Transcript: Duty of Candour


Iriss hosted a group discussion.

Podcast Episode: Duty of Candour

Category: Social work (general) 

Host(s):


What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.

SM - Stuart Muirhead
JW - Jackie Weston
AK - Alison Kirsty
LG - Lisa Greenan
LK - Linda Kemp

SM Hello and welcome to our discussion around the duty of candour, my name is Stuart Muirhead and I'm a project manager in Iriss. The thinking for this discussion came from being out about in the social services sector, over the last year and getting the feeling that the duty of candour provisions were something that were either well known, or known of and also something that was possibly causing some anxiety or confusion, either that or they weren't on people's radar at all. Last year I was at the Scottish Social Services Expo in Edinburgh and heard a couple of representatives from SSSC talk at a workshop about duty of candour, where it came from, what it means and they presented a few scenarios on the types of situations when it might come into play. So, today we have some representatives from across the sector and I'll let them introduce themselves in a moment. Lisa Greenan is with us from SSSC and she will spend a bit of time talking us through duty of candour to begin with and then we will have more of an open discussion following that. So, first of all, could I ask everyone around the table to introduce themselves and where they're from?

JW My name is Jackie Weston, and I'm the director of care for the Care Concern Group. As a group we have 25 services, care home services up in Scotland.

AK I'm Alison Kirsty from the Coalition of Care and Support Providers in Scotland, better known as CCPS.

LG I'm Lisa Greenan from the Scottish Social Services Council, the SSSC. I am part of the intake and engagement team which is a team within the wider fitness to practice team so we investigate matters relating to fitness to practice of people that are registered people on the SSSC register.

LK And I'm Linda Kemp, I'm an inspection team manager with the Care Inspectorate.

SM Great, thank you all. So, I'll just hand over to Lisa now to get us started and then we can go into a bit of a more informal discussion afterwards. Thanks Lisa.

LG Thanks Stuart, I'm just going to give you a little bit about background to the implementation of the duty of candour legislation and procedure in Scotland and then I'll go through the duty of candour provisions and it's purpose and from there I'll go through the procedure in a bit more detail including who's responsible for the duty, when does the duty apply, and then before going through some of the key stages of the procedure. And then I'll look at what resources are currently available to organisations and their staff to support the successful implementation of the duty and what we would have hoped organisations would have done since the implementation of the legislation, or that they're on their way to doing. And finally, I'll just end with a few key messages about the duty of candour which should then link in with the wider group discussion about how the duty is bedding in and any issues emerging from practice.

So, in terms of the background, the duty of candour was first introduced in England in 2014, that was initially just in health but it was expanded out to adult social care services in 2015. My understanding is of that was driven in part by the findings of the Robert Francis Report, which looked into the significant failures in care which occurred at the Mid Staffordshire Hospital where he found a culture of silence and an attitude amongst staff of "somebody else's problem" so the implementation of the duty in England then fuelled an appetite for a duty of candour to be implemented in Scotland, a number of campaign by various people and organisations drove the Scottish government to start consultations on the matter in 2014 and the government were clear from the beginning that they wanted to introduce an organisational duty of candour in both health and social care services in Scotland. The legislation was given Royal assent in April 2016 and it was then implemented in April 2018. The SSSC, Care Inspectorate and other partners and providers were involved in the Scottish government's strategic implementation group and relevant working groups and all partners were involved in the development of the duty of candour guidance which focuses on the implementation of the duty of candour procedure for all organisations, as I say, that provide health services, care services, or social work services in Scotland. And all partners were also involved in various learning and information events in the months leading up to the implementation and also in the development of learning resources to ensure that health and social care providers fully understood the duty, and what it would mean for them and their staff in practice.

In terms of what the provisions are, so the organisational duty of candour provisions, as I say, that were implemented in April 2018 are laid out in part 2 of the health, tobacco, nicotine, etc. in Care Scotland Act 2016 and the procedures, so the duty of candour procedure Scotland Regulations 2018 are at Section 22 of that Act, the law applies to all health and social care providers in Scotland, including independent contractors, hospitals and all regulated care services, except childminders.

