Writing a Duty of Candour Letter

All healthcare professionals must be open and honest with patients when things go wrong with their treatment or care which causes, or has the potential to cause, harm or distress. This is known as the ‘Professional Duty of Candour’ and many healthcare professionals may be required to prepare a formal letter of this kind at some point during their career.

When something goes wrong, the professional duty of candour requires healthcare professionals to:

  • tell the patient (or, where appropriate, the patient’s advocate, carer or family);
  • apologise to the patient (or appropriate person);
  • offer an appropriate remedy or support to put the matter right (if possible); and
  • explain fully to the patient (or appropriate person) the short- and long-term effect of what has happened.

 

A step-by-step guide for healthcare practitioners

  1. Before you start writing the letter, ensure you have access to the patient’s full medical records and take time to review them Drafting a chronology of events may be helpful.
  2. Type your statement neatly on your hospital or practice letterhead. Carefully check your spelling, grammar, and punctuation prior to signing. These are simple things which go towards giving the patient and other parties an impression of professionalism and
  3. Write your statement in the first person (“I….”) wherever possible. Start off your statement by setting out your full name, workplace address, and professional position.
  4. Begin with a sincere and personalised apology for the harm/distress that has happened as a result of the event. Avoid using language that suggests an admission of guilt or liability, such as “I acknowledge my error” or “I take full responsibility”. Apologising in the right way does not mean that you are admitting legal liability for what happened. Whether the harm was caused by negligence is a separate matter and the relevant legal test would need to be met. Apologising is not an admission of liability regardless of whether you are in the public or private sector.
  5. Explain how you came to be involved with the patient or person under your care. Specify who referred the patient to you (if appropriate) or asked you to undertake a specific task, why they did so and the relevant date.
  6. Proceed to set out a chronological and honest account of your involvement in the patient’s Start from the beginning and work right through to the event in question. Stick to the facts and avoid including speculation or comments on the actions of others.
  7. Explain fully the short- and long-term effect of what has happened.
  8. Consider the audience for whom you are writing and that people other than the patient may read your statement (for example family members, insurers, and solicitors). This letter would not be legally privileged and could be referred to in any subsequent proceedings, so you need to ensure you are happy with the content. Explain all medical terminology and acronyms in simple terms.
  9. If there is an obvious learning point from the circumstance/event, it is a good idea to address this within the letter so that the patient is reassured that no ongoing risk exists. Explain what new process or learning has been introduced in response to the issue. In this kind of scenario, it’s particularly important to have input from your insurer and hospital/place of work before issuing the letter. It is vital that as soon as you know of any incident which causes harm you notify your insurer as well as the patient in the event that any legal claim is subsequently brought.
  10. Ensure that you give information that the patient may find distressing in a considerate way, respecting the patient’s privacy and dignity.
  11. Conclude by making clear who the patient should contact if they wish to ask further questions or raise any potential concerns. It is also a good idea to provide information about independent advocacy, counselling or other services that can offer the patient further support and advice.

 

Please see this diagram for help:

 

 

Note A – harm threshold for non-NHS providers:

The harm threshold will be met if, in the reasonable opinion of a healthcare professional, the incident appears to have resulted in, or requires treatment to prevent:

  • the death of the person – directly due to the incident, rather than the natural course of the person’s illness or underlying condition;
  • the person experiencing a sensory, motor or intellectual impairment that has lasted, or is likely to last, for a continuous period of at least 28 days;
  • changes to the structure of the person’s body;
  • the person experiencing prolonged pain or prolonged psychological harm; or
  • a shorter life expectancy for the person using the service.

 

Conclusion

 

Preparing a duty of candour letter can be daunting, particularly in cases where you may feel as though you have done something wrong. However, excellent support is available from the OTSIS team and do not hesitate to reach out should you require any assistance.