Duty of Candour implementation

As you will be aware, the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 received Royal Assent on 1 April 2016 and introduced a new organisational duty of candour on health, care and social work services. This duty will apply to almost ten thousand organisations. Annex A gives a full list of the services to whom the duty applies. The implementation date for the duty of candour to come into effect is 1 April 2018.

The overall purpose of the new duty is to ensure that organisations are open, honest and supportive when there is an unexpected or unintended incident resulting in death or harm, as defined in the Act. This duty requires organisations to follow a duty of candour procedure which will include notifying the person affected, apologising and offering a meeting to give an account of what happened. The procedure will also require the organisation to review each incident and offer support to those affected (people who deliver and receive care). The details of this procedure will be set out in Regulations which will be published prior to 1st April 2018. Organisations will have a new requirement to publish an annual report on when the duty has been applied. This will include the number of incidents, how the organisation has complied with the duty and what learning and improvements have been put in place.

An implementation structure has been set up to oversee this work, with representatives from a broad range of health and social care organisations. To assist you to meet these new requirements the Scottish Government, Healthcare Improvement Scotland (HIS), the Care Inspectorate (CI), Scottish Social Services Council (SSSC) and NHS Education for Scotland (NES) are working in partnership with a wide range of stakeholders to design and develop education and training resources and monitoring requirements to support organisations meet the new statutory duty of candour.

Annex B gives some questions and answers which you may wish to consider when planning local implementation of the duty. If you have any further questions, please do not hesitate to email [email protected]

A dedicated webpage with Frequently Asked Questions has been established. Regulations and guidance, examples of duty of candour templates and local policies will be added during 2017.

As Care Inspectorate and Healthcare Improvement Scotland already have existing eForms systems for regulated health and social care services, the intention is to align existing processes and systems as far as possible to minimise paperwork whilst still ensuring that the organisational duty is being applied through a culture of openness and learning.

Further information and updates will be issued as this work progresses.

Yours sincerely,

Claire Sweeney,

Interim Director of Quality Assurance
Healthcare Improvement Scotland

Rami Okasha

Executive Director of Strategy and Improvement
Care Inspectorate

Professor Craig White

Divisional Clinical Lead, Planning & Quality Division
The Scottish Government

ANNEX A

Duty of Candour: organisations covered by the Act

• NHS Boards
• Scottish Ambulance Service
• State Hospital
• Golden Jubilee
• GP services
• Dentistry
• Glasgow Dental Hospital
• Pharmacy
• Optometry
• Independent hospitals and hospices
• Private psychiatric hospitals
• Independent clinics
• Independent medical agencies
• Independent ambulance services
• Support services
• Care home services
• School care accommodation service
• Nurse agencies
• Child care agencies
• Secure accommodation services
• Offender accommodation services
• Adoption services
• Fostering services
• Adult placement services
• Day care of children
• Housing support services
• Social work services offered by or on behalf of local authorities

ANNEX B

Points to consider
1. How will your organisation identify the incidents that trigger the Duty of Candour procedure, as outlined in section 21? Have you satisfied yourself that you understand your responsibilities and have systems in place to respond effectively?
2. Who do you need to engage with to satisfy yourselves you can meet the responsibilities of the Duty and deliver the requirements outlined in the Act?
3. What systems do you have in place to support staff to provide an apology in a person-centred way and how do you support staff to enable them to do this?
4. Do your current systems and processes provide you with the information required to report on the Duty of Candour? How will you align this annual report with other reports you are required to provide such as feedback and complaints, significant events reviews, case reviews etc.?
5. What training and education do you have at present that will support the implementation of the Duty? This could be training that considers issues such as how to give an apology, being open, meetings with families, dealing with difficult situations. You should also consider national training that is available freely to your staff such as e-learning opportunities.
6. What support do you have available for people involved in invoking the procedure (staff) and those affected (staff and service users)?
7. How do you currently share lessons learned and best practice around incidents of harm? Could this be improved in any way?

Useful links

The links below include an example of a local duty of candour policy in England. Although the legislation differs (there is no requirement for an annual report, a written apology must be given, definitions of harm are based on national patient safety agency), the policy intention is the same: to be open and honest with service users, regulators and the general public.
Executive summary of the Mid-Staffordshire Inquiry: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/279124/0947.pdf
Case of Robbie Powell, whose father campaigned for a duty of candour https://www.theguardian.com/society/2006/jan/04/health.healthandwellbeing
Sample policy from The Children’sTrust: https://www.thechildrenstrust.org.uk/media/images/IncidentReportingInvestigationIncludingDutyofCandourPolicy_1183.pdf

The following is the text of the address given by our Chief Executive Dr Donald Macaskill as he opened the Scottish Care Palliative Care event, ‘Trees that bend in the wind.’ in Glasgow on the 8th February.

 

Welcome to The Trees that bend in the wind… the Scottish Care Frontline Worker Event on Palliative Care.

 

Death happens to us all. It is a journey whose steps we each of us will make in our own way, at our own pace, and in our own time; it will for some of us be a journey which is a long one with all the emotions, energy, and fears and tears that a parting brings; for others it will be short, painfully brief, leaving us breathless with regret, with hopes unmet and tasks unfulfilled.

