Duty of candour – review of threshold Our response to consultation on proposals to enhance candour in the NHS

Following the Government's response to the Mid Staffordshire Public Inquiry, Professor Norman Williams, President of the College, and Sir David Dalton Chief Executive of Salford Royal Hospital, were asked by the Secretary of State for Health to lead a review on two proposals to enhance candour in the NHS.

These include whether the threshold for the new statutory duty of candour should be set at the level of death and serious injury, or death, serious duty, and moderate harm and how the NHS Litigation Authority might incentivise candour by seeking reimbursements from trusts in cases where they had not been candid with a patient or family.

Being open with patients when something goes wrong with their care is the right thing to do and there is evidence to support this. A key question is at what point should the requirement to be open be triggered? In our submission we set out some principles that should be followed when deciding the threshold for a statutory duty of candour. They are:

• Be clear – about definitions of harm and whether there should be an automatic 'push' of information, or whether information should be given in response to requests from the patient, or their family.
• Be consistent – at the moment, there is different guidance in the contractual duty of candour compared to the NHS Constitution.
• Be proportionate – the NPSA guidance Being Open provides clear principles and processes to help health care staff be open with patients and families. It should be implemented and there should be training and resources to support it.

The review should make reference to the typology of patient harm developed by Charles Vincent and Colleagues in The measurement and monitoring of patient safety.

Any work on a duty of candour should also be supplemented by work on genuinely informed consent and a safety culture. Without these two elements, the duty of candour wont led to significant change in safety.