Recent enforcement action and high-profile cases have once again brought transparency in healthcare into focus. Across health and social care services, one issue continues to stand out: when something goes wrong, organisations are still not consistently open about it.

At the heart of this is the Duty of Candour.

Under Regulation 20 of the Health and Social Care Act 2008, providers registered with the Care Quality Commission (CQC) must act in an open and transparent way when care does not go as planned.

While the regulation itself is clear, applying it consistently in practice remains a challenge for many providers.

What Is the Duty of Candour?

The Duty of Candour requires providers to be honest, open, and transparent with patients (or their families) when a “notifiable safety incident” occurs.

In practice, this means:

• Informing the person affected as soon as possible
• Offering a clear explanation of what happened
• Providing a sincere apology
• Keeping accurate written records of all actions taken

Duty of Candour is a legal requirement.

Why It’s Back in the Spotlight

Recent cases have highlighted ongoing failures in how Duty of Candour is applied. In many situations, the initial incident is compounded by delays in communication, incomplete explanations, or poor follow-up.

This has led to increased regulatory attention and enforcement action, reinforcing a key message for providers:

Transparency after an incident is just as important as the care itself.

Common Challenges for Providers

Despite clear guidance, several issues continue to appear across services:

• Delays in informing patients or families
• Uncertainty around what qualifies as a notifiable incident
• Inconsistent documentation of conversations and actions
• Cultural hesitation to be fully open when mistakes occur

These gaps can increase both regulatory risk and reputational damage.

What Good Practice Looks Like

Strong compliance with Duty of Candour is built on clarity and consistency:

• Staff understand when and how to apply the regulation
• Clear processes guide responses to incidents
• Leaders maintain oversight and accountability
• Communication with patients is timely, honest, and empathetic
• Actions are fully recorded.

At its core, this is about building a culture of openness.

 

Duty of Candour is not a box-ticking exercise. It is a fundamental part of safe, transparent, and accountable care.

As scrutiny from regulators continues to increase, providers who prioritise openness will be better placed to maintain trust and demonstrate compliance.

Those who do not, risk both regulatory consequences and a loss of confidence from the people they care for.