So, just to speak a little bit about the purpose of the provisions, we know that services deliver excellent care on a daily basis and that anyone who works in health and social care shares the same goal and that is to provide high quality care and to ensure the best possible outcomes for people using health and social care services. But sometimes things do go wrong and it's how we deal with those things that's important, how we respond to people who use services, their relatives, or to our own staff can make a huge difference to people's experience of health and social care services. The purpose of the duty of candour provisions therefore is to support the implementation of consistent responses across health and social care providers when there has been an unexpected event or incident that has resulted in death or harm and that is not related to the course of the condition for which the person is receiving care and it comes from a recognition that when adverse events occur during the provision of treatment or care, openness and transparency is fundamental in promoting a culture of learning and continuous improvement in health and social care settings, the duty of candour procedure previsions is about placing people at the heart of health and social care services when harm occurs, the focus must be on personal contact with those affected and that is support and a process of review and action that's meaningful and informed by the principles as a say of learning and continuous improvement and this is where the duty of candour differs a little from well established, already in place forms of incident reporting, not just in relation to the type of harm that we're looking at and we'll look at that a little bit later on, but it's also about placing a legal statutory duty to be open and to take steps to learn from what has happened. In the other way that it differs as well is that there is an organisational emphasis on staff support and training to ensure effective implementation of the organisational duty. We know that staff must feel that they have the necessary skills and confidence if they're able to be meaningfully involved in the delivery of the duty of candour procedure and this is support that is provided in terms of them knowing what the procedure is and how it works and everything but also support afterwards where an incident may have occurred and I'll speak a little bit more about that as well.

So, in terms of who's responsible in relation to the duty, the statutory duty is placed on organisations within health and social care. Within the legislation, relevant health and social care services are described as the responsible person, so in this, the responsible person is therefore not an individual but the organisation or provider. Duty of candour doesn't apply to individuals, although it is, just to note, that most of the regulated health and care professions have a professional duty of candour outlined by their regulator and whilst the SSSC does not directly stipulate a duty of candour, the co 3.6 does lay out the responsibility for social service workers to be open and honest when harm has been caused. Organisations need to decide themselves who is responsible for taking the lead on this work and I'd be interested to hear how that has worked in practice since implementation and individuals as I said earlier, do need to understand and be familiar with what the duty of candour means in practice for it to work properly.

So, when does the duty apply? It applies when in the reasonable opinion of a registered health professional, there has been an incident that has resulted in an unintended or unexpected harm to an individual, receiving a health or care service. And as I said, I'll speak a little bit more about what we mean or what the legislation means by harm, in a second. The registered health professional should confirm that the activation of the duty of candour procedure is necessary and it's important that that health professional hasn't been involved in the actual incident, and the procedure start day is the day that the organisation receives confirmation from the health professional that the duty of candour procedure should be activated. It's important to not that the duty of candour procedure should be activated for incidents that the responsible person becomes aware of after first of April 2018, so in that for example, after that date if the responsible person has become aware of an unexpected psychological harm for example, that occurred because of care provided to a relevant person in say, 2015, the duty of candour procedure should be activated. I won't say too much more about that, that the specific considerations that responsible persons will need to consider is outlined clearly in organisational duty of candour guidance.

