Recognising notifiable safety incidents and when to escalate

In England the statutory duty of candour sets legal steps for notifiable safety incidents. CQC says an incident is notifiable if it meets three criteria: it was unintended or unexpected, it occurred during a regulated activity, and a healthcare professional reasonably believes it has caused, or could cause, a defined level of harm.

For care-home services, examples of harm that may meet the threshold include:

• Death directly due to the incident
• Lasting sensory, motor, or intellectual impairment of 28 days or more
• Changes to the structure of the body
• Prolonged pain or prolonged psychological harm
• A shorter life expectancy
• Treatment needed to prevent one of these outcomes

Frontline care staff are not expected to make the final legal judgement. If you suspect harm may be serious, prolonged, or otherwise meet this threshold, escalate immediately to the nurse in charge, manager, registered person, GP, or other appropriate clinician. If you are unsure, use that uncertainty as a reason to escalate rather than stay silent.

CQC also notes some situations in care homes may count even if no staff member witnessed the event. For example, an unwitnessed fall during the regulated activity of accommodation for people requiring nursing or personal care may be notifiable if the harm threshold is met.

Do not confuse "not my fault" with "no candour needed". Fault and candour are different questions.