Duty of candour in care

Where the duty comes from, and why

The statutory duty of candour was introduced after inquiries into serious care failings found that a lack of openness had allowed harm to go unacknowledged and unaddressed — that families were too often left in the dark, and that a culture of defensiveness compounded the original harm. Regulation 20 is the response: it makes openness a legal requirement rather than a matter of good intentions. Understanding that history is useful, because it explains the spirit of the duty. It is not a bureaucratic hoop; it is a deliberate correction to the instinct to hide mistakes, built on hard evidence of what that instinct costs.

What triggers the duty: notifiable safety incidents

The duty of candour is triggered by a notifiable safety incident. In broad terms this is an unintended or unexpected incident, occurring in the course of a person's care, that a healthcare professional reasonably considers could result in — or already has resulted in — the death of the person, or serious or moderate harm to them. The precise thresholds are defined in Regulation 20, and they are what separate an incident that triggers the formal duty from a lesser mistake that does not.

That said, the wisest services do not treat the threshold as a line to hide behind. Even where an incident falls short of the formal trigger, the ordinary professional duty to be open and honest with the people you care for still applies. The statutory duty sets the floor for the most serious incidents; a genuinely candid service is open as a matter of habit, well below that floor.

The steps the duty requires, in order

When a notifiable safety incident occurs, Regulation 20 requires a specific sequence. Taken in order, it looks like this:

• Tell the person as soon as reasonably practicable. The person affected — or, where appropriate, someone acting on their behalf — must be informed in person that the incident has happened.
• Give a true account of what is known. Explain, in a way the person can understand, what happened as far as it is known at that point — without speculation, but without holding back what is known.
• Offer an apology. A genuine apology is a required part of the duty, not an optional courtesy — and it is not an admission of legal liability.
• Explain what happens next. Set out what further enquiries the service believes are appropriate.
• Provide reasonable support. Offer the practical and emotional support the person needs in the circumstances.
• Follow up in writing. Provide a written notification that gives the same account and apology, and share the results of enquiries as they are completed.
• Keep a written record. Securely record every step taken, including the conversations, the apology and the written follow-up.

The apology myth

One misconception does more damage to candour than any other: the fear that saying sorry is an admission of liability that will be used against the service. It is not. An apology under the duty of candour is an expression of sorrow and regret that something went wrong, and both CQC and professional guidance are explicit that staff should never be discouraged from apologising. The evidence points the other way — being open and apologising early tends to reduce the anger, mistrust and formal complaints that follow an incident, because what most people want after harm is honesty and acknowledgement, not a defensive wall. A service that trains its staff to understand this removes the single biggest barrier to meeting the duty well.

Candour and statutory notifications are not the same

It is easy to confuse the duty of candour with statutory notifications, because a serious incident often triggers both — but they point in different directions. The duty of candour is about being open with the person affected and their family. A statutory notification is about telling CQC. They are separate obligations, and meeting one does not discharge the other: you can notify CQC promptly and still breach the duty of candour by failing to be open with the family, or vice versa. Treat them as two parallel tracks that both run from the same incident, and make sure your process handles each.

Building a culture of candour

The formal steps only work if the culture underneath them supports honesty. In a defensive culture, staff hide near-misses, incidents get minimised, and the duty of candour becomes a reluctant exercise carried out too late. In an open culture, staff report things freely because they trust they will be supported rather than blamed, and candour with families becomes a natural extension of how the service already behaves. Building that culture takes deliberate effort: train staff on what the duty is and why it exists, make it genuinely safe to report mistakes, treat incidents as learning rather than as ammunition, and have leaders model openness themselves. A service that gets the culture right rarely has to worry about the mechanics of Regulation 20, because openness is simply how it operates.

What it looks like in practice

Suppose a resident is given another person's medication in error and, although quickly identified, needs monitoring and a GP review as a result. A defensive service might quietly note it in the medicines record and hope the family never asks. A candid service does the opposite, and the sequence is instructive. As soon as it is practical, a senior member of staff speaks to the resident and their family in person, explains plainly what happened and what is being done to check the resident is safe, and apologises sincerely. They explain that the service will review how the error occurred and share what it finds. They offer whatever support is needed. Then they follow up in writing with the same account and, once the review is complete, its findings — and they record every step.

Notice what that achieves. The family, told openly and early, is far more likely to trust the service than one that has to be prised for the truth. The written record demonstrates the duty was met if an assessor ever asks. And the review turns a mistake into a change in practice, which is exactly what the Safe and Well-led key questions reward. Handled this way, the incident — genuinely serious — becomes evidence of a service that is safe to trust, rather than one to worry about.

Sources

• Regulation 20 — Duty of candour (2014 Regulations)
• CQC — Regulation 20: Duty of candour
• CQC — Notifications

This guide is general information, not regulatory or legal advice. Always check Regulation 20 and CQC's own current guidance for the precise requirements and thresholds.

Duty of candour — FAQs