Understanding common induction

Common Induction Standard 5: Principles for implementing duty of care

Standard 5 is divided into the following four parts:

Overview

Duty of Care is defined simply as a legal obligation to:

  • always act in the best interest of individuals and others
  • not act or fail to act in a way that results in harm
  • act within your competence and not take on anything you do not believe you can safely do.

As a care worker you owe a duty of care to the people you support, your colleagues, your employer, yourself and the public interest. Everyone has a duty of care – it is not something that you can opt out of.

When acting in a person’s best interests you must do so with their consent unless you have evidence that the person lacks capacity to make that particular decision at the time it needs to be made.

If you are employed directly to support someone in their own home, duty of care still applies. Do you have access to supervision where you can talk about this?

Which CQC Essential Standards does this relate to?

  • Outcome 1: respecting and involving people who use services: People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run.
  • Outcome 4: care and welfare of people who use services: People should receive safe and appropriate care that meets their needs and supports their rights.
  • Outcome 17: complaints: People should have their complaints listened to and acted on properly.

Understand how duty of care contributes to safe practice

Your duty of care means that you must aim to provide high quality care to the best of your ability and say if there are any reasons why you may be unable to do so.

When professionals act within a duty of care they must do what a reasonable person, with their training and background, can be expected to do. So, for example, an accountant must get their sums right and apply for the right tax exemptions for their clients. In the same way, a care provider is expected to be trustworthy, in accordance with their code of practice, and apply suitable skills when carrying out care services.

Providers and care workers must always take reasonable care. This means you must:

  • keep your knowledge and skills up to date
  • provide a service of no less quality than that to be expected, based on the skills, responsibilities and range of activities within your particular work or profession
  • be in a position to know what must be done to ensure that the service is provided safely
  • keep accurate and up-to-date records of the care and support you provide, including any assessment of someone’s capacity and the rationale for any decisions that are taken on their behalf
  • not delegate work, or accept delegated work, unless it is clear that the person to whom the work is delegated is competent to carry out the work and vice versa
  • protect confidential information except where the wider duty of care or the public interest might justify making it known.

All of these things help to ensure that you are working safely and professionally.

Look at the following resources:

Check your understanding

  • With your supervisor, explain what is meant by each of the points above about taking reasonable care. Make sure you clarify anything that is not clear.
  • Think of a person you work with. How do you carry out your duty of care to them?

Did you know?

  • Duty of care exists in every type of work. For example, when you get on a train, the operating company has a duty of care to you to ensure you arrive safely.

Record what you have learned

  • Use the Learning Record Form to write down what you have learned and any questions you might have.

Know how to address dilemmas that may arise between an individual’s rights and the duty of care

Sometimes care workers may feel that there is a conflict between their duty of care and the wishes of the person using the service. Best interest decisions can only be made for individuals who cannot decide matters for themselves at the time a particular decision needs to be taken. So before starting to think about best interests, you need to be certain that the person doesn’t have the capacity to make this decision.

Think about this situation. Mr J has decided that he will go and collect his pension himself. You don’t feel this is wise as he has to cross a busy road and his sight and hearing are not good, but he is perfectly capable of making a decision. What is your response as a carer?

Look at the following resources:

  • This statement comes from the Department of Health (DH). It is very clear about the balance of risk:

Supporting people to make informed choices

Most of the choices that people make in life naturally involve some element of risk, and the decisions made by people using health and social care are no different. Avoiding risks altogether would constrain their choices and opportunities. Risk is a concept that tends to have negative connotations but people take considered risks all of the time and gain many positive benefits. As new health and social care choices and opportunities arise, they are likely to involve the consideration of taking risks.

Check your understanding

Consider the decision by Mr J to collect his own pension. Does he have capacity to make this decision at this time? Is there any evidence that he may lack capacity or that is he making an unwise decision with capacity? The law states that you cannot assume that a person cannot make their own decisions simply because of their condition (in this case a sight and hearing impairment). Mr J may, for example, know that a school crossing patrol officer  will help him across as she always does. If his behaviour or history suggests that he may lack capacity to make this decision, then you must carry out a capacity assessment.

This is a two stage process:

Is there an impairment or disturbance in the functioning of the mind or brain?

Does this prevent Mr J from making this decision? The MCA Code of Practice provides guidance about how to assess capacity.

The legal principles of the MCA state that we must:

  • assume people have capacity unless there is evidence to suggest otherwise
  • do all we can to maximise someone’s capacity to make their own decisions
  • not assume that someone who makes an unwise decision lacks capacity
  • act in a person’s  best interests
  • apply the least intrusive intervention.

You need to do all you can to support Mr J to understand the risks and your concerns. A duty of care does not mean that you have the automatic right to override Mr J’s wishes. Working within this process may sometimes create an uncomfortable situation, when you think a person is planning, with mental capacity, to take a risk that you may consider ‘unwise’. Discuss your concerns with the person, and explain your worries. If the risk seems great, you could  discuss the matter with other involved professionals, such as the commissioners, medical practitioners and the local safeguarding team.

  • Why is it important to let people make their own decisions whenever possible?

Did you know? 

  • People can become depressed, demotivated and more dependent if they are not allowed to make their own decisions and take risks.

Record what you have learned

  • Use the Learning Record Form to write down what you have learned and any questions you might have.

Know how to recognise and handle comments and complaints

In any type of job that involves working with people there will be complaints. Some of will seem trivial (but should not be dismissed as there could be something more serious underlying the complaint). Others may indeed be more serious. As well as complaints, you may receive comments about the quality of care provided or suggestions as to how to improve things. All comments and complaints should be treated seriously and not just dismissed. Comments and complaints can help improve the service provided to the people you care for and support.

It is important to be aware that people who use your services and their families may see things quite differently from you. They have different lifestyles, histories, expectations and situations.

Look at the following resources:

  • Your employer’s complaints policy. Make sure you understand what you have to do as far as your job is concerned when someone makes a complaint.
  • The local authority in whose area you work will also have a system to help people make complaints about care services. Look for it on their website (it may be referred to in your organisation’s policy).
  • This briefing from MIND describes how to complain about health and social care.

Check your understanding

  • Consider with your supervisor why it is important to take all complaints seriously.
  • Make sure you know the complaints procedure your employer has set up so that you can respond appropriately to any complaint you receive.

Did you know?

  • Complaints, properly handled, are an excellent way of improving the service you provide.

Record what you have learned

  • Use the Learning Record Form to write down what you have learned and any questions you might have.

Know how to recognise and handle adverse events, incidents, errors and ‘near misses’

Risk management and assessment helps us keep people safe. Part of risk management involves recognising and reporting adverse events, incidents, errors and ‘near misses’. These can cover a wide range of  activities:  trips and falls, medication  errors, challenging behaviour. As a care worker, you need to know how to respond. It’s all part of your duty of care. You will also help to prevent similar things happening in the future.

Look at the following resources:

  • Your employer will have a policy on accident and incident reporting. Make sure you read it and know what to do.
  • SCIE Care Skillsbase, Skill Check 14: reporting an incident. Takes you though reporting an incident in a residential and domiciliary care setting.

Check your understanding

Did you know?

  • If you report incidents, accidents and other dangerous occurrences, it will help stop them happening again.

Record what you have learned

  • Use the Learning Record Form to write down what you have learned and any questions you might have.