Unit 503
Unit 503 - Champion equality, diversity and inclusion
Learning outcome 1 - Understand diversity, equality and inclusion in own area of responsibility
1.1 Explain models of practice that underpin equality, diversity and inclusion in own area of responsibility
The United Kingdom has a diverse population, composed of people from nations around the world with many different cultures and religions. Some of this diversity brings with it a range of social and educational issues that practitioners need to recognise, understand and work with. All practitioners must work in a way that supports equality of opportunity and promotes diversity and inclusion. But what do we mean by equality, diversity and inclusion?
The government has a mandate to 'build a safe, just and tolerant society for everyone in the UK, regardless of their race, religion, gender, gender identity, sexual orientation, disability or age. Managers that value diversity and promote equality of opportunity and inclusion will tend to work in a person- centred way, focusing on individual strengths and needs, striving to improve the quality of participation of all people with whom they work. There are various pieces of legislation in place to promote equality and reduce discrimination. These include:
Every Child Matters
Rights to Action
Equality Act 2010
Essential standards for quality & Safety compliance criteria
The Equal Pay Act 1975
The Disability Discrimination Act 1995
Race Relations Act 1976
The Children Act 1989
The Children Act 2004
The NHS and Community Care Act 1990
The Data Protection Act 1984
The Mental Health Act 1983
Sex Discrimination Acts 1975 and 1986
Care Standards Act 2000
Care Homes Regulations 2001
European Convention on Human Rights and Fundamental Freedoms 1950
The Convention on the Rights of the Child 1989
Human Rights Act 1998
The Disability Discrimination Act 2005
GSCC Code of Practice for Social care Workers
GSCC Code of Practice for Employers of Social Care Workers
The Patient’s Charter
The aim of all this legislation is to promote equality of opportunity for all, regardless of age, sex, sexuality, disability, race, religion or any other difference. The legislation should have an impact on the way organisations provide and organise services and on the way managers approach their practice. However, whilst legislation is important because it protects people, the one thing it cannot do is change people's attitudes. Good practice should ensure that managers are constantly able to evaluate what they do and to receive appropriate support and training in this area.
Equality and Diversity will only become part of everything that we do if every individual within the organisation is committed to the following:
Taking a positive approach to equality and diversity through challenging their own stereotypes and assumptions which may affect the way they behave with colleagues or service users
Challenging inappropriate behaviour in others that may lead to discrimination, disadvantage or harassment
Treating each person as an individual and finding out what their needs are rather than making assumptions
Being prepared to take a flexible approach to ensure that all service users can access our services
There is no single way of treating people, as everyone has their own personal needs, values and beliefs. It means that a “one size fits all” approach to employees and service users will exclude some and so won’t work. This means that we have to be flexible and creative in the way that we provide employment opportunities and services. We have to be prepared to adapt what we do to be an inclusive employer and service provider.
1.2 Analyse the potential effects of barriers to equality and inclusion in own area of responsibility
Equality and diversity includes any issue which could result in less favourable treatment to an individual or group of individuals based on their disability, gender, race, age, sexual orientation, religion or belief etc. In addition, bullying, harassment or victimisation are also regarded as equality and diversity issues.
Barriers to Equality
“Social barriers are the main cause of our problems…These barriers include people’s attitudes to disability, and physical and organisational barriers.”
Disability Wales (2009)
When considering issues of stereotyping, prejudice and discrimination in relation to services we often talk in terms of overcoming the Barriers that people and groups might face. But what do we mean?
What are Barriers?
Barriers are those things that prevent or make access to a service more difficult for certain groups and individuals. Much as we described discrimination as existing at different levels, barriers can be personal, cultural, institutional and structural.
Different kinds of Barriers
Structural, where circumstances create or result in barriers - for example in access to a 'good education' adequate housing, sufficient income to meet basic needs. And as we have observed, structural barriers are associated with poor life outcomes that can be observed in the significant disparities in health between areas of affluence and those associated with poverty.
Institutional, where policies, processes, practices sustain an organisational or service culture that excludes certain people or groups; an obvious example being what has been called the 'glass ceiling', i.e. that while not visible, a ceiling exists beyond which women - find it very difficult to progress.
Cultural barriers can prevent, for example, consideration of spiritual, relational or dietary needs that do not conform with traditional expectations. For example "it took 3 days to organize Halal food".
Personal barriers, for example where healthcare staff hold individual prejudices that influence their practice. These actions may be conscious, but as we have discussed, they can often be unconscious or unwitting. Attitudinal barriers are not as easy to identify as physical barriers, but they can feel every bit as real to those who are exposed to them.
Barriers can be…
Physical in nature; observed in the built environment, for example in accessing buildings, narrow doorways, the absence of lifts or accessible toilets…
About communication; where for example the language, communication or information needs of certain group and individuals are assumed, not taken into account, valued or given weight.
1.3 Analyse the impact of legislation and policy initiatives on the promotion of equality, diversity and inclusion in own area of responsibility
Equality and diversity is a term used in the United Kingdom to define and champion equality, diversity and human rights as defining values of society. It promotes equality of opportunity for all, giving every individual the chance to achieve their potential, free from prejudice and discrimination. UK legislation requires public authorities to promote equality in everything that they do, also making sure that other organisations meet their legal duties to promote equality while also doing so themselves. In the UK there are certain legal requirements under existing legislation to promote equality in the areas of disability, gender and race. These are often collectively referred to as the general duties to promote equality. As the independent advocate for equality and human rights in Britain, a Commission of Equality and Human Rights (EHRC) exists that aims to reduce inequality, eliminate discrimination, strengthen good relations between people and promote and protect human rights. EHRC has a duty to challenge prejudice and disadvantage and promote the importance of human rights, enforcing equality laws on age, disability, gender, gender reassignment, race, religion or belief and sexual orientation and encourage compliance with the Human Rights Act.
An overview of equality and diversity legislation
Equality and diversity legislation exists for each of the equality strands of race, gender, disability, sexual orientation, religion/belief and age. An overview of some of the key legislation, for each equality strain, is detailed here. You can click on the link to access the legislation listed.
Race
Race Relations Act (1976) & Race Relations (Amendment) Act (2000)
This Act and its Amendment makes discrimination on the grounds of race, colour, nationality (including citizenship), ethnic or national origin unlawful. It covers people from all racial groups, including white people.
Following the Amendment (2000), it includes more public authority functions and places a general duty on public authorities to promote race equality.
Race Relations Act (1976) (Amendment) Regulations (2003)
This Amendment further enhanced the legislation, updating the definition of indirect discrimination.
Racial and Religious Hatred Bill (2005)
This Bill was introduced to make it illegal to threaten people because of their religion, or to stir up hatred against a person because of their faith. It is designed to fill gaps in the current laws, which already protect people from threats based on their race or ethnic background.
The Bill passed successfully through the House of Commons and the House of Lords on 31 January 2005 and should become law soon. The final Bill was altered by the Lords in two key ways:
Only threatening words or behaviour will be classified as criminal. Generally abusive or insulting words about religion that are not actually threatening will not be illegal; and
The burden will be on the prosecution to prove the speakers intended to stir up racial hatred – the bill has strong safeguards for free expression.
Any prosecutions under the Bill will also have to be approved by the Attorney General.
Gender
Sex Discrimination Act (1975)
This Act applies to women and men of any age, including children, and makes discrimination on the grounds of sex or marriage unlawful. However, it is not unlawful to discriminate against someone because they are not married.
Victimisation, because someone has tried to exercise his or her rights under this Act, is also unlawful.
The Sex Discrimination Act (1975) (Amendment) Regulations (2003)
This Act makes it unlawful to discriminate against someone after a formal relationship with an employer has ended - if the discrimination arises out of, and is closely connected to, that relationship.
In addition, it makes Chief Officers of police liable for unlawful acts of sex discrimination, committed by police constables against other police constables, in the course of their duties.
