Recommendation 174

Candour in the event of death or serious harm

Where death or serious harm has been or may have been caused to a patient by an act or omission of the organisation or its staff, the patient (or any lawfully entitled personal representative or other authorised person) should be informed of the incident, given full disclosure of the surrounding circumstances and be offered an appropriate level of support, whether or not the patient or representative has asked for this information.

The Secretary of State for Health legally required NHS England to insert a contractual duty of candour into the NHS Standard Contract in 2013-14. This means that NHS trusts and foundation trusts are contractually required to operate a duty of candour. The contract also refers organisations to the Being Open framework that was first produced by the National Patient Safety Agency.  This provides guidance on best practice for all healthcare organisations to create an environment where patients, their carers, healthcare professionals and managers all feel supported when things go wrong and have the confidence to act appropriately. The framework gives healthcare organisations guidance on how to develop and embed a being open policy that fits local organisational circumstances. Another key element of the framework is the process on how to communicate with patients, their families and carers following harm.

The government has also introduced in the Care Bill a new requirement for a statutory duty of candour and will be included as a new registration requirement for health and social care providers registered with the Care Quality Commission.   The duty will require providers to be open with patients and service users about failings in care provide an explanation, and where appropriate an apology. As a mark of the government’s commitment to the duty of candour, the Care Bill puts a requirement on the Secretary of State for Health to establish a requirement for registered with the Care Quality Commission to meet a duty of candour.


The Government has put in place a new statutory duty of candour as a requirement for registration with the Care Quality Commission which applies to NHS organisations now and all other organisations from April 2015. The threshold for the new duty will be in line with the recommendations of the review led by Professor Sir Norman Williams, President of the Royal College of Surgeons, and Sir David Dalton, Chief Executive at Salford Royal NHS Foundation Trust into enhancing candour in the NHS: Building a culture of candour: A review of the threshold for the duty of candour and of the incentives for care organisations to be candid published on 6 March 2014.