Duty of Care

Introduction

On this page, we will examine the terms ‘duty of care’ and ‘duty of candour’, how they are interrelated and how they affect your job role. We will also look at some of the dilemmas that can occur between your duty of care and the rights of the individuals that you support as well as managing complaints, confrontations, adverse events, incidents, errors and near misses.

What is ‘duty of care’?

As care workers, we have a duty of care towards the individuals that we support.

This means that we have professional legal and moral responsibilities to ensure that the individuals that we support are safe from harm, abuse and neglect and that we promote their wellbeing.

Duty of care relates to both our actions and inactions. This means that not only should we ensure that our actions do not cause an individual harm but also that harm is not caused by an omission of action. For example, if we forget to give an individual their medication, this could result in them being harmed.

How duty of care relates to your job role

Duty of care should encompass all areas of our job role. Some examples include:

• Regularly washing hands to prevent the spread of infection
• Reporting any safeguarding concerns
• Ensuring wet floors are clearly signposted to prevent slips
• Challenging discrimination and promoting rights
• Following organisational policies and procedures
• Obtaining consent before carrying out personal care tasks

How duty of care contributes to safeguarding and protection

Safeguarding and protection are the systems, processes and attitudes that are in place to prevent and protect individuals from harm, abuse and neglect. Your organisation should have a Safeguarding Policy and Procedure, which you should be familiar with.

Any concerns relating to the safeguarding of an individual must be reported. This relates to duty of care because it ensures that the best interests and wellbeing of the individual are looked after. In addition, it leads to interventions that prevent the individual from being harmed further – failure to report a concern may result in an individual being harmed due to your inaction.

What is duty of candour?

Duty of candour is the responsibility of health and social care professionals to be honest and transparent when errors occur.

We must always admit to our mistakes and apologise to the individual for our errors. We should also explain what went wrong and how we will prevent it from happening again in the future as well as provide the individual with support or treatment to make things right.

Duty of candour relates to duty of care because it promotes the best interests and wellbeing of the individual. It leads to a learning process that ensures that the individual and others are protected from harm in the future as the reasons for the error are addressed and processes put in place to stop them being repeated.

Further information about Duty of Candour can be found on the CQC website.

Dilemmas and conflicts between duty of care and individual’s rights

As well as our duty of care, we must also respect the choices that are made by the individuals that we support. This can sometimes lead to conflicts or dilemmas because an individual may make a choice that puts them at risk of harm.

Examples of conflicts and dilemmas

Example 1: An individual refuses to take their medication. Although this may result in adverse health effects, it is important that we acknowledge and respect the individual’s right to choose.

Example 2: An individual with dementia wishes to access the community alone, despite the risk of them getting lost or being taken advantage of.

Example 3: An individual with a learning disability and obesity regularly decides that they want to eat fatty and sugary foods.

Managing risk

Reading the examples above, you may feel that managing such conflicts and dilemmas between duty of care and personal choice is impossible to get right!

However, there will often be things that you can do to strike a balance between the two. For example, in the case of an individual refusing their medication, you may return a little later to offer them their medication again or ask a colleague to try to give it to them.

There is no strict rule that can be applied to all situations and each individual and circumstance should be assessed on its own merits. With experience in dealing with conflicts, you will become better at handling them, but they usually all boil down to risk.

Risk assessment is something that everyone that works in health and social care must be familiar with. This is the systematic process used to identify and assess risks and then put things in place to mitigate them.

For example, if an individual with dementia wants to go into town independently, you could look into providing a personal GPS tracker in case they get lost. A mobile phone and personal alarm may also be provided depending on circumstances. It is essential that the individual collaborates with the risk assessment process and agrees with the outcomes.

Another consideration would be an individual’s mental capacity to make their own decisions. In the case of the individual with a learning disability choosing to eat unhealthy foods, it could be that they do not understand the risks associated with their eating habits and require additional education in this area. Or they may undergo a mental capacity assessment to assess if they are able to make the decision for themselves – if they are deemed to not have capacity, decisions may need to be made by others – note that when a decision is made by others on behalf of an individual, it must be made in their best interests (see the Mental Capacity Act Code of Practice for further info on this).

If you are ever unsure about what to do when handling conflicts and dilemmas relating to duty of care, you should always obtain guidance and advice from others. In many cases, this will be your manager or supervisor but could also be more experienced colleagues, external agencies such as the local authority or charities. You may also gather information through your own research.

Managing complaints and comments

Your organisation should have policies and procedures for handling comments and complaints. Comments are expressed views, opinions and feedback and complaints are when somebody expresses dissatisfaction with a service.

You should be familiar with your organisation’s policies and procedures and know what to do if somebody comes to you with a complaint or comment. In addition, your organisation must ensure that the complaints policy and procedure are transparent and accessible to everyone.

Complaints should always be welcomed because they help to identify areas where work is not up to the necessary standards and provide an opportunity to learn and improve the way that the service operates. All complaints should be taken seriously and fully investigated within the timescales set out in the policy.

In general, when receiving a complaint, you should ensure that the individual can speak in privacy and listen carefully to what they say without judgment. It is useful to repeat back what they have said to you so that you can ensure there are no misunderstandings. You should ensure that the complaint is recorded and explain what will happen next along with the timescales stated in the policy.

If you need advice or guidance relating to the handling of complaints or comments, you should discuss it with your manager.

Confrontations and difficult situations

As a health and social care worker, there will be times when you will be put in difficult situations or confrontations that you will have to manage.

Individuals that you work with may be in a heightened state of emotion due to various factors, such as suffering from high levels of pain, experiencing delusions or hallucinations as part of a mental illness or feeling frustration at not being able to express themselves appropriately.

Again, your organisation will have policies and procedures which provide guidance about how to manage these situations effectively but general rules include:

• Remaining calm
• Demonstrating compassion and empathy and being non-judgmental
• Assessing and minimising risk (e.g. removing others from harm’s way or asking the individual to accompany you to a private room)
• Active listening and effective communication
• Making the individual feel safe and comfortable

All incidents should be recorded as soon as possible after they have occurred. As well as meeting regulatory and organisational requirements, records can be used to identify triggers or patterns in behaviours that can lead to changes in the individual’s care plan to prevent reoccurrence. For example, if an individual becomes agitated after being referred to as “mate” then their care plan can be updated to inform all care workers not to use this word.

Again, your manager will be able to offer advice and guidance if you require further support or information relating to confrontations or difficult situations.

Accidents, adverse events, incidents, errors and near-misses

To begin this section, let’s take a look at what these terms mean:

• Accidents – events that result in harm
• Adverse events – events where unintentional harm occurs
• Incidents – events that do not result in harm
• Errors – mistakes that result in harm or potential harm
• Near-misses – a potential adverse event that was narrowly avoided

Your organisation should have policies and procedures that explain what you should do if one of these events occurs. You should be familiar with your organisation’s way of working so you know what to do to comply with legislation, regulation and best practices. For example, all accidents should be recorded in an accident book and some accidents (e.g. those that result in death or serious injury) must be reported to the Health & Safety Executive (HSE).

Policies and procedures will be based on national legislation, particularly the Health & Safety at Work Act 1974 and related regulations, such as RIDDOR and the Management of Health & Safety at Work Regulations. Click here for a more detailed list of health and safety legislation that relates to the care sector.