Intended for healthcare professionals

Observations Duty of Candour

The hardest word: managers and leaders should say sorry too

BMJ 2015; 351 doi: (Published 03 July 2015) Cite this as: BMJ 2015;351:h3644
  1. David Oliver, president, British Geriatrics Society, and visiting fellow, King’s Fund
  1. d.oliver{at}

Doctors, nurses, and midwives have been told to apologise when at fault—but so too should organisational chiefs, including the health secretary

The two inquiries of Robert Francis QC into the unacceptable failings in care at Mid Staffordshire NHS Foundation Trust have had far reaching implications, for hospitals in particular.1 2 3 4 Since Francis’s recommendations on “transparency,” hospitals publish far more information on complaints, feedback, safety incidents, staffing numbers, who the staff are, and how to contact them.

For frontline clinical staff one big change concerns the “duty of candour,” requiring them to be open and honest about mistakes.5 Anyone who has investigated or tried to resolve complaints that have escalated or become litigious knows that in many cases they wouldn’t have reached such a stage if only staff had communicated openly and early, answered questions, and offered apologies when at fault. Yet too often complainants think that they’re facing a closed and defensive culture.6

Openness and honesty

In June 2015 the professional regulators the General Medical Council and the Nursing and Midwifery Council issued joint guidance setting out what a duty of …

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