Quick answer: The duty of candour is the legal and professional obligation to be open and honest with people when something goes wrong with their care. In England, the statutory duty — Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 — requires CQC-registered providers to tell the person affected, apologise, offer support and follow up in writing after a notifiable safety incident.
If you work in care — or you're studying towards a care qualification — the duty of candour appears in inductions, interviews, inspections and exams. It's also widely misunderstood: people confuse it with the duty of care, think an apology is an admission of liability, or don't know which incidents trigger it. Here's the whole picture in plain English.
What does duty of candour mean?
Candour means openness and honesty. In health and social care the duty of candour has two layers:
- The professional duty — every registered health and care professional must be open and honest with patients when something goes wrong. This is set out in joint guidance from professional regulators (the NMC and GMC publish it jointly) and applies to individuals: nurses, doctors, paramedics, social workers and others, wherever they work.
- The statutory duty — a legal requirement on organisations (not individuals) registered with the Care Quality Commission in England, under Regulation 20. It applies to hospitals, GP practices, care homes, domiciliary care agencies — every CQC-registered provider — and is enforceable: breaching parts of Regulation 20 is a criminal offence the CQC can prosecute.
Scotland and Wales have their own organisational duties (Scotland's came into force in 2018, Wales's in 2023), so the principle now applies UK-wide even though the exact rules differ.
When does the statutory duty of candour apply?
The organisational duty is triggered by a notifiable safety incident — an unintended or unexpected incident during care that, in the reasonable opinion of a healthcare professional, has caused or could cause:
| Harm level | What it covers (in outline) |
|---|---|
| Death | Where the incident (not the underlying illness) caused or contributed to it |
| Severe harm | Permanent lessening of bodily, sensory, motor, physiological or intellectual function |
| Moderate harm | Significant but not permanent harm, or harm needing a moderate increase in treatment (e.g. an unplanned return to surgery, extended hospital stay) |
| Prolonged psychological harm | Psychological harm experienced, or likely to be experienced, for a continuous period of at least 28 days |
Two things trip people up. First, the duty applies to incidents in the delivery of care, not to expected complications or the natural course of an illness. Second, general candour applies even below the threshold: being open about smaller mistakes is expected professional behaviour — the formal Regulation 20 procedure is what the threshold switches on.
What must a provider actually do?
Once an incident meets the threshold, Regulation 20 requires a specific sequence:
- Tell the person (or their representative) face to face, as soon as reasonably practicable after the incident is identified.
- Give a true account of everything known at that point — no minimising, no waiting for the investigation to finish before saying anything.
- Apologise. The regulation explicitly requires an apology — and an apology is not an admission of legal liability. This is the single most important myth to kill: saying sorry is required, protected and right.
- Explain what happens next — what will be investigated and how the person will be kept informed.
- Offer reasonable support — practical and emotional, from a named contact to signposting counselling or advocacy.
- Follow up in writing, recording the conversation, the account given, the apology and the investigation plan, and share findings when the investigation concludes.
- Keep records of it all — CQC inspectors ask for the paper trail.
What's the difference between duty of candour and duty of care?
They're related but distinct, and interviewers love the question:
- Duty of care is the ongoing obligation to act in a person's best interests and keep them safe from harm — it applies all the time, to every worker, before anything goes wrong.
- Duty of candour is what kicks in when something has gone wrong — the obligation to be open about it.
A useful way to remember it: duty of care aims to prevent the incident; duty of candour governs your honesty about the incident. Both sit alongside safeguarding (protecting people from abuse and neglect — see our safeguarding training levels guide) and the principles of person-centred care as the ethical core of care work.
What happens if a provider breaches the duty of candour?
The CQC can and does act. Failing to notify the person and give the account/apology required is a criminal offence, and the CQC has prosecuted NHS trusts and issued fixed penalty notices for breaches. Beyond prosecution, candour failures feed directly into inspection ratings under the well-led and safe key questions, and repeated failures signal a closed culture — one of the CQC's biggest red flags. For individual professionals, dishonesty after an incident is treated by regulators (NMC, GMC, HCPC) as among the most serious misconduct there is — typically worse for a career than the original mistake.
How is duty of candour covered in care qualifications?
Candour, duty of care and safeguarding thread through every regulated care qualification. In the Level 3 Diploma in Adult Care they appear in the duty-of-care and safeguarding units; in the Level 5 Diploma in Leadership and Management for Adult Care you study them from the manager's side — building the open culture, running the Regulation 20 procedure and evidencing it for the CQC. Both are studied fully online at Lift College on a monthly subscription, starting with a 7-day free trial.
For the day-to-day skills behind candour conversations — honest communication, record-keeping, supporting distressed people — our Care Certificate guide covers where new care workers start.
Lift College's health and social care qualifications — from Level 3 to the Level 5 leadership diploma — are Ofqual-regulated and studied 100% online on one monthly subscription, with a 7-day free trial.
Author: Lift College Editorial Team