Organisational duty of candour procedure: first year review

2. Introduction 

This report is a review of NHS Scotland's first year of experience in implementing  the statutory organisational Duty of Candour, including annual reporting. Scotland has 14 territorial health boards, 7 special boards and 1 public health body who support the regional NHS Boards by providing a range of important specialist and national services. 

These findings and observations have been informed by;

• 19 annual Duty of Candour reports from 1^st April 2018 to 31^st March 2019. Comprising of;
  a. 14 reports from territorial health boards
  b. 2 special boards
• Visits to 6 health boards 
• Visits to 2 special boards 

See Appendix 1 to see a list of boards visited. 

2.1 Background & Policy Context 

Scottish Ministers are committed to an integrated programme of measures to facilitate cultural change to achieve openness and transparency without blame in the provision of NHS health and social care services. Central to this is the statutory organisational duty of candour, which came into effect on 1 April 2018.

The duty of candour procedure provisions reflect the Scottish Government's commitment to place people at the heart of health and social care services in Scotland.   When death or harm occurs the focus must be on personal contact with those affected; support and a process of review and action that is meaningful and informed by the principles of learning and continuous improvement.

There is an organisational emphasis on staff support and training to ensure effective implementation of the organisational duty.  Staff must feel that they have the necessary skills and confidence if they are to be meaningfully involved in the delivery of the duty of candour procedure.

The Openness and Learning Unit was established in September 2017 in the Scottish Government to work with stakeholders in developing an approach that is accessible and meaningful for front-line professionals and national bodies to support improvements in health and social care outcomes.  The aim is to create an environment that uses knowledge to inform continuous improvement to services in a culture of openness without censure.

2.2. The New Organisational Duty of Candour Procedure 

The new organisational duty of candour underpins the commitment of the Scottish government to openness and learning, which is vital to the provision of safe, person-centred, and effective health and social care. 

The Scottish Government's organisational Duty of Candour provisions within the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 (The Act) and The Duty of Candour Procedure (Scotland) Regulations 2018 set out the procedure that organisations providing health services, care services and social work services in Scotland are required by law to follow when there has been an unintended or unexpected incident that results in death or harm (or additional treatment is required to prevent injury that would result in death or harm).

2.2.1. Why We Need Candour

Enabling and managing risk is a central part of delivering high quality health and social work services. Candour promotes responsibility for developing a safer way of working; better engages staff in improving their services, and creates a greater trust in people who use these services – either first-hand or on behalf of someone else. 

2.3. Project Aims & Objectives 

The aim of this research project was to identify what difference organisational duty of candour has made, whether it has been embedded in the operational procedures of organisations and to what extent it has influenced learning and service improvements. The project also aimed to identify any variation in the implementation of the procedural requirements of the procedure, and to highlight good practice or particular areas of concern.