Care Certificate Standard 3

In this article

After reading this Care Certificate standard 3 – Duty of Care, you should be able to:

Understand how duty of care contributes to safe practice.
Understand the support available for addressing dilemmas that may arise about duty of care.
Deal with comments and complaints.
Deal with incidents, errors and near misses.
Deal with confrontation and difficult situations.

The Care Certificate Standards detail what you must achieve and be assessed against to meet these learning outcomes.

If you have any concerns or queries, you should discuss these with your employer and/or assessor.

What is duty of care in health and social care?

As a health and social care worker, you have a duty of care to all individuals who you are caring for and supporting in your workplace.

Duty of care involves:

Promoting people’s rights.
Protecting people from harm, abuse and injury.
Promoting people’s wellbeing.

Wellbeing means a state of feeling healthy and happy and the positive ways in which a person thinks and feels.

Duty of care is not optional; it is a legal requirement, and you cannot choose whether to accept it. When a person receives care or treatment, it will apply from that point. If you break your duty of care, it could result in legal action, e.g. if you are found to be negligent.

Duty of care to others

You not only have a duty of care to the individuals who you are caring for and supporting but also to other workers.

For example, if you were working in a hospital, you would have a duty of care to:

Doctors.
Nurses.
Healthcare support workers.
Caterers.
Cleaners.
Maintenance workers.
Other types of workers.

Another example would be working as a home care worker, where you would likely work alone in different home environments. Even though you would be working alone, there may be others in the building, as well as the people you are supporting. You will have a duty of care to every individual and other workers you will meet in the community.

Code of Conduct

The duty of care is part of the Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England, and will usually be detailed in your job description. The Code of Conduct tells you what behaviours are expected of you as a health and social care worker.

It is vital that you possess the knowledge and skills to act on your duty of care in your role.

However, it is also important that you don’t go beyond it. You must be able to:

Identify any areas of concern.
Report concerns in agreed ways.

Reporting concerns

As you have learned, part of your duty of care requires you to pass on any concerns you may have regarding wellbeing. Your employer will have agreed ways of working to respond to potentially harmful situations, including reporting any concerns.

Some examples of things that may cause concern are:

Poor working conditions, e.g. working hours and salaries not meeting legal requirements.
Unsafe equipment, e.g. hoists not being inspected regularly.
Unsafe working practices, e.g. staff not following individuals’ care plans and the agreed ways of working.
Untrained workers, e.g. inexperienced staff carrying out tasks without appropriate training and competence.
Suspected abuse, e.g. individuals’ rights not being upheld and dignity not being promoted.

If you are unsure of any situation, you should ask your manager for advice.

Duty of care and agreed ways

To ensure that the duty of care is carried out, guidance should be provided on how to:

Deal with abuse and violence or substance misuse.
Handle toxic substances.
Carry out risk assessments.

Some of the routine ways of ensuring that everyone is aware of how to fulfil their duty of care include:

Fire drills.
Agreed ways of handling medication.
Cooking and food storage procedures.

It is important to note that different workplaces will have different agreed ways of working. Therefore, you will need to check them when you move to a new job in health and social care.

The agreed ways of working should be documented. If they are not written down and are only communicated to you verbally, you must ensure that you still work to them.

Roles and responsibilities

The Code of Conduct says, as a health and social care worker, you must:

Respect and protect individuals’ rights.
– Individuals have the right to be treated fairly and with dignity.
– You must always work in ways that protect the legal rights of individuals who you are caring for and supporting.
Promote individuals’ independence.
– Individuals must be supported so that they can live as independently as possible.
Allow people to make their own informed choices.
– Individuals must be allowed to have some control over their lives.
– They must be able to make informed decisions, be allowed to take risks, and should be involved in decisions regarding their care.

Individuals’ rights to make choices

There may be instances when individuals who you provide care and support for, will make choices that you disagree with or believe to be unwise and unsafe.

You could have a situation where an individual with a disability wants to start a new physical activity. You may also be faced with someone who wants to eat fatty and unhealthy foods.