The Sex Discrimination (Gender Reassignment) Regulations (1999)
These regulations are a measure to prevent discrimination against transsexual people, on the grounds of sex, in pay and treatment in employment and vocational training.
They extend the Sex Discrimination Act (1975), for the purposes of employment and vocational training, by making discrimination on the grounds of gender reassignment, equivalent to discrimination on the grounds of sex.
The Gender Recognition Act (2004)
This Act provides transsexual people with all of the rights and responsibilities appropriate to their acquired gender. For example, the right to marry in their acquired gender, birth certificates that recognise their acquired gender, and benefits and state pension of their acquired gender.
The Equal Pay Act (1970)
This Act gives an individual a right to the same contractual pay and benefits as a person of the opposite sex in the same employment, where the man and the woman are doing like work, work rated as equivalent under an analytical job evaluation study or, work that is proved to be of equal value.
However, the employer will not be required to provide the same pay and benefits if they can prove that the difference in pay or benefits is genuinely due to a reason other than one related to sex.
The Equal Pay Act (1970) (Amendment) Regulations (2003)
This Amendment introduced two changes to the 1970 Act: it allows the six month time limit for bringing equal pay claims to be extended, in cases of concealment or disability and, allows for the two-year limit on back pay to be extended up to six years, in cases of concealment and disability.
Disability
The Disability Discrimination Act (1995)
This Act deals with discrimination against disabled people and applies to all those who provide goods, facilities and services to the public.
The Disability Discrimination Act (2005)
This Act amends/extends the provisions of the 1995 Act, including:
Making it unlawful for operators of transport vehicles to discriminate against disabled people;
Ensuring that discrimination law covers all the activities of the public sector; and
A duty for public bodies to promote equality of opportunity for disabled people.
Some of the new laws will not be enforced until December 2006 (such as the duty to promote equality of opportunity for disabled people).
Sexual Orientation
Employment Equality (Sexual Orientation) Regulations (2003)
These regulations outlaw discrimination (direct or indirect discrimination, harassment and victimisation) in employment, and vocational training, on the grounds of sexual orientation. It covers people who are gay, lesbian, bisexual and heterosexual.
The Civil Partnerships Act (2004)
This Act permits a legal relationship to be formed by two people of the same sex, which is distinct from marriage. It gives same sex couples the ability to obtain legal recognition of their relationship.
Religion or Belief
Employment Equality (Religion or Belief) Regulations (2003)
These Regulations outlaw discrimination (direct or indirect discrimination, harassment and victimisation) in employment and vocational training on the grounds of religious belief or similar philosophical belief. Non-belief is also covered by the regulations.
Age
Age Discrimination Act
Age discrimination in employment and training will become unlawful from 1st October 2006. The Age Discrimination Act is due to come into force in December 2006. The legislation will cover all forms of age discrimination including discrimination of both younger and older individuals. For organisations, the key issue in the discrimination field is developing workable age legislation. This could impact on a wide range of employment practices including; graduate recruitment programmes, redundancy practices and, crucially, whether firms will be prohibited from setting retirement ages. Several discussions have focused on the impact the legislation is likely to have on mandatory retirement age.
Other Legislation
The Human Rights Act (1998)
This Act incorporates rights under the European Convention of Human Rights into domestic law. Individuals can bring claims under this Act against public authorities for breaches of Convention Rights (Convention Rights include, a right not to be discriminated against on non-exhaustive grounds where another Convention right is engaged).
UK courts and tribunals are required to interpret domestic law, as far as possible, in accordance with Convention Rights. Previous case law may be overturned if there is a breach of Convention Rights and the relevant law can be re-interpreted in a way, which is compatible with Convention Rights.
Learning outcome 2 - Be able to champion diversity, equality and inclusion
2.1 Promote equality, diversity and inclusion in policy and practice and
2.2 Challenge discrimination and exclusion in policy and practice
It is the responsibility of all of us to promote equality, whether we deal with service users directly or whether we are a support function.
Dignity and respect – respect individual’s need for privacy and dignity in the way that service is provided or the way that information is handled.
Information and Communication – providing information in different formats for example large print, Braille, video, tape, total communication, other languages, providing an interpreter.
Value the contribution - that each individual can make. Create a productive environment in which everybody feels valued, their talents are fully utilised and services meet the requirements of diverse service users.
Embrace difference as a way of attracting and retaining staff and improving customer satisfaction. Provide relevant and appropriate access for the participation, development and advancement of all individuals and groups.
Remove physical barriers - overcome physical features by removing them, altering them, avoiding them or providing access to work or service by an alternative method.
Stereotypes, assumptions and bias – avoid using negative or offensive language and images, which convey stereotypes. Avoid making assumptions about people’s ability to do things or not do things, their attitudes and their persona; circumstances. Don’t assume that you understand their needs and requirements. Don’t allow bias to affect decisions you make about recruitment, training, policies or procedures.
Improve access to services and workplaces - change opening times, alter work patterns to allow for caring responsibilities, provide mobile services for those who are physically or socially isolated.
Tailor services to needs - Provide auxiliary aids such as an induction loop, childcare facility or play area, and prayer room.
An equality, diversity and inclusion policy should summarise an organisation’s approach to the subject, for example by including your equality, diversity and inclusion mission or vision statement. It should make reference to more detailed supporting policies and practices. It should, in essence, clearly describe the approach in a way, which can be easily understood by both employees and customers alike. In designing your own equality, diversity and inclusion policy, you should include some key elements:
A definition of who is responsible overall for the policy. Leadership is necessary to ensure the policy is implemented throughout the organisation.
An overview of the rights that employees have under the policy as well as their responsibilities. For example, their right to have complaints of harassment investigated, as well as their responsibility to act when they become aware of inappropriate behaviour.
The operating principles of the policy. The organisation’s core values, employer and employee responsibilities for promoting and delivering the policy, and the legal and business context.
The details of the policy broken down into its component parts. These may include recruitment and promotion, with specific reference to discrimination, harassment and bullying, work-life balance and family- friendly policies, reasonable adjustments for disabled staff, etc.
Employee education and training. Use of internal communications to support the policy and action planning, such as newsletters, appraisal reviews, induction, training programmes etc.
How the policy will be monitored, evaluated and reviewed. The use of this data should allow the policies to evolve over time.
What will happen when employees breach, or are alleged to have breached, the policy.
Finally, is the policy readable? Policies that are over-long or too wordy are unlikely to be read, used or adhered to. Keep the language simple and the content to the point.
Line managers are responsible for ensuring the Equality and Diversity Policy is implemented in their part of the organisation; for ensuring staff and volunteers understand the policy and their roles within it; and for providing reports and monitoring information. In relation to this, managers should ensure that team and individual work programmes promote equality and diversity and keep this under review.
Every member of staff has an individual responsibility to ensure this policy is actively implemented. This should be reflected in the development of individual work programmes, which take account of the needs of all potential users of services. It should also be reflected in individuals’ performance and conduct.
Policies should be circulated to all employees, volunteers, and all candidates applying for positions with the organisaton. Organisations should actively encourage individual members of staff or volunteers who feel that they have in any way suffered from, been disadvantaged by, been discriminated against unlawfully, or has been subjected to harassment to report these incidents to their appropriate line manager, in the first instance, or alternatively directly to the Head of Human Resources, if they prefer. In the same way, members of staff who witness an act of discrimination or harassment against a fellow employee, volunteer and/or visitor should report this.
Challenge Discriminatory Behaviour
Challenging discriminatory behaviour means not letting this behaviour happen without taking some sort of action against it. There are many ways that people can be discriminated against. They include verbal or physical abuse, exclusion, labelling or stereotyping. It is important to challenge discriminatory behaviour because it can cause distress, ill health, isolation and stress to a service user.
