This page covers Learning outcome LO1, LO2 and LO3
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Understand how Health and Safety legislation is implemented in the Health and Social Care Workplace
This report and presentation will analyse the systems, policies and procedures in place within the work setting, and will investigate the various roles and responsibilities surrounding health and social care which apply to health and safety. To continue it will additionally take into account the attitudes that promote good health and safety practice and conclude with a critical reflection of significant health and safety priorities within my own practice setting.
“Safety culture is the attitude, beliefs, perceptions and values that employees share in relation to safety in the workplace. Safety culture is a part of organizational culture, and has been described by the phrase “the way we do things around here” (Perry, 2016).
Culture is a way of doing things that is mutual, taught or imitated. Everyone in a specific culture has a tendency to do things similarly, and this would be considered typical . Therefore, an organisation’s safety culture consists of its shared working practices, its affinity to accept or tolerate risk, how it controls hazards and how it deals with accidents and near misses . The best safety culture will be rooted in the reasonable distribution of responsibility. In this kind of culture, all failures can be reported without fear of reprisal (Institution of Occupational Safety and Health, 2015).
In a positive environment there is clear access to systems such as the whistle-blowing procedure and open complaint pathways. According to the institute of Occupational safety and Health Positive Safety Culture has 3 elements.
- Working practices and rules for effectively controlling hazards. The organisation promotes these strategies by incorporating the use of risk assessment, local policies and procedures, codes of conduct, effective joint-working relationships and person centred practice.
- A positive attitude towards risk management and control processes – Within the work setting this equates to an open and honest approach towards the reporting of poor practice, accidents and near misses.
- The ability to learn from accidents, near misses and safety performance indicators and bring about continual improvement (IOSH, 2015) – Because of the open attitude the organisation endorses – delivery of care is constantly evolving and being imnproved from previous errors. It is this capacity to disclose mistakes and put systems into place to prevent them occurring again, which demonstrates positive safety culture.
There is evidence to suggest that disagreements between managers and employees about the causes of accidents and unsafe work behaviours can lead to serious workplace conflicts and distract from a positive safety climate. A study by Brown and Willis in the Journal of Safety Research demonstrated that when a positive safety climate is present, both management and staff accept that safety is a shared responsibility. However when the safety ethos was poor there was a culture of blame between management and employees which then contributed to poor practice (Brown & Willis, 2003).
The organisation incorporates relevant health and safety policies and procedures in accordance with the law. These local strategies are in place to protect both employees and service users. Abiding by these systems ensures that a best practice philosophy is able to be applied. The Care Quality Commission are the independent regulator of health and social care in England and responsible for overseeing practice within the agency and all other organisations providing care and support. They inspect, monitor and ensure standards are being observed. To determine compliance they do on the spot unannounced checks on services and also publish poor ratings on their website (The Care Quality Comission, 2017). This promotes corporate accountability and serves as a guide to the public about the type of services they may be considering and whether they are safe to use or require improvement. In addition to this the organisation has regular audits which are undertaken by the National Contracts Team to measure compliance .
In a health and social care setting the need for good health and safety systems becomes amplified because of the types of client which may be accessing services. Having effective systems in place allows for risk to be managed and ensures that reasonably foreseeable hazards are assessed with suitable control measures put into place to cover users of services, staff , visitors and outside agencies. It also highlights the responsibilities surrounding health and safety that are expected from all who are present at the service. The organisation incorporates an assurance and risk management strategy which states:
“Living a rich life includes the ability to take risks. Entering into a relationship is fraught with the dangers of potentially negative outcomes, even financial loss. Yet as human beings we are all driven to engage with others as the prize of self discovery is immense. We have shown that supporting people with learning disabilities not only enhances their lives, but adds to the richness of the lives they touch”
This is how the organisation acknowledges that risk is a normal part of life, but shouldn’t restrict any individual from making choices or exercising independence. The objectives of this document are to comply with legislation, compliance with the external standards which promote safe services, clear intentions, governance processes and realistic corporate risk capacity.
All aspects of risk should be effectively defined. The risks can be defined into numerous groups:
- zero risk – no opportunity for accident or incident
- Minimum risk – opportunity for risk is slight.
- Risks to individuals and self
- Protection from harm and abuse
- Safety vs security
- Risk from substances
- Risk to property
Within the organisation there is the capacity for accidents and incidents to occur, this risk within the work environment is managed by the use of risk assessment which allows staff to make a careful examination of what, within the surroundings could cause harm, so that it can be decided if enough precautions have been take or if more needs to be done to prevent harm. The purpose of risk assessing is to make sure that no one gets hurt or becomes ill. This is a legal requirement according to the Management of Health and Safety at Work Regulations 1999, which states that all employers should make a suitable and sufficient assessment of the risks to the health and safety of employees and any other individuals using services or accessing the property of the business (legislation.gov.uk, 1999), and of the Health and Safety at Work Act 1974 which puts the onus onto employers to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all his employees (legislation.gov.uk, 1974).