In these types of situations, you should ensure that the individual has been provided with detailed information regarding their choices and what could potentially happen if they make that choice.

Health and social care workers must not take away individuals’ rights to make decisions that they are legally capable of making.

Dilemmas

You may come across a situation where there is a conflict between protecting an individual’s rights and independence and their safety and wellbeing. These situations can lead to dilemmas.

There may be a need to balance:

Their right to make decisions.
The need to protect them from harm.

Try to think of a scenario that is relevant to your workplace.

Some examples could include:

An individual with a disability wants to try a new physical activity.
An individual chooses to eat fatty and unhealthy foods.
An individual decides that they do not want to take their medication.
An individual who has dementia wants to go out on their own.

Think about the actions you should take if an individual who you are caring for and supporting, makes an unwise decision.

Risk assessments and support

If the individual still wants to make a choice you think is risky, a risk assessment may be the best course of action. It will identify the hazards and help decide on ways to reduce the risks.

Also, highlighting the risks will support the individual in making those choices.

Your employer will provide you with guidance on:

Risk assessments.
Risk enablement.
Health and safety.

An individual’s wellbeing must be considered as your main priority regardless of the situation you may come across. If you are unsure about anything, you must ask your manager.

Other sources of support that can help the individual make a decision may include:

The individual’s family and friends.
A befriender.
An advocate.
Their GP.
Another care worker.

You may also find it useful to record any decisions on the individual’s care plan so that others can be made aware of the situation.

What is an advocate

An advocate is a trusted and independent person who can speak and act for an individual who is being cared for and supported.

An advocate can:

Advise on issues such as welfare benefits.
Ensure that an individual’s voice is heard in care planning meetings.
Ensure that any decisions that are made are in the best interests of the individual.

The Care Act 2014 made the role of advocates and advocacy services more vital.

Supporting individuals in decision-making

Individuals should be supported when they make decisions, and they will decide on things all of the time.

There may be instances where an individual may:

Struggle to understand and retain the information which is needed to make, or communicate, their decision.
Lack the mental capacity required to make decisions.
Not be able to make decisions about finances or medical issues, but can make day-to-day decisions, e.g. what they want to wear or eat.

In these situations, you should seek additional guidance and advice if you are unsure of an individual’s capacity.

Mental capacity

Some individuals who you provide care and support for may not be able to:

Understand their choices.
Make an informed decision.
Understand what could happen.

If an individual lacks the capacity to make decisions, then whatever decisions are made for them, must be with their best interests in mind.

You will look at capacity in further detail in Care Certificate 9 (awareness of mental health, dementia and learning disabilities).

The Mental Capacity Act

The Mental Capacity Act (MCA) is an Act of the Parliament, which applies to England and Wales.

The purpose of the Act is to protect and empower those who may lack the mental capacity to make their own decisions about their care and treatment.

The Act assumes that people can make decisions unless they are not capable of doing one or more of the following:

Understanding the information given to them.
Retaining information long enough to be capable of making the decision.
Weighing up the information available to make the decision.
Communicating their decision (they must be supported to communicate by all possible means).

Temporary lack of capacity

It is important to note that an individual may not have a permanent lack of capacity, for example:

The symptoms of dementia can be worsened by infections – this can mean that an individual is temporarily incapable of retaining information long enough to make an informed decision. They may be capable of making a decision when the infection clears.
An individual in a coma will not be capable of communicating any decisions – they may be capable of making decisions when they wake from the coma.

There may also be instances where an individual can make certain decisions about some things but not others, e.g. they can make a decision about what to wear or what to eat, but not about finances or medical treatment.

Dealing with complaints, concerns, and comments

As a health and social care worker, you have a duty to ensure that every individual is aware of their rights to complain or comment regarding their care or support.

It is part of your duty of care, and you should also support these individuals if they have a complaint or comment.

If an individual has a complaint or comment, it is vital that:

It can happen quickly and positively.
They are taken seriously.
The issue is investigated so that lessons can be learned. This will highlight if things are being done correctly or whether improvements are necessary.

