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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:
- Healthcare support workers.
- 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.
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.
You should only act within the limits of your role. If you have any doubts regarding any situation, you should always talk to your manager.
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.
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.
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.
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.
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.
Individual rights to complain or comment
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.
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.
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.
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.