The contractual Duty of Candour was introduced by NHS England in 2013 under the Being Open framework. It became a legal duty in 2014 for NHS organisations, making failure to comply a criminal offence.

In 2015, this duty was extended to:

• All NHS bodies

• Adult social care providers

• Primary medical and dental care

• Independent healthcare providers

Under this law, any provider that fails to notify and apologise to patients harmed by their care commits a criminal offence. The Care Quality Commission (CQC) regulates compliance.

The Register requires all accredited practitioners to uphold these standards in their own work.

Athena Herd Foundation expects practitioners to act openly and transparently throughout all aspects of care.

If a notifiable safety incident occurs, practitioners must:

1. Notify the service user as soon as reasonably possible.

2. Provide reasonable support to them regarding the incident.

This aligns with Section 20 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Duty of Candour is based on three core principles:

• Openness: Concerns and complaints can be raised freely without fear, and questions are answered honestly.

• Transparency: Honest information about performance and outcomes is shared with practitioners, service users, the public, and regulators.

• Candour: If a service user is harmed, they are informed and offered a remedy — even if no complaint is made.

The Register’s Compliments and Complaints Policy outlines how breaches are reported and addressed. Depending on the outcome, matters may be escalated under the Malpractice and Maladministration Policy, with sanctions or action plans applied as needed.

Practitioners must have their own complaints process aligned with the Register’s policies and should use it before escalating issues to the Register.

Under the Duty of Candour, a notifiable patient safety incident is any unintended or unexpected incident that causes (or is expected to cause):

• Death or severe harm (e.g., permanent loss of function, removal of the wrong organ, brain damage).

• Moderate harm that requires additional treatment or has significant but not permanent effects.

• Prolonged psychological harm lasting at least 28 continuous days.

Incidents involving near misses or low harm are outside the Duty of Candour but should still be addressed under the practitioner’s Health and Safety policy.

Service users must be informed as soon as possible and given reasonable, appropriate support.

Individual practitioners are personally responsible for meeting this duty and must also inform the Accredited Practitioner Register when such incidents occur.