So, let's chat a little bit more about what we mean by harm. As I said earlier, the definition of harm is really specific in the provisions and is probably one of the things that makes this duty different to other incident reporting duties and procedures already in place and well established in health and social care. The legislation defines harm, and I will list these just so that people are quite clear, so the harm is defined as death of a person, a permanent lessening of bodily functions, that could be sensory, motor, physiologic, or intellectual, changes to the structure of a person's body, loss of a limb for example, or harm that has triggered an increase in the person's treatment, or that has led to that person requiring treatment in order to either prevent the death of the person or to prevent any injury to the person, which left untreated would result in any of the types of harm listed, also it lists the shortening of the life expectancy of the person, if that harm has caused that and then the next 2 are, when I say that the harm is clear in the legislation this is maybe where there is a bit more of a judgement made by the health professionals, so an impairment of the sensory, motor or intellectual functions of the person which has lasted or is likely to last for a continuous period of at least 28 days, or pain or psychological harm which has been or is likely to be experienced by the person for a continuous period of at least 28 days and yeah, again it would be interesting to see how the health professionals are finding that and those definitions.

So, just to go on and speak a little bit about the key stages of the procedure, again these are laid out pretty clearly in the procedure and there's more information in the duty of candour guidance about it. The key stages really are, so the first stage is that you notify the person affected, so that is either the person that has been harmed or if appropriate, their family or relative. And they're notified that unintended or unexpected harm has been caused, I'm not sure if I said this, but they're referred to as the relevant person in the legislation, and absolutely key to this is to, as soon as possible to provide an apology and I'll say a little bit more about that in a second. And the next stage is to carry out a review of the circumstances which led to the incident and part of that is to offer a face to face meeting with the person affected or again, their family, and to provide the person affected with an honest account of the incident and also to provide information about any further steps taken or plans to take certain steps. And importantly to make available or to provide information about support which is available to the people who have been affected by this incident.

And the final bit of the procedure is about preparing and publishing an annual report on the duty of candour, which again I'll say a bit about in a second, the timescales for all those key stages of the procedure are laid out in the procedure itself, in the regulations, and so I won't say too much more about that just now.

So, in terms of apology, apologising is central to the duty of candour and it's laid out in section 23 of the act and that's what it states that an apology means a statement of sorrow or regret in respect of the unintended or unexpected incident and it's acknowledgment that harm has been caused and that the person affected or their family may be experiencing difficult emotions because of this. And we know from research and previous incidents and lots of learning from case reviews that a meaningful apology can help to calm a person who's become angry or upset and we know that most people just want an acknowledgement and an understanding of what went wrong, and to know what will be done by the service to ensure it doesn't happen again. And the guidance lays out in more detail about what a meaningful apology is and that might be something we can discuss later. And the critical thing for services and staff to remember is that an apology does not of itself amount to an admission or reliability of negligence or a breach of a statutory duty but we know that historically some services may have been concerned about this but we do hope that the culture might be changing around that.

The other part of the procedure I mentioned was the review, so just to speak a little bit more about that in terms of how that works, so the responsible person must carry out a review of the circumstances which it considers led or contributed to the incident, if this isn't completed within 3 months, an explanation must be provided to the relevant person and the relevant persons, and this is key, they're views must be sought and taken account of as part of the review. And a written report of the review should be provided and should include, a description of the manner in which the review was carried out, a statement of any actions to be taken by the responsible person to improve the quality of the service and to share learning with other persons or organisations, and again that's key around the underlying ethos about learning from these incidents and sharing that learning, and a list of actions taken in accordance with the duty of candour and the date each action was taken. And the relevant person should always be offered a copy of the written report and any further information about the actions taken for the purposes, again of improving the quality of the service. And just finally a little thing on the annual report, so all organisations must publish and annual report, and that must show the number and nature of duty of candour incidents throughout the year, an assessment of how the duty was carried out and any changes made to policies or anything else as a result of the incidents. It's not a report for each incident and it is ultimately about reporting on how successfully the duty has been implemented, and again any learning and changes that have come as a result and we're not quite at the end of the first year of implementation, as I say it was implemented in April 2018, so it will be interesting to see what is reported by organisations and any learning that has come from this.

