What is meant by the term ‘duty of care?’ (Question 3.1a)

As a care/ support worker you owe a duty of care to the people you support, your colleagues, your employer, yourself and the general public and society.

The Social Care Institute for Excellence (SCIE) has stated that in relation to our work, the duty of care requires us to:

• Always to act in the best interests of individuals and others
• Not to act, or fail to act, in a way that results in harm.
• Act within our competence and not take on anything we do not believe we can do safely.

For more information see:

(http://www.scie.org.uk/workforce/induction/standards/cis05_dutyofcare.asp)

General Duty of Care

The general duty of care is a legal obligation and has been defined through common law. It applies to every person, with the capacity to carry it out, in our society in any situation and not just to us when we are engaged in working in a caring profession. Not only do we have the duty of care towards others, they, if they have the maturity and mental capacity to understand the situation and/or the physical capacity to take the appropriate action, also have a duty of care towards us. Exercising the duty of care is about acting as any other reasonable person in a responsible way towards others to keep them safe from immediate significant danger and protect from being put at risk of significant harm.

How duty of care affects your work role

Duties relating to care when in a formal health and social care role:

Support/care workers must treat service users with dignity and to work to the values of social care. The duty to conduct ourselves in our work in line with:

• Agreed/national and professional standards, such as the CQC’s Fundamental Standards which came into force in April 2015
• Standards which our employers have in place to prevent emergencies from arising by addressing known risk in agreed ways
• Standards in relation to following agreed procedures such as those relating to the safeguarding of children and adults at risk
• Standards which do not cause the organisation and the service we provide to fall into disrepute
• Workers who have to register with a regulator in order to practise e.g. social workers, nurses, OT’s, psychologists etc. Have codes of conduct and codes of ethics and other requirements which they must follow in order to be regarded as fit to practice.

Use to answer question 3.1a and 3.1b of the Care Certificate

Examples of how you exercise the duty of care in your work:

Risk Management – Ensuring that

People are moved, positioned and assisted safely (e.g. using the risk enablement approach).

Equipment is safe for all parties who use and handle it and that it is moved and handled safely (e.g. hoists, wheelchairs, electrical appliances).

Food and medicines are handled safely.

People are not put at risk by other clients, staff, or company activities.

Health and Safety – Ensuring that:

Equipment is tested and maintained to minimise the risk of harm.

Fire procedures are followed.

Accidents are properly recorded.

Hygiene standards are followed.

Safeguarding – Ensuring that:

Joint adult safeguarding and protection procedures and child safeguarding and protection procedures are followed, to protect people at risk from harm and to support others to engage safely and effectively in safeguarding and protection work. This includes implementing the Mental Capacity Act. As well as following the general safeguarding procedures.

The Workplace – ensuring that:

• Our behaviour does not put colleagues at risk.
• We flag up danger connected with the work we do or in premises where we work.
• We flag up dangerous equipment or procedures.
• We do not disclose personal details of colleagues to clients or other third parties.
• Colleagues are not left to work alone or unprotected when it has been identified that this puts them at too much risk.

Clients – In addition to safeguarding them from abuse. Ensuring that:

• Their individual needs are met and addressing aspects of their care plan which involve managing risk, e.g. if they are at risk of choking ensuring that they are given the correct support to prevent it from happening.
• They are not deprived of their rights.
• They are treated with dignity, compassion, respected and consulted.
• They receive services which are appropriate to their individual circumstances

Use to answer question 3.1b of the Care Certificate

Conduct:

You are required to conduct yourself in both your work time and private life in a way that does not put yourself or Active into disrepute, e.g. using social networking sites whether in your own or your work time to discuss clients, carers or colleagues or breaching confidentiality.

Negligence: 

You are required to work in accordance with the above standards, so that you can fulfil your duty of care. Failure to do this could result in a claim of negligence being brought against yourself and/ or the organisation.

Definition of Negligence

In law, three criteria must be met for negligence in the Duty of Care to be proved through the Courts. The Duty of Care must:

• Actually be owed to the person or persons in question
• Have been breached
• A person must have suffered as a result

Where a duty of care has been breached because acts or omissions fell below the standard of an ‘an ordinarily competent’ social care worker, it is not an acceptable defence to argue this happened because if a person’s inexperience.