That journey at the end of life will happen at a time beyond our calculation or design; whether in the depth of winter’s cold or the tiredness of an uncomfortable summer it has a season of its own time. For some it will be heralded by progressive illness and decline, for others its suddenness will take our living breath away.

For many people today around Scotland they will make that journey and take these steps, in the company of others; their families, friends partners and lovers  – who will sit with them and walk with them, carry them and support them.

 For countless hundreds the last few weeks and months of life will be accompanied by someone who entered into their life as a stranger,  became a companion and often towards the end becomes a friend.

 It is those individuals, the undervalued, unrecognised thousands of frontline carers in care homes, in homecare and housing support services whose contribution to giving our fellow Scots a good death we are here to value, to learn from and be inspired by.

 It is they who somewhere in a quiet house at the bottom of a glen will be the worker who this morning shares a moment of laughter which distracts from the loneliness of absence;

 It is they who in a high rise flat are giving companionship and a listening ear to someone who never gets out anymore and probably won’t leave their home until they die;

 It is they who in a suburban, very ordinary street, are the worker who today right now is holding someone’s hand as they tremble with emotion and upset;

 They are the worker who brushes the hair and dries up the tears of the woman in the room in the care home that has become their home showing that touch is often more important than talk;

 It is these workers who when folks are on their end of life journey and stumble in uncertainty and fear, in pain and distress – it is they who give the strength to find direction and carry on; it is these workers who spot the subtle signs of conditions changing, a new path starting and a final stage dawning.

 Today we are indeed here to celebrate these workers, to hear their stories,  but we are also here to be challenged by their words and experiences.

 Because we have not always valued these workers or their contribution; we have not always resourced them so that they feel more confident and skilled;

Indeed we have through some of our practices served to place very real obstacles in their path as they have sought to bring solace and give comfort to others at the end of their life’s journey.

 So in the midst of the stories you hear this morning, do not just listen to the words of dedication and professionalism; give space in your listening and your response to the challenge and to the call to do things differently and better.

 This morning is part of a bigger piece of work we have started here at Scottish Care on palliative and end of life care. We hope that our call in this report for a National Conversation on Dying will encourage our fellow Scots to challenge the silence, which adds to the loneliness of our final steps.

 For whilst the ending of our life will always be a journey which no-one else can make for us, we can become much better as a nation at being there, being with, at talking, consoling and holding.

 Donald Macaskill 

Today (8 February 2017), Scottish Care has launched its latest report relating to the role of social care staff in palliative and end of life care.

‘Trees that bend in the wind: Exploring the experiences of front line support workers delivering palliative and end of life care’ is a 47 page report which provides a forum where the views, experiences and values of social care staff in palliative and end of life supports are explored in detail.

It has allowed those involved in the front line of social care to:

• speak for themselves
• share their insights on what constitutes good palliative support
• express their frustrations and anxieties, and
• explain what keeps them going in the face of such emotional challenges.

The report highlights the contributions of 50 individual staff in care home and care at home services in four areas of Scotland who took part in structured focus groups. The research took place in Glasgow, Edinburgh, Highland and Dumfries and Galloway but the insights are without boundary or geography.

The report was launched on the 8^th February at an event which brought together over 100 stakeholders from across Scotland who explored together its insights and recommendations.

At the event Scottish Care’s Chief Executive, Dr Donald Macaskill, highlighted Scottish Care’s commitment to ensuring that the often unrecognised and undervalued contribution of social care staff in palliative and end of life care was given a greater prominence at both policy and practice levels.

He said the aim of the research was to ensure that everyone in Scotland was able to achieve a truly person centred end of life experience by being supported by staff who were properly resourced and supported. He reflected on the way in which the ‘tree that bends’ (an image from one of the workers to describe their role) was in danger of breaking unless front line care staff are adequately supported.

Dr Macaskill encouraged all stakeholders to work together with Scottish Care to ensure the recommendations in the report, which arose directly from the insights of the frontline workforce and which included a call for a National Conversation on Dying, were enacted as soon as possible. In addition, the report highlights the potential contribution of social care staff to supporting the work of Integrated Joint Boards in achieving positive end of life outcomes, including the benefits of joint team-working and the value of Anticipatory Care Planning.  It also stresses the need to explore the role of commissioning practice in relation to palliative and end of life care in social care delivery.

We hope you will find reading the report of interest.  It is also available in hard copy format directly from the Scottish Care offices.

We would be more than happy to meet with individuals and organisations to discuss ways in which we could work collaboratively in the implementation of the report’s recommendations.

If you have any questions either about the report or our work with front line support staff, please don’t hesitate to contact Katharine Ross, Becca Gatherum or Donald Macaskill.

 

 

The Scottish Government recently ran a public consultation on the new National Health and Social Care Standards, to which Scottish Care submitted a response.

This response was informed by the National Care Standards Consultation event which Scottish Care ran for members on 10 January 2017.  Thanks to all those who participated.

Scottish Care’s response can be accessed here.

Now that the consultation has closed, the Scottish Government will review and analyse the responses.   The Project Board and Development Group will consider the findings and a consultation report will be published in Spring 2017.

The final Standards will be published in Spring 2017, and will be implemented from Spring 2018.

For more information about the new Standards, visit http://www.newcarestandards.scot/