We all have a responsibility to avoid discrimination and exclusion. Here are some things that we can all do to make sure that we do not discriminate:
Treat everyone as an individual – remember that each person is different and that treating everyone the same does not work
Be aware that we might exclude people unintentionally by making the assumption that a policy or practice suits everyone
Ask team members or service users what they need – talking to people about their needs is the best way of avoiding making assumptions
Find out what services are available to help people and be flexible in your approach.
The most effective way for a service provider to challenge discriminatory practice in adult social care settings is to be educated about the regulations that govern the care, be aware and report situations that are discriminatory to your team leader or group manager. There is not a specific step by step process where you fill out a piece of paper and the discrimination evaporates. What is important to remember is that the model for adults social care is based on the needs of the individual matched with the services that will most closely meet those needs. The care is patient centered, but team driven.
Education is probably the best weapon to have in cases of discrimination in addition to sharing information with the team to find a solution to the problem causing discrimination. Listed below are either ideas that a care provider needs to understand and actions that can be taken to minimise the likelihood of discriminatory action. In addition, follow the job description for your area of service and communicate any concerns in a positive, resolution-oriented manner to your team.
Define ‘positive ageing’ and the contribution that older people make to society
Discuss ageism, and the stereotypes and labels that are associated with ageing and old age
Demonstrate an understanding of the importance of dignity and respect for many older patients
Recognise the possible signs of abuse or neglect, so that concerns can be raised to ensure the safety and empowerment of vulnerable adults
Identify best practice and opportunities to achieve person-centred care in both community and hospital settings
Reflect on your own practice and the standards of care provided within your practice setting, and establish actions that you can take to ensure that patients are treated with dignity and respect, and receive care that’s person centered
2.3 Provide others with information about:
The effects of discrimination
The impact of inclusion
The value of diversity
As a manager the best way to provide staff with information about the effects of discrimination is to ensure they regularly attend the appropriate equality, diversity and inclusion training. You could also discuss this area during team meetings, supervision and appraisal. You should ensure all staff are aware of the procedures to follow if they suspect discrimination is taking place or they are themselves the subject of any form of discrimination. All staff and service users should be aware of their rights. An easily accessible complaints procedure should be in use, which can be accessed if they feel their rights are not being observed.
People who are discriminated against can suffer significant negative consequences. General well-being, self-esteem, self-worth, and social relations can be severely impacted as a result of discrimination. But recognising exactly how perceived discrimination affects an individual is much less understood. Studies have found that discrimination; racism and harassment may have significant mental and physical health consequences such as frustration, stress, anxiety, depression, possible nervous breakdown, or high blood pressure that can cause heart attacks.
Effects of discrimination physically and emotionally:
Depression
Anger
Loss of self-esteem
Isolation
Feeling stressed or unable to cope The long-term effects could include:
Loss of motivation
Reduced individual rights
Restricted opportunities
Limited access to services
Mental illness caused by stress
Inclusion is a human right for every individual. The aim of inclusion is to embrace all people irrespective of race, gender, and disability, medical or other need, culture, age, religion and sexual orientation. It is about giving equal access and opportunities and getting rid of discrimination and intolerance. Inclusion is recognising our universal "oneness" and interdependence. Inclusion is recognising that we are "one" even though we are not the "same". The act of inclusion means fighting against exclusion.
Fighting for inclusion involves making sure that all support systems are available to those who need support. It is everyone’s responsibility to remove the barriers to inclusion. Research has suggested that the feeling of inclusion is a critical factor in bridging individuals’ differences in age, ace and gender in the workplace (MorBarak & Cherin, 1998). Inclusion may lead to the feeling of acceptance in an organisation, which links to satisfaction with the organization and commitment to it (Lawler, 1994; Lawler, 1995; Deming, 1986).
It has been proven that by valuing diversity, organisations bring benefits to the people they work with, their local communities, as well as to themselves.
Diversity is more than just being ‘politically correct’ or having an equal opportunities policy. Embracing diversity brings benefits for an organisation. It is a move away from policies and procedures and embeds diversity into the organisation’s culture. Rather than simply minimising the effect of discrimination and encouraging equal treatment it takes positive advantage of the differences between individuals and works against prejudice. It is possible to place attitudes towards diversity on a continuum, from organisations that have a disinterested (or in some cases a prejudicial) attitude, to a position where an equal opportunities approach is established, to one where the diversity of the organisation is celebrated:
Valuing diversity is the next step in growing and developing as an organisation.
2.4 Support others to challenge discrimination and exclusion see 2.2
The first step to supporting others to challenge discrimination and exclusion is to accept that it exists and to acknowledge that discrimination is a significant factor in inhibiting equality.
In your role as Manager one of your most important responsibility, with regards discriminations and exclusion is to ensure all staff have attended the respective training and are fully aware of the workplace policies and procedures in this area. By ensuring staff have this information, knowledge and skills they will then be more able to identify situations where discrimination is taking place and will be aware of the correct procedures to follow in the event. Supporting both staff and service users to challenge discrimination and make a complaint will also be part of your responsibility. Service users should also be supported and encouraged to complain if they feel discriminated against or excluded. By providing service users with details of where they can seek further support and advice regarding discrimination, will allow them to feel they have more choice and control over their lives. Every workplace should have the following in place to aid both service users and staff to complain;
Whistle blowing policy
Complaint procedure
Appeals procedure
Once a complaint has been made it is important to monitor and review the situation periodically to ensure no reoccurrence happens. Some complaints may result in a review of practice and a change to the workplace policies, which you would need to oversee. This would ensure that there is a clear directive for future similar events, should they occur.
Learning outcome 3 - Understand how to develop systems and processes that promote diversity, equality and inclusion
3.1 Analyse how systems and processes can promote equality and inclusion or reinforce discrimination and exclusion
see 2.1
The starting point for any effort to promote equality in the workplace is to assess what you are doing already and look for areas where you can improve.
This might include:
Carrying out an equality audit or equal pay review of your organisation
– use your audit as a basis for ongoing monitoring
Investigating the possibility of more flexible work patterns
Looking for examples of good practice in other organisations
Talking to staff representatives such as unions about where improvements could be made
Checking that you use clear and justifiable job criteria that are demonstrably objective and job-related.
Building equality into everyday practice is achieved by mainstreaming equalities into every part of an organisation's work. Mainstreaming equalities is about ensuring that an equalities perspective is built into every part of the organisation's work. Mainstreaming equalities is also about building a work culture that provides equal opportunities for all by making sure everybody gets a chance to participate regardless of differences based on race, gender, disability, age, sexual orientation, language, and social origin. It also includes other personal attributes such as beliefs or opinions which can be political, religious spiritual or philosophical. In order to mainstream effectively organisations should ensure that they have systems and processes set up to suit the needs of different people from the beginning. Equal access can vary for different people depending on their specific needs. For example, providing access for wheelchair users in office buildings or providing space for religious prayers. More women than men have responsibilities for looking after children and would benefit more from flexible working hours.
3.2 Evaluate the effectiveness of systems and processes in promoting equality, diversity and inclusion in own area of responsibility
Reflecting on the effectiveness of systems and processes that are in place to promote equality, diversity and inclusion will identify the improvements required to contribute tot the health, self esteem and happiness of the people using the service as well as your staff. It is essential that you are able to identify good practice to improve or eliminate poor practice.
It is important as a manager that you are not complacent about the effectiveness of policies and procedures that have been designed to support a culture that promotes and assures equality and respect for diversity. An annual assessment of effectiveness is a good way of checking whether this issue remains at the forefront of people’s minds and in their practice. The types of activities that can be used to monitored the effectiveness of policies include:
User surveys – a quick questionnaire or a short questions and answers interview can used to assess how well the users of the service feel that their difference id respected and equality promoted by your staff
When working alongside others or have an opportunity to witness staff interactions, you can do this in a purposive way and concentrate on how well staff promote equality and respect diversity
Reflective practice, including incident analysis, allows you and your team to reflect on behaviours, interactions and incidents and identify ways of enhancing or improving practice. Reflective practice also allows you to identify good practice and share this more widely.
