Blog · Regulation 20

Duty of candour in adult social care: what Regulation 20 asks of you

Most services can quote the duty of candour. Far fewer can show an inspector the conversation, the apology, the written follow-up and the learning, all linked to one incident. This guide sets out the thresholds, the steps in order, and the evidence that closes the loop.

Who the duty applies to

Regulation 20 applies to all CQC-registered providers carrying on a regulated activity in England — care homes, home care and supported living included. There is also a professional duty of candour on registered nurses and other regulated professionals through their regulators, which sits alongside the organisational duty rather than replacing it.

The duty is owed to the 'relevant person': the person who received the care, or someone lawfully acting on their behalf where the person has died, is under 16, or lacks the capacity to receive the information.

The harm thresholds

Death — where the incident, rather than the natural course of an illness or condition, caused or is thought to have caused the death.
Severe harm — permanent lessening of bodily, sensory, motor, intellectual or social functions.
Moderate harm — harm requiring a moderate increase in treatment, or significant but not permanent harm.
Prolonged psychological harm — psychological harm the person has experienced, or is likely to experience, for a continuous period of at least 28 days.
The test is the reasonable opinion of a health care professional, so record whose opinion you relied on and when.

The steps, in the order Regulation 20 expects

Tell the relevant person in person as soon as reasonably practicable after becoming aware of the incident.
Give an account of all the facts you know at that point — do not wait for a complete investigation.
Explain what further enquiries you believe are appropriate.
Apologise, in words, for what happened.
Keep a written record of the conversation, including who was present and what was said.
Follow up in writing, repeating the account, the apology, the enquiries and their results, and keep a copy.
Keep a secure written record of all correspondence, including attempts to make contact that were unsuccessful.

Having the conversation well

Families judge candour by the first ten minutes, and so do assessors when they read your record of it. Agree who leads the conversation before you make the call, and make sure that person has the facts.

Say what happened plainly, without clinical euphemism or blame language.
Apologise early in the conversation, not at the end after a defence of the service.
Be explicit about what you do not yet know and when you will come back.
Offer a named contact and a realistic timescale.
Ask what the person or family wants to happen next, and record it.
Consider communication needs and use interpreters or accessible formats where required.

The records CQC looks for

An incident record with the harm level assessed and the professional opinion behind it.
A candour log linking each notifiable safety incident to the conversation date, the letter date and the outcome.
The follow-up letter itself, with the apology and the findings.
The related CQC statutory notification and safeguarding referral, where applicable.
Evidence of learning: changes to care plans, risk assessments, training, supervision or the way the service is run.
Governance minutes showing candour cases are reviewed for themes, not just closed individually.

Where services usually fall short

A verbal conversation with no written follow-up — the commonest breach.
Applying the duty only to the most severe incidents and missing moderate or prolonged psychological harm.
A defensive letter that explains but never apologises.
Nothing recorded when the family could not be reached.
A policy that names the duty but no staff who can describe what they would actually do.

Common questions

What is the duty of candour?

The duty of candour is a legal requirement to be open and honest with people when something goes wrong with their care. For CQC-registered providers in England it sits in Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and it applies to every registered provider, not just the NHS.

What counts as a notifiable safety incident?

An unintended or unexpected incident during care that, in the reasonable opinion of a health care professional, could result in — or appears to have resulted in — death, severe harm, moderate harm, or prolonged psychological harm lasting or likely to last at least 28 days. Prolonged psychological harm is the threshold managers most often overlook.

Is the duty of candour the same as a CQC notification?

No. The duty of candour is owed to the person and their family. A statutory notification is owed to CQC. Many incidents trigger both, plus a safeguarding referral, and each has its own record.

Does saying sorry admit liability?

An apology is an expression of sorrow or regret about what happened, and Regulation 20 requires one. It is not an admission of legal liability, and both CQC and NHS Resolution have been clear that providers should apologise.

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