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V4 EH JEG Duty of Candour Policy for Execs Septmber 2019

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V4 EH JEG Duty of Candour Policy for Execs Septmber 2019 Duty of Candour Policy Document type: Policy Version: 4 Author (name): Emily Harrison Author (designation): Clinical Risk Manager Validated by Procedural Document Oversight Committee Date validated 14th August 2019 Ratified by: Executive Directors Date ratified: 2nd September 2019 Name of responsible committee/individual: Clinical Governance & Quality Committee Name of Executive Lead (for policies only) Trish Armstrong-Child, Director of Nursing Master Document Controller: Governance Support Co-ordinator Date uploaded to intranet: Key words Being Open, Duty of Candour, Candour, incident, investigation Review date: August 2022 Version control Version Type of Change Date Revisions from previous issues 1 New Policy May 2015 2 To emphasise the July 2016 Figure 1, the boxes for ‘Offer Meeting’ and ‘Send need for a meeting an apology letter with the findings’ have been or conversation to swopped around. share the findings Paragraph 15 has been amended to highlight the with the patient or need to talk to the patient / family prior to sending family. an apology with the findings. Paragraph 18 has an additional line to emphasise To emphasise that that the authority for an exemption for Duty of authority for Candour comes from the Director of Nursing, exemptions can Medical Director or Deputy Director of Nursing only come from the Version 4 Policy Duty of Candour Policy Reviewed By: Page 1 of 21 Date July 2019 Next Review Date August 2022 E. Harrison, Clinical Risk Manager Director of Nursing, Paragraph 40 has been amended to clarify that the Medical Director or initial approach for an exemption is made to the Deputy Director of Clinical Risk Manager, or Head of Governance, Nursing. then confirmed by the Director of Nursing, Medical Director or Deputy Director of Nursing. To introduce the Family Liaison Person Improve the quality of guidance given for the verbal Appendix 2 apology discussion Amend the Roles and Responsibilities to add in the role of Appendix 5 the Clinical Risk Manager and Family Liaison Person 3 Update roles and November responsibilities 2018 Into new format 4 Major amendments July 2019 Amendments to content of introduction and purpose to include clarity regarding statutory requirements and principles of openness and transparency. Amendments to definitions list. Minor amendment to 1s stage duty of candour process. Previously stated letter had to be issued within 10 days of identifying an incident. This is not factually correct – the statutory obligation is to notify the patient/relevant person verbally within 10 days of identification of an incident and to follow this up in writing. The deadline for this has been set as 5 working days post verbal notification. Minor amendments to process to clarify role of Duty of Candour Lead and Family Liaison Person. Amendments to specific considerations section to include HSIB investigations and provide clarity regarding responsibilities in relation to patients who lack capacity. Amendments to monitoring section in line with amendments to required timescales as described above. Version 4 Policy Duty of Candour Policy Reviewed By: Page 2 of 21 Date July 2019 Next Review Date August 2022 E. Harrison, Clinical Risk Manager Amended EQIA. Equality Impact Bolton NHS Foundation Trust strives to ensure equality of opportunity for all service users, local people and the workforce. As an employer and a provider of healthcare Bolton NHS FT aims to ensure that none are placed at a disadvantage as a result of its policies and procedures. This document has therefore been equality impact assessed to ensure fairness and consistency for all those covered by it regardless of their individuality. The results are shown in the Equality Impact Assessment (EIA). Version 4 Policy Duty of Candour Policy Reviewed By: Page 3 of 21 Date July 2019 Next Review Date August 2022 E. Harrison, Clinical Risk Manager Contents Page 1. Introduction 5 2. Purpose 5-6 3. Scope 6 4. Definitions 6-7 5. Reporting Requirements – Stage 1 7-8 6. Reporting Requirements – Stage 2 8-9 7. Communication 9-10 8. Special Considerations 10-12 9. Recording Incidents 12 10. Serious Incidents 12 11. Training and Resource 12-13 12. Monitoring Compliance 13-14 13. Associated Documents and References 14 Appendices Appendix 1: Roles and Responsibilities 15-16 Appendix 2: Draft letter template 17 Appendix 3: Document Development Checklist 18-19 Appendix 4: Equality Impact Assessment 20-22 Version 4 Policy Duty of Candour Policy Reviewed By: Page 4 of 21 Date July 2019 Next Review Date August 2022 E. Harrison, Clinical Risk Manager 1 Introduction 1.1 There has been a responsibility for health care providers to be open and honest with patients since the Being Open Framework, published by the National Patient Safety Agency (NPSA) in 2009. The publication of the Francis Inquiry report in 2013 raised the profile of the principle of being open and honest, with two recommendations centred on the value of transparency with patients and/or families. 