UKHCA Consultation Response
Duty of Candour Consultation
c/o Jeremy Nolan
Room 2E11
Quarry House
Quarry Hill
Leeds
LS2 7UE
Sent by e-mail to: dutyofcandourconsultation@dh.gsi.gov.uk
28 April 2014
Dear Sirs,
UKHCA consultation response to
“Introducing the Statutory Duty of Candour”
Thank you for the opportunity to respond to the above consultation, which I
have the pleasure to do on behalf of the United Kingdom Homecare
Association (UKHCA).
UKHCA is the national professional association for organisations who provide
care, including nursing care, to people in their own homes. Our mission is
to promote high quality, sustainable care services so that people can
continue to live at home and in their local community. We do this by
campaigning, through leadership and support to social care providers.
The majority of our members in England provide services which are
regulated by the Care Quality Commission, and therefore will be within the
scope of these regulations.
The following paper responds to the questions that Government has asked
within the consultation exercise. Please do not hesitate to contact me if you
require any additional information.
Yours sincerely,
Dominic Carter
Policy Officer, UKHCA
Tel: 0208 661 8188
E-mail: Dominic.carter@ukhca.co.uk
Alternative formats: If you would prefer to receive this letter in another
accessible format, including e-text, ‘clear print’, large print or audio
cassette, please contact us on 020 8288 5291 or accessibility@ukhca.co.uk.
UKHCA, Duty of Candour Consultation response, April 2014.
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United Kingdom Homecare Association (UKHCA) Response to
Department of Health ‘Duty of Candour’ Consultation
Do you have any comments on the Duty of Candour harm
threshold chosen for adult social care?
We broadly agree with the premise of using the existing CQC notification
requirements relating to ‘serious injuries’ as the Duty of Candour harm
threshold for adult social care. Members of UKHCA are already familiar
with the framework that CQC uses for notifications, and we believe that
incorporating this framework into the Duty will help for a smoother and
faster implementation of the Duty.
By linking the harm threshold to existing CQC frameworks, homecare
providers are more likely to proactively adjust to a system they have
some familiarity with.
Nevertheless, providers of homecare would be reassured and feel more
confident to fulfil the requirements of the Duty if further guidance was
produced. That guidance should provide greater clarity on what would
count as a reportable incident, or ‘serious injury’, and would also help to
reduce the number of inappropriate reports, therefore reducing
unnecessary added bureaucracy for the regulator. If the threshold is not
made clearer, providers might feel compelled to act in a cautionary
manner. In turn this may result in CQC having to handle many more
reports than it has the capacity to process.
A statement of intent that makes clear to providers, regulator staff
(including inspectors) and the public, the situations in which a ‘serious
injury’ should be reported will also help to reduce differing viewpoints and
drawn out arguments. It is vital that this information exists, to allow for
consistent decisions to be made when reviewing notifications made.
UKHCA, Duty of Candour Consultation response, April 2014.
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There is also the risk that confusion over the exact definition of the
threshold will lead to providers who are already compliant taking
additional, and unnecessary, action that will go over and above the
requirements of the Duty of Candour to ensure they are compliant. In
addition to costs of time and added bureaucracy, this may have an
adverse effect on the reputation of the organisation and the confidence of
the staff they employ.
A clear definition, including examples of uncertain situations, would also
assist in cases where a number of agencies are involved in providing care
to one individual. With the progression of the integration agenda, we feel
that clarity is very important in assisting each party in a multi-agency
approach understand their responsibilities, especially if they have only had
a limited role to play in the care of that individual. The requirements of
the Duty of Candour need to be included in the coordination and
communication between different agencies.
Do you agree with the requirements to be placed on service
providers under the Duty of Candour?
Members of our Association who wrote to us have agreed that the
requirements to be placed on them as service providers are largely
reasonable. As stated in answer to the first question, above, homecare
providers registered with the Care Quality Commission are already familiar
with the processes expected of them in terms of quality monitoring,
complaints and notification of incidents. Outcomes 16 to 20 of the Care
Quality Commission ‘Essential Standards of Quality and Safety (March,
2010) detail a variety of actions that a provider must take when certain
situations occur. Indeed the Essential Standards outline that CQC expect
to be informed about a wider scope of ‘moderate’ incidents than the
threshold included within the proposed Duty of Candour.
UKHCA, Duty of Candour Consultation response, April 2014.
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We believe that it would make sense to link quite closely the CQC
reporting process expected of homecare providers with the reporting
process under the Duty of Candour. Valuable time and resources may be
lost if providers are required to submit the same information relevant to
an incident through a number of different channels. Instead a more
efficient, streamlined process relating to an incident could ensure more
focus is placed back on the person using a service. We hope that CQC will
consider reviewing the notification reporting process in combined view of
the Essential Standards and Duty of Candour.
In addition to the CQC notification processes, homecare providers are also
familiar with the procedures for bringing incidents to the attention of their
local Safeguarding Adults Board (with the local authority as the lead) or
the Health and Safety Executive. We hope that further work will be done
by the Department of Health in terms of best practice for encouraging
information sharing between the SABs, local authorities and CQC.