So, just to move on to resources that are available for organisations and staff to allow them to better understand the duty of candour and any supports that need to ensure they're implementing it. So, I mentioned earlier that there is an organisational emphasis on staff support and training to ensure effective implementation of the duty, we know that staff must feel that they have the necessary skills and confidence if they're to be meaningfully involved in the delivery of the duty. So, one of the main things that's available and has been since the implementation is the e-learning module, that was developed jointly by NHS Education for Scotland, SSSC, Care Inspectorate and Health Improvement Scotland, we would expect and hope that organisations are actively encouraging their staff to complete the module which takes no longer than an hour, I've done it myself so that's true. The e-learning module includes case studies and scenario-based videos, a knowledge check exercises and prompts to check local procedures and it's really good. The other thing that's available is direct on the Scottish government website, so they have a dedicated duty of candour page which includes links to all relevant documents so, the legislation, procedure, guidance as well as information on awareness raising materials including fact sheets and the fact sheets are really straight forward and really helpful. There's also a helpful frequently asked questions section which again, appears to cover lots of bases and is really helpful and one of the newer resources that has now been developed is the train the trainers pack and that's due to be piloted imminently, this training will be for staff within organisations to be able to train their own staff in the duty of candour legislation and procedure, my understanding is the training is due to be rolled out in the coming months so, that's another helpful resource.

In terms of what we would have hoped or we hope that organisations have done or doing since implementation, so we hope that they understand or are on their way to understanding how ready they are to respond to the new duty and that is individually, within teams and also organisation wide, that they have or are on their way to aligning the duty of candour with existing reporting or recording incident processes and procedures. That they've considered who are the right people with the right skills to lead on the duty within their team or their organisation and that they have engaged themselves with training materials and events that they also ensure that relevant staff have all they need to implement their duty correctly and meaningfully and I would imagine all of that's a bit work in progress.

Just finally, just to end on a few key messages and just to summarise some of what I've said, so the duty of candour is about developing and building on a culture of openness, transparency and learning, it should compliment other already established forms of incident reporting and should not be something that staff or organisations are scared of or nor should it be an additional and bureaucratic process. Duty of candour is underpinned by the understanding that how we respond to incidents of unintended or unexpected harm will make a huge difference to people's experience and it stipulates that we have a duty to acknowledge honestly when something has gone wrong, to offer a meaningful apology and to take appropriate steps in order to learn from the incident so that it does not happen again and that's the key. And when this is done promptly and fully, we know that it can help people cope better with the after-effects of the incident and help to build trust. And the approach expected of organisations within the duty of candour should also be one of help and support for staff involved in such incidents rather than blame, for this to work we know that staff need to feel confident that they'll be safe and supported to report duty of candour incidents so that again, lessons are learned and shared in order to improve and increase the safety of our care system for everyone. Finally it is really early days since the implementation of the legislation, it might be the following review of how it has bedded in that more work is needed to ensure that organisations fully understand their duties and what it means in practice, and it will be really interesting to see what emerges in the coming months.

SM Thank you very much Lisa, that's brilliant you were able to, in pretty much 15 minutes, summarise something that is so large, complex and has so many different facets to it. I mean even as you were talking through the background to it, the wee bit of the English perspective, where it came from and health and then you're talking through definitions and process and summary and I really liked that when you get to the summary bit, you've been talking through a lot on relevant person and responsible people and organisational but the kind of message of the idea is that actually you feel safe in being able to give that apology, it's for the person, for people that care for them, it's meant to be getting towards that, even though behind it is all this language and act and provisions and everything else, it actually needs to work in place and go towards doing some of that. So, thank you very much for being able to outline for us, hopefully folk listening found that really useful as well as highlighting some of those resources, as well as what's coming up. Is the train the trainers pack going to be released at some point in the nearest future?

LG Yes, uh huh.

SM Is that the idea?

LG My understanding is that it's being piloted at the moment ...

SM Right.

LG ... imminently, I think, in the next month or so and then it should then be rolled out in the next few months, hopefully.

SM Great.

LG And in terms of the pack being available, I'm not sure but it's ... well it certainly will be available to the people that need to have it and need to be trained ...

SM Great.

LG ... in it.