3.3 Propose improvements to address gaps or shortfalls in systems and processes
The results gained from implementing and trialling your assessment tool should enable you to determine whether you have sufficient information to make judgments about staff knowledge and compliance with equality and diversity policies and procedures. It should also help you to assess whether these are embedded in the culture or whether staff pay ‘lip-service’ to these. If you are unable to determine these or need further information regarding a particular aspect because you have identified an area that is not complied with or gives rise to a trend, then it is important that you do some further monitoring using a different tool. Action plans must be based on firm and reliable evidence. Possible actions may be raising awareness or further staff development, and in some cases may lead to disciplinary action.
By recognising roles and responsibilities, preparation, and working as a group, recording and revising situations. Enhancements can be made to address any concerns such as gaps in systems and procedures. Regular staff meetings and supervisions aid this development. Staff should feel support from their employer and feel that they can freely communicate and have the right to complain. Gaps and shortfalls are recognised with the assistance of others (residents and staff) actions can then be implemented to amend policies or practices.
Learning outcome 4 - Be able to manage the risks presented when balancing individual rights and professional duty of care
4.1 Describe ethical dilemmas that may arise in own area of responsibility when balancing individual rights and duty of care
When working in a health or social care environment, professional practitioners are quite often faced with situations involving moral dilemmas. Therefore, it is very important for health and social care workers to have a clear understanding of morality and the meaning of moral decisions and how they are linked to health and social practice.
Health and social care workers also need to have a good understanding of their legal position, and the morals and ethics that form the basis of their professional code of practice. This is very important when a person refuses medical treatment or decides to take a course of action that might not be in their best interests. In such situations legislation and professional codes of practice can provide valuable guidance for the health and social care worker. The care worker also needs to consider the following ethical points when dealing with moral dilemmas:
Duty
When working with vulnerable individuals, all health and social care practitioners have a duty of care to protect their rights. If a proposed course of action or a proposed treatment could be harmful to the individual, practitioners have to weigh up the advantages and disadvantages. For example, cancer patients are quite often advised to undergo a course of chemotherapy or radiotherapy. Both treatments involve some harmful side effects, but the benefits should outweigh the harm caused by the treatment.
Safeguarding individuals
Social care providers should ensure that environments safeguard vulnerable individuals. This involves recruiting new staff and providing resources to ensure that individuals’ needs are met. However, there are times when the behaviour or actions of one individual could harm other people within the organisation. This could be an individual with mental health problems who might become violent towards other people. If this is the case then the social care professional must follow the organisation’s policies and procedures and if the behaviour of an individual is likely to result in significant harm to themselves or other people then he individual has to be restrained. Section 5 of the Mental Capacity Act 2005 provides guidelines for the social care professional, relating to the degree of harm that is likely to be suffered by a person if he or she is not restrained.
Beneficence
Beneficence refers to actions that promote the wellbeing of others. In the medical context, this means taking actions that serve the best interests of patients. Social care professionals have a duty to act in an individual’s best interest at all times. This can involve balancing the benefits of medical treatment against the risks and costs. Health care professionals quite often have to weigh up arguments over cost, the effectiveness of treatment and the benefit that patients gain from the proposed course of action. For example, the cancer drug Herceptin could cost £30,000 for one person – would this money be better spent on saving multiple heart attack victims?
Social justice
All individuals should have equal access to medical treatment and be fully aware of their legal rights. Practitioners have to make sure that relevant legislation is put into practice. The Children Act 1989, for instance, states that local authorities must act in the ‘best interests’ of all children, and that each child has a fundamental right to housing, health care and education. However, there are times when social justice is not available to all individuals – for example, asylum seekers’ children who are being detained at Yarl’s Wood Detention Centre without access to adequate medical care.
Empowerment and autonomy of the individual
Empowering an individual means ensuring that they know enough to make an informed choice about decisions that could affect the quality of their life. This helps individuals to have control over their own lives. Vulnerable people who receive health and social care services rely on professional carers to ensure their independence. It is important that care workers empower individuals and don’t use benevolent oppression to make decisions for individuals in their care, especially when it might seem that risky behaviour is involved. While staff might appear to be acting in ‘the best interest’ of individuals, they could in fact be denying a person’s right to act as an independent individual and control their own life. Examples of benevolent oppression include:
Not allowing relationships to develop between consenting adults
Limiting alcohol intake of individuals
Leaving the bathroom door open; not ‘allowing’ an individual to take a bath/shower in private
Preventing individuals with physical/learning disabilities from going out alone Choosing activities that are thought to be suitable, but are not the choice of the individual
Not providing resources to encourage independence and autonomy.
Promotion of dignity, independence and rights of the individual
It is very important when working with vulnerable people, especially when undertaking personal care activities, that dignity, independence and the rights of individuals are taken into consideration. For example, when supporting an older women to bathe and dress, make sure that the task is undertaken in a way that protects her dignity. This involves letting her choose the toiletries she wants to use and providing ways in which her independence can be encouraged and her rights recognised.
Moral status of the individual
When working in health and social care, professionals will meet a diverse range of people who hold a variety of different values and attitudes. These can quite often be in conflict with those of other people. For example, people hold very different views on abortion and euthanasia. Professional practitioners have to be sensitive to the moral status of the people they are working with, and not cause offence by making comments that undermine the views of other people. All principles are equal – one is not more important than another. In recent years there has been a closer focus on individual autonomy and it has become essential to offer choice and empower individuals. However, does respect for autonomy mean that a patient can request treatment that a health care practitioner does not think is in his/her best interests, or that they think will not work? If this occurs, respect for autonomy can come into conflict with nonmaleficence or justice. Cases, a doctor may not wish to prolong the situation and may therefore resort to withholding treatment, known as an act of omission.
Rights, responsibilities and duties
Legislation, policies and codes of practice provide clear guidelines as to the rights and responsibilities of care workers and these should be adhered to at all times. The duties of the care worker are clearly laid out in such documents, as well as in their contract of employment. In most situations a care worker’s duties are clear and there is no conflict of interest. However, at times there can be a conflict of rights and ethical principles to consider. For example, the rights of one person may clash with the rights of others. For instance, in a supported housing project there may be a resident who likes to play music late into the evening, while another resident likes to retire early and get up early. In other cases, one person may have two rights that conflict with each other. For example, in certain situations an individual’s right to privacy and confidentiality may clash with the right to be protected from harm. Cultural or religious values may also conflict with the right to be protected from harm. For example, a Jehovah’s Witness (who does not agree with blood transfusions) may find themselves in hospital with a medical condition where a blood transfusion offers the only means of saving their life. In these situations the rights and duties of the care workers may also conflict with those of the individual using the service, and a decision will have to be taken as to which is the best course of action.
4.2 Explain the principle of informed choice
Informed choice involves the exchange and understanding of relavent information so that an informed, reasoned and unpressured decision can be made by someone who has the competence and legal capacity to make such choices. Informs choice is a pre condition of informed consent. It emphasises the autonomy of the individual, and involves respect for the rights of individuals to make decisions about actions, which affect them. Making an informed choice and giving informed consent are parts of process: they are not isolated events. Informed choice can help to:
Increase peoples control over their own lives, and increase their autonomy and integrity
Promote trust and partnership between the health care user and the health care provider
Encourage individuals to accept responsibility for their health
The principles of informed choice and consent are autonomy, responsibility and accountability. Adoption of these principles is based on assumptions that health care services should be:
Provided by health care providers who have the relavent knowledge, skills and competence
and
Provided in way that the rights of all health service users are respected
The provision of information may enable a person to become informed, but it may play little part in enabling an autonomous choice to be made. Although comprehensive information is a prerequisite for informed choice, a person can be informed without having (or indeed wanting) a choice. Equally, a person may want to make an autonomous choice without the use of information.