The Health and safety at work Act 1974 introduced a unified, inclusive and governing law encompassing health and safety in Great Britain. This legislation is overseen by the Health and Safety Executive and enforces numerous expectations upon employers and employees and its three chief aims are to:
- secure the health, safety and welfare of persons at work;
- protect persons other than persons at work against risks to health or safety arising out of, or in connection with, the activities of persons at work;
- control the keeping and use of explosive or highly flammable or other dangerous substances, and generally prevent the unlawful acquisition, possession and use of such substances (In Brief, undated).
The act places responsibility on to employers and employees to work collaboratively and reasonably to solve any health and safety issues or concerns they may have. Consultation over those health and safety issues in the workplace should be carried out to achieve agreement on the solution. The act created two administrative bodies with powers to investigate and enforce health and safety.
- The Health and Safety commission which was formally responsible for policy making and enforcement and answerable to the present government.
- The Health and Safety Executive – its functions range from enforcement, research and investigation into serious incidents, to liaison with Europe over health and safety standards. Some of its powers are delegated to the Local Authority Environmental Health Department (Bingham, et al., 2009). Both of these agencies were merged into the Health and Safety Executive on the 1sr April 2008 (In Brief, undated).
The Reporting of Dangerous injuries, Diseases and Dangerous Occurrences Regulations 2013 requires employers to report and keep records of work related accidents which cause death and certain serious, reportable injuries, illnesses and incidents (Health and Safety Executive, 2013).
The organisation incorporates specific parts of the legislation into its own local Health and Safety policy and procedure and appoints a nominated person to be responsible for all health and safety matters. The policy defines that trustees of the organisation recognise it is their duty oversee Health and Safety and outlines:
- How staff whether employed or working in a voluntary capacity must be trained in all relevant health and safety matters and made aware of their own responsibilities for personal safety, and the safety of others.
- The use of medical grab sheets to provide “at a glance” summaries of important medical information
- The need to ensure that compliance is maintained with safety requirements, for example lighting, temperature, ventilation and rest facilities.
- The necessity to use and store substances which are hazardous to health appropriately.
- That provision of appropriate safety signs where needed, and their maintenance are compulsory.
- The need for a designated individual to be responsible for first aid
How does the organisation adopt this into recruitment and practice?
The policy is freely available for employees to access and is incorporated into delivery of support through the use of:
- CRB checks to ascertain that employees have no previous criminal history which could pose a threat to clients or other colleagues.
- Incident forms and the reporting of accidents and abuse.
- Regular training to keep up to date with training relevant to the client base.
- Complaints forms and procedures which are in place
- Monthly outcome forms, which monitor the health, well-being and inclusion outcomes of the individual.
- Home Hazard checklists – which the organisation use to identify additional hazards such as repairs.
- Tenants meetings to consult with clients and gain input on current or potential problems encountered.
In 2008 The Corporate Manslaughter and Corporate Homicide Act was introduced. For the first time, companies and organisations can be found guilty of corporate manslaughter as a result of serious management failures resulting in a gross breach of a duty of care. This legislation means that the livelihood of an organisation is at risk if they do not ensure their own health and safety systems are secure (HSE, undated).
The Health and Safety Act 1974 additionally requires the organisation to remain responsible for the safety of its lone working employees. This is detailed in the Lone working policy of the organisation which states “It is the role of the Chief Executive to ensure lone workers are suitably fit and healthy to work unaccompanied”. The following factors are considered when establishing risk:
- Does the place of work present increased risk to lone workers?
- Are there safe ways out of the premises?
- Is personal protective equipment needed?
- Are women at risk while working alone
- Are younger workers at risk of working alone?
- Is there any risk of violence
To minimise the risk to employees the agency issues all staff with mobile phones and a basic first aid kit. Staff must obtain the name, address and telephone number of the person being supported and enter this in to the main diary which is kept in the managers office., In the case of an emergency call staff use a key phrase which alerts a response from colleagues without raising an alarm. This measure is put into place to safeguard employees who are more at risk than those working in a group setting.
Responsibility for staff to safeguard themselves is obtained through making themselves aware of known risks by contacting referring parties such as the clients social worker or care manager and to familiarise themselves with documentation such as individual support plans, and the lone working policy and procedure.
