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Duty of Candour Policy

1. Purpose

At {{org_field_name}}, we are committed to providing high-quality, safe, and compassionate care to all our service users. However, we recognise that despite best efforts, things can sometimes go wrong. When this happens, we have a legal and moral responsibility to be open and honest with service users, their families, and representatives.

This policy outlines our approach to fulfilling the Duty of Candour as required under Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It ensures that service users are informed of incidents that have affected their care, provided with an apology, and given an explanation of what happened and what actions will be taken to prevent recurrence.

Furthermore, this policy applies equally to adults and to children and young people (0–18 years) who use our services. We ensure that the Duty of Candour is carried out in an age-appropriate manner: when an incident involves a child, we will involve their parent or legal guardian (with parental responsibility) in the process and communicate with the child at a level they can understand. This approach allows us to meet our obligations under Regulation 20 for service users of all ages, while respecting the rights and needs of children and their families.

2. Scope

This policy applies to all employees, agency workers, contractors, and volunteers working for {{org_field_name}}. It ensures that our organisation operates with transparency and integrity when responding to incidents where a service user has suffered harm or may be at risk of harm due to the care or treatment provided.

This scope includes all service users, from adults to children and young people (0–18 years old), receiving personal care from us. Our domiciliary care service is delivered in a variety of settings: in service users’ own homes and in community settings such as parks, libraries, leisure centres, places of worship, clinics, youth groups, and during travel to and from these locations. Although we do not provide regulated clinical interventions to children, we uphold the same Duty of Candour principles for any notifiable safety incident that occurs during the care or support of a child or young person in these settings.

The Duty of Candour applies to all notifiable safety incidents, meaning those that have resulted in moderate or severe harm, prolonged psychological harm, or in the most serious cases, death. By embedding a culture of openness and honesty, we aim to build trust with service users and their families while continuously improving the quality of our services.

3. Policy Statement

At {{org_field_name}}, we are committed to:

• Being open and honest when things go wrong.
• Acknowledging mistakes and learning from them to prevent future occurrences.
• Providing timely and transparent communication to those affected by incidents (the service user and/or their family or representative).
• Issuing a genuine apology and explaining what happened and why.
• Ensuring that when an incident involves a child or young person, their parent or guardian is appropriately informed and involved throughout the process, with communication tailored to the child’s age and understanding.
• Ensuring all staff understand and fulfil their responsibilities under the Duty of Candour.

We believe that honesty is fundamental in maintaining the confidence of those who use our services. We will ensure that any incident meeting the criteria for a notifiable safety incident is handled with integrity, professionalism, and empathy.

4. Definitions

4.1 Duty of Candour: The Duty of Candour is a legal obligation requiring health and social care providers to act in an open and transparent manner when something goes wrong that has caused, or has the potential to cause, harm to a service user.

4.2 Notifiable Safety Incident: A notifiable safety incident is an unexpected or unintended event that occurs in the provision of care and results in any of the following outcomes:

• Death (when the death is not a direct result of the service user’s underlying condition or illness, but is linked to the incident).
• Severe harm (a permanent lessening of bodily, sensory, motor, or intellectual functions – for example, a serious disability or life-threatening condition – that is directly related to the incident and not just to the natural course of the service user’s condition).
• Moderate harm (non-permanent harm that requires a moderate increase in treatment, such as an unplanned return to surgery or a prolonged recovery, and causes significant but not permanent effects).
• Prolonged psychological harm (psychological distress or harm that a service user has experienced, or is likely to experience, for a continuous period of 28 days or more).

4.3 Relevant Person: In the context of the Duty of Candour, the “relevant person” is the individual who must be notified about a notifiable safety incident. In most cases this will be the service user themselves. However, if the service user cannot be informed directly – for example, because they have died, they are an adult who lacks the mental capacity to understand or make decisions, or they are a child under 16 who is not competent to make decisions about their care – then a person lawfully acting on their behalf must be notified. This could be a person with parental responsibility (such as a parent or legal guardian for a child) or another appointed representative (such as someone holding a Lasting Power of Attorney for health and welfare, or the next of kin). The relevant person will receive all the information, apologies, and support on behalf of the service user as required by the Duty of Candour.

