Understand how principles of support are implemented in health and social care practice – LO.1
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Miss P is a 47 year old female with a diagnosis of autistic spectrum disorder and moderate learning disability, her physical health is good and the only medication she currently requires is lactulose for occasional constipation. Living independently within a block of 12 supported living flats, Miss P currently receives 20 hours of support per week from her care provider to enable her to
- Maintain her community presence
- Support with household tasks
- Receive support with shopping
- Maintain all aspects of her health
- Receive guidance with finances
- Receive support with banking and benefits
- Receive support with anxiety
Miss P maintains her personal care needs independently although she requires prompts to successfully complete these. The Local Authority currently fund Miss P for 14 hours per week at day services, one day is spent at a local gardening centre tending to plants, and the other at a social services led centre accessing the community. Miss P has contact with her father and step family regularly. Her father is It and it is important to her that she enjoys Italian food and wine with her father during these visits and that she engages in conversations about her culture and her past. Miss P stays with her family on special occasions such as Easter and Christmas and enjoys supported holidays once or twice a year. Miss P can become anxious if her plans suddenly deviate or if she makes a mistake, but she is always supported by staff who are familiar and know her very well, thus any episodes of anxiety can usually be anticipated and overcome very quickly. Miss P is unable to access the community without support so attending day services, and accessing social functions regularly to engage with peers is very important to her. When she is not being supported Miss P likes to spend time alone listening to the radio, not being disturbed. Her privacy is essential to her maintaining her anxiety levels.
In order to fully meet her needs, support staff work in agreed ways alongside Miss P as outlined in The Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England (2013) which states that “care workers should promote and uphold the privacy, dignity, rights, health and well-being of people who use health and care services and their carer’s at all times”, and by having knowledge of legislation which is relevant. The organisation promotes and enables Miss P to utilise choice and maintain her independence by applying a person-centred approach during the care planning stage.
Person centred planning has its foundations in a theory developed by the psychologist Abraham Maslow (1970), who identified that to reach their full potential, or self-actualise, people must first fulfil certain needs in order to progress to a higher level of development. Maslow proposed that realising our full potential could only come about through essential needs being met and organised this into a hierarchy of needs (Brotherton and Parker, 2011, 160). This approach was echoed by Carl Rogers who acknowledged the human tendency to self-actualise and built upon it further by suggesting that all individuals are capable of making the right choices, and know what is best for them, and that provided with the appropriate client/carer relationship this can be achieved. Rogers emphasised that it was the attitude of the worker, in his case the counsellor towards the client, that gave it its person-centredness or client-centredness. The helper should demonstrate empathy, genuineness and respect as the core conditions of the helping relationship (Brotherton and Parker, 2011, 181). Organisations now realise the benefits of Rogers approach and this concept has been transferred successfully across other sectors such as teaching, childcare settings, healthcare and to resolve conflict (The British Association for the Person-Centred Approach, 2015).
This concept is applied when composing the care plan of Miss P. She is an active participant during the planning of her support. Her values, beliefs, wishes and identity are respected by the organisation and incorporated into her support. Miss P’s right to exercise choice, independence and equality is outlined in the Adult Autism Strategy Guidance which suggests to local authorities that “People should live in their own homes with support to live independently if that is the right model of care for them” (Department of Health, 2015), and in the Disability Discrimination Act 1995 s.19(1) which states “It is unlawful for a provider of services to discriminate against a disabled person — (a)in refusing to provide, or deliberately not providing, to the disabled person any service which he provides, or is prepared to provide, to members of the public”.
Miss P’s rights to her own views and opinions are further promoted and protected by the Human Rights Act 1998 under Article 10 which states:
“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 of public authority and regardless of frontiers”.
In practice this legislation can be applied to promote inclusion, clear communication and to enable Miss P to utilise choice. The organisation demonstrates this by listening to what Miss P wants and enabling her to achieve it, not by dismissing her ideas and opinions.