Continued training is especially important for lone workers as their supervision, guide, control and help may be restricted in certain situations. This enables employees to have strategies to use when exposure to violence or aggression occurs. The organisation manages this by ensuring its policies and procedures are kept in line with National legislation, and by ensuring that training providers themselves are delivering up to date teaching (Health and Safety Executive, 2013).
The incorporation of these policies and systems into service delivery ensures that expectations and responsibilities are clear for all departments.
There is evidence to suggest that employees who work lots of hours are more likely to to be involved in a health and safety incident, and that impairment of recovery between working shifts may trigger numerous health issues that are connected with long working hours (Geurts and Sonnentag, 2006). Sparks et al. (1997) highlighted in their research about the health implications connected with long working hours. They determined that there is an association between hours of work and both physical and psychological ill-health. In the support of individuals who are already vulnerable it is not difficult to see how staff members who are overworked are at risk of making errors or poor decisions. The Working Time Regulations 1998 implemented the European Working Time Directive into the law of Great Britain. This states that a worker’s working time, including overtime, in any reference period should not exceed an average of 48 hours for each seven days (Crown Copyright, 1998).
The Health and Safety Executive is responsible for enforcing this law (Health and Safety Executive, undated). These specific regulations are integrated into the local Working Time Policy Statement, which agrees with the legislation but add that additionally the 48 hour law may be averaged out over a period of weeks.
The Care Act 2014 supports the safety of people using health and care services by placing a duty on local authorities to promote individual well-being by protecting from abuse and neglect. Since 2014 county councils have new safeguarding measures which they must implement. Part of this requirement is to identify and safeguard adults with needs for care and support who are experiencing or are at risk of abuse and neglect.
It is now compulsory to
- lead a multi-agency local adult safeguarding system that seeks to prevent abuse and neglect and stop it quickly when it happens
- make enquiries, or request others to make them, when they think an adult with care and support needs may be at risk of abuse or neglect and they need to find out what action may be needed
- establish Safeguarding Adults Boards, including the local authority, NHS and police, which will develop, share and implement a joint safeguarding strategy
- arrange for an independent advocate to represent and support a person who is the subject of a safeguarding enquiry or review, if required.
No Secrets was a code of practice which was combined into the Care Act in 2015. It outlined a code of practice for the protection of adults at risk and endorsed joint working between commissioners and providers of health and social care services (Bonnerjea, L. 2008). No secrets detailed how collaborative working can promote safety and clearly guided how to achieve effective outcomes while recognising the requirement of having transparent lines of accountability. In addition to this No Secrets highlighted that to protect adults at work, it may be necessary to divulge information on a ‘need-to-know basis’ (Department of Health, 2015).
The organisation adopts this strategy into the delivery of support by recognising the need for effective partnerships and compliance in matters surrounding the safety of adults-at-risk. Approaches such as implementation of person-centred planning and support, following codes of conduct and adherence to the safeguarding policy and procedure all limit the risk of an incident occurring. There is also additional focus on training and awareness about the client base – as those with learning disabilities are more vulnerable to abuse than the rest of the general population this may occur because they may have learned to comply with the wishes of others through previous experience of an institutionalised setting, which can make it much easier for others to bribe, force or manipulate them. Additionally clients may not fully understand their rights, especially the right to say “NO”. There is the strong possibility that individuals with learning disability also have not had access to education about sexual boundaries and relationships (Enable Scotland, 2009).
The Mental Capacity Act is designed to protect and restore power to those vulnerable people who lack capacity. If a person has been assessed as lacking capacity then any action taken, or any decision made on behalf of that person, must be made only in their best interests. All professionals have a duty to comply with this legislation. It also provides support and guidance for less formal carers. Understanding and using the MCA supports practice – for example, application of the Deprivation of Liberty Safeguards. The Act’s statutory principles are the point of reference and must be embedded in all acts carried out and decisions taken in relation to the Act.
The organisation incorporates this guidance into their Mental Capacity and consent policy and procedure to support individuals to make decisions, and in a care capacity this is embedded into every day choice, support planning and reviewing. Records relating to decision making and consent are kept as required. Health and Safety is promoted by care staff in supporting the individual to find the information they need in a way they understand and using their personal communication methods. This ensures a sound understanding of choices they are making. If an individual lacks capacity to make decisions the organisation makes sure they are central in the decision making process and that the right people are involved.
It is the responsibility of all care providers, regardless of the nature of provision being delivered, to handle medicine in the safest way possible.. Care providers are required to demonstrate that the standards of care as outlined in the Health and Social Care Act 2008, and the Care Quality Commission.
