Duty of Candour: What CQC Regulation 20 Requires

The duty of candour is the legal duty on every CQC-registered health and social care provider in England to be open and honest with people when something goes wrong with their care. Under Regulation 20, when a notifiable safety incident happens you must tell the person, apologise, explain what you know, follow up in writing and keep records. Registered professionals have a separate professional duty too.

Two duties, not one

• The statutory duty of candour sits on the organisation. It is Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It applies to every provider registered with CQC in England, from care homes and home care agencies to GP practices and NHS trusts, and binds the registered provider and the registered manager. CQC enforces it.
• The professional duty of candour sits on individual registered professionals, such as nurses and doctors. Their own regulators oversee it.

Scotland and Wales have their own statutory duties. Scotland's organisational duty of candour has covered health, care and social work services since 1 April 2018. Wales brought in a duty of candour for NHS organisations from 1 April 2023. This guide covers England.

What counts as a notifiable safety incident

The specific steps kick in when there is a notifiable safety incident: something unintended or unexpected that happened to a person during their care or treatment, which a health care professional reasonably thinks has caused a set level of harm. The test is different for NHS bodies and for everyone else, as set out below.

NHS trusts and other health service bodies

For NHS trusts, NHS foundation trusts, Special Health Authorities and NHS England, the incident must have resulted, or could result, in a death directly related to it, or in severe harm, moderate harm or prolonged psychological harm.

Everyone else, including care homes and home care

For all other registered providers, the incident must appear to have resulted in:

• a death directly related to the incident, rather than to the natural course of the person's illness or condition
• an impairment of sensory, motor or intellectual functions that has lasted, or is likely to last, at least 28 days
• changes to the structure of the person's body
• prolonged pain or prolonged psychological harm (at least 28 days)
• a shorter life expectancy

It also counts if the person needs treatment by a health care professional to prevent their death, or to prevent an injury that would lead to one of those outcomes.

In a care home, think of a fall that ends in a fractured hip. Check each incident against the test and record your decision either way.

What you must do, and when

The regulation doesn't set a number of days. You must act "as soon as reasonably practicable" after becoming aware of the incident.

1. Tell the person face to face. One or more representatives of the provider notify the relevant person in person and offer reasonable support. The relevant person is the person who used the service, or someone acting lawfully for them if they have died, are under 16 and can't make the decision, or lack capacity.
2. Give an honest account. Explain the facts you know so far, say what further enquiries you think are appropriate, and apologise.
3. Write it down. Keep a secure written record of that conversation.
4. Follow up in writing with the same account, details of any enquiries, their results, and an apology.
5. Keep copies of all the correspondence.

If you can't reach the person, or they don't want to speak to you, keep a written record of your attempts to contact them. Failing to give the notification, or leaving out what it must include, is a criminal offence under the regulations, and CQC can prosecute. CQC's Regulation 20 page sets out the full wording.

Saying sorry isn't admitting liability

The regulation defines an apology as "an expression of sorrow or regret". In England and Wales, section 2 of the Compensation Act 2006 says an apology does not of itself amount to an admission of negligence or breach of statutory duty. "I'm so sorry this happened to your mum" is not the legal risk some managers fear.

The professional duty of candour

Joint GMC and NMC guidance, Openness and honesty when things go wrong, says every health and care professional must tell the person (or their advocate, carer or family) when something has gone wrong, apologise, offer an appropriate remedy or support to put matters right if possible, and explain fully the short and long-term effects.

It isn't limited to notifiable safety incidents. It covers anything that has caused, or could cause, harm or distress, and it includes reporting incidents and near misses early. So the nurse on duty should be honest with the family straight away, even while the provider is still deciding whether the statutory duty applies.

How the duty of candour differs from complaints

• Who starts it: a complaint starts with the person or their family. Candour starts with you, before anyone has to ask.
• What triggers it: anyone can complain about anything. The statutory candour steps apply to notifiable safety incidents.
• The rule behind it: complaints sit under Regulation 16, which requires an accessible complaints system and says any complaint received must be investigated. Candour sits under Regulation 20.

They overlap: a complaint can reveal an incident that should have triggered candour earlier, and the candour steps still apply.

Making it work in your service

• Add a candour question to your incident form: does this meet the test, who decided, and when.
• Name who has the conversation, usually the registered manager or a senior nurse, not whoever answers the phone.
• Don't wait for the investigation to finish. Share what you know now and follow up with the results.
• Write the record as you'd want it read later. Our record keeping and defensible documentation courses help your team write records that hold up.
• Watch the culture. If staff hide mistakes because they fear blame, candour fails long before the manager hears about it. See our closed cultures training.

Is the duty of candour changing?

The Department of Health and Social Care announced a review of the statutory duty in December 2023. Its call for evidence ran in spring 2024, and the findings, published in November 2024, named culture, inconsistent understanding and training as recurring themes. In July 2025 the government said the review was still in progress. When this guide was last updated in October 2026, no outcome had been published and Regulation 20 hadn't changed.

Separately, the Public Office (Accountability) Bill, often called the Hillsborough Law, would create a duty of candour for public authorities and officials in inquiries, inquests and similar investigations. It hadn't become law when this guide was last updated in October 2026, so check its current status on the UK Parliament website.

How Kasorb can help

Our complaints handling training for managers runs for a full day, on-site or live online, and is quoted for your team. It covers good complaint handling in health and care, understanding what the complainant needs, responding in writing and in person, managing challenging interactions, the duty of candour, and learning and improvement. Managers practise through role play and case studies, with feedback from the trainer. Everyone receives a Kasorb certificate of completion, emailed the next day.

This guide summarises the law and guidance; it isn't legal advice.

FAQs

What is the duty of candour under CQC Regulation 20?

It is Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It requires every CQC-registered provider in England to be open with people about their care and, after a notifiable safety incident, to tell them in person, apologise, follow up in writing and keep records.

What is a notifiable safety incident?

An unintended or unexpected incident during care or treatment that a health care professional reasonably thinks has caused a set level of harm. For care providers that includes death, harm lasting at least 28 days, or needing treatment to prevent death or serious harm. For NHS trusts, incidents that could cause moderate or severe harm also count.

How soon must the duty of candour be carried out?

The regulation says "as soon as reasonably practicable" after you become aware of the incident, with no fixed number of days. Tell the person what you know now, then follow up in writing with the results of your enquiries.

Is an apology under the duty of candour an admission of liability?

No. An apology under the duty is an expression of sorrow or regret. In England and Wales, section 2 of the Compensation Act 2006 says an apology doesn't of itself amount to an admission of negligence or breach of statutory duty.

Does the statutory duty of candour apply to individual care workers?

The statutory duty sits with the organisation: the registered provider and registered manager. It doesn't place a separate legal duty on each care worker, but staff play a big part by reporting incidents promptly and honestly. Registered professionals such as nurses also have their own professional duty of candour.