Positive comments can be encouraging and can be used to highlight how good ways of working are making a positive difference.

Additional support

Some individuals may require additional support to enable them to make a complaint or comment.

Some examples of where an individual may need additional support could include:

Where their first language is not English.
Where they require support with reading or writing due to literacy needs.
Where they need help with communication, e.g. communication boards.
Where they require forms in a different format, e.g. large print.

You should ask your employer what you should do if an individual has a complaint or comment, and look at whether they need additional support.

Complaints handling

The legislation for complaints in health and social care is the Local Authority Social Services and NHS Complaints (England) Regulations 2009.

These regulations set out the legal requirements for local authority social care departments and NHS organisations when handling complaints.

The NHS Constitution was published by the Department of Health in 2011, and it:

Informs you about guiding principles and patients’ rights.
Sets out the principles and values of the NHS.
Establishes how people can expect to be treated when dealing with the NHS.

There should be a recorded process in place, which you should follow, and this may differ from workplace to workplace. There may also be a time limit for a complaint to be made after the situation has occurred.

Complaints and agreed ways of working

If an individual wants to make a complaint or comment, you should ensure that you deal with it as per your organisation’s agreed ways of working.

This will depend on where you work and will be specific to your workplace. It is likely to include the paperwork and forms that will be used to record complaints and comments, along with the details of the person who will deal with them.

If you have not got a copy of the agreed ways of working for your organisation, you should ask your manager.

Responding to a complaint

You should support and respond to an individual who wants to make a complaint or comment regarding their care.

You must follow the agreed ways of working, which could include:

Arranging to speak to the individual privately, in a suitable environment, where they feel they can communicate openly and honestly.
Ensuring they are aware of the limits of confidentiality and that information may have to be passed on if there is a safety risk to themselves or others.
Listening calmly and actively and assuring them that you are taking their complaint or comment seriously.
Not being judgemental or emotional.
Offering your support, but not trying to give them an answer before checking the agreed ways of working.
Explaining the complaints procedure, i.e. what will happen next, who will be dealing with it and when they can expect to receive feedback.

After the complaint or comment has been made, you should:

Thank the individual.
Inform your manager about what was said.
Record it as soon as you can.

Patient Advice and Liaison Service (PALS)

There will often be one named person in the organisation who will deal with complaints. Alternatively, there may be a specific complaints section, such as the NHS’s Patient Advice and Liaison Service (PALS).

This will depend on the size of the organisation and is likely to be found in larger workplaces.

Your workplace should have a responsible person or an accountable officer, and you should ask who it is. If your workplace is smaller, you may find that there is nothing in writing. Regardless of this, you will still have agreed ways of working for dealing with complaints and comments, which you must follow.

Incidents, errors and near misses

Unfortunately, vulnerable adults are not always protected from harm despite having the:

Best ways of working.
Code of Conduct.
Duty of care.

All workers in health and social care workplaces should collaborate towards the wellbeing of those who need care or support.

Mistakes can and do happen, as a result of things such as:

A lack of worker knowledge or understanding.
Poor communication between workers.
Not sharing information.
Stress.
Negligence.
Being distracted.

Types of mistakes

Mistakes can be one of the following:

Adverse events – occur when an action or inaction can lead to unexpected, unintended and preventable harm.
Errors – occur when an activity is not carried out in the way it should have been done, e.g. as a result of bad planning or forgetfulness.
Near misses – are situations where an action could have caused harm to an individual, but it was prevented by chance or purpose.
Incidents – are specific negative events, which are serious. They are known as events which need investigation. They should be investigated as they have caused severe harm or damage to either the individual receiving care or the organisation.

When mistakes do happen, they must be dealt with appropriately to prevent similar things from occurring in future.

Actions to take

When something has gone wrong, the first priority is to do whatever you can to improve the wellbeing of those involved and meet their immediate needs.

There should be forms for recording accidents, incidents and near misses in your workplace.

If there is an incident or another type of event, you should do the following:

Complete the appropriate form, including the:
– Date and time.
– Facts, e.g. incident location, who was involved and other details.
Make your manager immediately aware of the situation.
Do not blame anyone or include your opinion on why it happened in reports and incident forms.

