KNOWLEDGE BOOSTER - THE DUTY OF CARE

In this series of Knowledge Booster titles, we will be taking a look at

a number of areas that can be used by employers and their staff to
help ensure knowledge and understanding is maintained around
key topics pertinent to different roles. Knowledge Boosters will be
different in length as each deals only with specific targeted
information.
Here we will look at the ‘duty-of-care’.
The duty-of-care is one individuals will come across regularly in
their roles within health and social care and involves keeping those
who receive care and support free from harm and prejudice and
remain safe from abuse. It is therefore something that is mentioned
at all relevant points in different topics covered by the Red Rock
portfolio.
Duty of Care Principles
It is a legal responsibility to keep a person safe and maintain their
well-being, so to ignore this responsibility or fail to uphold the Duty
of Care could mean that you are negligent, something that can result
in disciplinary and even legal action.
The Duty of Care forms a part of the Code of Conduct for Healthcare
Support Workers and Adult Social Care Workers and these codes
identify the standards expected from healthcare support workers
and adult social care workers, outlining the behaviour and attitudes
expected. Whilst the Code of Conduct is voluntary, it is nevertheless
seen as a sign of best practice.

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Good Working Practices
Good working practices which keep service users free from harm
include:
 ensuring environments are safe from hazards and free from
the risk of harm occurring
 following organisational policies and procedures in relation to
health and safety and care of service users
 reporting harmful or dangerous issues so that further harm
can be prevented
 reporting abuse
 preventing abuse by being vigilant and aware of safe working
practices
 reporting unsafe working practices.
By ensuring the safety of service users, responding to your duty of
care within your work role and following the guidelines of
Compassion in Practice and the 6C's, you will help to maintain the
highest possible standards and contribute to the safeguarding and
protection of all individuals.
Legislation
Legislation relating directly to roles and responsibilities associated
with the Duty of Care includes:
The Health and Safety at Work etc. Act 1974 - This is the main
piece of legislation covering occupational health and safety in the
UK. It places a duty on employers and employees for the health,
safety and welfare of persons in the workplace.

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The Management of Health and Safety Regulations 1999 -
Workplaces should have a procedure in place for recording,
reporting and evaluating all serious incidents.
The Reporting of Injuries, Diseases and Dangerous Occurrences
Regulations 2013 (RIDDOR) - This places duties on responsible
persons working on the premises to report specific workplace
accidents, occupational diseases and specific dangerous occurrences
or near misses to their local Health and Safety Executive (HSE).
The Control of Substances Hazardous to Health Regulations
2002 (COSHH) - This requires employers to assess the risks of
potentially harmful substances and take precautions to minimise
these. They include, for example, cleaning materials and medication.
The Provisions and Use of Work Equipment Regulations 1998
(PUWER) - Anyone responsible for work equipment should ensure
that it is suitable for the job, well maintained, inspected regularly
and only operated by well-informed and trained staff. A breach of
any of these regulations is a crime in the UK and therefore needs to
be reported immediately. If any person suffers harm as a result, the
offender may be taken to court.
The Care Act 2014
The Care Act 2014 provides a regulatory framework for people who
have care needs and represents the most significant reform of social
care in more than 60 years. It sets out the expectations of local
authorities and the steps which must be followed to ensure the right
level of care and assistance is in place.
The main aim of the Health and Social Care Act 2008 was to create a
new regulator whose purpose was to provide registration and
inspection of health and adult social care services and ensure the
safety and quality of care. This led to the creation of the Care Quality
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Commission (CQC) who had responsibility for regulating primary
care services including hospitals, GP practices, dental practices and
care homes.
The Health and Social Care Act 2012 made minor changes to the
2008 Act and forged the relationship between the CQC and Monitor
(the independent regulator of NHS foundation trusts). Since the
2008 Act was passed, updated legislation has been passed to give
greater clarity. For example, the Health and Social Care Act 2008
(Regulated Activities) Regulations 2010, concentrating on defining
the types of services which were to be regulated and the activities
being provided which must be registered.
The Care Act 2014 has since introduced a statutory framework for
safeguarding adults in England. This saw the introduction of the
Duty of Candour and Fundamental Standards by which all service
providers are now inspected against. It was fully implemented in
2015.
The 6 C's
Compassion in Practice is the vision for nurses, midwives and care
staff and the following provides an overview of the 6Cs:
 "Care - 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 - 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.

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  Competence - Competence means all those in caring roles
must have the ability to understand an individual’s health and
social needs. It is also about having the expertise, clinical and
technical knowledge to deliver effective care and treatments
based on research and evidence.
 Communication - Communication is central to successful
caring relationships and to effective team working. Listening is
as important as what we say and do. It is essential for “no
decision about me without me”. Communication is the key to a
good workplace with benefits for those in our care and staff
alike.
 Courage - Courage enables us to do the right thing for the
people we care for, to speak up when we have concerns. It
means we have the personal strength and vision to innovate
and to embrace new ways of working.
 Commitment - A commitment to our patients and populations
is a cornerstone of what we do. We need to build on our
commitment to improve the care and experience of our
patients. We need to take action to make this vision and
strategy a reality for all and meet the health and social care
challenges ahead."
Safe Practices
Safe working practices include:
 working to organisational guidelines, policies and procedures
 following these guidelines, policies and procedures
 adhering to health and safety