It can be argued that there are three main aspects of choice in the context of healthcare in general and screening in particular. Firstly, there should be options available to choose from and people should know that they have a choice. Secondly, the person should be able to carry out their preferred choice. There may be barriers (for example, disability, language, poor health, access), which mean that, even though a choice is available in principle, it cannot be carried out in practice. Thirdly, the choice should be autonomous. The predominant theory of autonomy in relation to patient choice and healthcare is proposed by Fadden and Beauchamp. They define an autonomous action as one, which is performed intentionally, with understanding, and without controlling actions. However, this definition was largely for people making decisions about different treatment options.
Whether such notions of autonomy can exist within public health policies is perhaps open to debate.
Informed shared decision making has been described as “decisions that are shared by the organisation and service user and informed by best evidence, not only about risks and benefits but also service user specific characteristics and values”. In shared decision making, both the health professional and the service user are assumed to have a legitimate investment in their care decisions.
Informed choice is not just about the provision of relevant up-to-date information, it is also about making sure that the appropriate choices are available to people, and that the choice is autonomous and free from coercion. It should also be recognised that, even with the best of intentions, there are extraneous, unpredictable factors, which will prevent people from performing a behaviour, which is in keeping with their preferred choice. Thus there may be differences between the intended choice and the final behaviour. This difference needs to be taken into account when designing a measure of informed choice, before we can be sure of the impact of informed choice on uptake or other desired endpoints.
4.3 Explain how issues of individual capacity may affect informed choice
For persons consent to be valid, the person must be:
Able to comprehend and retain information material to the specific decision
Use and weigh information when making the decision
Acting voluntarily and without pressure or duress from anyone
Provided with enough information to enable them to make a decision
To communicate a decision by what ever means (Mental Capacity Act 2005)
A person’s capacity should always be determined in the context of a specific decision. It should never be assumed that because a service user is incapable of making certain kinds of decisions they cannot make some decisions about their own life. A service user’s capacity to consent should be assessed and the outcome of that assessment should be recorded. Life and support plans should reflect the extent and imitations on the service user’s capacity to make decisions. Individual plans should also identify the measures that need to be taken to develop and support the service user’s decision making abilities. A service user’s capacity to make a decision should not be confused with a judgement on the assumed reasonableness of the service users decision. A service user is entitled to make a decision, which is based on their own value system even if others perceive it as irrational. An irrational decision has been defined as “one which is so outrageous in it’s defiance of logic or of accepted moral standards that no sensible person who had applied his or her mind to the question could have arrived at it.” A competent person does, for example, have the legal right to refuse a life-saving procedure even if this might appear irrational to others. Consent may be expressed in writing, verbally and non- verbally. Normally consent to personal care is indicated by the service user’s speech and behaviour. For example, active co-operation with assistance to dress or bathe can be taken as an indication of the service user’s consent. A person with capacity is entitled to withdraw consent at any time.
When decisions have to be taken on someone else’s behalf, the decision must always reflect that persons best interests. The following factors should be taken into account:
The past and present wishes and feelings of the service user.
The need to permit and encourage the service user to
Participate as fully as possible in any decision affecting them.
The views of others whom it is appropriate consult about the service user’s wishes and feelings – and what would be in their best interests.
Whether the desired outcome from a specific decision can be achieved in a manner less restrictive of the service user’s freedom of action.
The need to be satisfied that the wishes of the service user were not the result of undue influence.
4.4 Propose a strategy to manage risks when balancing individual rights and duty of care in own area of responsibility
It is the responsibility of the Care Manager / Social Worker / Care Management Assistant / Approved Mental Health Practitioner to balance promoting safety and positive risk taking and therefore needs to:-
Build working relationships with individuals and their carers including where people prefer not to engage.
Help individuals understand how to identify risk and the potential consequences of them to self and or others via violence, self neglect, self harm, and suicide or hate crime so they can make validated decisions.
Complete clear and factual risk assessments, identifying risks to the individuals and or others
Ensure risk management strategies and plans define the agreed actions, roles and responsibilities and objectives to be gained.
Have safe and effective management of minimising potential risks
Be informed about national and local policies relating to assessing and managing risk.
Ensure practice is multi agency and multi disciplinary working with regard to assessing and managing risk.
Be informed of individual and service responses to address crises and reduce risks when occur.
People receiving services have an equal right to feel safe. The challenge is to support people in taking reasonable risks to accommodate choice while ensuring their safety in the process. Risk is defined as the exposure to harm or danger of the safety and well being, actual or potential, of people using the service, and the employment and others directly involved with services such as volunteers, or indirectly involved, such as any member of the general public.
Stages of Risk Management Process
Identifying if a risk exists
Assessing the nature of the risk
Developing a plan to manage the risk
Periodically reviewing the risk management plan for this person and changing it as and when the circumstances require.
Personal Risk Management Plan
The personal risk management plan is a tool designed to provide staff with guidance in how to consider the risks that are part of life’s experience for service users and then to examine the nature of those risks in order to develop an agreed approach to managing those risks with and for people using the services. The following diagram is a framework for assessing risk:
Learning outcome 1 - Understand diversity, equality and inclusion in own area of responsibility
1.1 Explain models of practice that underpin equality, diversity and inclusion in own area of responsibility
The United Kingdom has a diverse population, composed of people from nations around the world with many different cultures and religions. Some of this diversity brings with it a range of social and educational issues that practitioners need to recognise, understand and work with. All practitioners must work in a way that supports equality of opportunity and promotes diversity and inclusion. But what do we mean by equality, diversity and inclusion?
The government has a mandate to 'build a safe, just and tolerant society for everyone in the UK, regardless of their race, religion, gender, gender identity, sexual orientation, disability or age. Managers that value diversity and promote equality of opportunity and inclusion will tend to work in a person- centred way, focusing on individual strengths and needs, striving to improve the quality of participation of all people with whom they work. There are various pieces of legislation in place to promote equality and reduce discrimination. These include:
Every Child Matters
Rights to Action
Equality Act 2010
Essential standards for quality & Safety compliance criteria
The Equal Pay Act 1975
The Disability Discrimination Act 1995
Race Relations Act 1976
The Children Act 1989
The Children Act 2004
The NHS and Community Care Act 1990
The Data Protection Act 1984
The Mental Health Act 1983
Sex Discrimination Acts 1975 and 1986
Care Standards Act 2000
Care Homes Regulations 2001
European Convention on Human Rights and Fundamental Freedoms 1950
The Convention on the Rights of the Child 1989
Human Rights Act 1998
The Disability Discrimination Act 2005
GSCC Code of Practice for Social care Workers
GSCC Code of Practice for Employers of Social Care Workers
The Patient’s Charter
The aim of all this legislation is to promote equality of opportunity for all, regardless of age, sex, sexuality, disability, race, religion or any other difference. The legislation should have an impact on the way organisations provide and organise services and on the way managers approach their practice. However, whilst legislation is important because it protects people, the one thing it cannot do is change people's attitudes. Good practice should ensure that managers are constantly able to evaluate what they do and to receive appropriate support and training in this area.
Equality and Diversity will only become part of everything that we do if every individual within the organisation is committed to the following:
Taking a positive approach to equality and diversity through challenging their own stereotypes and assumptions which may affect the way they behave with colleagues or service users
Challenging inappropriate behaviour in others that may lead to discrimination, disadvantage or harassment
Treating each person as an individual and finding out what their needs are rather than making assumptions
Being prepared to take a flexible approach to ensure that all service users can access our services
There is no single way of treating people, as everyone has their own personal needs, values and beliefs. It means that a “one size fits all” approach to employees and service users will exclude some and so won’t work. This means that we have to be flexible and creative in the way that we provide employment opportunities and services. We have to be prepared to adapt what we do to be an inclusive employer and service provider.