Establishing a care package which is specifically and appropriately tailored to the needs of an individual with a disability requires agencies to work in partnership. It is well known that people with learning disabilities, especially people with less severe learning disabilities, are more likely to be exposed to common ‘social determinants’ of (poorer) health such as poverty, poor housing conditions, unemployment, social and overt discrimination” (Improving Health and Lives: Learning Disabilities Observatory, 2010). The Equality Act 2010 defines disability as having a “physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities” (Equality Act 2010 s.6(1)).
Miss P’s learning disability impacts upon her capacity to understand rights surrounding her choices, therefore these are explained to her in a simplified and jargon-free manner. It is then clarified that Miss P has understood by asking her to explain back the information given to her. To promote autonomy, support staff enable Miss P to access information that will support her in making informed choices.
The manner in which organisations communicate with each other, and with the individuals they support can have a significant impact on the quality of care delivered. Multi agency collaborations which include organisations such as the Learning disability team, day services, general practitioners, social workers and support staff are required to be working within clearly defined roles but with the common purpose of working in the best interests of the individual. Successful partnership working is dependent upon each agency receiving accurate information and being able to communicate that effectively. By being supported to actively participate in the development of her care plan Miss P and her family can be entirely involved in decisions regarding the delivery of her care. Information must be gathered correctly and include friends and family who know her well. With her as the client at the centre of the decision making process, having her thoughts, wishes and rights respected, forming an opinion and making fulfilling choices becomes more effective and achievable. In respecting her identity, cultural diversity and fostering barrier-free ways in which to achieve this, the care organisation can promote well-being by placing the control into the hands of the individual. This also builds positive bonds with family members who are crucial in relaying key information during the decision making process. Any support given to Miss P directly affects those close to her. Family members who know that their loved one is receiving the right kind of support also have improved well-being and their confidence in services is enhanced.
There are open and clear guidelines in relation to the complaints procedure, and this process is encouraged. Working alongside families this way promotes clear and honest communication and inclusion. There is also a recognition that the viewpoint and the physical presence of family is important and their participation is welcomed.
Reviews of support plans should be performed regularly and Miss P must be informed of this, and enabled to modify aspects of this at any time. Understanding and listening to what the client wants is fundamental to them achieving a good delivery of care. The choices and opinions of Miss P, even if considered to be unusual or eccentric must be acknowledged. It should always be assumed that Miss P has full mental capacity. Her right to make decisions, even those which are deemed unwise is protected under The Mental Capacity Act 2005, which insists that everybody has the right to make decisions without being discriminated against (social care institute for excellence, 2016), and by The Equality Act, 2010, which defines disability as a “protected characteristic” and thus protects the individual from discrimination (citizens advice, 2016).
The Mental Capacity Act 2005 further safeguards the right to choices and risk taking by attesting the following principles: (Please see Persons who lack capacity, appendices 2, 3 and 4)
- A person must be assumed to have capacity unless it is established that he lacks capacity.
- A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
- A person is not to be treated as unable to make a decision merely because he makes an unwise decision. (Mental capacity Act, 2005)
Miss P’s right to privacy and the preservation of her private life is safeguarded under article 8 of the Human Rights Act 1992 which states:
- Everyone has the right to respect for his private and family life, his home and his correspondence.
- There shall be no interference by a public authority with the exercise of this right such as in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedom of others (Human Rights Act, 1998).
Miss P is of Italian heritage and it is vital that agencies working alongside her recognise the necessity to maintain her traditional and cultural values, such as her Catholic faith and her need to acknowledge Italian public holidays. There should be an awareness that Miss P and her family may address certain issues very differently or want to avoid a subject altogether because it goes against their own particular values. This must be respected and not interpreted as resistance of services or disinterest. Support should be delivered in a non- discriminatory way without imposing personal viewpoints that could influence Miss P’s present beliefs. Adhering to the equality and diversity policy of the company supports in the delivery of good practice, as can training in anti-discriminatory practice and cultural diversity. In addition to this awareness and implementation of the Equality Act 2010 which categorises race as a protected characteristic under Chapter 1.
