Law, Ethics and Professional Decision-Making in Healthcare
When things go wrong: candour, complaints, incidents and investigations
Applied learning on when things go wrong: candour, complaints, incidents and investigations.
Learning objectives
• Distinguish professional candour from organisational statutory or regulatory duties of candour. • Respond openly and supportively when care has caused or may have caused harm or distress. • Understand that apology is not the same as an admission of legal liability. • Participate honestly in complaints, incident reviews and investigations while preserving evidence and records. • Use learning systems to reduce recurrence rather than focusing only on individual blame.
Learning objectives
- Distinguish professional candour from organisational statutory or regulatory duties of candour.
- Respond openly and supportively when care has caused or may have caused harm or distress.
- Understand that apology is not the same as an admission of legal liability.
- Participate honestly in complaints, incident reviews and investigations while preserving evidence and records.
- Use learning systems to reduce recurrence rather than focusing only on individual blame.
Overview
When something goes wrong, patients need honesty, explanation, support and a credible plan for what happens next. Clinicians also need to distinguish several overlapping processes: professional candour, organisational duty of candour, complaints handling, patient-safety investigation, employment processes and possible legal or regulatory review.
Professional candour
The professional duty of candour requires openness and honesty when something goes wrong and causes, or has the potential to cause, harm or distress. The professional should tell the person what is known, apologise, explain likely effects, offer appropriate support or remedy where possible, and contribute honestly to review and learning.
Organisational duties are not identical across the UK
Professional candour applies to regulated professionals, while organisational candour frameworks vary by jurisdiction. Wales has a statutory NHS duty of candour; England and Scotland have their own statutory or regulatory arrangements; Northern Ireland has developed a Being Open framework. Publication-stage checks should confirm the current jurisdiction-specific position.
Apology and factual explanation
A sincere apology acknowledges what happened and its impact. It should not speculate beyond the known facts or assign blame prematurely. Saying sorry is not, by itself, the same as admitting legal liability. The clinician should distinguish confirmed facts, reasonable current understanding and matters still under investigation.
Preserving the record
Never alter a clinical record to make an event look better in retrospect. Necessary later entries should be clearly dated and attributable. Preserve relevant documents, messages and records in accordance with policy. Candour depends on an accurate account, not reconstruction designed to defend an individual.
Complaints and incident investigations
Complaints and incident reports can expose failures in systems, communication, expectations or care. Respond objectively, address the actual concern, acknowledge uncertainty, and avoid defensive language. Patient-safety investigations should seek to understand contributing factors and opportunities for improvement rather than assuming that a single person caused the event.
Applied practice, risk and escalation
Different processes, different purposes
A complaint, patient-safety investigation, disciplinary process, coroner or procurator fiscal process, civil claim and regulatory inquiry each has a different purpose. Facts may overlap, but the tests and decision-makers are different. Do not assume that an adverse incident automatically establishes negligence or misconduct.
Supporting patients, families and staff
People affected by incidents may need practical, emotional and clinical support. Staff may also experience distress, but support for staff must not displace openness with patients or compromise investigation. Leaders should create conditions in which people can report errors and near misses without concealment or retaliation.
Practical framework and source anchors
Learning and follow-through
Candour is incomplete if the organisation apologises but does not learn. Improvement may involve redesigning systems, clarifying responsibility, training, equipment, staffing, communication or follow-up. Where action is promised, responsibility and timescales should be explicit.
Source anchors
Primary anchors include GMC/NMC professional duty of candour guidance, Good medical practice, jurisdiction-specific organisational duty-of-candour legislation or regulation, and local incident/complaints procedures. In Wales, the NHS duty of candour has been a legal requirement for NHS organisations since April 2023.
Source anchors
- GMC/NMC Professional duty of candour
- GMC Good medical practice
- GOV.WALES NHS Duty of Candour
- Jurisdiction-specific complaints and incident frameworks