SM Great, it was just in case it was anything that we highlight up there or put a link up along with other resources but I guess folk can either keep an eye on that from their own organisations or look at SSSC for that so, thank you very much. So, I think it might be useful now if folk would like to make a comment on what we've just heard from Lisa, if you've got any key message or question that you've taken from some of that. I've certainly being taking down a few notes and a few thoughts on there from some of our perspective.

LK It might be helpful just to say that in next years annual return, the 2020 return, the Care Inspectorate will be asking services to confirm that they've complied with the requirement to provide a duty of candour report, we may well not ask for it, we won't ask services to submit it but we will want to know that they've produced a report about duty of candour. There's also training available for staff on the Care Inspectorate website, it's probably the same link to the e-learning that you were talking about, and that is suitable for all social care and health staff. It may well be, you know that when your service is getting inspected, the inspector might want to see evidence that you are working towards having, you know, a process and a procedure in place to meet the duty of candour requirements. They may well, you know, ask staff about their knowledge of it, their awareness of it and what not.

JW Can I just follow up on that with a question because I've ...

LK Yeah.

JW ... been preparing my services for the possibility of looking at a report on the back of April 2019's information.

LK That's right, yeah.

JW So, that's still applicable, for this year, this coming year, for April 2019?

LK Yeah you should ... uh huh, for the year 2019, and then we'll be asking the question, when we ask you to submit your annual return in 2020. I suppose, you know, from the Care Inspectorate's view and you know, we don't only inspect services, we also deal with a significant amount of complaints every year and people, I think, underestimate the power of apology. You know, the power of if you acknowledge something, you know when someone expresses a concern or raises a complaint with you, that initial acknowledgement and that initial apology can actually go a long, long way to resolving issues and can actually prevent complaints in coming to us. A lot of complainants that we deal with, are dissatisfied by the way that, you know, concerns have been acknowledged by care services and that is why in turn they come to us. Certainly, talking to providers and staff in the sector about duty of candour, some people are still quite anxious that by offering an apology, you're sort of putting your hands up and saying, "I'm liable, I'm guilty." And we all know from what you've talked about this morning, that is not the case.

JW Certainly that's been our experience and one of our services, more recently over the kind of Christmas period unfortunately 3 residents suffered major fractures of limbs and they thought that they had very good relationships with the family members of the residents affected but what was really positive was that as part of their duty of candour, they issued a written letter, first and foremost, and what was really positive was what the families had communicated back, to say, "Do you know, we didn't expect the letter, but that was really lovely of you." So, it was really positive feedback that they had received on the back of ...

LK Yeah.

JW ... issuing the letter in the first instance which was really helpful for us then to kind of share as a group, I think. I support 8 services, so that's 450 residents in care homes across the country, from a provider point of view I think it will be very interesting for us, we're kind of leading up to that at the moment and I'll be honest, I don't think enough reflective discussion happens in services, that's been my experience and often it's got to be prompted after there have been any incidents and accidents. ESP's ...

LK Yeah.

JW ... all of which or some of which can be duty of candour, so I think that's certainly a focus for our organisation and it's how we consider, as an organisation, as a large organisation, how we collate all this information.

LK Uh huh.

JW And consider on what form of published report that's going to take and I think that's something that we'd be looking for our relevant professionals to be offering a bit more support and advice on.

LK I think you're correct in that respect, Jackie, in there are certain accidents, incidents and events that you know, you're required to report to the Care Inspectorate and we do ask, on the notification now, you know, has this invoked, you know, duty of candour procedures. I think a lot of people still aren't quite clear about that, so we get a lot of false yes's and we also get other that, yeah, it should have but it's not. And I think in terms of the information that we get on notifications, it's usually of really quality, explaining what's happened, how it was managed but what it lacks is "what have we learned from this? What are we now doing? What are the next steps to minimise the risk of this happening again and to make and sustain improvements?" and I'm hoping the duty of candour will help to deliver this.