4.4 Mental Capacity Act 2005 (Capacity): The Mental Capacity Act 2005 (MCA) is the legislation that provides the framework for assessing and supporting individuals aged 16 and over who may lack capacity to make decisions. Under the MCA, a person aged 16 or over is presumed to have capacity to make their own decisions unless it is demonstrated that they cannot do so. If a service user aged 16 or over is assessed as lacking capacity to understand and make decisions about a notifiable incident (for example, due to a cognitive impairment, learning disability, or other condition affecting understanding), we must act in that service user’s best interests. This means communicating information about the incident to an appropriate representative (such as a family member or someone legally authorised to act on the person’s behalf) and involving that representative in decisions about the service user’s care, in accordance with the MCA’s principles and guidance.

4.5 Gillick Competence: “Gillick competence” refers to the ability of a child under 16 to fully understand and consent to their own treatment or care without parental involvement. This term comes from a legal case which established that a child who has sufficient intelligence, maturity, and understanding of what is being proposed can give consent independently. In the context of this policy, if a child under 16 is judged to be Gillick competent regarding the situation (meaning they fully understand the nature of the incident and the implications of any decisions or actions), then that child should be directly involved in discussions about the incident and in decision-making, much like an adult service user would be. If a child is not Gillick competent (for instance, a very young child or a child who does not have enough understanding of the situation), then their parent or guardian – the person with parental responsibility – will be the one informed of the incident and will make decisions in the child’s best interests.

5. Responsibilities

5.1 Responsibilities of the Registered Manager

The Registered Manager is responsible for ensuring compliance with the Duty of Candour. Their role includes:

• Overseeing the reporting and management of notifiable safety incidents.
• Ensuring that service users and their families are informed promptly and appropriately when incidents occur.
• Making sure that if an incident involves a child or young person, the child’s parent or legal guardian is informed and involved without delay, and that communication with the child is conducted in an age-appropriate manner (taking into account the child’s capacity or Gillick competence).
• Training and supporting staff to understand and comply with the Duty of Candour.
• Submitting incident reports to the Care Quality Commission (CQC) where required by regulation.
• Reviewing incidents to identify learning opportunities and ensure service improvements are made.

5.2 Responsibilities of All Staff

All staff have a duty to:

• Report incidents, errors, and concerns immediately to their manager.
  • Where to report:
    1. Verbally to the Registered Manager or Safeguarding Lead as soon as possible.
    2. Inform the Registered Manager by email at {{org_field_registered_manager_email}}.
    3. Call the office and inform the Registered Manager or Safeguarding Lead by phone at {{org_field_phone_no}}.
    4. If the incident occurs out of normal hours, call the out-of-hours number: {{out_of_hours}}.
• Engage in open and honest communication with service users and families (including involving the service user’s parent or guardian when the service user is a child, in accordance with this policy).
• Support those affected by an incident with compassion and understanding, offering any assistance or reassurance they may need.
• Adhere to the procedures outlined in this policy, including carrying out the additional steps required for incidents involving children or service users who lack capacity (such as involving parents or other representatives and adjusting communication appropriately).
• Participate in training and development related to the Duty of Candour.

Failure to comply with this policy may result in disciplinary action, as transparency and honesty are fundamental values of our organisation.

6. Procedure for Managing a Notifiable Safety Incident

When a notifiable safety incident occurs, {{org_field_name}} follows a structured process to ensure transparency and compliance with the Duty of Candour.

Note: If the incident involves a child or young person (under 18), the following steps must be carried out with additional consideration for parental involvement and the child’s capacity to understand. This means ensuring a parent/guardian is informed and adjusting how we communicate so it is suitable for the child’s age and level of comprehension, as detailed below.