Legislation is integrated into a local “Supporting a person with their medication” policy and procedure. This draws on mandatory requirements from the Medicines Act 1968, The Misuse of Drugs Act 1971, Safe Custody Regulations 1973, The Health and Social Care Act 2008, and The Handling of Medications in Social Care. There is also compliance to guidelines from the National Institute of Care Excellence. The policy and procedure requires medication administration to be delivered in a way that promotes individual control of health and with dignity and respect. The policy states it follows best practice and legal and regulatory responsibilities and that they understand and respect the persons rights to choice, consent and refusal.
Within the organisation there are differing health and safety duties that are dependent upon where in the organisation an employee is based. These roles and responsibilities form a structure that promotes clarity and accountability.
- The trustee committee is responsible for effective implementation of the health and safety policy within the local area by ensuring that contractors employed are familiar with health and safety systems and that safe methods of work are adopted. And additionally the Trustee committee must make itself readily available to discuss health and safety related enquiries from employees or volunteers.
- The Safety officer is responsible for carrying out periodic inspections to identify unsafe working conditions and to promote safety education where needed.
- The steering group which includes members from throughout the organisation is responsible for consultation within health and safety and Produce summary reports on organisational health and safety performance and risk management as defined within governance arrangements.
- Management are required to provide access to training to keep their staff up to date with role specific training, and to ensure that their employees are both competent in their understanding and delivery of practice and that they have a clean CRB.
- Support workers and volunteers have a duty of care to themselves and to all other persons in the workplace and therefore must observe all health and safety rules at all times and ensure compliance with statutory regulations.
- Contractors which come to local services should ensure their employees abide by the health and safety systems at the premises where the work is being undertaken and should certify that any equipment they use is safe and maintained.
- Visitors and external agencies must sign the visitors book, and must abide by acceptable standards of behaviour, maintain privacy and confidentiality by not taking photographs or video of other service users without their prior consent, and ensure they do not engage in any action which may cause physical or mental harm to themselves or others.
Understand the ways in which Health and Safety requirements impact upon customers and the work of practitioners in the Health and Social Care Workplace
The necessity of accurate assessment, planning and the identification of risk
The calculation of risk is not intended to be complex, it involves making practical and proportionate measures to identify hazards and control risks (Health and Safety Executive, undated). Within social care, health and safety practice must link to national and local policies and procedures so that correct, non-discriminatory and ethical management of care planning and risk can be performed. When this is done well, individuals are able to access opportunities and live their lives fully without prejudice being placed upon their vulnerabilities.
A positive health and safety culture within an organisation is integral to providing a good delivery of care and support. This is underpinned by robust risk management systems to ensure that individuals, employees, external agencies and visitors have their safety ensured so far as is reasonably practicable. When the assessment and planning of client requirements is done effectively, and in line with national legislation, agreed ways of working and local policy it provides a safety mechanism by:
- Providing accessible pathways to complain
- Utilising best practice guidance
- Taking into consideration the philosophies, choices and needs of the client
- Safeguarding the sensitive information of the individual
- Accurately recording information
- Promoting effective communication within teams
- Enabling successful collaborative working
Good assessment should be thorough and individualised with a central focus on client empowerment. Adopting this principle supports in the promotion of autonomy, and in the case of individuals with learning disabilities highlights the “importance of being allowed to live a life that is as independent and typical as possible” (Wolfensberger, 1972).
The development of a care plan should consider the needs of the client holistically and should reflect their cultural, spiritual, health, social and emotional needs with full involvement from the client. Utilising effective care planning frameworks which are reinforced by current legislation such as the Care Act 2014, ensures that dignity, preference and lifestyle is respected. In addition to this the implementation of local policies such as Health and Safety, Diversity, Safeguarding and Confidentiality further improve upon the safety culture surrounding individuals by limiting the opportunity for accident, incident and abuse. An accurate support plan with clearly identified risk is fundamental to the delivery of good support because it defines how the individual should be supported in a way that maximises their potential whilst ensuring their rights are not infringed (Martin, 2007).
The National Occupational Standards
The National Occupation Standards acknowledge that best practice can only be obtained by combining current skills, values and knowledge. These tools which are the context for training and qualifications in health and social care, are also utilised within specific job roles, recruitment and as part of the supervision process (Skills for Care, undated). From the perspective of the organisation these skills can be used as part of the employment procedure and to promote staff development as well as ways to work effectively with employees. The standards are additionally used as part of advertised job specifications to highlight the specific values and skills organisations are looking for within potential employees (Skills for Care, 2006). Commissioning the strategies from the standards throughout an entire organisation ensures the health and safety of the individual remains a principal factor, and that probability of risk is reduced.
