1 Presentation to the National Care Forum on the New Duty of Candour on 13 February 2014 Jeremy Nolan (Department of Health)

2 The Response to Francis In the wake of the Mid-Staffordshire Public Inquiry, the Government intends to introduce a range of measures to reinforce the value of openness, with sanctions for the most serious failings in candour and honesty. The new statutory Duty of Candour on organisations, supported by strengthened guidance and codes for regulated professionals, will champion openness and safety across health and adult social care.

3 How will the New Statutory Duty of Candour Work? The new duty of candour will apply to organisations and will be a statutory requirement. From October, all providers registered with the Care Quality Commission will have to inform the patient/service user when harm above a certain threshold has arisen. Breaches of the duty will be enforced by CQC. Just as importantly, CQC will be part of the process of ensuing that provider organisations have open cultures and work with their staff, so that mistakes are acknowledged and lessons learnt.

4 The Dalton/Williams Review Currently, one of the key outstanding issues concerns the harm threshold – the level of harm at which the statutory duty comes into force. The Secretary of State has asked Sir David Dalton and Professor Norman Williams to conduct a review focussed primarily on the duty of candour threshold. The Review is taking evidence from a wide range of healthcare stakeholders including patient advocate groups, professional organisations and academics. It is intended that the review, and supporting papers, will be published shortly.

5 Professional Requirements In conjunction with the development of the statutory duty of candour on organisations, the professional regulators are working to strengthen references to candour in professional regulation guidance Regulated health and care professionals will have to be candid with patients/service users about all avoidable harm, and obstructing colleagues in being candid will be a breach of the professional codes. Professional regulators will also review their guidance to professional misconduct panels to ensure they take proper account of whether professionals have raised concerns promptly.

6 Professional Regulators To take this duty of candour work forward, all nine professional regulators have agreed to join a working group, which is led by the General Medical Council and Nursing and Midwifery Council. The nine professional regulators are: 1.General Medical Council 2.Nursing and Midwifery Council 3.General Chiropractic Council 4.General Dental Council 5.General Optical Council 6.General Osteopathic Council 7.General Pharmaceutical Council 8.Health and Care Professions Council 9.Pharmaceutical Society of Northern Ireland

7 The Duty of Candour and Individuals (1) We are not intending to introduce a statutory duty of candour on individuals, but providers will be expected to implement the new duty of candour through their staff. Training and education of staff will also support the establishment of an open culture Also, a noted above, professional regulators are working to strengthen references to candour in professional regulation guidance. Enter the presentation's title using the menu option View > Header and Footer

8 The Duty of Candour and Individuals (2) However, board members or senior managers of provider organisations can already be prosecuted for a failure to comply with CQC registration requirements if the offence has been committed with their consent, connivance or negligence. This will also be the case with the duty of candour. Enter the presentation's title using the menu option View > Header and Footer

9 The Duty of Candour and Adult Social Care The statutory duty of candour will apply to all adult social care providers registered with CQC. One key issue is how duty of candour incidents will be reported to CQC. Adult Social Care providers currently submit direct reports to CQC on all deaths and serious injuries as part of CQC’s notification system.

10 Role of TLAP The Dalton/Williams review only covers healthcare, and there need to be complementary arrangements to consider social care views. It has been agreed that TLAP will oversee work on behalf of DH that will: –Consider the harm threshold from a social care perspective; –Enable an engagement process for social care providers and users.

11 Final TLAP product Based on feedback from this meeting, and other stakeholder contacts, TLAP will produce a paper for DH reporting back on adult social care issues and stakeholder views, which the TLAP board will approve. This document will feed into policy discussions. A formal consultation will then follow on the Regulations before they are laid before Parliament.

12 The False or Misleading Information Offence (FOMI) The duty of candour, and the false or misleading information offence, are both designed to improve openness among providers of care, but they focus on different things. The new duty of candour, overseen by CQC, is about the day to day interaction of provider organisations with patients and service users. The false or misleading clauses in the Care Bill are about certain information that providers are required to supply or publish. It creates a new criminal offence where health or care providers supply or publish specified false or misleading performance and management information provided under a statutory or other legal obligation. Taken together the two measures aim to increase openness to patients and service users (duty of candour) and in reporting performance (false or misleading information). Enter the presentation's title using the menu option View > Header and Footer

13 Duty of Candour Issues Your Questions Are Very Welcome. I would also be very interested in your views on the following issues: 1.To what extent do you think providers are already candid? Do they inform service users of harm and investigate appropriately? 2.Are external reporting of social care harm incidents well- developed and comprehensive? 3.Do you think further duty of candour reporting systems would be beneficial or un-necessary? 4.Are candour reporting/governance arrangements within provider organisations already reasonably well developed? 5.Do you have any other views to report relating to candour?