AK Just going back to what you said about, you know, has this incident triggered the duty of candour? And that's, I'm involved in it as a representative organisation, not as someone who has to report on it, but the feedback that I've got from the few providers that have considered it have been because of the severity of the incident, there has been this assumption that this will trigger the duty of candour. When in actual fact, it's based on harm.

LK Uh huh, that's right.

AK And it's trying to get providers to think, even though this might be disciplinary, it won't necessarily be duty of candour.

LK Yeah, exactly.

LG Yeah, I think that's the slight shift, particularly in social care, I think, where when you are reporting on something it may well be that you're making your own assessment on of harm caused, whereas actually the legislation in duty of candour is, largely really specific in terms of what harm was caused ... LK Yeah.

LG ... and so it's maybe just going to take a bit of time for people to get their head's round that.

LK That's right.

JW I think to prepare for it, what we've had to do as an organisation is look at some of the best practice tools that we're currently using and thankfully they're in editable format so that we can put in amendments that offers that prompt as to whether or not it's a duty of candour, particularly post-false tools that we can use so that when managers are looking at a monthly analysis and they've got that data there for when they are collecting their information 12 months later to help inform a published report so there's various additions that we've made to various best practice tools in order to be able to just prompt that though process when managers tend to go round a route of, you know, when there's a major incident or an accident then they know who they've to report to but the duty of candour tends to be the kind of last thought really just because they're not used to it so there has to be that prompt, we've certainly found that very helpful.

LK Yeah, whereas the duty of candour and the apology should be the first thing they do. You know, we don't wait until an investigation or whatever has been carried out. And we're finding that, again, services often leave it quite a while to feedback to people, not only in relation to duty of candour but in relation to accidents and incidents and you know that sometimes is why people will come to us because they feel it's not been dealt with quick enough or they've been promised an outcome from an investigation and hey, 6/8 weeks down the line, that they still haven't heard anything so, I would emphasise to staff that, you know the apology needs to take place right away, it does not wait until you've undertaken any investigation or review into the incident.

JW I think what's interesting with the guidance is that there is not any set, there's no guidance by way of timescales so, there isn't that and perhaps that's something I need to consider as working with a provider as to how we further prompt that for individuals, you know for some learning for us more recently with an incident was that we are still 5 months on waiting a report form the HSE. I think that report would help conclude that matter for that affected resident and family but as such 5 months on, there's only so much information that you can provide until you get that information back and I think there's been a delay throughout that 5 months process, it would be for up to me to support that particular service to look at what was appropriate by way of regular updates and for that, so that's even today that's given me further food for thought.

LK Yeah.

LG I suppose key to that is what you're saying, is just keep communicating as far as you can and keep that dialogue going and if that apology has been made in the early stages then hopefully families or the person affected, you've already been able to build that trust and hopefully that relationship is still okay even if things are going on longer than you would have hoped but that's maybe an ideal world and the things are just, yeah, going to take a bit of time to get used to the new process.

LK I'm interested in the focus that the legislation has on supporting staff and I wonder what we can all do to help shift the blame culture that often exists in services because if that culture's there, people are not going to be open and transparent.

AK I think it's important that we continue as regulators or like myself that we continue to encourage providers to ensure that the staff have done the e-learning and I think that the more people on the frontline who have an awareness of this, and particularly as the Care Inspectorate start to ask what their knowledge is and their understanding, I think that will help to shift some of the culture, if the frontline staff are fully involved ...

LK Uh huh.

AK ... as well us, at senior management.

JW Yeah, absolutely.

LG It has to come from both sides, doesn't it?

LK Yeah.

AK Yeah.

LK And I suppose, you know that the duty of candour actively encourages the responsible person to involve staff fully and I think that will help to shift the culture as well a bit and also to fully engage with them when they're thinking about their development plans and improvement plans.

LG Yeah, so almost from the get go with staff, new staff are being part of induction and actually this is a little bit, the ideas behind this are not new in terms of ...

