Duty of Candour in a Medical Setting

What does a Duty of Candour letter mean?

If you receive a ‘Duty of Candour’ letter from the NHS, it is likely to be significant because it means that the doctor or NHS Trust treating you has come to the conclusion that an incident occurred during your care that may have caused, or did cause, a level of harm that means it has a legal obligation to be open and honest with you about events that have occurred and the concerns they have about your treatment.

The concept of a ‘Duty of Candour’ letter arose from the legal requirement that came into force for NHS trusts and Foundation trusts in November 2014 and was then extended to all other regulated health and social care providers in April 2015. Under the regulations, organisations must inform patients (or their families) when a ‘notifiablesafety incident’ has occurred, offer an apology, explain why the treatment or care was lacking and then follow this up in writing.  

Why were Duty of Candour letters introduced?

The main catalyst was the Mid Staffordshire NHS Foundation Trust Public Inquiry, (more commonly known as the Francis Inquiry). The Inquiry investigated serious failings in patient care at Mid Staffordshire NHS Foundation Trust and found a culture in which openness, transparency, and honesty with patients and families were often lacking. The Inquiry recommended a statutory duty requiring healthcare providers to be open and transparent when poor care had caused serious harm or death.

What is a ‘Notifiable Safety Incident’?

A notifiable safety incident is an unintended or unexpected incident that occurs during the provision of regulated care or treatment which has caused or could cause significant harm to a person.

For an incident to be considered notifiable, all three of the following criteria must be met:

1. The incident was unintended or unexpected.
2. It occurred during the provision of a regulated activity (health or social care service).
3. It has resulted in, or could result in:
   • Death,
   • Severe harm,
   • Moderate harm, or
   • Prolonged psychological harm (depending on the type of provider).

Examples

A notifiable safety incident might include:

• Administration of the wrong medication.
• A surgical error requiring additional treatment.
• A patient fall resulting in an injury where lack of care provided was a factor in the incident.
• A delay in diagnosis leading to significant deterioration in a patient’s condition.

What must happen if a notifiable safety incident occurs?

Under the Duty of Candour, the organisation is obliged to:

• Inform the patient (or their representative) as soon as reasonably practicable.
• Provide a truthful explanation of events.
• Offer an apology.
• Give appropriate support.
• Keep a written record and follow up with the outcome of any investigation.

Does a Duty of Candour letter mean that the NHS is admitting negligence?

Not necessarily. Under the Duty of Candour framework, an apology and acknowledgment that something went wrong do not necessarily amount to an admission of legalliability or clinical negligence. The NHS may be saying:

• an unexpected incident occurred;
• you suffered harm or were exposed to risk;
• the incident requires investigation;

but that does not mean that liability for negligence is accepted.

Why not? It is important to remember that during the course of someone’s care, things can and do go wrong. If a hospital or doctor was held liable for every unexpected event, it would be impossible for a hospital to function. There is always scope for doctors and nurses to have different opinions about the best course for treatment. Differing opinions might be equally valid and provided the treatment is accepted as being reasonable within a range of medical opinion, it is unlikely that liability would attach to a hospital if it turned out that one course of treatment did not work as well as another.

 If, however, the standard of care was below that which any reasonable doctor or nurse would opt to follow, liability then may attach to the doctor or hospital.

Why is the letter important?

The letter can be important evidence because it may:

• confirm that the NHS recognised a significant incident;
• provide a timeline of events;
• identify concerns about care, communication, procedures, or systems;
• lead to a formal investigation report with findings and recommendations.

If you are considering a complaint, seeking answers about what happened, or exploring a potential clinical negligence claim, a Duty of Candour letter is often a key document to retain.

What should you do after receiving one?

If you believe you suffered significant harm, our clinical negligence team at PR Scully & Co will be able to advise you further. The letter itself does not prove negligence, but it may indicate that there are issues worth investigating.

Keep the letter and all related correspondence.

Ask for the investigation report or review findings if they have not yet been provided.

Request copies of your medical records if you want a fuller understanding of events.

Get in touch with PR Scully today

If you have suffered as a result of medical negligence or malpractice, you could be entitled to thousands of pounds in compensation. 

We have extensive experience as medical negligence solicitors in England and Wales. We are a leading Manchester medical negligence law firm, serving clients throughout the UK, from Liverpool to London. Trust us to fight on your behalf.

Make an enquiry with our legal specialists  0161 768 317 or  request a call back today.

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Worsley,

Manchester,

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