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  encouraging service users to have the right to make choice but
making sure that they are guided towards making and taking
the correct choice.
Knowledge Point
Important Point to Remember!
It is important to think about your own role at work and how you
work safely in relation to your duty of care towards those you care
for/support.
Safeguarding and the Protection of Individuals
Within the duty of care, you have a responsibility to raise any
concerns you may have in relation to all aspects of your work. These
may be about working practices, the safety of working
environments, poor practice (from colleagues or managers) and
even concerns relating to a person's friends and family, as
safeguarding and protecting individuals from harm is the main
aspect of the duty of care.
If a person is not protected from harm or abuse, then those involved
could be considered negligent (even if this is unintentional or
results from carelessness) and if found to be negligent, a person
could face disciplinary action or dismissal.
Your employer should have safeguarding policies and procedures
which you can access and become familiar with to help your
understanding.
Conflicts and Dilemmas with the 'Duty of Care'
At times, conflicts or dilemmas may arise between a person's rights
and the duty of care (in relation to their health and safety) and
understanding how to address these and manage any risks
associated will always be important.
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A conflict could be described as a situation where a person becomes
upset, aggressive or overly emotional if they feel that they are not
being supported in terms of being able to make a particular choice.
A dilemma could be described as a situation where a person wishes
to apply their right (to make a particular decision) but because it
may come with risks to their health and safety, their request cannot
be actioned.
So, although it is the right of every person receiving care/support to
make their own choices and take their own risks, the role of the
person providing care/support in assisting them in making these
choices should ensure they ensure any risks are minimised (without
compromising their rights).
Potential Conflicts or Dilemmas
Here are some examples of potential conflicts or dilemmas that
might arise between the duty of care and person's rights:
 situations where a person wishes to act independently but you
feel they are unable to do so. For example, bathing alone,
leaving the premises alone, using public transport alone etc.
 situations where a person wishes to decide on their own health
and dietary welfare. For example, changing of an eating plan,
wishing to stop a prescribed medication etc.
 situations that involve other people (external to the care
setting environment) for example new friendships or other
partnerships/relationships which may affect a person's safety
or wellbeing.

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What you Can and Cannot do
As it is the person's right to make choices (and take risks), they can
only be advised and encourage in a supportive manner (whilst
considering their safety). You cannot force your own impressions or
opinions on them and make them do things they don't want to do.
However, a service user needs to be capable of making an informed
decision or choice.
Under the Mental Capacity Act 2005 (MCA)
“… a person who lacks capacity means a person who is unable to
make a particular decision or take a particular action for themselves
at the time the decision or action needs to be taken”.
This essentially means that if a service user has been assessed as
being incapable of making decisions or taking actions, then certain
decisions and choices may be made on their behalf.
Managing Conflict and Dilemmas
As a process, risk assessment can be used to help manage conflicts
and dilemmas that may arise between a person's rights to make
choices and decisions and their safety and allows those involved to
to 'weigh up' risks that may be faced by the person when making
their choices with the duty of care to protect them.
For example, if a person refuses to take medication which they have
been prescribed (but their well-being relies on this medication
being taken), they cannot be forced to take it. However, a supervisor
or manager will need to be contacted/informed, as they are likely to
be the ones responsible for undertaking a risk assessment (to
determine the potential consequences and risks the person may face
by not taking the medication). The findings can then be discussed
with the person.
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Managing the Risk of Conflict and Dilemmas
Managing risks to a person in such instances can be helped by:
 discussing issues of conflict and dilemmas with those involved
directly and explaining the various consequences and courses
of action
 reporting issues and concerns to a manager or supervisor or
other senior colleagues
 recording incidents where conflicts or dilemmas arise within in
a person’s care plan and ensuring that these are communicated
to all important others
 not making promises to people about the requests they may
make, instead discussing these openly and stressing that
further action will be taken or confirmation offered
Seeking Advice When Needed
Within topics like this that can be difficult to handle, it is important
to understand the limits of your role and responsibilities, especially
where this may put you in a situation you are not comfortable with.
If this is the case, you should bring it to the attention of senior
colleagues by reporting it immediately (for example to your
supervisor or manager).
You can gain additional support and advice about conflicts and
dilemmas by
 reviewing your organisation's policies and procedures
 requesting support and advice from social workers and other
professionals

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  reviewing guidance as set by the Care Quality Commission
An Example
A person who is in a residential care setting wants to make their
way to a concert which is being held in their local city. In discussion
with your manager and when reviewing their care plan, it is decided
that they must be accompanied by a member of care staff.
When you speak to the person, they are unhappy about this decision
and refuse to accept that they can only go to the concert if a member
of staff accompanies them. The person argues their point and
becomes quite aggressive, mentioning their rights to be able to go to
a concert of their choice independently.
What would you do in this situation?
Knowledge Point
Important Point to Remember!
Think about what you would do in this situation and perhaps ask
colleagues what your organisation's policies/procedures are
(including how to best keep records about issues of this kind).
Complete
You have reached the end of this module.
As you have completed all elements required here, you can now take
the assessment.
You must answer all questions in order to complete the assessment,
although you don't have to complete it in one session. Please ensure
you have sufficient time (you should allow at least 15 minutes) to
finish.

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