The National Institute of Care Excellence
NICE produce guidelines which are defined to different areas of health and social care. This can be especially useful in the partnership support of a specific client group, such as those with learning disabilities and additional mental health problems. NICE issue quality statements which outline expected services and standards that those individuals with dual diagnosis can access:
- people and adults with learning disabilities have an annual health check that includes a review of mental health problems.
- People with learning disabilities who need a mental health assessment are referred to a professional with expertise in mental health problems in people with learning disabilities.
- People with learning disabilities and a serious mental illness have a key worker to coordinate their care.
- People with learning and mental health problems who are receiving psychological interventions have them tailored to their preferences, level of understanding, and strengths and needs.
- People with learning disabilities who are taking antipsychotic drugs that are not reduced or stopped have annual documentation on reasons for continuing this prescription (National Institute for Care Excellence, 2017).
Correspondingly NICE (2015) also provide safety measures in their quality standards for “Challenging behaviour in people with learning disabilities: prevention and management” report. The standard references the care of adults with learning disabilities and behaviour that challenges. It also examines why the standards are needed and highlights previously failed and abusive strategies in the care of those with challenging behaviour. The guidance is focused on ensuring that “positive assessment leads to personalised care planning and access to meaningful activities and that people are supported to plan ahead and have the freedom to manage risks the way that they wish” (Quality Standards Advisory Committee, 2015). The overall purpose of the challenging behaviour standards is to adopt appropriate strategies by staff in their support of people with learning disabilities. This involves following the least restrictive practice possible to promote client dignity and privacy. The report’s emphasis on previously identified poor practices supports in staff learning thus decreasing risk of reoccurrence, and improving employee knowledge and quality of life for clients. This guidance links to local Health and Safety, Safeguarding, Health and Wellbeing and Challenging Behaviour policies, further preserving the good practices surrounding risk.
The Care Quality Commission
CQC inspect and regulate all services providing care to ensure they maintain standards of safety and quality. Their role is to outline to care providers and the public the quality of support individuals can expect, and the ways in which this must be delivered. Any organisation providing services is required to meet the essential standards defined by the CQC by law. The central standards defined by the Care Quality Commission all promote the safety and wellbeing of any individuals accessing care and support services. These are:
- Person-centred Care – Health and social care services must be delivered in a way that is personalised to the choices and chosen outcomes of clients.
- Consent – Any person acting on behalf of an individual must have consent to do so before any care is delivered.
- Any care or support administered must be done so in a way that does not put the individual at risk of harm. Care organisations are responsible for measuring risks that may arise from support, and for ensuring that employees have appropriate training in order to provide suitable care.
- Ability to complain – there must be a clear complaints process that all individuals are aware of, and have access to.
- Duty of candour- Transparency about the care and support delivered to individuals, being accountable when things do not go to plan, and providing an explanation as to why.
- Staffing – Any organisation providing care must ensure it has enough suitably qualified, experienced staff to meet standards
- Safeguarding from abuse – All individuals have the right to be free from all types of abuse including, degrading treatment, neglect, unnecessary/disproportionate restraint, inappropriate limits on freedom (Care Quality Commission, 2017).
Comprehension and implementation of the standards increases safety within the care setting, thus enabling individuals to take carefully evaluated but positive risk and increase their autonomy and inclusion within society.
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 16
The purpose of regulation 16 under the Health and Social Care Act 2008 is to ensure that individuals using services have accessible routes to complain about their care and support. It places accountability onto the care provider to maintain “effective and accessible system for identifying, receiving, handling and responding to complaints from people using the service, people acting on their behalf or other stakeholders” (Care Quality Commission, 2017). Failure to provide this service can result in prosecution. For vulnerable adults a complaints procedure may be the only way they can safely report abuse and so is essential to their wellbeing and any risk which may present. Within a care capacity, not having available and transparent complaint pathways is essentially prevention of the exercising of rights and forbidden under The Convention Rights and Freedoms section in the Human Rights Act 1998 which states under Freedom of Expression
“Everyone has the right to freedom of expression. This right shall include freedom to hold opinions and to receive and impart information and ideas without interference by public authority and regardless of frontiers” (legislation.gov.uk, 1998).
Learning and development opportunities
“The organisation will provide adequate and appropriate Health and Safety Training for all employees including induction training and skills training. It will maintain appropriate training records. All staff will receive basic Health and Safety training”.