Race includes— (a)colour; (b)nationality; (c)ethnic or national origins (Equality Act 2010, s.9)a
and of the Human Rights Act 2010 article 14, which states:
The enjoyment of the rights and freedoms set forth in this Convention shall be secured without discrimination on any ground such as sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status (Human Rights Act 1998)
The organisation supporting Miss P promotes her safety by adhering to confidentiality policies and procedures which are kept on site and accessible at all times. As part of the job role all employees are required to follow this policy which states:
- Personal and private information about people with learning disabilities and their families should be treated sensitively and only shared on a “need to know basis” within the organisation.
- Discussion about personal matters relating to families and individuals should take place in a private office. Open discussion in public or open areas is discouraged.
- Unless there are exceptional circumstances, information should only be shared with outside agencies with the permission of the individuals concerned (please see highlighted excerpt from confidentiality policy).
This practice protects not only Miss P, but also the employee. It is critical that care staff understand the procedures and embed them into any support given.
Maintaining confidentiality is a crucial component of building a respectful and trusting relationship between the client and the care provider and an integral part of agencies working together successfully in partnership. However, private information relating to Miss P, should only be given on a need to know basis, and whenever possible with her consent. There may be times however when, for safeguarding reasons, information must be passed on. Care staff working alongside Miss P must make her aware that should she be at risk of harm then information may have to be disclosed to other professionals. During this time only the minimum amount of information necessary to safeguard the individual should be given.
Confidential information relating to Miss P is safeguarded by the Data Protection Act 1998. Sensitive data is defined as personal data consisting of information as to the racial or ethnic origin of the data subject, his political opinions, his religious beliefs or other beliefs of a similar nature, his sexual life, his physical or mental health or condition (Data Protection Act 1998 s.2).
The Caldicott Standards are guidelines which are underpinned by the Data Protection Act and identify 8 principles for the handling or processing of personal data. These principles are often incorporated into the confidentiality polices of organisations and are used daily within care practice. The Caldicott Standards state that employees must:
- Justify the purpose for which the information is needed.
- Only use personally identifiable information when absolutely necessary.
- Use the minimum personal identifiable information possible – if possible use an identifier number rather than a name.
- Access to the information should be on a strict need to know basis.
- Everyone should be aware of his/her responsibilities to respect client’s confidentiality.
- Understand and comply with the law. The most relevant legislation is the Data Protection Act 1998, the Police & Criminal Evidence Act 1984 and the Human Rights Act 1998. (Calidicott Standards and Data Protection)
Standard 9 of the National Minimum Training Standards for Healthcare Support Workers and Adult Social Care Workers in England 2013 also advises that employees working with individuals should be familiar with agreed ways of working and understand the legislation surrounding the recording, storing, and sharing of personal information, and to have knowledge about who and where to report concerns to regarding the breaking of confidentiality.
To ensure protection from risk of harm the organisation implements risk assessment, which is a legal requirement, and which measures and calculates the likelihood of harm to an individual. It also looks at the potential outcomes from not having measures in place. Miss P has risk assessments in place for using the kettle and oven, use of the iron, burns and scalds, accessing the community, travelling alone in a taxi, the event of a heatwave, and accessing the community with support. Hazards are identified and the risk is evaluated. Most organisations recognise that risk cannot be eliminated entirely, but that by putting control measures into place any potential for an incident can be minimised.
Decisions by Miss P which are considered diverse or unusual should not be dismissed. The rights surrounding her personal choices are promoted by both the Mental Capacity Act 2005, which states that individuals should not be deemed without capacity until an assessment has proved otherwise, and by the Equality Act 2010 which deems it discriminatory to discard her choices simply because she has a disability. By calculating risk, incidents can be foreseen and preventative measures put into place as far as is reasonably practicable. Positive risk taking has many benefits to the individual, such as increased confidence, improved client/staff relationships, and greater opportunities for inclusion. Risk assessment should be reviewed regularly and immediately if new risk presents itself. The organisation additionally risk assesses all staff working on premises for lone working, moving and handling, slips and trips and harm from challenging behaviour. Miss P has fire and flood information in her chosen format inside her property, which she is familiar with and knows what to do should either of these situations arise. Staff working alongside individuals undertake training and top up sessions in safeguarding, fire safety, COSHH, and first aid so that knowledge is up-to-date and relevant. Local initiatives such as monthly health and safety checklists, fire alarm testing and testing of any care lines that are in place further support the safety of Miss P.
