The State Hospitals Board for Scotland Duty of Candour Annual Report 1 April 2023 – 31 March 2024 Lead Author Risk Manager Approval Group Clinical Governance Committee Responsible Officer Associate Medical Director

and Care) Scotland Act 2016 (“The Act”) introduced an organisational Duty of Candour on health, care and social work services. The Act is supplemented by the Duty of Candour Procedure (Scotland) Regulations 2018, which highlight the procedure to be followed whenever a Duty of Candour incident has been identified. [...] where there has been an unexpected incident that has resulted in death or harm that is not related to the course of the condition for which the person is receiving care) the focus of the Duty of Candour involves notifying the person (and/or relevant person) affected, apologising and offering a meeting to provide an account of what happened, reviewing the incident and offering support to those [...] This system includes a section whereby staff can record if an adverse event has the potential to trigger a Duty of Candour incident. [...] Furthermore, all adverse events and near misses reported within the incident reporting system (Datix) are reviewed in accordance with Incident Reporting & Review Policy – RR01 the toPage 4 of 8 understand what happened and to establish if there is action that can be taken to prevent/ minimise a recurrence and/or improve patient care. [...] an unintended or unexpected act incident that resulted in death or harm, as defined within the Act and did not relate directly to the natural course of a person’s illness or underlying condition. [...] 1 incident that was identified is still under review as part of a Category 1 Investigation, the report was due on 24 February 2024 but due to unavailability of key staff involved in the investigation it has been delayed. [...] The incident related to a medication error, further learning will be shared and action as soon as it is available. [...] Liaise with local hospitals and confirm a process that will minimise the resources required when patients are required to attend A&E. [...] 4 have been allocated to owners and are being considered at the time of writing. [...] Any members of staff who have been directly involved in the incident and those with the responsibility for undertaking the Review process and communicating with the patient and/or relevant person should be given access to assistance, support and necessary information, where required.