Duty of Candour in the NHS: What Hospitals Must Tell You

What is the statutory duty of candour?

The general duty in Regulation 20(1) is to act in an open and transparent way with the patient, or the person lawfully acting for them, about the care and treatment provided. The more specific steps below are triggered when a "notifiable safety incident" occurs.

What counts as a notifiable safety incident?

For an NHS body, the regulation defines it as any unintended or unexpected incident during a regulated activity that, in the reasonable opinion of a health care professional, could result in, or appears to have resulted in:

• the death of the patient, where the death relates directly to the incident rather than to the natural course of their illness or condition; or
• severe harm, meaning a permanent lessening of bodily, sensory, motor, physiologic or intellectual functions that is directly related to the incident;
• moderate harm, meaning harm that requires a moderate increase in treatment (for example an unplanned return to surgery, an unplanned re-admission, a prolonged episode of care, or transfer to intensive care) and is significant but not permanent; or
• prolonged psychological harm, meaning psychological harm experienced, or likely to be experienced, for a continuous period of at least 28 days.

For other registered providers the regulation uses a different list of outcomes, including impairment lasting at least 28 days, changes to the structure of the body, prolonged pain, and shortened life expectancy. The text of Regulation 20(8) and (9) sets out both definitions.

What must the provider do?

Once the provider becomes aware that a notifiable safety incident has occurred, Regulation 20 requires it, as soon as reasonably practicable, to:

1. notify the relevant person that the incident has occurred, in person, through one or more representatives of the provider;
2. give an account, true to the best of its knowledge, of all the facts it knows about the incident at that date;
3. explain what further enquiries it believes are appropriate;
4. include an apology, defined as an expression of sorrow or regret about the incident;
5. keep a secure written record of the notification;
6. provide reasonable support to the relevant person; and
7. follow the meeting with a written notification containing the facts, details of the enquiries, the results of those enquiries once known, and a further apology.

If the person cannot be contacted or declines to speak to the provider, these steps do not apply, but the provider must keep a written record of its attempts. It must also keep copies of its written correspondence with you.

Who is the "relevant person"?

Usually the patient. The regulation lets a person lawfully acting on their behalf stand in after the patient has died, where the patient is under 16 and not competent to make decisions about their care, or where the patient is 16 or over and lacks capacity in relation to the matter.

Does an apology mean I will win a claim?

No. Under section 2 of the Compensation Act 2006, an apology, an offer of treatment or other redress does not of itself amount to an admission of negligence or breach of statutory duty. The duty of candour is a regulatory obligation. It is separate from the civil test in a clinical negligence claim, which asks whether care fell below the standard of a reasonably competent practitioner and whether that failure caused you harm (see how to prove medical negligence).

How can the duty of candour help with a claim?

Without turning the duty into a promise of compensation, the information it produces can be useful to a solicitor:

• The written account and the list of planned enquiries show what the provider said it knew and when.
• The results of those enquiries, which must be sent to you in writing, may identify what went wrong.
• The record of the notification shows when you were told, which can matter when working out your date of knowledge for the time limit.

Keep every letter and note of what was said. See evidence for a medical negligence claim for what else to gather, including your medical records.

What if the provider did not tell me?

You can raise it through the provider's complaints process (see our guide to the NHS complaints procedure, which also covers escalation). You can also tell the CQC, which regulates compliance with Regulation 20. None of these routes pays compensation. A failure to be open does not by itself give you a compensation claim. That depends on whether the underlying care was negligent and caused you harm.

Duty of candour and Never Events

A Never Event is, by its nature, an unexpected safety incident that will usually involve serious harm or the risk of it, so the duty of candour is likely to be engaged. Whether it is depends on the facts and on whether the harm meets the regulation's definitions. See NHS Never Events for more.

Scope of this page

This page covers Regulation 20 as it applies in England, checked against legislation.gov.uk in October 2026. It is general information, not legal advice on any individual case, and it does not promise any outcome. If you think you may have a claim, a specialist clinical negligence solicitor can assess your circumstances. Funding options are explained in our no win no fee guide.

Frequently asked questions

Related guides

• Patient rights in England and Wales
• NHS medical negligence claims
• Medical negligence claims: complete guide