Duty of Candour Policy

Last updated: April 2022

Next review: April 2023

 

Summary

 

  • This document describes how MyConsultant and its’ partner Consultants will practice within the legislative framework around duty of candour legislation.  This means being open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress.

  • We will facilitate our partner Consultants in informing, apologizing and offering appropriate remedy or support and fully explain the effects to the patient. We will involve patients in meetings reviewing what happened with a view to identifying areas for improvement.

  • As part of our drive to be an organization with a memory, we will always strive to learn from such events (taking account of the views of relevant persons).

  • As part of our responsibilities, we must produce an annual report to provide a summary of the number of times we have trigger duty of candour within our service. In this report we will describe the way that the duty of candour procedure has been followed for all the cases that we have identified.

  • We will also provide support for our employees and for others who may also be affected by unintended or unexpected incidents.

 

 

Procedure in the event of an incident

 

  • In the event of an unintended or unexpected incident that results in death or harm (or additional treatment required to prevent injury that would result in death or harm), MyConsultant will undertake the following steps and stages.

  1. Notify the person affected (or family/relative where appropriate) and find out how they wish to be communicated e.g. by telephone, email.

  2. Provide a formal apology

  3. Carry out a review into the circumstances that led to the incident

  4. Offer a meeting with the person affected and/or their family where appropriate

  5. Provide the person affected with an account of the incident

  6. Provide information about further steps taken

  7. Offer to meet and discuss the case with the consultant involved with the incident. If this is not feasible for patients, we will endeavor to create a meeting virtually using an appropriate telecommunication service where appropriate.

  8. Provide support to MyConsultant staff dealing with the incident.

  9. Prepare and publish an annual duty of candour report.

  10. Review all cases at an annual board meeting and at our monthly governance meetings.

 

The following questions from a toolkit from Healthcare Improvement Scotland will be regularly reflected upon as a framework to continuously improve our abilities to discharge our duty of candour.

 

What Incident would Activate Duty of Candour procedure at MyConsultant?

 

The Duty of Candour procedure will be activated by the Board as soon as becoming aware that an individual who has received a health service from one of our partner Consultants has been the subject of an unintended or unexpected incident, and in the reasonable opinion of a registered health professional has resulted in or could result in:

 

  • Death of the person

  • A permanent lessening of bodily, sensory, motor, physiologic or intellectual functions

  • An increase in the person’s treatment

  • Changes to the structure of the person’s body

  • The shortening of the life expectancy of the person

  • An impairment of the sensory, motor or intellectual functions of the person which has lasted, or is likely to last, for a continuous period of at least 28 days

  • The person experiencing pain or psychological harm which has been, or is likely to be, experienced by the person for a continuous period of at least 28 days

  • The person requiring treatment by a registered health professional to prevent

    • The death of the person, or

    • Any injury to the person which, if left untreated, would lead to one or more of the outcomes mentioned above.

 

Have you satisfied yourself that you (and your staff, if you employ staff) understand your responsibilities and have systems in place to respond effectively?

 

At induction with MyConsultant, all clinical partners (Consultants) and support staff will be mandated to read and understand this policy document as well as all other governance and policy documents. All individuals are directed to visit the useful NES toolkit on candour available at  http://www.knowledge.scot.nhs.uk/adverse-events/duty-of-candour.aspx. We will also share with our staff and partner Consultants at least annually, and encourage them to reflect on

 

  1. any lessons from incidents

  2. a copy of our annual Candour report

  3. other reports such as feedback and complaints, significant events reviews and case reviews

 

An e-learning resource has been produced by NHS Education for Scotland, The Scottish Social Services Council, The Care Inspectorate and Healthcare Improvement Scotland. Relevant staff will be encouraged to complete the module which takes no longer than an hour and available via this link:

 

 

 

Who do you need to engage with to satisfy yourselves you can meet the responsibilities of the Duty and deliver the requirements outlined in the Act?

As well as the key stakeholders above, MyConsultant will engage both internally and externally to satisfy us that we can meet the responsibilities of the Duty and deliver the requirements outlined in the Act.

Internally: partner Consultants, the board, Consultant Advisory Committee, Chief Executive Officer, relevant administrative staff.

Externally: the patient and family, the regulator with whom we will share our annual report. It may be necessary to engage with other agencies depending on the nature of the harm received by the patient.

What systems do you have in place to support staff to provide an apology in a person-centered way and how do you support staff to enable them to do this?

It is mandatory for our staff and partners to be fully up to date with our policies on induction. Our emphasis on promoting a just culture means we will facilitate our staff in staying up to date with national legislation and guidance and also, will support our partners when things do go wrong. For example, our executive committee will research available information how best to provide an apology in a person centered way and avail this to individuals involved. The extract below from ‘The Knowledge Network’ factsheet on candour summarises how to do this. This will be reproduced in our policy here for ease of access for our partners.

(http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4084017/365e385b-f098-4071-be74-397a4d0c2dfa.pdf)

For the purposes of the Act, an “apology” means a statement of sorrow or regret in respect of the unintended or unexpected incident that caused harm or death.

An apology or other step taken in accordance with the duty of candour procedure does not of itself amount to an admission of negligence or a breach of a statutory duty.

Sometimes clinical and care staff find it difficult to say sorry when something has gone wrong and harm has occurred. People may be unclear if they can say sorry and worry that the timing for doing this won’t be right or that they will make things worse. The 4Rs are an easy way to remember how we can get this right:

  • Reflect – stop and think about the situation

  • Regret – give a sincere and meaningful apology

  • Reason – if you know, explain why something has happened or not happened and if you don’t know, say that you will find out

  • Remedy – what actions you are going to take to ensure that this won’t happen again and that the organisation learns from the incident.

It is important that an open and honest apology is provided from the outset as this can reassure an individual and/or their family and will also set the tone for moving things forward. It is important to understand that by making an apology following an event that triggers the duty of candour procedure you are acknowledging that harm has been caused, a mistake has been made and you may be acknowledging emotions that are felt by the individual and/or their family. A meaningful apology can help to calm a person who has become angry or upset. An apology is not an admission of liability in a legal sense.