Even if you have an idea of the causes of the incident, you should not record this. If you were wrong, it could result in losing the trust and respect of the individual and their family.

Relevant legislation around handling incidents

In health and social care, there is a variety of legislation that sets standards on how to handle incidents, which can improve services and result in positive outcomes.

Relevant legislation includes:

The Health and Safety at Work etc. Act 1974.
The Management of Health and Safety at Work Regulations 1999.
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR).
The Control of Substances Hazardous to Health Regulations 2002 (COSHH).
The Provision and Use of Work Equipment Regulations 1998 (PUWER).

The Health and Safety at Work etc. Act 1974

The Health and Safety at Work etc. Act 1974 is also known as HSWA, the HSW Act, the 1974 Act or HASAWA. It is the primary piece of legislation covering occupational health and safety in Great Britain.

The HSWA places duties on employers, employees and the self-employed regarding the health, safety and welfare of those at work.

For example:

Employers have duties towards employees and others, e.g. members of the public.
Employees have duties towards themselves and to each other.
Those who are self-employed have duties towards themselves and others.

The HSWA is an enabling Act which means that other health and safety regulations, also known as Statutory Instruments or delegated legislation, can be made under this Act.

Health and safety legislation is mainly enforced by two enforcement authorities: the Health and Safety Executive (HSE) and local authorities.

The Management of Health and Safety at Work Regulations 1999

The Management of Health and Safety at Work Regulations 1999 (MHSWR) places numerous duties on employers.

For example, they must:

Make suitable and sufficient assessments of the health and safety risks to employees and others. They must also manage those risks.
Have adequate health and safety arrangements in place.
Provide health surveillance where a risk has been identified.
Appoint competent persons to assist them in their duties.
Have emergency procedures for recording, reporting and evaluating all serious incidents. Measures should be taken to avoid them from happening again.
Cooperate and coordinate with other employers where workplaces are shared.
Provide employees and temporary workers with appropriate information and training.
Have additional measures for young people (under 18 years old) and expectant/nursing mothers.

In addition to the HSWA, employees also have duties under the MHSWR. They should:

Use equipment and safety devices in accordance with the training and instructions they receive.
Report any serious and imminent dangers to their employer.
Notify their employer of any shortcomings in their health and safety arrangements.

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR)

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 is also known as RIDDOR.

These regulations place duties on responsible persons (usually employers) to report the following to the Health and Safety Executive (HSE):

Accidents at work that have caused fatalities.
Accidents at work that have caused a specified injury.
Diseases caused by work.
Certain types of dangerous occurrences.
Other injuries that cause a person to be absent from work for more than seven days.
Gas incidents.
Injuries to members of the public.

The above are reported via online forms to the HSE and reports have to be submitted within a certain timeframe. There is also an Incident Contact Centre (ICC) phone number for fatalities and serious injuries.

Records must be kept for:

RIDDOR reportable deaths, injuries, diseases and incidents.
Injuries that result in over three-day absences

The Control of Substances Hazardous to Health Regulations 2002 (COSHH)

The Control of Substances Hazardous to Health Regulations 2002 is often known as the COSHH Regulations. This law requires employers to prevent, reduce or adequately control exposure to hazardous substances in the workplace.

They must:

Risk assess the substances that are hazardous to health, i.e. a COSHH assessment.
Look at the precautions required and put control measures in place.
Make sure that control measures are maintained, tested and examined.
Monitor exposure where hazardous substances are in use.
Provide health surveillance for those who are at risk of exposure.
Provide training, information, instruction and supervision to those who will come into contact with hazardous substances.
Have arrangements to deal with accidents, incidents and emergencies.

Hazardous substances can include cleaning chemicals, medication and bodily fluids.

They can also take many different forms, such as:

Chemicals and products.
Fumes.
Dust.
Vapours.
Mists.
Nanotechnology.
Gases.
Biological agents.