The culture of an organisation will influence human behaviour and human performance at work (Health and Safety Executive, undated), consequently poor awareness of support strategies and guidelines can result in poorly delivered care, planning and risk management. The company is expected to maintain its ethos and the values that it promotes, therefore all aspects of training are considered to be of prime importance to the health and safety of both individuals and employees. In the case of person-centred planning, it is recognised that tailored approaches can be restricted due to inadequate staff skill base ( (Cowley, Dowling, & Manthorpe, 2006), and that this factor can therefore prevent client outcomes being accomplished. Additionally, training and development supports in broadening awareness about the increased potential for risk in those individuals who are marginalised, or who may fall within a protected characteristic under the Equality Act 2010. Clients who are from an ethnic minority, peripheral religious group, or who are yet to decide which gender they identify with, have an increased possibility of risk, as do those with disabilities. This because they are already facing discrimination and isolation prior to accessing services which places them at greater disadvantage. When support staff have appropriate training in place, their expertise and aptitude for understanding and identifying risk is improved, resulting in strengthened care and support systems and consequently safeguarding individuals. Individual needs are met through these learnt skills and by adhering to strategies such as:
- equality and diversity policies which identify practices, such as discrimination, victimisation, bullying and harassment and give specific examples of how these may occur.
- Safeguarding Policies which define the types of abuse, who may be a perpetrator or victim, how to appropriately deal with allegations of abuse, and the correct reporting process.
Application of these strategies increase the potential for maximum health and wellbeing.
The Risk Management Procedure
The organisation adheres to the risk management procedure which is a requirement of the Management of Health and Safety at Work Regulations 1999, and the Health and Safety at Work Act 1974. The procedure is in place to ensure that all necessary measures to have appropriate risk management are in place across the organisation. The organisation are required by statute to evaluate risk. Vital elements to consider are whether a hazard is substantial and therefore requires an assessment of the risk; or whether the hazard is inconsequential and already has satisfactory precautions in place. With these strategies in place and observed, the prospect for substantial risk to health and wellbeing is reduced.
The Importance of current knowledge and skills and its impact upon the client
The organisational Health and Safety Policy highlights the importance of training and development within its employee base. The health and wellbeing of vulnerable adults is dependent upon management and direct support staff having enough knowledge and experience to care and plan for individuals with a range of diverse needs, and the organisation provides a comprehensive learning and development plan for all staff. This provides employees with the skills to address and support in resolving issues which arise within the delivery of care. A study by the University of Kent “Measuring the productivity of workforce development in care homes” observed the link between skill levels and qualifications among the workforce and its impact upon quality of care and outcomes for clients. The study found that “When a greater proportion of staff had or were working towards NVQs, outcomes and structural issues, such as how homelike the environment was, were better” (Netten, Beadle-Brown & Welch, 2011). This is not a complex illustration but highlights how even basic knowledge can support in achieving individual outcomes.
Training which is specific to the client group across the entire employee base results in improved effective communication, the knowledge to identify the social determinants of that group, inequalities they may potentially face, and the skills to efficiently plan and care for individuals. To illustrate the impact of this on a client, a case study:
Miss P is 47 with autistic spectrum disorder and learning disability. The difficulties that she experiences with her social interaction, communication and anxiety can all further deteriorate during times of stress. Miss P likes to go into town and to an activity club so that she can maintain her peer relationships. At time’s she finds the noise in town and at the activity club so unbearable it intensifies her anxiety levels. This has, in the past, resulted in Miss P lashing out at herself, staff members and other individuals. There have also been incidents when Miss P has run away from support staff and into the road, or in shops unsupervised. Support staff identified the times when Miss P is most likely to have anxiety due to noise whilst in the community, and via the risk assessment process, evaluated ways in which this could be managed therefore lessening the potential for harm to occur, and enabling her to continue maintaining her community presence and important relationships.
To fully support Miss P in both the planning and achieving of outcomes, it is vital that support staff have up-to-date training and a robust awareness of the current values being delivered in social care. This includes being able to identify problems, put measures in place to lessen risk and alleviate difficulties, and to review or modify regularly to ensure the plan is working. If the problems Miss P is experiencing were simply resolved by stopping her access to the community, her health and wellbeing would decline, and her right to take risks would be restricted, but because staff are encouraged to participate in learning opportunities, and undergo mandatory training the situation is managed in a way that enables Miss P to continue doing the things that are crucial to her wellbeing. The challenging behaviour policy necessitates that “employees have a duty of care towards the people they support, and requires that reasonable measures are taken to prevent harm to them”. This is in place to promote the security and welfare of clients, as well as ensuring inclusion, independence and autonomy are preserved.
2.3 & 2.4
Risk-analysis benefit debate
In the above case study (see 2.2), the hazards that were affecting Miss P were identified and evaluated. To continue this, an examination of the potential advantages and disadvantages that may arise from this course of action to the individual, others, and the tensions that may present from non-compliance as a result.
