Recommendation 178

Duty of candour to be included in the NHS Constitution, employment contracts, policies and guidance

Accepted in principle
The NHS Constitution should be revised to reflect the changes recommended with regard to a duty of openness, transparency and candour, and all organisations should review their contracts of employment , policies and guidance to ensure that, where relevant, they expressly include and are consistent with above principles and these recommendations.

Staff should be honest and open with patients, and The NHS Constitution already emphasises the importance of honesty and openness in its values and sections outlining staff responsibilities, rights and pledges. In addition, wording was included in the March 2013 update of the Constitution to reflect the contractual duty of candour.

The inquiry has made a number of recommendations which relate to openness and transparency in policies and guidance of providers and other healthcare organisations, along with the reporting processes of these organisations and how they interact with regulators. While the importance of these recommendations is recognised, the Constitution focuses specifically on setting out the values of the NHS along with the rights and pledges to patients and staff, and their responsibilities. As it is not intended to address organisational reporting processes and interactions with regulatory bodies, it is not considered appropriate to reflect these issues in the Constitution.

If, as is currently planned, a new legal duty of candour is created, we will consult on how best to reflect this in the Constitution when it is next updated.

Including a duty of openness, transparency and candour into contracts of employment is not relevant, not least because of the difficulty in defining these terms for contractual purposes.  This recommendation can be best delivered through improved appraisal and, for example, revalidation arrangements being developed by the Nursing and Midwifery Councils (see response to recommendation 193) and other professional regulators.  Steps have already been taken to improve staff performance and appraisal systems (as set out in the response to recommendation 7).

NHS Employers will support NHS organisations in strengthening local policies on appraisals so that there is a clear link on the need for candour, openness and transparency in local appraisals and performance arrangements.


Sir Robert Francis QC was clear in his Inquiry report that the principal message of the NHS Constitution should be that patients and their safety come first.  In Hard Truths, the Department of Health committed to strengthening the NHS Constitution to make this clearer for patients, staff and the public.  To this end, The Government has launched a consultation into, amongst other things, refreshing the NHS Constitution to reflect the recommendations made by Sir Robert Francis QC. These are:

  • duty of candour;
  • safe care and avoidable harm;
  • staff guidance, and;
  • a patient-centred NHS.