At a glance
- The NHS duty of candour requires healthcare providers to be open with you when certain patient safety incidents cause harm.
- Where the statutory duty applies, the healthcare provider must explain what happened and provide an apology.
- An apology does not automatically mean the NHS has accepted legal liability.
- You can ask for copies of your NHS medical records through a Subject Access Request.
- You can make an NHS complaint and explore a medical negligence claim separately.
Being told that something may have gone wrong with your medical care can be upsetting.
You may have received an unexpected letter from an NHS trust. You may have been told that your treatment is being reviewed. Or you may simply be trying to understand what happened after an incident caused you harm.
The NHS duty of candour is a legal requirement that makes healthcare providers responsible for being open and honest with patients when certain things go wrong.
In this guide, we explain what that means in practice, what information you may be given and what you can do if you still have questions about your care.
What is the NHS duty of candour?
The NHS duty of candour is a legal requirement intended to promote openness when patients are harmed during healthcare.
The statutory duty is set out in Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Where a qualifying patient safety incident occurs, the healthcare provider must tell the patient, or someone acting on their behalf, what has happened.
This can include:
- Explaining what is known about the incident.
- Providing information about what happens next.
- Offering an apology.
- Keeping the patient informed as more information becomes available.
For NHS bodies, the statutory process applies to certain incidents that result in harm or death.
Receiving a duty of candour notification can understandably feel alarming. However, it does not automatically mean the NHS trust has accepted legal responsibility for what happened.
An apology is part of the duty to be open with patients. Whether there has also been medical negligence is a separate legal question.
What does a duty of candour letter mean?
If you receive a duty of candour letter, it usually means the healthcare provider has identified an incident relating to your care that meets the legal threshold for formal notification.
The letter may explain:
- What happened
- What is currently known about the incident
- What investigations are taking place
- Whether anything is being done differently as a result
- Who you can contact with questions
You may not receive every answer immediately.
Some incidents require a wider investigation before the healthcare provider can establish exactly what happened and why.
If that happens, the provider should continue to communicate with you as the investigation progresses.
What is the difference between the statutory and professional duty of candour?
You may hear both the statutory duty of candour and the professional duty of candour mentioned.
They are closely related, but they apply in different ways.
| Feature | Statutory duty of candour | Professional duty of candour |
|---|---|---|
| Who it applies to | Healthcare organisations and registered providers | Individual healthcare professionals |
| Who oversees it | Care Quality Commission (CQC) under Regulation 20 | Professional regulators such as the General Medical Council (GMC), Nursing and Midwifery Council (NMC) |
| What it requires | Organisations to be open with patients when certain safety incidents cause harm | Individual professionals to be open and honest when something goes wrong |
| What it can involve | Formal notification, explanation, apology and further updates | Speaking openly with patients, explaining what happened and reporting concerns appropriately |
The statutory duty applies to the healthcare organisation.
The professional duty applies to the individual doctors, nurses, midwives and other professionals involved in your care.
In practice, both require openness and honesty when patients have been harmed or when something unexpected has happened.
Why do NHS trusts carry out historical lookback reviews?
When an NHS trust identifies recurring safety issues or concerns regarding a specific practitioner, it may launch an NHS lookback review. You might receive a letter out of the blue explaining that your past care is being audited, which understandably causes distress.
Trusts initiate these audits for several reasons:
- Systemic clinical errors identified across a particular department over a specific timeframe.
- Internal or independent audit findings that highlight deviations from standard national guidelines.
- Regulatory investigations into an individual practitioner’s historic treatment choices.
- Clusters of unexplained patient complications reported to safety monitoring bodies.
Being contacted as part of a review doesn’t necessarily mean you suffered permanent harm or were the victim of clinical negligence.
In many cases, trusts audit broad cohorts of patients simply to verify safety standards. However, if an audit reveals that your treatment fell short, knowing what constitutes negligence can help you decide whether to explore a formal claim for compensation.
How to request your NHS medical records
Accessing your complete medical records is often the first practical step towards understanding your care and verifying what occurred. Under UK GDPR and the Data Protection Act 2018, you have a legal right to view your records.
- Identify the data protection team: Contact the Subject Access Request (SAR) team or Health Records Department at the specific NHS trust or GP practice.
