared to 27% of health and care professionals.
5. Patient Rights: Many patients and service users are unaware of their rights to access documents and receive an apology or response from health and care providers, and what to do if processes have not been followed.
6. Respondents: Patients, service users, family members or caregivers were generally more critical of the duty and its application compared to health and care professionals.

Caveats

There are a few of these including:

• The findings are only representative of those who responded and not the population at large (given there were 600m patient contacts in 2023/24)
• Many respondents did not know the professional duty was distinct from the statutory duty
• The Infected Blood Inquiry report was published on 20 May but this call for evidence closed on 28 May so there was not much time between them
• 80% of respondents stated their ethnicity was white and 66% of respondents were female.

Quotes

There are some quotes within the report that do make you stop and think:

“The challenge for clinicians is in the definitions and a consistent understanding of when the duty applies”

“Similar terminology used in professional duty can give rise to confusion as to when the duty applies”.

“There is little organisational learning or sharing of incidents. Managers operate within a bubble and do not look to each other, or other services to benefit from learning opportunities available from other services…”

“The statutory duty has been transformed into a challenging and sometimes confusing process…. rather than being an intuitive, compassionate response simply because it is the right thing to do”.

Next steps

The government will consider these findings alongside findings from the new consultation on regulating NHS managers, as part of its wider aims to develop candour healthcare policy. This consultation proposes introducing the professional duty of candour for NHS managers, such as ICB board members. This consultation closes on 18 February 2025  

We will keep readers update on the government’s proposals. 

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