1.2 Analyse the potential effects of barriers to equality and inclusion in own area of responsibility
Equality and diversity includes any issue which could result in less favourable treatment to an individual or group of individuals based on their disability, gender, race, age, sexual orientation, religion or belief etc. In addition, bullying, harassment or victimisation are also regarded as equality and diversity issues.
Barriers to Equality
“Social barriers are the main cause of our problems…These barriers include people’s attitudes to disability, and physical and organisational barriers.”
Disability Wales (2009)
When considering issues of stereotyping, prejudice and discrimination in relation to services we often talk in terms of overcoming the Barriers that people and groups might face. But what do we mean?
What are Barriers?
Barriers are those things that prevent or make access to a service more difficult for certain groups and individuals. Much as we described discrimination as existing at different levels, barriers can be personal, cultural, institutional and structural.
Different kinds of Barriers
Structural, where circumstances create or result in barriers - for example in access to a 'good education' adequate housing, sufficient income to meet basic needs. And as we have observed, structural barriers are associated with poor life outcomes that can be observed in the significant disparities in health between areas of affluence and those associated with poverty.
Institutional, where policies, processes, practices sustain an organisational or service culture that excludes certain people or groups; an obvious example being what has been called the 'glass ceiling', i.e. that while not visible, a ceiling exists beyond which women - find it very difficult to progress.
Cultural barriers can prevent, for example, consideration of spiritual, relational or dietary needs that do not conform with traditional expectations. For example "it took 3 days to organize Halal food".
Personal barriers, for example where healthcare staff hold individual prejudices that influence their practice. These actions may be conscious, but as we have discussed, they can often be unconscious or unwitting. Attitudinal barriers are not as easy to identify as physical barriers, but they can feel every bit as real to those who are exposed to them.
Barriers can be…
Physical in nature; observed in the built environment, for example in accessing buildings, narrow doorways, the absence of lifts or accessible toilets…
About communication; where for example the language, communication or information needs of certain group and individuals are assumed, not taken into account, valued or given weight.
1.3 Analyse the impact of legislation and policy initiatives on the promotion of equality, diversity and inclusion in own area of responsibility
Equality and diversity is a term used in the United Kingdom to define and champion equality, diversity and human rights as defining values of society. It promotes equality of opportunity for all, giving every individual the chance to achieve their potential, free from prejudice and discrimination. UK legislation requires public authorities to promote equality in everything that they do, also making sure that other organisations meet their legal duties to promote equality while also doing so themselves. In the UK there are certain legal requirements under existing legislation to promote equality in the areas of disability, gender and race. These are often collectively referred to as the general duties to promote equality. As the independent advocate for equality and human rights in Britain, a Commission of Equality and Human Rights (EHRC) exists that aims to reduce inequality, eliminate discrimination, strengthen good relations between people and promote and protect human rights. EHRC has a duty to challenge prejudice and disadvantage and promote the importance of human rights, enforcing equality laws on age, disability, gender, gender reassignment, race, religion or belief and sexual orientation and encourage compliance with the Human Rights Act.
An overview of equality and diversity legislation
Equality and diversity legislation exists for each of the equality strands of race, gender, disability, sexual orientation, religion/belief and age. An overview of some of the key legislation, for each equality strain, is detailed here. You can click on the link to access the legislation listed.
Race
Race Relations Act (1976) & Race Relations (Amendment) Act (2000)
This Act and its Amendment makes discrimination on the grounds of race, colour, nationality (including citizenship), ethnic or national origin unlawful. It covers people from all racial groups, including white people.
Following the Amendment (2000), it includes more public authority functions and places a general duty on public authorities to promote race equality.
Race Relations Act (1976) (Amendment) Regulations (2003)
This Amendment further enhanced the legislation, updating the definition of indirect discrimination.
Racial and Religious Hatred Bill (2005)
This Bill was introduced to make it illegal to threaten people because of their religion, or to stir up hatred against a person because of their faith. It is designed to fill gaps in the current laws, which already protect people from threats based on their race or ethnic background.
The Bill passed successfully through the House of Commons and the House of Lords on 31 January 2005 and should become law soon. The final Bill was altered by the Lords in two key ways:
Only threatening words or behaviour will be classified as criminal. Generally abusive or insulting words about religion that are not actually threatening will not be illegal; and
The burden will be on the prosecution to prove the speakers intended to stir up racial hatred – the bill has strong safeguards for free expression.
Any prosecutions under the Bill will also have to be approved by the Attorney General.
Gender
Sex Discrimination Act (1975)
This Act applies to women and men of any age, including children, and makes discrimination on the grounds of sex or marriage unlawful. However, it is not unlawful to discriminate against someone because they are not married.
Victimisation, because someone has tried to exercise his or her rights under this Act, is also unlawful.
The Sex Discrimination Act (1975) (Amendment) Regulations (2003)
This Act makes it unlawful to discriminate against someone after a formal relationship with an employer has ended - if the discrimination arises out of, and is closely connected to, that relationship.
In addition, it makes Chief Officers of police liable for unlawful acts of sex discrimination, committed by police constables against other police constables, in the course of their duties.
The Sex Discrimination (Gender Reassignment) Regulations (1999)
These regulations are a measure to prevent discrimination against transsexual people, on the grounds of sex, in pay and treatment in employment and vocational training.
They extend the Sex Discrimination Act (1975), for the purposes of employment and vocational training, by making discrimination on the grounds of gender reassignment, equivalent to discrimination on the grounds of sex.
The Gender Recognition Act (2004)
This Act provides transsexual people with all of the rights and responsibilities appropriate to their acquired gender. For example, the right to marry in their acquired gender, birth certificates that recognise their acquired gender, and benefits and state pension of their acquired gender.
The Equal Pay Act (1970)
This Act gives an individual a right to the same contractual pay and benefits as a person of the opposite sex in the same employment, where the man and the woman are doing like work, work rated as equivalent under an analytical job evaluation study or, work that is proved to be of equal value.
However, the employer will not be required to provide the same pay and benefits if they can prove that the difference in pay or benefits is genuinely due to a reason other than one related to sex.
The Equal Pay Act (1970) (Amendment) Regulations (2003)
This Amendment introduced two changes to the 1970 Act: it allows the six month time limit for bringing equal pay claims to be extended, in cases of concealment or disability and, allows for the two-year limit on back pay to be extended up to six years, in cases of concealment and disability.
Disability
The Disability Discrimination Act (1995)
This Act deals with discrimination against disabled people and applies to all those who provide goods, facilities and services to the public.
The Disability Discrimination Act (2005)
This Act amends/extends the provisions of the 1995 Act, including:
Making it unlawful for operators of transport vehicles to discriminate against disabled people;
Ensuring that discrimination law covers all the activities of the public sector; and
A duty for public bodies to promote equality of opportunity for disabled people.
Some of the new laws will not be enforced until December 2006 (such as the duty to promote equality of opportunity for disabled people).
Sexual Orientation
Employment Equality (Sexual Orientation) Regulations (2003)
These regulations outlaw discrimination (direct or indirect discrimination, harassment and victimisation) in employment, and vocational training, on the grounds of sexual orientation. It covers people who are gay, lesbian, bisexual and heterosexual.
The Civil Partnerships Act (2004)
This Act permits a legal relationship to be formed by two people of the same sex, which is distinct from marriage. It gives same sex couples the ability to obtain legal recognition of their relationship.
Religion or Belief
Employment Equality (Religion or Belief) Regulations (2003)
These Regulations outlaw discrimination (direct or indirect discrimination, harassment and victimisation) in employment and vocational training on the grounds of religious belief or similar philosophical belief. Non-belief is also covered by the regulations.
Age
Age Discrimination Act
Age discrimination in employment and training will become unlawful from 1st October 2006. The Age Discrimination Act is due to come into force in December 2006. The legislation will cover all forms of age discrimination including discrimination of both younger and older individuals. For organisations, the key issue in the discrimination field is developing workable age legislation. This could impact on a wide range of employment practices including; graduate recruitment programmes, redundancy practices and, crucially, whether firms will be prohibited from setting retirement ages. Several discussions have focused on the impact the legislation is likely to have on mandatory retirement age.
