Board apologies

Accept

Healthcare organisations have a statutory duty of candour, which sets out specific requirements providers must follow when things go wrong with care and treatment, including providing truthful information and an apology. This duty is regulated by CQC.

NHS Resolution has consistently advised its members to apologise when things go wrong, and to provide a full and frank explanation at the earliest possible stage, irrespective of the possibility of a legal claim. More work is underway to ensure that this NHS Resolution guidance is promoted.

The government accepts this recommendation in full and agrees that patients should receive an apology from boards at the earliest stage of investigation when things go wrong.

Statutory Duty of Candour

In November 2014, the Government introduced a statutory (organisational) duty of candour for NHS trusts and NHS foundation trusts. The duty places a direct obligation upon trusts to be open and honest with patients and service users, and their families, when something goes wrong that appears to have caused or could lead to moderate harm or worse in the future (known as a ‘notifiable safety incident’). From April 2015, the duty extended to all other health and social care providers registered with the CQC including care homes.

The duty of candour is enforced by CQC with consequences for health and care providers who are found to be non-compliant. This can include CQC’s ability to:

• impose conditions
• issue warning notices and fines
• remove a provider’s registration
• bring criminal prosecutions without needing to first serve a warning notice

CQC has produced guidance on the statutory duty of candour which explicitly states that apologising is “a crucial part of the duty of candour” that does not amount to an admission of liability. Compliance with the statutory duty of candour is integral to the CQC’s assessment process. NHSR has launched a new animation on the duty of candour, which underlines that apologising is always the right thing to do. NHSR continues to provide resources and engagement on both the need to provide apologies when appropriate, and on how to do so effectively.

Saying sorry meaningfully when things go wrong is vital for everyone involved in an incident, including the patient, their family, carers, and the staff that care for them. It is part of the duty of candour. NHS Resolution publish supporting guidance.

The Government announced a review of the statutory duty of candour in December 2023. A call for evidence to gather evidence about the operation of the duty of candour was published by DHSC on 22 May 2024.

PSIRF

The NHS England Patient Safety Incident Response Framework confirms that patients, families and carers should receive a meaningful apology as soon as possible. Face-to-face verbal apologies are preferable, and as soon as possible after an incident has occurred. A written apology clearly stating the healthcare organisation is sorry for the suffering and distress resulting from the incident must also be given.

Leadership Framework

The NHS Leadership Competency Framework for board members published in February 2024 sets out six competency domains to support board members to perform at their best which are aligned to the NHS Values as set out in the NHS Constitution. The competency domains are aligned to Our NHS People Promise , Our Leadership Way, and the Seven Principles of Public Life.

Action 10.2

This recommendation has been implemented. CQC has produced guidance on the statutory Duty of Candour which explicitly states that apologising is “a crucial part of the duty of candour” that does not amount to an admission of liability. Compliance with the statutory Duty of Candour is integral to the CQC’s assessment process. NHSR has launched a new animation on the Duty of Candour, which underlines that apologising is always the right thing to do. NHSR continues to provide resources and engagement on both the need to provide apologies when appropriate, and on how to do so effectively.

CQC has produced guidance on the statutory duty of candour, which explicitly states that apologising is “a crucial part of the duty of candour” that does not amount to an admission of liability.

NHS Resolution has launched a new animation on the duty of candour, which underlines that apologising is always the right thing to do.

NHS Resolution continues to provide resources and engagement on both the need to provide apologies when appropriate, and on how to do so effectively.

Compliance with the statutory duty of candour is assessed as part of the CQC assessment process.

Action 10.2:

Accepted in full.

New Care Quality Commission guidance has been produced on the statutory duty of candour, which explicitly states that apologising is “a crucial part of the duty of candour” that does not amount to an admission of liability. Compliance with this statutory duty is part of the Care Quality Commission assessment process.