Duty of Candour in NHS-Commissioned Services: From Policy to Practice
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Duty of Candour is often misunderstood as a policy requirement. In reality, it is a test of organisational culture, leadership and accountability.
Commissioners do not simply ask whether a Duty of Candour policy exists. They assess how openness is embedded in day-to-day practice and whether people using services are treated with honesty and respect when things go wrong.
This article links closely with regulation and oversight and culture and leadership.
What Duty of Candour requires
In NHS-commissioned services, Duty of Candour applies when:
- Moderate or severe harm occurs
- Unexpected outcomes arise
- Errors affect patient safety
Providers must inform the individual, apologise and explain what happened.
Moving beyond compliance
Compliance-focused approaches often result in:
- Delayed disclosure
- Defensive communication
- Minimal learning
Commissioners value providers who approach candour as part of ethical care rather than legal risk management.
Operationalising Duty of Candour
Effective providers:
- Train managers in difficult conversations
- Provide staff with clear guidance
- Support people through the disclosure process
This ensures candour is delivered consistently and compassionately.
Recording and evidencing candour
Commissioners expect:
- Clear documentation of disclosures
- Evidence of apologies given
- Records of follow-up actions
Poor record-keeping undermines confidence even where good conversations occurred.
Candour and learning
Strong providers link Duty of Candour to:
- Incident review outcomes
- Service improvements
- Feedback to affected individuals
This demonstrates that openness leads to meaningful change.
Why candour matters to commissioners
From a system perspective, Duty of Candour:
- Builds trust
- Reduces escalation
- Supports safer services
Commissioners see candour as a marker of organisational maturity.
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