- Submit a written request: Send a formal request clearly stating that you require full copies of your medical notes, operation sheets, nursing charts, and diagnostic imagery.
- Verify your identity: Provide the required identification documents, such as a passport or utility bill, to meet privacy checks.
- Review your documentation: Once delivered, carefully examine the records. Pay close attention to soft labels, handwritten notes, or discrepancy codes between nursing logs and surgeon reports.
Your request is free of charge, and the trust must comply within one calendar month. If your records are complex, the trust may extend this deadline by up to two months, but they must inform you promptly.
Should you make an NHS complaint, a claim, or both?
When facing unresolved questions about your medical care, you may wonder whether to lodge an NHS complaint or start a legal claim. You’re entitled to pursue both options simultaneously without compromising your ongoing medical care.
The NHS complaints process
Submitting a complaint through the Patient Advice and Liaison Service (PALS) or the formal trust complaints procedure allows you to seek an official explanation. This route aims to investigate administrative or clinical shortcomings, secure an explanation, and prompt procedural changes to protect future patients. It doesn’t provide financial compensation.
Medical negligence compensation claims
A medical negligence claim is a civil legal process designed to address the personal and financial impact of improper care. Where a healthcare provider breaches their duty of care, compensation can fund vital rehabilitation, lost income, and specialist equipment. Pursuing a claim helps protect your financial stability if an avoidable error leaves you unable to work or requiring ongoing support.
What are the time limits for medical negligence claims?
Legal claims for medical negligence are subject to strict statutory limitation periods. Under the Limitation Act 1980, you generally have three years from the date the negligence occurred, or three years from your ‘date of knowledge’, to initiate court proceedings.
The date of knowledge refers to the moment you first realised, or should reasonably have realised, that your injury was connected to the medical care you received. This distinction is particularly critical if you’re notified about past care through a lookback review years after treatment ended.
For care dating back several years, establishing the exact limitation window requires expert legal advice. Identifying when the clock started ticking depends on the specific facts contained within your medical notes and formal correspondence from the trust.
Who will handle your claim following an NHS lookback review?
Being contacted as part of an NHS lookback review can raise questions about whether the care you received was appropriate and what you should do next. If your concerns relate to breast cancer care, Tanzeela and her all-female team can listen to what happened and help you understand your legal options.
They’ll take the time to review your individual circumstances and explain the difference between the NHS review and an independent clinical negligence claim. If there are grounds to investigate further, they’ll guide you through the process with care and sensitivity.
Next steps for your peace of mind
Receiving a notification regarding the NHS duty of candour or a historical lookback review can feel overwhelming, but these processes exist to uphold transparency and patient safety. Knowing your rights, from accessing your complete medical records free of charge to seeking independent legal advice, ensures you can make informed decisions about your health, recovery, and future.
We’re here to help you understand your rights
If you have questions about an NHS duty of candour notification or suspect medical errors affected your health, we’re here to support you. You can contact our friendly team for calm, clear advice.
FAQs about the NHS duty of candour
What is the statutory threshold for duty of candour in the NHS?
The statutory duty of candour applies when a Notifiable Safety Incident occurs during treatment, resulting in moderate harm, severe harm, prolonged psychological harm, or death. NHS trusts are legally required under Regulation 20 to report these incidents to you.
Does duty of candour apply if no physical harm occurred?
The statutory duty applies to moderate or severe physical and psychological harm. However, individual clinicians remain bound by their professional duty of candour to be open and honest about any unexpected event, including near misses where no actual harm occurred.
Do I need a solicitor if my care is part of an NHS review?
You don’t need a solicitor simply to participate in an NHS lookback review. However, if the review highlights that you suffered avoidable harm, seeking independent legal advice helps you understand your options for pursuing a compensation claim.
Will making a complaint or claim affect my future NHS treatment?
No, taking legal action or submitting a complaint won’t compromise your future healthcare. Healthcare professionals are bound by strict ethical codes of conduct to provide equal, high-quality care to all patients regardless of ongoing legal proceedings.
Is the County Durham breast care review an NHS lookback review?
Yes. County Durham and Darlington NHS Foundation Trust is carrying out a retrospective review, or “look-back”, of breast care following concerns about the safety and quality of its services. The Trust has also agreed to examine earlier years, beginning with patients treated in 2022 and potentially progressing backwards towards 2015.