Other Legislation
The Human Rights Act (1998)
This Act incorporates rights under the European Convention of Human Rights into domestic law. Individuals can bring claims under this Act against public authorities for breaches of Convention Rights (Convention Rights include, a right not to be discriminated against on non-exhaustive grounds where another Convention right is engaged).
UK courts and tribunals are required to interpret domestic law, as far as possible, in accordance with Convention Rights. Previous case law may be overturned if there is a breach of Convention Rights and the relevant law can be re-interpreted in a way, which is compatible with Convention Rights.
Learning outcome 2 - Be able to champion diversity, equality and inclusion
2.1 Promote equality, diversity and inclusion in policy and practice and
2.2 Challenge discrimination and exclusion in policy and practice
It is the responsibility of all of us to promote equality, whether we deal with service users directly or whether we are a support function.
Dignity and respect – respect individual’s need for privacy and dignity in the way that service is provided or the way that information is handled.
Information and Communication – providing information in different formats for example large print, Braille, video, tape, total communication, other languages, providing an interpreter.
Value the contribution - that each individual can make. Create a productive environment in which everybody feels valued, their talents are fully utilised and services meet the requirements of diverse service users.
Embrace difference as a way of attracting and retaining staff and improving customer satisfaction. Provide relevant and appropriate access for the participation, development and advancement of all individuals and groups.
Remove physical barriers - overcome physical features by removing them, altering them, avoiding them or providing access to work or service by an alternative method.
Stereotypes, assumptions and bias – avoid using negative or offensive language and images, which convey stereotypes. Avoid making assumptions about people’s ability to do things or not do things, their attitudes and their persona; circumstances. Don’t assume that you understand their needs and requirements. Don’t allow bias to affect decisions you make about recruitment, training, policies or procedures.
Improve access to services and workplaces - change opening times, alter work patterns to allow for caring responsibilities, provide mobile services for those who are physically or socially isolated.
Tailor services to needs - Provide auxiliary aids such as an induction loop, childcare facility or play area, and prayer room.
An equality, diversity and inclusion policy should summarise an organisation’s approach to the subject, for example by including your equality, diversity and inclusion mission or vision statement. It should make reference to more detailed supporting policies and practices. It should, in essence, clearly describe the approach in a way, which can be easily understood by both employees and customers alike. In designing your own equality, diversity and inclusion policy, you should include some key elements:
A definition of who is responsible overall for the policy. Leadership is necessary to ensure the policy is implemented throughout the organisation.
An overview of the rights that employees have under the policy as well as their responsibilities. For example, their right to have complaints of harassment investigated, as well as their responsibility to act when they become aware of inappropriate behaviour.
The operating principles of the policy. The organisation’s core values, employer and employee responsibilities for promoting and delivering the policy, and the legal and business context.
The details of the policy broken down into its component parts. These may include recruitment and promotion, with specific reference to discrimination, harassment and bullying, work-life balance and family- friendly policies, reasonable adjustments for disabled staff, etc.
Employee education and training. Use of internal communications to support the policy and action planning, such as newsletters, appraisal reviews, induction, training programmes etc.
How the policy will be monitored, evaluated and reviewed. The use of this data should allow the policies to evolve over time.
What will happen when employees breach, or are alleged to have breached, the policy.
Finally, is the policy readable? Policies that are over-long or too wordy are unlikely to be read, used or adhered to. Keep the language simple and the content to the point.
Line managers are responsible for ensuring the Equality and Diversity Policy is implemented in their part of the organisation; for ensuring staff and volunteers understand the policy and their roles within it; and for providing reports and monitoring information. In relation to this, managers should ensure that team and individual work programmes promote equality and diversity and keep this under review.
Every member of staff has an individual responsibility to ensure this policy is actively implemented. This should be reflected in the development of individual work programmes, which take account of the needs of all potential users of services. It should also be reflected in individuals’ performance and conduct.
Policies should be circulated to all employees, volunteers, and all candidates applying for positions with the organisaton. Organisations should actively encourage individual members of staff or volunteers who feel that they have in any way suffered from, been disadvantaged by, been discriminated against unlawfully, or has been subjected to harassment to report these incidents to their appropriate line manager, in the first instance, or alternatively directly to the Head of Human Resources, if they prefer. In the same way, members of staff who witness an act of discrimination or harassment against a fellow employee, volunteer and/or visitor should report this.
Challenge Discriminatory Behaviour
Challenging discriminatory behaviour means not letting this behaviour happen without taking some sort of action against it. There are many ways that people can be discriminated against. They include verbal or physical abuse, exclusion, labelling or stereotyping. It is important to challenge discriminatory behaviour because it can cause distress, ill health, isolation and stress to a service user.
We all have a responsibility to avoid discrimination and exclusion. Here are some things that we can all do to make sure that we do not discriminate:
Treat everyone as an individual – remember that each person is different and that treating everyone the same does not work
Be aware that we might exclude people unintentionally by making the assumption that a policy or practice suits everyone
Ask team members or service users what they need – talking to people about their needs is the best way of avoiding making assumptions
Find out what services are available to help people and be flexible in your approach.
The most effective way for a service provider to challenge discriminatory practice in adult social care settings is to be educated about the regulations that govern the care, be aware and report situations that are discriminatory to your team leader or group manager. There is not a specific step by step process where you fill out a piece of paper and the discrimination evaporates. What is important to remember is that the model for adults social care is based on the needs of the individual matched with the services that will most closely meet those needs. The care is patient centered, but team driven.
Education is probably the best weapon to have in cases of discrimination in addition to sharing information with the team to find a solution to the problem causing discrimination. Listed below are either ideas that a care provider needs to understand and actions that can be taken to minimise the likelihood of discriminatory action. In addition, follow the job description for your area of service and communicate any concerns in a positive, resolution-oriented manner to your team.
Define ‘positive ageing’ and the contribution that older people make to society
Discuss ageism, and the stereotypes and labels that are associated with ageing and old age
Demonstrate an understanding of the importance of dignity and respect for many older patients
Recognise the possible signs of abuse or neglect, so that concerns can be raised to ensure the safety and empowerment of vulnerable adults
Identify best practice and opportunities to achieve person-centred care in both community and hospital settings
Reflect on your own practice and the standards of care provided within your practice setting, and establish actions that you can take to ensure that patients are treated with dignity and respect, and receive care that’s person centered
2.3 Provide others with information about:
The effects of discrimination
The impact of inclusion
The value of diversity
As a manager the best way to provide staff with information about the effects of discrimination is to ensure they regularly attend the appropriate equality, diversity and inclusion training. You could also discuss this area during team meetings, supervision and appraisal. You should ensure all staff are aware of the procedures to follow if they suspect discrimination is taking place or they are themselves the subject of any form of discrimination. All staff and service users should be aware of their rights. An easily accessible complaints procedure should be in use, which can be accessed if they feel their rights are not being observed.
People who are discriminated against can suffer significant negative consequences. General well-being, self-esteem, self-worth, and social relations can be severely impacted as a result of discrimination. But recognising exactly how perceived discrimination affects an individual is much less understood. Studies have found that discrimination; racism and harassment may have significant mental and physical health consequences such as frustration, stress, anxiety, depression, possible nervous breakdown, or high blood pressure that can cause heart attacks.
Effects of discrimination physically and emotionally:
Depression
Anger
Loss of self-esteem
Isolation
Feeling stressed or unable to cope The long-term effects could include:
Loss of motivation
Reduced individual rights
Restricted opportunities
Limited access to services
Mental illness caused by stress
Inclusion is a human right for every individual. The aim of inclusion is to embrace all people irrespective of race, gender, and disability, medical or other need, culture, age, religion and sexual orientation. It is about giving equal access and opportunities and getting rid of discrimination and intolerance. Inclusion is recognising our universal "oneness" and interdependence. Inclusion is recognising that we are "one" even though we are not the "same". The act of inclusion means fighting against exclusion.