Step 1: Immediate Notification

As soon as a notifiable safety incident is identified, the affected service user (or their representative) must be informed as soon as reasonably practicable. This initial notification should occur promptly and in person, delivered by the Registered Manager or a senior staff member, and it must be conducted with compassion and sensitivity.

• For incidents involving children or young people: In these cases, the term “affected service user” includes the child’s parent or guardian, who must be informed at the earliest opportunity. If the service user is a child, a parent or person with parental responsibility should be notified immediately. If the child is old enough to understand what has happened, staff should also speak directly with the child using words and explanations appropriate to the child’s age and level of comprehension. In the case of a young person aged 16–17 who has capacity to understand, speak to them directly and frankly (as you would with an adult service user), while also offering to have a parent or family member present for support (according to the young person’s wishes). The opportunity for a parent or guardian to be involved in the conversation should always be provided unless a competent young person expressly declines to have them present. If a child or young person indicates that they do not want their parent/guardian present for the discussion, staff should consider this request in line with the child’s rights and level of understanding (Gillick competence) – however, the parent/guardian must still be informed about the incident itself in a timely manner, even if they are not in the room for the initial conversation at the child’s request.

Step 2: Providing a Clear Explanation

The following information must be shared with the service user and/or their representative during the initial discussion of the incident:

• A factual account of what happened, presented clearly and without speculation or blame.
• The immediate actions that have been taken to ensure the safety and well-being of the service user following the incident.
• The potential impact of the incident on the service user’s health and well-being (including any injuries sustained or possible effects on their physical or mental health).
• The steps that are being taken to investigate the incident and to prevent a recurrence in the future.

When explaining the incident, it is important to be honest and use plain language. For incidents involving a child or young person: provide explanations in simple, age-appropriate terms so that the child can understand as much as possible. A parent or guardian should normally be present during the explanation (except in the rare circumstance where a competent older child has specifically requested to speak alone, as noted above) to hear the information first-hand and support the child. Encourage both the parent and the child (if the child is able to communicate about the incident) to ask questions and express any concerns. Our staff should answer questions truthfully and clarify any points to ensure that those involved fully understand what occurred and what will happen next.

If the service user lacks capacity, or if the service user is a child who is too young or not competent to fully understand the situation, then the information should be shared with the relevant representative acting on their behalf. In practice, this means that if the service user is an adult who lacks mental capacity, we share the information with their legally appointed representative or nearest relative as appropriate; if the service user is a child who is not Gillick competent (unable to understand or make decisions about the incident), we share the information with their parent or legal guardian. These actions should be carried out in line with the Mental Capacity Act 2005 and, for children, in accordance with best practice on involving those with parental responsibility.

It is also important during this step to discuss what will happen next. Advise the service user and/or their family about any further enquiries or investigations that will take place. If any immediate or follow-up medical treatment or other remedial action is required as a result of the incident, ensure that informed consent is obtained from the appropriate party before proceeding (for example, obtain consent from the service user themselves if they are an adult or a competent young person, or from a parent/guardian if the service user is a child who cannot consent for themselves). Reassure the service user and/or their parent/guardian that they will be kept informed of the investigation’s progress and any findings or changes that result from it.

Step 3: Offering a Meaningful Apology

A sincere and genuine apology must be provided both verbally and in writing to the affected person and/or their representative. This is not an admission of liability, but an expression of regret and responsibility for what has happened. The apology should acknowledge any distress caused to the service user and reassure them that lessons will be learned and action will be taken to prevent such an incident from happening again.