“In simple statistical terms, risk can be thought of as expected loss — the probability of some adverse event, multiplied by some measure of the severity of that loss” (Wilson & Crouch, 2002). Often in attempts to stabilise risk between duty and expectations of care, other risks may present and this can impact upon the efficiency of risk assessment. In Miss P’s case study the organisation had to intervene to protect her and others from harm. This process has the potential to influence the wellbeing of Miss P both positively and negatively and, furthermore, can impact upon the job role of support staff, other individuals and the organisation as a whole. The Department of Health (2007) established that a “balance must be struck between risk and the preservation of rights, especially where the person has capacity”. When achieving outcomes for one individual places others at risk, the care organisation must take steps to intercede, and this can be a source of conflict.
Advantages of Miss P’s risk assessment
- Miss P is able to continue achieving her chosen outcome
- The risk to self and others is lessened
- Legislation and local policy is followed
- Increased prospects to access social and learning opportunities
- Proactive measures are introduced in comparison to crisis measures
- Positive audits and reviews of organisation
Disadvantages of Miss P’s risk assessment
- Possible feeling of exclusion and isolation resulting from higher staffing ratio and noise cancellation headphones
- Strain on staffing resources
- Extra cost to the organisation
- Increased staff responsibilities
- Tension arising from theory-policy gaps
- 1-1 support in the community may restrict opportunities to go out as frequently due to staff availability/resources
- Other stakeholders may disagree with plans outlined in the risk assessment
With risk calculated and measures put into place, in this case with an increased staff ratio and noise reducing headphones, Miss P can still maintain her community presence and the risk to self and other individuals is lessened. This adheres to the Care Act 2014, and local person-centred, challenging behaviour and health and safety policies and so is legally correct. However, it is also appropriate to consider that the changes may impact upon Miss P and others negatively. Having a 1:1 staff ratio may overwhelm the client, who is used to being supported within a group of 3. The new noise cancellation headphones draw attention to her vulnerability and could marginalise her further rather than increasing her presence. Furthermore, this may be viewed as a solution for the organisation rather than Miss P. The requirement for a higher staff ratio places increased staffing and financial pressure onto the organisation and could result in a reduction of social opportunities which will ultimately impact upon relationships.
Other stakeholders involved in the care of Miss P, such as multi-disciplinary team members, may have differing priorities to those outlined in the risk assessment and could feel that some aspects are unrealistic or not in the best interests of the client.
Members may be working in different geographical areas, each having its own distinct statutory responsibilities and working practices, which can make meeting the requirements of local policies even more complex. This can result in a fragmented approach in which direct support staff are delivering some, but not all of the expected standards of care, thus weakening health and safety strategies put into place to safeguard the client. Mantell & Scragg (2009), suggest that “resolution within partnerships can be achieved with clear ground rules and an open, reflective approach”. This may be unrealistic and difficult to accomplish given that other members of the collaboration may only see Miss P sporadically and for short amounts of time and therefore have a limited understanding of the impact.
Utilising the risk assessment procedure has enabled the organisation to evaluate problems proactively, rather than waiting until crisis action is required, but there is a probability that the process could highlight gaps between policy and provision and be a source of low employee morale. If employees are educated to deliver care holistically but find themselves unable to do so, the tension, along with poor pay vs responsibility can be a cause of high staff turnover.
The Report of the Inquiry into Adult Mental Health Services in England has expressed that “No service can function well when those responsible for delivering the service are tired, stressed, and themselves at risk of mental distress” (Lewell-Buck, 2016). Because there are secondary plans in Miss P’s risk assessment to seek advice from psychology and source alternative activity group times, at the present time the benefits outweigh the risk. Should primary plans within the risk assessment be successful, then the requirement for constant 1:1 support may reduce. An equally significant factor to consider is that not all episodes of challenging behaviour are permanent, and Miss P’s anxiety may transfer and be triggered by different things.
Ethical dilemma occurs within care practice when the professional obligations and duty of care of the worker conflict with their personal values and beliefs. Values exist at societal, organisational and individual levels, and these varying levels constantly influence each other. Sometimes this can result in tension and ethical dilemma for the care worker (Brotherton and Parker, 2011).
In health and social care, the probability for an ethical dilemma to present is high because of the complex nature of the job. The complications are entrenched between the inconsistent nature of care conduct, and personal values. It has been acknowledged that the anxiety and behaviours which led to to the risk assessment for Miss P, are also being demonstrated at day services and Miss P has been placed onto an anti-psychotic medication. It is noticed that at home, in her usual environment and with known staff providing care, that her anxiety is easily managed. The anti-psychotic medicine prescribed for Miss P has known profound side effects, and direct support staff feel that not only is it unnecessary, but also that it is impacting upon Miss P’s ability to interact well and making her extremely sleepy all of the time.
