Last reviewed and updated: 15 January 2025
Next review due: 15 January 2028
Introduction
Candour is defined as:
“The volunteering of all relevant information to persons who have or may have been harmed by the provision of services, whether or not the information has been requested and whether or not a complaint or a report about that provision has been made.”
It is Cluaran Care policy to take an honest and open approach with people who use our services. When things go wrong with care or treatment, Cluaran Care will provide service users and relevant persons with support, truthful information and a written apology.
It is widely acknowledged that healthcare and social care are not risk‑free. Service users, families and carers generally understand this and expect not only that every effort will be made to put things right, but also that learning will take place to prevent similar incidents happening again. A critical test of service users’ trust in Cluaran Care is how we respond when things go wrong.
Cluaran Care will ensure that an honest and open culture exists at all levels of the organisation. Systems will be in place for reporting notifiable safety incidents and for informing relevant person(s) in a timely and appropriate manner when such incidents occur.
The principles of Being Open and the ethical duty of openness apply to all incidents and failures in care or treatment (see Appendix 1). The statutory Duty of Candour applies where an incident has resulted in moderate harm, severe harm or death.
Determining whether an incident meets the Duty of Candour threshold requires professional judgement on a case‑by‑case basis. An incident that initially appears minor may later meet the threshold once further information becomes available.
Cluaran Care will ensure that all staff are aware of and comply with the Duty of Candour Procedure (Scotland) Regulations 2018.
Incidents reportable under the Duty of Candour Regulations are also likely to be reportable to the Care Inspectorate. Cluaran Care therefore undertakes to meet all relevant Care Inspectorate notification requirements.
Roles and Responsibilities
Chief Executive
The Chief Executive is responsible for the governance arrangements of Cluaran Care, including effective risk management systems. They are responsible for ensuring that appropriate clinical and care policies, procedures and guidelines are in place to safeguard service users and reduce risk, and for obtaining assurance that these are implemented, monitored and reviewed for effectiveness and compliance.
Director of Care
The Director of Care has overall responsibility for service user safety and for ensuring that effective risk management processes are in place which meet statutory requirements and adhere to guidance issued by the Scottish Government, the Care Inspectorate and other relevant regulatory bodies.
Managers
Managers are responsible for ensuring that:
- This policy is accessible to all staff within their area of responsibility
- Staff implement and comply with the policy
- Staff are informed of any changes to the policy
- Staff complete annual refresher training on Duty of Candour, including updates on best practice and regulatory changes
- Duty of Candour discussions and actions are accurately recorded within care records and incident management systems
All Staff
All staff employed by Cluaran Care, regardless of role, seniority or employment status, have a responsibility to comply with this policy and the Duty of Candour procedures.
Key Principles of the Duty of Candour
Cluaran Care is committed to:
- A culture that promotes candour, openness and honesty at all levels of the organisation
- Policies and procedures that support openness and transparency
- A zero‑tolerance approach to bullying or harassment, including behaviour that obstructs the Duty of Candour
- Investigating any allegation that a member of staff has obstructed another in exercising their Duty of Candour
- Referring registered professionals to their regulatory body where a breach of Duty of Candour is substantiated
- Providing training and appropriate support to staff involved in notifiable safety incidents
- Using secure digital systems for notifications and follow‑up communications, in line with current data protection legislation
Duty of Candour Requirements
As soon as reasonably practicable after becoming aware that a notifiable safety incident has occurred (moderate harm or above), the healthcare professional must:
- Notify the relevant person that the incident has occurred
- Provide reasonable support to the relevant person
The notification must:
- Be provided in person, where possible
- Include all facts known at the time
- Explain what further enquiries will be undertaken
- Include a meaningful apology or expression of regret
- Be recorded in the care records
Verbal notification must be followed by written notification.
Where the level of harm is not yet clear but may fall within the Duty of Candour threshold, the relevant person must still be notified.
It is not necessary to notify the relevant person of a near miss where no harm has occurred, although openness remains best practice.
Where a service user lacks capacity, or is under 16 and not competent to make decisions about their care, the relevant person acting lawfully on their behalf must be notified.
Information must only be shared with family members or carers where the service user has provided express or implied consent, unless an exception applies.
Information must be provided clearly, without jargon, and in a format suitable for the relevant person’s communication needs. Interpreters, advocates or other aids should be used where appropriate.
A meaningful apology must be delivered in person by the most appropriate representative of Cluaran Care.
Support for Relevant Persons
Cluaran Care will provide reasonable and proportionate support, including:
- Respectful, empathetic communication
- Emotional support, including the involvement of a trusted person or advocate
- Assistance to understand information provided
- Access to further treatment or care where appropriate
- Information on independent advice, advocacy or counselling services
- Support to access the complaints procedure
- Alternative care arrangements, where appropriate and requested
Written follow‑up must be provided even if investigations are ongoing. Outcomes of investigations will be shared in writing if the relevant person wishes to receive them.
All attempts to contact a relevant person must be recorded. If the relevant person declines further communication, this must be respected and documented.
Methodology
Stage One – Incident Identification and Reporting
Immediate action must be taken to reduce any ongoing risk to the service user. Initial facts must be established and the level of harm assessed:
- No harm / near miss: Duty of Candour does not apply; openness remains best practice
- Low harm: Managed locally with open discussion; Duty of Candour not required
- Moderate harm, severe harm or death: Duty of Candour policy applies
All incidents must be reported and recorded within 48 hours of discovery.
Stage Two – Being Open
Staff must follow the Being Open principles (Appendix 1). Cluaran Care maintains an up‑to‑date list of support services, including those relevant to remote or telehealth‑related incidents, where applicable.
Stage Three – Communication
The most senior appropriate practitioner will coordinate communication. Clear, honest explanations must be provided, acknowledging uncertainty where facts are still emerging. The relevant person’s views must be heard and documented.
For incidents arising from telehealth or remote care provision, the same Duty of Candour principles apply. Secure communication methods must be used, where applicable.
Stage Four – Investigation
Investigations will be led by the Line Manager or an appropriate senior manager. The service user or relevant person will be offered a meeting and informed of advocacy services where appropriate.
Stage Five – Notification Meeting
The notification meeting must take place within 10 working days of the incident being identified. A written summary, approved by the Chief Executive or nominated deputy, must follow.
Stage Six – Closure and Learning
A final investigation report and action plan will be approved through governance processes and shared with the relevant person. Learning outcomes will be cascaded through management and staff teams.
Staff Training
All relevant staff will receive training on the Duty of Candour, with refresher training provided annually.
Audit and Review
This policy will be reviewed every three years. Compliance with the Duty of Candour process will be audited at least every three years, or sooner where required.