LK No.

LG ... openness and as I said, it's in the codes of the SSSC, it's in the codes or standards for most other regulators, both in health and social care so the ideas behind it are not new but yeah, there's maybe a shift in culture needed away from that fear and as you say blame as well.

SM Cos I can imagine it must feel quite exposing to give an apology but also to give it in that written form and do it quite quickly, I mean I could understand wanting to wait a wee bit longer to make sure you've got everything right in there, that would be my, probably, first reaction thinking, "Okay, I can verbally apologise but I need to get this right to be able to make sure." But that's not where this is wanting to go to with that. My other thought from what you mentioned Jackie there was about, if an organisation already has processes in place where they have reflective practice whether that's folded through supervision or leadership or induction or all these things then you feel as if this could get slotted in more, into those types of discussion, that culture of openness and then that ability to react to any of this, is a lot easier to do than if you're having to build that up from underneath and it's not already existing. And certainly when we have conversations with organisations and we will start talking about what ever subject area it is, most recently supervision, when you go in and you say, you ask about why they do something, why it's there and it can open up a can of worms, around they're like, "Oh, actually maybe we don't do this as well as we have." Or not the whole organisation's not coming along with this so, there's little pockets in here so, it's really interesting hearing how that fits amongst something else coming in there and it not necessarily being that add on but it's something that is just part of the rest of the discussion that goes on.

The other thing that when I first read this and it was interesting to hear you present it again, Lisa, was when it's written down and the responsible person isn't a person, it's an organisation or a provider and it's not an individual responsibility. I think even with that language, you need to go over that barrier to think actually this apology isn't from Steve or Ann, this apology is from that organisation or that service so, that took me a little while to get beyond that and I can imagine for somebody, hopefully, going through some of that e-learning module and training would get them into that space but you have to go a wee bit beyond that to think, "Oh, this isn't just on me or on somebody that I would be reporting as a health professional." So, I think there's, underneath all of this, there is still trying to get people to take on some of that trust in it and trust in each other to be able to get to the point that this becomes normal and part of the good practice, caring practice that we're hoping to get towards.

AK Can I just go back to something that you said, Lisa, about sharing your learning from incidents?

LG Uh huh.

AK Did you mean that this would be information that would be shared within organisations or would there be some focal point to share?

LG Central operations.

AK (... unclear)

LG Yeah, so I don't know Care Inspectorate might be better to answer that but my understanding is that yes, it's sharing the learning within their own organisation cos ultimately, it's about reducing the risk of that happening again within that organisation. But I don't know if that is information that then goes, is shared elsewhere, I don't know.

LK I don't think it's been agreed yet, we're still working with Scottish government on this in that respect to decide how we're going to use the information but certainly we would encourage organisations to share their learning. You know Jackie, you're saying you've got 8 care homes in Scotland or whatever so we would want to see any learning shared across all your teams and that's a real strength. If we're in regulating and we're looking at quality assurance, management and leadership, and if we see evidence of that, we'd look on that as being a strength.

AK It's also another way of just reassuring people and increasing their confidence that duty of candour is about supporting learning.

LK Yeah, it's not about blame and that's where I think a lot of organisations, actually need to make that shift.

JW And it helps you look at risk, you know if you're sharing it, within our services we share it as a bigger group, 4 times a year when we're sitting down with managers meetings and we've now got a head of health and safety so, that's a real focus and that sharing and that learning allows you then to go back to your service to be saying, "This at any point could happen at my service."

LK Absolutely.

JW "And what do I need to look at by way of level of risk." And that's been very, very helpful.

LG Yeah cos only good can come from, as they understand there may well be fears and around it but actually only good can come from looking into incidents and understanding them better and also not seeing it as, everyone said, not just sort of incidents on their own that don't link up to anything else, they may well be isolated incidents but actually a lot of the time there are other reasons that we need to learn from what's happened so that it's not just, you know it could just be one person's error but also it could be that actually there's been other things that have impacted on that and this opportunity to reflect and look into things in a bit more detail and then, yeah, link it to other people and share that.