1.2 In November 2013 the Department of Health published the ‘Hard Truths’ report, the department’s response to the Francis recommendations. This emphasised a commitment to greater openness and candour, to developing a culture dedicated to learning and improvement that continually strives to reduce avoidable harm. 1.3 The duty of candour then took effect in contractual form by way of being included in the NHS Standard Contract. This requires all NHS and non-NHS providers of services to patients to comply with the duty of candour under contract. 1.4 An addendum to the Health and Social Care Act in November 2014 brought the statutory requirements on Duty of Candour into effect. Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 made the Duty of Candour a regulatory requirement and clearly stipulates the actions health care providers must take to be compliant. This requirement is monitored and enforced by the Care Quality Commission. 1.5 ‘The intention of this regulation is to ensure that health care providers are open and honest with people who use services and other ‘relevant persons’ (people acting lawfully on their behalf) in general in relation to care and treatment. It also sets out specific requirements health care providers must follow when things go wrong with care and treatment.’ (Guidance for providers on meeting the regulations, Care Quality Commission, 2015) 1.6 The principles of being open and honest apply to all incidents and any failure in care or treatment. Being open about what happened and discussing patient safety events promptly, fully and compassionately with patients and/or relevant persons can: Help patients and/or relatives cope better with the after-effects; Ensure that a thorough investigation into the patient safety event takes place and provide assurance that lessons learned will help prevent to ensure a similar type of incident from recurring; Provide an environment where patients and/or their carers, healthcare professionals and managers feel supported when things go wrong. 2 Purpose 2.1 The Trust is committed to the principles of duty of candour and encouraging a culture of openness and transparency at all levels of the organisation. Version 4 Policy Duty of Candour Policy Reviewed By: Page 5 of 21 Date July 2019 Next Review Date August 2022 E. Harrison, Clinical Risk Manager 2.2 This document outlines the Trust’s policy on duty of candour and the processes by which it will be encourage candour, openness and honesty at all levels. This will support the Trust to meet its obligations to patients, relatives and the public by being open and honest when communicating with patients or other relevant persons in relation to care and treatment. 2.3 This policy should be followed in conjunction with the Trust Incident Reporting Policy and Serious Incident Policy. 3 Scope 3.1 This policy is relevant to all care delivered by any of the Trust clinical services to patients and their families, both while on Trust property and when care is delivered by a member of Trust staff while working in the community. 4 Definitions 4.1 Apology – An expression of sorrow or regret in respect of a notifiable safety incident 4.2 Notifiable safety incident – Any unintended or unexpected incident that occurred in respect of a person using the service during the provision of care and treatment that appears to have resulted in: i. The death of the person using the service, where the death relates directly to the incident rather than due to natural course of any underlying condition/illness. ii. Severe harm, moderate harm or prolonged psychological harm 4.3 Relevant person(s) – A person lawfully acting on behalf of a patient under the following circumstances: i. The patient has died ii. The patient is under 16 and not competent to make a decision in relation to their care and treatment iii. The patient is 16 and over and lacks capacity in relation to the matter. 4.4 Moderate harm – significant but not permanent harm that requires a moderate increase in treatment. 4.5 Severe harm – A permanent lessening of bodily, sensory, motor, physiological or intellectual function that is directly related to the incident and not related to the natural course of any underlying illness/condition 4.6 Prolonged psychological harm – Psychological harm which the person using the service has experienced or is likely to experience, for a continued period of at least 28 days 4.7 Candour - 'The volunteering of all relevant information to persons who have or may have been harmed by the provision of services, whether or not the information has been requested and whether or not a complaint or a report about that provision has been made’ (Francis, 2013). Version 4 Policy Duty of Candour Policy Reviewed By: Page 6 of 21 Date July 2019 Next Review Date August 2022 E.
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