It is a support workers responsibility to make their line manager aware that they feel they do not have the skills or knowledge to undertake a task.

Likewise, the line manager is responsible for ensuring that tasks are only delegated to, or undertaken by, competent staff and that new members of staff are trained in order to attain the required standard.

Managing dilemmas that may arise about duty of care

The work we do in health and social care and support often puts us in difficult situations which can pose ethical dilemmas.

Examples of this are detailed below:

• In an emergency situation such as someone running into the road, you may need to take action which, in other circumstances would not be acceptable e.g. you may need to grab the person or knock them to the floor. You would not be blamed for your actions if your intentions were to stop them coming to serious harm.
• There may be times when a client makes choices that you think are unwise, unsafe or that you disagree with. e.g. when someone with a disability wants to try a new physical activity or when someone chooses to eat fatty foods. You should make sure that they have as much information as possible about their choices and what could happen if they still choose to make a risky choice a risk assessment may identify ways in which the risk can be reduced and the individual can be supported to make those decisions.
• You have a responsibility to report poor practice in relation to your client or the organisation so that this can be addressed and stopped. It can sometimes feel difficult to challenge your colleagues or the organisation but in Active such practice is encouraged and welcomed as this improves service for clients.

Use to answer question 3.2a and 3.2b of the Care Certificate

Managing dilemmas that may arise about duty of care continued

Positive Risk Taking v’s Risk Management

Focussing on social care values (such as respecting individuality, actively promoting independence, not being judgemental, respecting people’s rights etc.) enables us to make decisions and resolve dilemmas. We need to support service users to exercise their legal rights, make independent and informed decisions about the risks and know that they must not put others in significant danger as a consequence of their decision.

When we support people to make informed decisions the risks can be identified using a risk enablement/positive risk taking approach to risk management by working with the person to agree course of action to address the risk.

Positive risk taking is the up to date method of working with the service user to address the risks in relation to their care and support.

Risk management is the appropriate method for assessing risks to workers. This is reinforced in Standard 13 of The Care Certificate.

How to manage conflicts and dilemma’s in your job role

What you must do

• Be familiar with and follow policies and procedures to protect clients, yourself and colleagues so that conflict and dilemmas are managed in accordance with the law and Active’s specifications including best practice models.
• Deal with physically challenging behaviours by clients in accordance with Active’s policies and procedures. Only undertake physical interventions you are authorised to undertake within the law.
• Intervene if a client or colleague is being bullied.
• Report to CQC if the Company chooses to ignore a practice which is putting clients at risk of significant harm.
• Report any allegation of abuse disclosed to you by a client or vulnerable person.
• Report colleagues who do not act in a client’s best interests e.g. sit in a room gossiping during work time resulting in clients not being assisted or having delays in their care such as with regard to toileting.
• Report incident to your line manager as soon as possible.
• Record what happened and what you and others said and did.
• Pass on any concerns about a client’s wellbeing, poor working conditions, faulty equipment or untrained workers.
• Support independence by working in ways that respect and protect individuals rights, including their right to live as independent as possible, to make their own choices and to take risks.

Use to answer question 3.2b of the Care Certificate

How to manage conflicts and dilemma’s in your job role

What you must not do

• Perpetrate degrading or harmful treatment as this is abuse
• Prevent a client with full capacity from making a decision that you and/ or other professionals or their family consider to be foolish
• Lock a client room to prevent them from entering or leaving as this is classed as an illegal restraint
• Fail to respect a client’s religious observances as this would result in degrading treatment and an infringement of their right to practice their religion under the Equality Act 2010
• Ignore a concern
• Engage in or condone poor or illegal practice
• Fail to put people’s Health & Safety first
• Fail to report or record an incident
• Assume someone else will take responsibility to report an incident
• Cover up the occurrence of an incident or destroy records or evidence
• Engage in an activity which is not permitted within Active’s policies

Where to get additional support and advice about how to resolve dilemmas

Consult your line Manager who will consider the implications of the Mental Capacity Act 2005, whether the consequences of their decision will put others in significant danger, use of a risk enablement/ positive risk taking approaches.

It might be helpful to discuss dilemmas about the ethics of practice with colleagues but you must not assume that someone, even with years of experience, may give you the correct advice. Always seek authorisation and endorsement from a Manager.

Use to answer question 3.2c of the Care Certificate