As highlighted in the Think Local Act Personal report, ‘The Duty of
Candour – an Adult Social Care Perspective’ (March, 2014), homecare
tends to be less episodic in nature than many aspects of the National
Health Service. Relationships are therefore often built over a longer period
of time, which in itself can promote candour in terms of good practice.
Additionally, with a rapidly growing private market for homecare and a
fiercely contested public sector market, homecare providers are now more
aware than ever that appropriate processes regarding quality need to be
in place and followed to win and retain the business that allows them to
remain operational.
We therefore feel confident that our members, who provide homecare
across England, are well placed to respond successfully to the
requirements placed on them under the Duty of Candour.
There will, however, be challenges for providers to tackle. Training may be
required to help homecare provider staff from top to bottom to
understand what exactly is expected of them, and the actions they should
take if acting under the Duty of Candour. This is likely to be particularly
relevant for Registered Managers, a role that will be vital in leading
homecare organisations’ approach to the Duty.
UKHCA, Duty of Candour Consultation response, April 2014.
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Furthermore, providers will need to redraft and expand current
documentation on policies and procedures to help staff to be fully aware
of what is expected of them under the Duty of Candour. New policies will
also require a certain level of expertise to ensure every aspect is covered.
The Department of Health or CQC may have a key role to play in
developing further guidance that will help providers with their approach to
training and with drafting new policies.
Do you have any views on the costs and benefits associated with
the Duty of Candour as set out in the draft impact assessment?
Our members believe there will be certain non-monetised benefits
associated with a Duty of Candour. Principally it is hoped that the Duty
will help to further develop a transparent culture, where people who use
services are a key part of the conversation of how lessons are learnt from
incidents.
In his review, Professor Bruce Keogh KBE (July 2013, p. 6.) stated that
there is an ‘imbalance that exists around the use of transparency for the
purpose of accountability and blame rather than support and
improvement.’ We believe that the requirements placed on service
providers under the Duty of Candour provide a platform for that balance
to be improved. People who use services and the service providers are
potentially given a greater opportunity in the ‘pursuit of improvement’
(July 2013, p.6.). In addition to leading to a better quality of care, the
culture of the organisation and the policies, procedures and processes that
back that culture up will renew staff confidence from top to bottom that
they are being fully supported in their responsibility to the people who use
their services.
UKHCA, Duty of Candour Consultation response, April 2014.
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Homecare providers also felt that the Duty of Candour may help the
general public to view the sector in a more positive light. Although
incidents are likely to gain greater attention, the legal requirements of the
Duty to then react and improve may reassure their local community that
lessons will be learnt and even better care will ensue. Providers were
aware how highly service users value openness and an apology when
things go wrong, and believe that culture, cemented further by the Duty
of Candour, could strengthen the relationship between providers and the
general public.
Our members told us they felt requirements enshrined in the Duty of
Candour could be important in avoiding escalation of a situation. Prompt
apologies, explanations and plans for further action may reduce the
likelihood of expensive and stressful (for all parties) legal redress.
There are likely to be a series of costs associated with a Duty of Candour,
both monetised and non-monetised, that will affect homecare providers.
Members of UKHCA highlighted that there is an inherent added risk to the
reputation of an organisation that admits to their role in an incident
involving a service user. Members were keen to impress, however, that
this cost was part and parcel of the business environment in which they
operate, and that the safety and wellbeing of their service users was of
paramount importance.
There will be monetised business costs too. These will vary from one
homecare provider to another, depending on the systems and processes
that are already in place. For many organisations changes will need to be
implemented to develop the necessary avenues of support that will allow
staff to be candid. This may be in the shape of developed policies and
procedures, staff training (especially for Registered Managers), and the
production of materials to ensure both staff and service users are fully
informed of changes that are occurring. These costs are unlikely to be a
one off, as continued support will be required. Furthermore it is possible
that if the Duty of Candour creates a great deal more work for CQC, the
additional costs they experience may be passed on to providers through
fee rises.
UKHCA, Duty of Candour Consultation response, April 2014.
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We are concerned that the Department has underestimated the costs of
the Duty of Candour and the potential increases that may result in the
costs of insurance cover. Providers will need to understand how they can
comply with the Duty of Candour, while not admitting legal liability and
incurring increased premiums from their insurer. It is our belief that the
most likely reason for providers failing to comply with the Duty will be fear
of jeopardising their insurance cover.
In addition, where providers either fail to comply with the Duty of
Candour, or admit liability inappropriately, it is possible that insurance
cover for social care providers may increase at a faster rate than would
otherwise have happened.
We strongly urge the Department to consider (1) producing suitable
guidance for providers to accompany the Regulations and (2) to seek the
assistance of the Association of British Insurers in producing such
guidance.
Do you think any of the proposals set out in this consultation
document could have equality impacts for affected persons who
share a protected characteristic, as described above?
No, we believe the proposals set out in this consultation document,
providing they are appropriately followed, would be fair to all provider
staff and people who use homecare services.
United Kingdom Homecare Association Ltd (UKHCA)
Sutton Business Centre
Restmor Way
Wallington
SM6 7AH
Telephone: 020 8661 8188
E-mail: policy@ukhca.co.uk
Website: www.ukhca.co.uk
Twitter: @ukhca
Registered in England. No 3083104
UKHCA, Duty of Candour Consultation response, April 2014.
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