Dignity in care
Stand up for dignity - Legislation - Summary of further legislation that supports Dignity in Care
Care workers in health and social care have a whole range of legal and professional responsibilities both to the people for whom they provide services and to others, such as their fellow workers and unpaid carers. These responsibilities are very important. Human rights should not be used as an excuse for failing to discharge those responsibilities. The Bichard inquiry into the murders of Jessica Chapman and Holly Wells highlighted concerns that confusions about the operation of human rights and data protection legislation caused failures to record essential information about alleged sex offenders. It was not the Human Rights Act that caused the difficulties but the failure to understand how it operates. The key point is that the human rights of any one individual do not override duties to ensure public safety. The response to this inquiry led to the Safeguarding Vulnerable Groups Act 2006
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Quality in careOpen
Circumstantial influences on dignity, such as the living conditions in care homes or the standards in day centres, are governed by a whole host of regulations.
The Care Quality Commission (CQC) regulates directly provided health and social care services. These are categorised in 28 service types.
New essential standards of quality and safety have been published (PDF file).
Personal assistants paid for through Direct Payments and Personalised Budgets and Day services are unregulated.
Overview of the CQC regulatory model (PDF file).
A new registration system is being introduced gradually from April 2010. Until all services are registered under the new system (by October 2010), existing National Minimum Standards will apply. You can find a quick guide to the new system here.
CQC also participates, with other key bodies, in the Comprehensive Area Assessment (CAA). The CAA assesses how well public services are working together to meet the needs of local people. CAA gives the public an annual snapshot of quality of life in their area.
Food Safety Act 1990, Food Safety (General Food Hygiene) Regulations 1995 and Food Safety (Temperature Control) Regulations 1995
The Food Safety Act covers the preparation, storage and service of food and requires the registration of food businesses whether they are run for profit or not. A 'food business' includes canteens, clubs and care homes.
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Legal responsibilitiesOpen
The fact that a responsibility is a legal duty generally means that any action that interferes with a qualified right, such as the rights in Article 8, is going to be seen as legitimate and necessary. It does not answer the question about proportionality (whether the action is excessive).
The Manual Handling Operations Regulations 1992 cover the transporting or supporting of a load (including people). While employers are required to ensure that they comply with the regulatory framework, this does not mean that an individual's human rights can be disregarded. What is required is a balanced approach that reduces risks for workers while at the same time maintaining the dignity, privacy and autonomy of those they are caring for. The problem of lifting an overweight person, for example, must be solved not ignored (see box).
Heavy lifting
The county council, concerned for the health of its employees, imposed a blanket ban on manual lifting of patients and other service users. Unfortunately this resulted in the certain people (known anonymously as A, B, X and Y) not receiving the community care to which they said they were entitled. There are detailed guidelines on manual lifting set out in the Manual Handling Operations Regulations of 1992, but the court held that these did not prohibit manual handling of people, nor operate a cut-off above which they would be too heavy to lift manually. Failure to lift these people could leave them stuck in a bath or on a lavatory, or suffering from bedsores. This created a potential breach of Article 3 of the Human Rights Act (the right not to be subject to inhuman or degrading treatment). Care workers' rights to a safe working environment must be respected, but these require safe working practices to be devised, not blanket bans that restrict levels of service. [R (on the application of A and B, X and Y) v East Sussex County Council (2003)]
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Responsibilities to carersOpen
Family and friends who act as unpaid carers often play a vital role in maintaining the dignity of service users, particularly when the person they are caring for is incapacitated, either physically or mentally. There are legal responsibilities to carers and some of these are contained in the following Acts:
- Carers (Recognition and Services) Act 1995 (CRSA)
- Carers and Disabled Children Act 2000
- Carers (Equal Opportunities) Act 2004
Other responsibilities to carers are contained in the Mental Health Acts 1983 and 2007 and the Mental Capacity Act 2005.
In summary, the responsibilities for practitioners are to assess carers' needs and to involve them in developing support for the person they care for if that is what both wish.
There may be circumstances in which responsibilities to carers appear to conflict with the human rights of the cared for person. If a person lacks the capacity to make a decision or to consent to care and treatment, then the provider of health or social care services must act in the best interests of that person.
It is generally in the best interests of the cared for person to have the carer involved in decisions about his or her care (but sometimes it is not). If there is a conflict between the best interests of the carer and the best interests of the person, then the best practice is to seek advocacy and separate practitioners for both parties. It may be that independent advocacy services should be involved or commissioned to resolve the conflict. In some cases an independent mental capacity advocate (IMCA) might be able to act; the local authority and NHS trust will have details of how to contact this service locally and advise on what services it offers.
