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Duty of Candour: Do we have to be compelled to be candid?
In March 2015 a new duty of candour came into force for social care providers that aimed to remove the cloak of secrecy surrounding some adverse events, which only became public when large-scale investigations exposed them.
The requirement is to offer an explanation and apology to those service users affected by incidents in the delivery of care. Examples given are of omissions, incidents of restraint and medication errors. In fact anything which could be described as having an unexpected and negative outcome for service users.
At first glance, the duty of candour appears a bit of a no-brainer. If the consequence of something you do is that the person you are doing it to comes to harm, then of course you should explain, notify and apologise. When it was introduced, I read the guidance with an increasing sense of incredulity. Not because I was alarmed that we would have to be upfront and honest, but because it was necessary to create a legal requirement for us to be so.
If you believe, as I do, that the service user, client, customer is the centre of everything you do, then it seems absolutely reasonable that they are kept informed and involved in all aspects of their care. The care plan, central to the process of delivering person-centred services, should be owned by and driven by the service user. It should be written from their point of view, discussed and reviewed with them at every stage.
It is the right of everyone receiving care to have access to information being collected, used and shared to provide that care. Not as a passive recipient, but as a partner in the process. The fact that many of our service users lack the capacity to participate fully in this should not be a reason to remove them from the loop. Using advocates or family members to assist them is a good way to ensure we stay client focused.
Good news and bad
When things go well, the service user should be continually updated as to the successes they are achieving. Outcomes should be clear and milestones reached should be celebrated. However, when things go less well, the service user needs to be engaged with the care process sufficiently to have a choice about how it is managed. This should include involving them in managing any adverse events.
The Duty of Candour offers a ‘harm threshold’ for reporting that provides guidance as to what type and level of incidents should be disclosed to service users. However, a good provider should be reporting everything in the same way, removing the need to make decisions as to what we do and don’t reveal.
When you consider the appalling situation at Stafford Hospital and other examples of providers covering up mistakes, it makes sense that regulators compel us to be upfront about adverse incidents. Also, the potential to continually improve services through honesty and transparency should not be underplayed. Perhaps this is the real benefit of this new duty.
Writing our in-house Duty of Candour policy was to state the obvious; achieving compliance with this new duty should not challenge any responsible provider. I’m not opposing the Duty of Candour at all, but merely wondering where we lost our way so much that we needed to be ordered to be open and honest.
Ginny Tyler – QCS Expert Learning Disabilities Contributor