Duty of Candour

In this information the person receiving CBT or Low Intensity CBT will be referred to as the ‘client’.

This information should be read in conjunction with the Standards of Conduct Performance and Ethics which all BABCP members, whether registered, accredited or a member only, are required to adhere to.

There is a motion to update our Standards of Conduct, Performance and Ethics to explicitly include a professional duty of candour for BABCP members.

Introduction

All health and care professionals have a professional responsibility to be open, honest, and transparent with service users, client or patients when something goes wrong. This responsibility is the professional ‘Duty of Candour’.

As a holder of trusted professional registers, the British Association for Behavioural and Cognitive Psychotherapies (BABCP) takes the stance that this ‘Duty of Candour’ is a crucial element of providing professional services and care. This is reflected in our policies and documents and in our ethos as an organisation.

The BABCP Standards of Conduct, Performance and Ethics Section 1 states that "you must act in the best interests of service users", and Section 14.1 states "You must justify the trust that other people place in you by acting with honesty and integrity at all times. You must not get involved in any behaviour or activity which is likely to damage the public’s confidence in you, your practice, or BABCP."

These requirements are commensurate with a professional duty of candour, which is the requirement to be open and honest about any mistakes that are made during treatment, or any harm or distress that has, or might, occur during treatment.

Our Standards of Conduct, Performance and Ethics are also consistent with the statutory duty of candour that is imposed on health and social care providers by Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, to be transparent with clients in relation to their care. This legal requirement stems from the findings of the Mid-Staffordshire NHS Foundation Trust Public Inquiry into poor patient care (‘the Francis Inquiry’) and the recommendations from the UK Government’s response to this Inquiry entitled ‘Hard Truths: The Journey to Putting Patients First’ published in January 2014.

The Professional Standards Authority (PSA), the organisation which BABCP has applied to for accreditation states that “telling patients openly and honestly that something has gone wrong with their care is an essential part of a healthcare professional’s practice” and that healthcare professionals are “expected to be candid by the public and regulators” alike.

CBT is not a legally regulated activity, however our professional standards as an organisation impose duty of care in relation to their practice of CBT and Low Intensity CBT on our members. The BABCP recognise that our members may work under specific policies on professional and statutory duty of candour that are required by their employer. We advise members to be familiar with their workplace policies and ethical and legal obligations to patients as well as with this document.

What this means

This means that if something goes wrong during your work with a client, you have a duty to tell your client and apologise. You should apologise for any harm caused, regardless of fault, and be open and transparent about what has happened.

Apologising is an important part of Duty of Candour and is always the right thing to do. It is not an admission of liability. But it is important because:

• It allows steps to be taken to mend the relationship between the therapist and client
• The client receives a genuine apology for what has happened
• Steps can be taken to prevent the mistake from happening again

Duty of Candour throughout the therapeutic relationship

The Duty of Candour applies from beginning to the end of the therapeutic relationship. However, it is particularly relevant when things go wrong.

As a member you must be honest at the onset of therapy about the risks of therapy as well as the benefits, and should discuss these openly with your client so they can make an informed decision about their treatment.

You should make clients aware that you are Registered or Accredited with BABCP. If not on our register, you must not refer to your membership to imply any registration or accreditation status with BABCP. This should be included in your therapy contract, as well as information about their right to complain and how to do so.

Risk should also be reviewed throughout therapy. [link to guidance on risk and guidance on private practice here]. 

If you change your approach or the level of risk changes, you must discuss this with your client.

• For example: you may have been initially working with a client with panic disorder, but then decide together with the client that a trauma focused approach would be more therapeutic. This needs to be discussed honestly with both risks and benefits outlined, so the client can make an informed decision.

What could go wrong in the the therapeutic relationship

If you are registered or accredited with BABCP, you will be aware that not all therapeutic relationships with service users, clients or patients are straightforward and sometimes the therapeutic relationship can break down. It is entirely possible that registered or accredited therapists may:

• Misunderstand or mis-hear something during a session which is not corrected.
• Make an off the cuff comment or displaced joke, or have said something unhelpful or inappropriate.
• Inadvertently disclosed confidential information such as mis-sending an email to the incorrect service user, client or patient.
• Had a security breach of IT equipment.
• Lost or accidentally left paper records in a public place, which cannot be recovered.
• Mistakenly shredded client records.

What you should do if things do go wrong

Throughout therapy, we have a responsibility to make the client aware of any harm that may have occurred, whether they are aware of this or not. Consequently, if something does goes wrong in treatment, we must:

• Tell the service user, client or patient and take all relevant action to limit any further harm and / or to repair any harm.
• Explain fully the short-term and long-term effects of what has happened.
• If any harm occurs, we also need to offer an apology to the client.
• Offer the appropriate support or remedy to put the matters right, where possible.
• We must also take the issue to supervision and/or our employer. Supervision extends the protection to service users, clients or patients by virtue of enabling a therapist to discuss what has happened with a senior colleague.
• We need to then investigate what has happened to avoid it happening again.
• If the client wishes to complain we need to be open and honest about the complaints process and give them information about how to complain.

Throughout therapy, and particularly when ending, you should seek feedback from your client. This should help to identify issues not disclosed earlier in the therapy, which can then be discussed honestly together and worked with.

Being candid

Being candid with a patient not only alerts the patient but minimises and prevents further harm being caused to the patient. By being candid and telling the service user, client or patient that a problem has happened not only alerts them, but also minimises and prevents further harm being caused. A therapist doing this is also maintaining the level of trust and confidence placed in them by the service user, client or patient and also the profession.

Being candid should not be misunderstood as admitting liability or wrongdoing nor should it be confused with complaint handling. The Duty of Candour applies regardless of whether a complaint or concern has been raised and any action taken should always be in the best interests of the service user, client or patient.

Is the Duty of Candour just limited to service users, clients or patients?

The Duty of Candour is not just limited to the above, as all Healthcare professionals must be open and honest with their colleagues, employers, and relevant organisations and take part in reviews and investigations when requested.

If a BABCP member suspects misconduct by a professional colleague which cannot be resolved or remedied by discussion with the colleague concerned, they must take steps to bring that misconduct to the attention of BABCP.

BABCP members are required to co-operate with BABCP with regards to raising concerns. This includes a duty to supply any records and information that any Panel asks for that is reasonably related to their professional behaviour and fitness to practice.