CQC Duty of Candour Explained: A Plain English Guide for Care Providers
The duty of candour is one of the most important — and most misunderstood — regulations in adult social care. It's often described in vague terms like "being open and honest," which leaves many registered managers unsure exactly when it applies, what steps are legally required, and how to evidence compliance. This guide breaks it down in plain English, without the legal jargon.
Getting the duty of candour wrong isn't a minor paperwork issue — CQC can and does take enforcement action against providers who fail to meet it, entirely separately from whatever incident triggered the duty in the first place.
What Is the Duty of Candour?
The statutory duty of candour is set out in Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It places a legal duty on every CQC-registered provider to be open and transparent with people using their service — and their families — when something goes wrong during their care.
It has applied to NHS trusts since 2014 and to all other CQC-regulated providers, including care homes and domiciliary care agencies, since 2015.
The duty of candour is a legal requirement, not just good practice guidance. CQC can take enforcement action for breaches, and it applies whether or not the incident was anyone's "fault" — it's about what happened, not who's to blame.
What Counts as a Notifiable Safety Incident?
The duty is triggered by what CQC calls a "notifiable safety incident" (NSI). For adult social care, an incident is notifiable when three things are true:
- It was unintended or unexpected
- It happened during the provision of a CQC-regulated activity
- In the reasonable opinion of a healthcare professional, it has resulted in, or could result in, moderate or severe harm, prolonged psychological harm, or death
Important: whether something counts as notifiable is based on what happened during the incident, not on the eventual outcome. A medication error that could have caused serious harm is notifiable even if the person happened to be unaffected — you assess the incident itself, not just the result. A notifiable safety incident under the duty of candour is a distinct concept from — though often overlapping with — the events covered in our CQC statutory notifications guide; many incidents trigger both duties at once.
Many providers assume the duty of candour only applies when something has gone visibly wrong or when a complaint has been made. In fact, it applies to any qualifying incident regardless of whether the person or family has noticed, complained, or asked questions. The duty to be open is yours to initiate — not theirs to request.
What You Must Actually Do
Once you've identified a notifiable safety incident, CQC expects providers to follow these steps without delay:
✅ Duty of Candour: Required Steps
- Tell the relevant person face-to-face that a notifiable safety incident has occurred
- Say sorry — a genuine, meaningful apology, not just an acknowledgement
- Provide a true and honest account of what happened, based on what's known at that point
- Explain what further enquiries or investigation will take place
- Offer reasonable support to the person and others affected by the incident
- Follow up in writing — the same information and apology given verbally must also be provided in writing
- Keep a secure written record of every conversation, communication and action taken
These steps need to happen "as soon as reasonably practicable" after the incident is identified — not once an internal investigation has concluded. Providers sometimes wait until they have a full picture before speaking to the family; this is a misunderstanding of the duty, which requires openness from the point of identification, updated as more is learned.
The Written Apology Requirement
A verbal apology alone doesn't meet the duty of candour. The written follow-up must include the same apology and explanation given face-to-face — an "as discussed" reference isn't sufficient. Many requirement notices in this area stem specifically from a genuine verbal conversation happening, but no equivalent written record or apology following it up.
Duty of Candour vs Regulation 20A
It's worth distinguishing the statutory duty of candour (Regulation 20) from the separate requirement under Regulation 20A to display your CQC rating. They're often confused because both concern transparency, but they're different legal duties: Regulation 20 concerns individual incidents and how you respond to them; Regulation 20A concerns your published rating being visibly displayed at your premises, on your website, and in your literature.
What Inspectors Look For
When assessing duty of candour compliance, inspectors typically want to see:
- A clear, accessible policy that staff understand — not just a document filed away
- Evidence that incidents were identified and acted on promptly, not after delay
- Written records showing the apology and explanation were actually delivered, not just planned
- Staff who can describe, in their own words, when and how the duty applies
- A culture where staff feel able to report incidents openly, without fear of blame
CQC pays close attention to organisational culture around candour — the same open, blame-free culture that underpins good safeguarding practice. A service where staff are afraid to report incidents — because of blame culture rather than a genuine commitment to learning — is a Well-led concern, even if the paperwork technically exists.
Frequently Asked Questions
What is the CQC duty of candour in simple terms?
It's a legal requirement for CQC-registered providers to be open and honest with people in their care, and their families, when something goes wrong that results in — or could have resulted in — moderate or severe harm. This means telling them face-to-face, apologising, explaining what happened, and following up in writing.
Does the duty of candour apply even if no one was harmed?
Yes, if the incident could reasonably have resulted in moderate or severe harm, it's notifiable — the assessment is based on what happened, not solely on the eventual outcome for the individual.
What happens if a provider breaches the duty of candour?
CQC can take enforcement action, including issuing a requirement notice, and in serious or repeated cases this can affect registration. Breaching the duty of candour is treated as a serious governance failure, separate from whatever incident triggered it.
Who is responsible for ensuring the duty of candour is met?
The registered provider is legally responsible, but in practice the registered manager typically ensures the duty is understood and applied consistently by staff, and that individual incidents are handled correctly and evidenced.
Is a verbal apology enough to meet the duty of candour?
No. The duty requires both a verbal, face-to-face apology and explanation, and a written follow-up containing the same information. Missing the written element is one of the most common compliance gaps CQC identifies.
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