Care workers have a responsibility to report any potential dangers or risks that could result in harm on to management and to make colleagues and individuals aware. The utilisation of incident and accident forms for near-misses and injuries ensures that a record is kept and that possible hazards are detected and dealt with. The organisation, employer or allocated responsible person has an obligation to report deaths, serious workplace accidents, occupational diseases and specified dangerous occurrences to the Health and Safety Executive (HSE) and abide by RIDDOR or the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995.
In order to maintain the safety of Miss P several pieces of legislation, policy, safety guidance and regulators are pertinent:
- DBS checking, to ensure new staff have no previous criminal history.
- SOVA or Safeguarding Vulnerable Groups Act 2006 was passed to help avoid harm, or risk of harm, by preventing people who are deemed unsuitable to work with children and vulnerable adults from gaining access to them through their work (Social Care Institute for Excellence, 2013).
- No Secrets – Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse and outlines who is at risk and how this may present itself (Department of Health, 2000).
- The Health and Safety at Work Act 1974 – places a responsibility onto employers to ensure that all employees are provided with a safe place to work, the use of secure and regularly maintained equipment needed for work, appropriate first aid equipment, to limit exposure to substances that are harmful to health, to provide safe storage of materials which may be toxic, to provide regular supervision and to make the workplace safe.
- CQC or Care Quality Commission. Independent regulator for health and social care across England. The CQC oversee all care homes, dentists, hospitals, supported living residences, and GP surgeries. They are in charge of monitoring all establishments and publishing data about them with the intention of providing more informed choice for individuals. The CQC also has the power to ensure services meet expected quality standards, and to demand that improvements be made.
- Organisational Health and Safety policy and procedure which details the procedure for COSHH (care of substances hazardous to health), hygiene and welfare, Manual handling, personal protective equipment.
The administration of medication must only be undertaken by staff who have an awareness of and access to the medication policy and procedure, are up to date with medication training, and have knowledge of how to appropriately record and store medication. Information on how to manage errors in medication is accessible in the medication policy and it is an expectation that in the event of a medication error, Miss P would be informed, medical advice would be sought immediately and the discrepancy recorded and effectively communicated to colleagues and supervisory staff and managers. Efficient documentation onto medication administration records, and correct storage of medication narrows the scope for mistakes.
Safety of family members, friends or professionals who may be visiting Miss P is protected through the use of various strategies and policies, including the visitor’s book. The organisation visitor’s policy requests that all people who come onto the premises document their arrival and departure and their reason for visiting. This ensures that there is a record of who is present within the building and, should an emergency such as a fire occur, staff can refer to the book to establish that everybody is out of the premises. Regular fire alarm testing ensures that with support Miss P is confident of what needs to be done when the alarm is heard. However, the use of the visitor’s book relies heavily upon each visitor remembering to sign this, and that staff will be present when each visitor arrives on the premises. Miss P’s safety is further promoted through the use of the organisational Health and safety policy and procedure, which considers it a duty that:
- employees take reasonable care for the health and safety of themselves;
- take reasonable care for the health and safety of other persons who may be affected by their acts of omissions at work;
- cooperate with employers, or any other person, or any of the relevant statutory provisions so far as is necessary, to enable that duty of requirement to be performed or complied with.
The Safeguarding Adults at Risk Policy and Procedure provides detailed information to care staff regarding how to recognise the signs and symptoms of abuse and the action to take should such an incident occur. The staff supporting Miss P have a duty of care to protect her from the risk of abuse to be aware of the possibilities surrounding this. There is a requirement to act on concerns of abuse as a priority with any vulnerable adult. This can be applied into practice with Miss P by immediately ensuring her safety and removing her from any situation which may be placing her in immediate danger, by accurately documenting, recording onto any appropriate paperwork, communicating effectively and factually with colleagues, managers and other professionals who may need to know, and by reporting concerns on to the relevant authority. Further safety measures can be specifically incorporated into support with Miss P, and her awareness about abuse increased. Staff should encourage her to report abuse, and inform her about what she can do if a member of staff, or a manager is suspected of abuse.
By S.D. (2016)