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 RCN蜜桃直播檚 Head of Legal (Regulatory) Lucy Catterall. 蜜桃直播淲e蜜桃直播檙e all human and we make mistakes,蜜桃直播� she says. 蜜桃直播淚t蜜桃直播檚 about how you deal with them that counts.蜜桃直播�
Duty of candour also applies if you witness others蜜桃直播� 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.
蜜桃直播淭he NMC is now willing to include it as a standalone charge in fitness to practise investigations,蜜桃直播� 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蜜桃直播檛 right
Importantly, duty of candour also applies if you witness others蜜桃直播� behaviour or actions that you think may be wrong.
蜜桃直播淲e want to empower RCN members to question what蜜桃直播檚 happened, or at least escalate their concerns if they feel anxious about challenging it themselves,蜜桃直播� says Lucy. 蜜桃直播淎bove all, you need to act if you come across something you feel isn蜜桃直播檛 right. Don蜜桃直播檛 just ignore it. This applies equally to nursing students. Talk to your tutor if you don蜜桃直播檛 feel able to raise it on your placement.蜜桃直播�
In both cases, it蜜桃直播檚 about identifying when something蜜桃直播檚 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? 蜜桃直播淭he NMC accepts that people make mistakes,蜜桃直播� says Lucy. 蜜桃直播淏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 蜜桃直播� and you learned from it.蜜桃直播�
In practice, this means taking responsibility for your mistake at the earliest stage, before following the correct procedures, she advises. 蜜桃直播淭he key words for the NMC are always: remediation, insight and reflection,蜜桃直播� says Lucy. 蜜桃直播淚f you can show you have done all of these, it increases the likelihood that your case won蜜桃直播檛 go beyond the screening stage and no regulatory intervention will be needed.蜜桃直播�
If it's not written down, it didn't happen
She also suggests making sure you keep as much evidence as possible. 蜜桃直播淔or example, if you do some extra training, keep the paperwork,蜜桃直播� says Lucy.
蜜桃直播淲rite notes about what has happened and what you did to put things right, dating and signing them. Always remember, if it蜜桃直播檚 not written down, it didn蜜桃直播檛 happen.蜜桃直播�
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蜜桃直播檚 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蜜桃直播檝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 RCN steward or local officer, who will refer you to others for more expert support, if needed. You can do this through your local RCN branch.
- Read the RCN’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 RCN guide to duty of candour.
- Find out more about RCN reps and how they can support you.
Words by Lynne Pearce