For incidents involving a child or young person: the apology should be delivered in a manner that is understandable and comforting to the child, as well as reassuring to the parent or guardian. When speaking to a child, use a gentle tone and simple words to say that you are sorry for what happened. Recognise the child’s feelings (for example, fear, pain, or confusion that the incident may have caused) and also acknowledge the concern and upset the parent may feel. Ensure the parent or guardian is present to hear the verbal apology, so they know that the organisation is taking responsibility and expressing regret. In the written apology, address it to the parent or guardian (as they are the responsible adult for the child’s care) and, if appropriate, also address the child or young person. For instance, if a teenager was affected and can understand written communication, the written apology letter might be addressed to both the young person and their parent. All apologies – whether spoken or written – should be specific about what we are apologising for, and they should convey empathy and commitment to put things right.

Step 4: Documenting the Incident

A detailed written record of the incident and our response must be kept. This record will include:

• The nature of the incident and what went wrong (a clear, factual description of the event).
• The information provided to the service user and/or their representative about the incident.
• Who was notified and involved in the discussion about the incident – for example, noting if the service user was informed directly, if a parent/guardian was informed on behalf of a child, and any assessments made regarding the service user’s capacity or the child’s competence to understand.
• A copy of the written apology that was issued.
• Any actions taken to address and mitigate the incident (such as immediate care provided, investigations initiated, or support given to the service user).
• Plans for future prevention and improvement (for example, any changes to procedures or additional staff training that have been identified to reduce the likelihood of a similar incident).

These records must be stored securely and be available for CQC inspection. It is essential that the documentation is thorough and accurate, as it provides evidence of our transparency and the actions we took. For incidents involving children, the records should clearly indicate how the parents were informed, how the child was communicated with or supported, and who made decisions on the child’s behalf (if applicable). Good record-keeping not only ensures compliance but also helps us review and reflect on the incident to improve our services.

Step 5: Reporting the Incident to CQC

If the incident meets the criteria for a notifiable safety incident, the Registered Manager must report it to the Care Quality Commission (CQC) within the required timeframe. This external notification is a regulatory requirement and will typically include details of the incident, the harm caused, and the actions taken by our service in response.

For incidents involving a child or young person, the CQC notification should clearly indicate that a child was affected by the incident and describe how we have fulfilled our Duty of Candour (for example, confirming that we informed the parents and offered an apology). In addition to notifying the CQC, the Registered Manager will consider whether the incident triggers any other reporting duties. If the incident raises safeguarding concerns (for instance, if a child was seriously harmed due to neglect or abuse, or if it reveals risks that could affect the child’s welfare beyond this incident), then the Registered Manager must also report it through safeguarding channels. This could involve notifying the local authority’s children’s safeguarding team or Multi-Agency Safeguarding Hub (MASH), in line with our organisation’s safeguarding policies and the requirements of the Children Act 1989/2004. Such safeguarding reporting is separate from, but complementary to, the Duty of Candour – it ensures that appropriate authorities are alerted to protect the child and to investigate the circumstances if needed. The Registered Manager will document any such additional notifications made.

Step 6: Learning and Improving

After the immediate response to the incident, a full internal review or investigation must take place to determine the root causes and contributing factors. The purpose is to learn from the incident and implement changes to prevent a similar event in the future. The Registered Manager (or a designated investigator) will lead this process, gathering input from staff involved, the service user (where appropriate), and other relevant parties.

Any necessary changes in policies, procedures, or practices identified through this investigation will be put into action. This could include revising how certain care tasks are performed, providing additional staff training or supervision, updating risk assessments, or improving communication systems within the team.

When an incident involves a child or young person, the learning process will also evaluate how we addressed the unique aspects of caring for a younger service user. We will consider questions such as: Did we involve the parent properly and at the right times? Was our communication with the child and family clear and supportive? Do staff feel confident and knowledgeable about handling such situations? If any shortcomings are found in how we managed the situation with respect to the child or their family, we will develop strategies to improve (for example, additional training on communicating with children, or adjustments to how we obtain consent and involve parents in care decisions).