The Provision and Use of Work Equipment Regulations 1998 (PUWER)

The Provision and Use of Work Equipment Regulations 1998 is often referred to as PUWER.

The regulations place duties on employers, the self-employed and others who control the use of work equipment.

They cover a wide range of new, used and hired equipment and require it to be:

Suitable for its intended use and fit for purpose.
Safe to use, maintained, inspected and installed correctly.
Safe and have adequate safety measures, e.g. emergency controls, isolation points, guarding of dangerous parts, warnings and markings.
Only used by those who are competent and have received appropriate training, information and instruction.

Those who have responsibilities for work equipment should ensure that it is suitable for the task, well maintained, regularly inspected and only operated by well-informed and trained staff.

Enforcement

Breaching health and safety laws is a criminal offence in the UK. The Health and Safety Executive (HSE) can start proceedings for prosecution, and the offender may be taken to court.

This can result in fines and even prison sentences; particularly if a person is harmed as a result of negligence or a deliberate act. The HSE can also issue enforcement notices if laws have been broken.

If there is a breach of any health and safety regulations, it must be reported immediately.

How to manage conflict in the workplace?

Two of the 6Cs are care and compassion.

Care – is our core business and that of our organisations; and the care we deliver helps the individual person and improves the health of the whole community. Caring defines us and our work. People receiving care expect it to be right for them consistently throughout every stage of their life.
Compassion – is how care is given through relationships based on empathy, respect and dignity. It can also be described as intelligent kindness and is central to how people perceive their care.

You should:

Think clearly and carefully regarding the possible reasons for a person’s distress.
Use your person-centred approach and knowledge of them as an individual.
Recognise their unmet needs.
Respond by providing supportive care and/or additional services.

If you do these things, you may find that you can de-escalate a challenging situation.

What causes conflict?

According to the Health and Safety Executive (HSE), health and social care workers have a higher than average risk of experiencing threats or violence in the workplace.

Conflict or challenging behaviour, with or between people, often occurs as a result of distress or because needs are not being met.

There are a number of factors that can cause conflict, such as:

Biological, e.g. a person is in pain, suffering from the side effects of medication or substance misuse.
Social, e.g. boredom, wanting social contact, needing to be in control and unable to communicate or understand.
Environmental, e.g. poor lighting, loud noises or mobility barriers.
Psychological, e.g. feeling lonely of left out.

Policies and incident forms

Your organisation may have a policy that covers how to respond to challenging behaviour in your workplace.

There will usually be a form to report and record factual information about an incident, such as:

The date and time of the incident.
What happened.
Where the incident happened.
Who was involved.
Whether anyone was injured.
Whether anyone required medical assistance.
Whether the police were called.

The form should be signed and dated. It should be based on facts and not include personal opinions or blame.

The information provided will then be used to identify whether any further action is required to improve the care and support of the individual.

Managing conflict

Conflict can be prevented from turning into violence, if the early signs of frustration and aggression are acted upon.

A solution can often be found by having an open discussion with any individual and by treating them with respect and dignity.

If you are working with someone whose behaviour is challenging, and if it is possible and safe, you should:

Take them to a quiet place where you are unlikely to be disturbed.
Ask them questions and listen carefully to what they say.
Take their upset or angry feelings seriously.
Attempt to find a way forward that they can understand and agree to.

Knowing and working with individuals

When you are working with individuals, it is vital that you:

Get to know them, as far as possible, as this will help you recognise what triggers their distress.
Don’t get emotionally involved.
Keep a clear head, look out for body language and be aware of their reactions.
Try and leave the scene if you feel that the situation is becoming confrontational, which will give them time to calm down.

Using and developing skills

Recognising frustration and aggression in an individual’s behaviour will help you learn and develop in your role.

It will teach you how to manage a situation before it gets violent or aggressive by using your communication skills and other ways of working.

Your manager will:

Provide guidance.
Explain the ways of working.
Support you to develop your knowledge and skills as you progress in your role.

You may require additional training to manage conflict and challenging behaviour, and therefore prevent aggression and violence. You should ask your manager about further training requirements.