LK Absolutely.

LG Which then, hopefully, in the longer term should reduce the risk.

LK Yeah because as you say, it's not always a human factor, it's often the process or the procedure and you know this should offer an opportunity to review that. Lisa, colleagues have asked me for some clarity about the registered health professional, who is that? We kind of think, it's say in care homes for example, it's most likely to be like the visiting GP or if someone's in secondary care, it would be someone in hospital, but what about care at home and housing support and those types of services?

LG Yes, so I think this is still an area that isn't that clear and not to speak for health but there may be challenges for them in that but that is that my understanding is that where there is a registered health professional as linked to that organisation, it is that person providing that they've not been part of the incident that's caused harm and that if there isn't one then it is their GP that is linked to that individual. How that's working in practice, I don't know and that's probably for future review.

LK Yeah, it's early days ...

LG And see what comes.

LK ... yet, isn't it?

LG Yeah, yeah.

SM I think that's important though, because I think there would always be in your mind then if it is would just have been that person, then it's easy for something to be hidden but there's lots of things outside the duty of candour, hopefully, that would capture that organisationally within care but with that, almost that, it seems like a more powerful term, registered health professional, it sets up a hierarchy off it so it will be interesting to see how that comes through and how people are able to report on that and fold that in and see if that's something that does have a need revisited or there needs to be more help with how that's understood and how that actually works out.

LG I mean again, we don't have a health representative here but just from reading around it that I think there had been some anxiety potentially from ... or potentially that there was anxiety from health side because they're likely to have more incidents and be more involved because of the nature of the harm that is stipulated in the legislation so, it will be interesting to see if there has been a lot of, if the numbers do match up and if that does still cause anxiety and increased work load or if in fact actually, it's been okay and they've managed it okay cos the nature of it is so specific it then actually, maybe the numbers aren't going to be as big as maybe people initially thought, either health or social care.

LK Yeah, we don't anticipate huge numbers of events in social care, I think as you said at the start, Lisa, most services do provide a very good standard of care.

AK One of the issues that was not just from the voluntary sector but during the implementation was about, what if an incident, you as a social care organisation perhaps, in care at home, and you discovered the incident, and the concern was, well who would be responsible for it if it didn't happen during your service, who would be responsible, who would trigger the duty of candour? You know all of those concerns, so it will be interesting to see if anything, now that the duty is implemented, it will be interesting to see if things do happen in the community where the origin of the incident was not in a community and how that's managed by both health and social care.

LK And particularly now when some people are having their care packages provided by multiple providers yeah, it's complex.

JW Yeah, even I was thinking when you were, you know when you were doing your presentation, about when providers take over new services and then historic claims arise and then that duty to report and that's something that I don't think as an organisation, we've actually fed into our policy and procedure for home so I think that's something, certainly to think about.

LG Yeah, it will be interesting to see how that works cos the way its laid out is that, yeah, if you hear about something that happened a few years ago, it's as soon as you, as the responsible person, so it's that organisation at that time, as soon as they become aware of it then they should trigger the duty of candour but yeah the complexities around who would be responsible. I suppose ultimately, and I could be wrong with this but the triggering the duty of candour doesn't necessarily mean that they themselves are, they're taking responsibility for the fact that harm has been caused at some point and I suppose the process of looking into that and reviewing that and that there could still be learning from that I suppose but yeah time will tell in terms of how that works.

SM Thank you everyone, is there anything before we round up that anybody would like to add, that's outlying? Any thoughts from themselves or any questions?

JW No just that our discussions today have prompted further review for us certainly as an organisation, so that's been particularly helpful, thank you.

SM Great, well hopefully people listening will have had similar thoughts and thank you all very much for coming along and sharing those thoughts. Lisa, thank you for doing that introduction for us and getting us all sorted. Thanks.


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