We will share lessons learned from incidents with the care team so that everyone can benefit from the insights gained. The emphasis is on creating a culture where staff are not afraid to report mistakes and near-misses, because they know we will use that information constructively to enhance safety and care quality. By learning and improving continuously, we aim to reduce the risk of harm to all service users – adults and children alike – and to strengthen trust in our service.

7. Training and Awareness

All staff must receive comprehensive Duty of Candour training as part of their induction and ongoing professional development. Training will cover:

• The legal and ethical responsibilities of staff and the organisation under the Duty of Candour (understanding the requirements of Regulation 20 and why openness is crucial).
• How to communicate effectively with service users and families after an incident – including practical communication skills for delivering difficult news with clarity, honesty, and empathy.
• The importance of offering a meaningful apology and how to apologize appropriately (emphasising that saying sorry is the right thing to do and does not equate to admitting liability).
• The process for reporting and documenting incidents, both internally (within the organisation’s reporting systems) and externally (to regulators like CQC), ensuring that staff know what steps to take when something goes wrong.
• Applying the Duty of Candour when caring for children and young people – including understanding the role of parents and the need for parental involvement and consent, assessing a child’s capacity or Gillick competence to be involved in decisions, and techniques for communicating with children at different developmental stages in an age-appropriate way.

Managers will also receive specific training on how to lead open conversations and manage serious incidents in a transparent manner. This includes training on supporting staff through the Duty of Candour process, conducting investigations, and liaising with families (particularly in sensitive cases such as those involving serious harm or child service users). By ensuring that our entire team is knowledgeable and comfortable with the principles of Duty of Candour, we foster a culture where honesty and learning from errors are the norm.

8. Compliance and Monitoring

To ensure that this policy is followed consistently, the Registered Manager will:

• Conduct regular audits of incident reports and associated documentation to verify that each notifiable safety incident has been handled in accordance with the Duty of Candour (e.g. checking that notifications, apologies, and records were completed as required).
• Collect feedback from service users and their families to assess the effectiveness of communication and support following incidents. This feedback can highlight whether those affected felt informed, respected, and cared for after an incident, and whether the explanations and apologies were adequately conveyed.
• Specifically review incidents involving children and young people to confirm that the policy’s additional requirements were met. This includes verifying that parents or guardians were informed promptly and appropriately, that communications were tailored to the child’s understanding, and that any decisions regarding the child’s involvement (such as assessments of Gillick competence or best-interests decisions) were properly handled and documented.
• Take corrective actions where necessary to address any gaps or deviations in compliance. If an audit or feedback indicates that an aspect of the Duty of Candour was not carried out (or not carried out to the expected standard), the Registered Manager will implement measures such as refresher training, updated guidance, or closer supervision to prevent future lapses. Repeated or serious non-compliance by staff may lead to disciplinary measures, in line with our organisational policies.

Any failure to adhere to the Duty of Candour requirements (including failure to follow the special procedures outlined for incidents involving children or for service users who lack capacity) will be addressed through additional training and support and, if appropriate, through the organisation’s disciplinary process. Adherence to this policy is a key factor in our CQC compliance and, more importantly, in our commitment to being truthful and accountable in all our dealings with service users.

9. Sources

• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 20 – Duty of Candour.
• Care Quality Commission (CQC) Guidance on Regulation 20: Duty of Candour (guidance for providers on being open and transparent when things go wrong).
• Mental Capacity Act 2005 – Legislation governing capacity and decision-making for individuals aged 16 and over.
• Children Act 1989 – Defines parental responsibility and the duties of parents/guardians (relevant to involving parents in decisions about a child’s care).
• Gillick v West Norfolk & Wisbech AHA (1985) – Legal case establishing the principle of Gillick competence (that some under-16s can consent to treatment if they have sufficient understanding).

10. Review

This policy will be reviewed annually, or sooner if regulatory updates or best practices change that affect our Duty of Candour obligations.

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