The First 24 Hours After a Significant Incident

Leadership When It Matters Most

There are incidents from years ago that I still remember clearly. I've lost sleep thinking about some of the families involved. I've replayed conversations in my mind and wondered whether there was anything more that could have been done.

I suspect many leaders in health and social care will recognise that feeling.

The responsibility doesn't end when you leave work; it stays with you.

That's why, when people ask me about investigations, my mind doesn't immediately go to reports, evidence or regulatory processes. It goes to the first 24 hours.

Of course not every incident will result in external scrutiny, but every significant incident deserves a thoughtful, compassionate and well-governed response.

During my career, I've been involved in several incidents that resulted in Coroner's inquests, Local Authority scrutiny, CQC involvement and, on occasions, media interest. Every one was different, and every organisation responded within its own circumstances, but what remained constant was the significance of those first few hours.

People often assume the investigation is where learning begins. I don't believe it is. Learning begins the moment the incident happens. In those first 24 hours, organisations reveal far more about themselves than any investigation report will. They reveal their leadership, culture and whether governance is something that exists on paper or something that genuinely supports people when they need it most.

The First 24 Hours Are About People

The first priority is always people. This means responding to any immediate risks, supporting families facing unimaginable circumstances and recognising that the member of staff involved may also be experiencing one of the most difficult days of their professional life. Compassion and professionalism are not mutually exclusive; they should underpin every decision that follows.

Duty of Candour Is More Than a Conversation

Where the statutory Duty of Candour applies, organisations should act promptly, openly and compassionately in accordance with Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Being open does not mean having every answer immediately. It means responding honestly and allowing the facts to guide what follows. It means communicating what is known at that point in time, acknowledging what remains uncertain and explaining what will happen next, whilst taking account of any legal, regulatory or investigative considerations.

There are occasions where organisations must balance openness with police investigations, Coroner's processes, legal advice, confidentiality and the integrity of the investigation itself. Good judgement means understanding the difference between openness and speculation.

Supporting Staff Without Compromising the Investigation

One aspect that can easily be overlooked is the wellbeing of the staff involved.

Many will be distressed or worried about the consequences for the person they supported, the family and their own professional future. Some may require immediate emotional support, while others may need access to occupational health, employee assistance programmes, professional representation or independent advice.

Supporting staff is not the same as interviewing them. Looking after their wellbeing should be separate from establishing the facts.

Leaders should ensure staff know what support is available, understand the processes that will follow and feel able to speak openly without fear of assumptions or premature judgement. Looking after staff and protecting the integrity of an investigation are not competing priorities; both are essential.

Establish the Facts

The first 24 hours are rarely calm. Decisions often need to be made quickly and with incomplete information. This is where good governance provides structure.

A coordinated response is essential. Identify who is leading, create an accurate chronology while events are fresh and preserve records and other relevant evidence.

Make appropriate notifications, including to CQC, meet safeguarding responsibilities and ensure relevant agencies are informed in accordance with legislation, local procedures and the circumstances of the incident. This may include working with healthcare professionals, the police or other agencies where appropriate.

Seek advice from HR, legal advisers, insurers or professional bodies where appropriate.

Most importantly, avoid assumptions.

Facts first. Conclusions later.

One of the biggest mistakes organisations can make is trying to answer questions before they know what actually happened.

Start Learning Immediately

One question should be asked as early as possible. Could this happen again tomorrow?

If the answer is yes, learning cannot wait until the investigation report is complete.

Good organisations don't simply investigate an individual incident. They ask whether the same risks, systems, competency gaps or communication issues exist elsewhere across the organisation. This is where Regulation 17, Good Governance, becomes more than a regulatory requirement. It is about using information to understand risk, take action and continually improve.

The Moment Governance Becomes Real

By the time you're speaking to a family, notifying the regulator or preparing information for the Coroner, your governance arrangements have already been tested. The decisions made in those first few hours can shape everything that follows.

We spend a great deal of time preparing for inspections. Perhaps we should spend just as much time asking ourselves: if something serious happened tomorrow, would our governance arrangements give us the confidence to lead with compassion, integrity and professionalism from the very first hour?

We don't prepare for the first 24 hours because we expect the worst to happen.

We prepare because every person we support deserves an organisation that's ready if it does.

The reflections in this article are drawn from my professional experience of leading through significant incidents in health and social care. Every incident is unique, and organisations should always follow their own policies, seek appropriate legal and professional advice where necessary, and comply with applicable legislation, regulatory requirements and local procedures.

If your organisation would benefit from support following a significant incident, or you want to strengthen your governance and assurance before one occurs, I'd be happy to help.