According to the Codes of Conduct “Nothing that a person does, or omits to do, should harm the safety and wellbeing of people who use health and care services, and the public” (General Social Care Council, 2010). Support staff recognise that Miss P’s quality of life is reduced due to the medication, but have no choice other than to manage the medication in line with the GP’s instruction. Administering the medication leaves the staff feeling guilty of abuse and that this practice goes against all the values they were taught.
Non-compliance of staff to administer medication would be considered neglect by the organisation, the prescribing doctor, and by the local authority. “Neglect is the deliberate withholding OR unintentional failure to provide appropriate and adequate care and support, where this has resulted in, or is highly likely to result in the person experiencing severe ill health or adverse effects” (Newcastle Safeguarding Adults Board, 2011). Non-compliance would also be in violation of the Care Act 2014 which explains that “Local Authorities must make enquiries, or cause others to do so, if they reasonably suspect an adult is experiencing, or at risk of, abuse and neglect;” (NSAB, 2011). The impact of not adhering to statute and policy upon the organisation would involve loss of reputation, probable withdrawal of contracts from the Local Authority, financial issues, legal consequences and investigation by the Care Quality Commission. The impact of non-compliance to administer medication on Miss P could result in further deterioration of her anxiety, and thus her health and wellbeing. Opportunities could be further restricted by anxiety becoming so bad that Miss P is unable to maintain community presence, resulting in isolation and exclusion. Correspondingly, any joint-working relationships would effectively dissolve. Resolution to this situation can only occur through transparent and open lines of communication, accurate recording of information, and discussion of negative side effects with the prescribing doctor.
Vecchio-Sadus, (2007) explains that “The way we communicate about safety will influence whether or not people will understand and participate in the safety process, and the language we use will often determine whether the process is accepted or rejected”. In care providers with a poor communication ethos the potential for serious incidents is much greater. An ethical dilemma could arise when a client discloses abuse to an employee with a lack of appropriate training or gaps in their competency. The client may request that the information be kept private instead of being documented and reported. Insufficient relevant knowledge on the part of support staff could be a source of confusion about how to suitably approach the situation, and the staff member may feel morally obliged to comply with a client’s wishes. Gaps in staff skills, such as incomplete training in Mental Capacity, confidentiality and effective communication can result in misunderstandings about the right course of action to take.
Non-compliance in reporting the disclosed abuse is in violation of numerous statutes, including:
- Regulation 13 of the Health and Social Care Act 2012 which states “Where any form of abuse is suspected, occurs, is discovered, or reported by a third party, the provider must take appropriate action without delay. The action they must take includes investigation and/or referral to the appropriate body” (Care Quality Commission, 2017). The Care Quality Commission can prosecute the organisation for contravening this regulation and can also take additional governing action.
- The Care Act 2014 which expresses that “agencies supporting adults at risk of abuse and neglect can prevent and detect harm but they must act swiftly and competently when abuse is suspected or reported” (Skills For Care, undated).
- The local safeguarding policy which informs staff that “there is a responsibility for all staff to report an allegation or concern to the appropriate statutory organisation such as Adult Social Services or the police”.
- The local confidentiality policy – where someone discloses that they have abused someone or are being abused or when any breach of a disciplinary rule is alleged. In these circumstances a Department Manager or DSP must be contacted. In the event that someone is being abused, the Safeguarding Adults Protection Policy must be followed.
- The organisational Health and Safety Policy which states that employees must ensure that “ they take reasonable care for the health and safety of other persons who may be affected by their acts or omissions at work” .
- The Codes of Practice for Social Care Workers informs employees of care providers that “they must comply with employers health and safety policies”, and that “they must make sure their conduct does not fall below standards set out in the code and that no action or omission on their part harms the wellbeing of service users” (General Social Care Council, 2010).
The non-reporting of abuse is considered an extremely serious offense. Vulnerable adults, especially those with learning disabilities, may have impairments to their social understanding which puts them at risk of further exploitation if disclosures are not reported. The impact of non-compliance on the individual can create a scenario in which they are exposed to repeated acts of abuse, while suffering decline to their health and well-being. Employees who are non-compliant and do not report abuse will be regarded as essentially allowing exploitation to continue and possibly accused of neglect themselves. This could result in being reported to the General Social Care Council, and banned from ever working within the care sector again.
Non-compliance within health and safety always has negative consequences and a quality organisation will recognise this and empower their clients by providing a high standard of training and development for staff. Health and safety legislation, codes, regulations and policy exist to prevent previously learned mistakes from reoccurring. The law is not perfect, and gaps and contradictions are constantly being identified. However, the sector continues to identify flaws, put measures in place to correct them and in doing so continues developing improved safety measures to protect the most vulnerable people in our society.