Fighting for inclusion involves making sure that all support systems are available to those who need support. It is everyone’s responsibility to remove the barriers to inclusion. Research has suggested that the feeling of inclusion is a critical factor in bridging individuals’ differences in age, ace and gender in the workplace (MorBarak & Cherin, 1998). Inclusion may lead to the feeling of acceptance in an organisation, which links to satisfaction with the organization and commitment to it (Lawler, 1994; Lawler, 1995; Deming, 1986).
It has been proven that by valuing diversity, organisations bring benefits to the people they work with, their local communities, as well as to themselves.
Diversity is more than just being ‘politically correct’ or having an equal opportunities policy. Embracing diversity brings benefits for an organisation. It is a move away from policies and procedures and embeds diversity into the organisation’s culture. Rather than simply minimising the effect of discrimination and encouraging equal treatment it takes positive advantage of the differences between individuals and works against prejudice. It is possible to place attitudes towards diversity on a continuum, from organisations that have a disinterested (or in some cases a prejudicial) attitude, to a position where an equal opportunities approach is established, to one where the diversity of the organisation is celebrated:
Valuing diversity is the next step in growing and developing as an organisation.
2.4 Support others to challenge discrimination and exclusion see 2.2
The first step to supporting others to challenge discrimination and exclusion is to accept that it exists and to acknowledge that discrimination is a significant factor in inhibiting equality.
In your role as Manager one of your most important responsibility, with regards discriminations and exclusion is to ensure all staff have attended the respective training and are fully aware of the workplace policies and procedures in this area. By ensuring staff have this information, knowledge and skills they will then be more able to identify situations where discrimination is taking place and will be aware of the correct procedures to follow in the event. Supporting both staff and service users to challenge discrimination and make a complaint will also be part of your responsibility. Service users should also be supported and encouraged to complain if they feel discriminated against or excluded. By providing service users with details of where they can seek further support and advice regarding discrimination, will allow them to feel they have more choice and control over their lives. Every workplace should have the following in place to aid both service users and staff to complain;
Whistle blowing policy
Complaint procedure
Appeals procedure
Once a complaint has been made it is important to monitor and review the situation periodically to ensure no reoccurrence happens. Some complaints may result in a review of practice and a change to the workplace policies, which you would need to oversee. This would ensure that there is a clear directive for future similar events, should they occur.
Learning outcome 3 - Understand how to develop systems and processes that promote diversity, equality and inclusion
3.1 Analyse how systems and processes can promote equality and inclusion or reinforce discrimination and exclusion
see 2.1
The starting point for any effort to promote equality in the workplace is to assess what you are doing already and look for areas where you can improve.
This might include:
Carrying out an equality audit or equal pay review of your organisation
– use your audit as a basis for ongoing monitoring
Investigating the possibility of more flexible work patterns
Looking for examples of good practice in other organisations
Talking to staff representatives such as unions about where improvements could be made
Checking that you use clear and justifiable job criteria that are demonstrably objective and job-related.
Building equality into everyday practice is achieved by mainstreaming equalities into every part of an organisation's work. Mainstreaming equalities is about ensuring that an equalities perspective is built into every part of the organisation's work. Mainstreaming equalities is also about building a work culture that provides equal opportunities for all by making sure everybody gets a chance to participate regardless of differences based on race, gender, disability, age, sexual orientation, language, and social origin. It also includes other personal attributes such as beliefs or opinions which can be political, religious spiritual or philosophical. In order to mainstream effectively organisations should ensure that they have systems and processes set up to suit the needs of different people from the beginning. Equal access can vary for different people depending on their specific needs. For example, providing access for wheelchair users in office buildings or providing space for religious prayers. More women than men have responsibilities for looking after children and would benefit more from flexible working hours.
3.2 Evaluate the effectiveness of systems and processes in promoting equality, diversity and inclusion in own area of responsibility
Reflecting on the effectiveness of systems and processes that are in place to promote equality, diversity and inclusion will identify the improvements required to contribute tot the health, self esteem and happiness of the people using the service as well as your staff. It is essential that you are able to identify good practice to improve or eliminate poor practice.
It is important as a manager that you are not complacent about the effectiveness of policies and procedures that have been designed to support a culture that promotes and assures equality and respect for diversity. An annual assessment of effectiveness is a good way of checking whether this issue remains at the forefront of people’s minds and in their practice. The types of activities that can be used to monitored the effectiveness of policies include:
User surveys – a quick questionnaire or a short questions and answers interview can used to assess how well the users of the service feel that their difference id respected and equality promoted by your staff
When working alongside others or have an opportunity to witness staff interactions, you can do this in a purposive way and concentrate on how well staff promote equality and respect diversity
Reflective practice, including incident analysis, allows you and your team to reflect on behaviours, interactions and incidents and identify ways of enhancing or improving practice. Reflective practice also allows you to identify good practice and share this more widely.
3.3 Propose improvements to address gaps or shortfalls in systems and processes
The results gained from implementing and trialling your assessment tool should enable you to determine whether you have sufficient information to make judgments about staff knowledge and compliance with equality and diversity policies and procedures. It should also help you to assess whether these are embedded in the culture or whether staff pay ‘lip-service’ to these. If you are unable to determine these or need further information regarding a particular aspect because you have identified an area that is not complied with or gives rise to a trend, then it is important that you do some further monitoring using a different tool. Action plans must be based on firm and reliable evidence. Possible actions may be raising awareness or further staff development, and in some cases may lead to disciplinary action.
By recognising roles and responsibilities, preparation, and working as a group, recording and revising situations. Enhancements can be made to address any concerns such as gaps in systems and procedures. Regular staff meetings and supervisions aid this development. Staff should feel support from their employer and feel that they can freely communicate and have the right to complain. Gaps and shortfalls are recognised with the assistance of others (residents and staff) actions can then be implemented to amend policies or practices.
Learning outcome 4 - Be able to manage the risks presented when balancing individual rights and professional duty of care
4.1 Describe ethical dilemmas that may arise in own area of responsibility when balancing individual rights and duty of care
When working in a health or social care environment, professional practitioners are quite often faced with situations involving moral dilemmas. Therefore, it is very important for health and social care workers to have a clear understanding of morality and the meaning of moral decisions and how they are linked to health and social practice.
Health and social care workers also need to have a good understanding of their legal position, and the morals and ethics that form the basis of their professional code of practice. This is very important when a person refuses medical treatment or decides to take a course of action that might not be in their best interests. In such situations legislation and professional codes of practice can provide valuable guidance for the health and social care worker. The care worker also needs to consider the following ethical points when dealing with moral dilemmas:
Duty
When working with vulnerable individuals, all health and social care practitioners have a duty of care to protect their rights. If a proposed course of action or a proposed treatment could be harmful to the individual, practitioners have to weigh up the advantages and disadvantages. For example, cancer patients are quite often advised to undergo a course of chemotherapy or radiotherapy. Both treatments involve some harmful side effects, but the benefits should outweigh the harm caused by the treatment.
Safeguarding individuals
Social care providers should ensure that environments safeguard vulnerable individuals. This involves recruiting new staff and providing resources to ensure that individuals’ needs are met. However, there are times when the behaviour or actions of one individual could harm other people within the organisation. This could be an individual with mental health problems who might become violent towards other people. If this is the case then the social care professional must follow the organisation’s policies and procedures and if the behaviour of an individual is likely to result in significant harm to themselves or other people then he individual has to be restrained. Section 5 of the Mental Capacity Act 2005 provides guidelines for the social care professional, relating to the degree of harm that is likely to be suffered by a person if he or she is not restrained.
Beneficence
Beneficence refers to actions that promote the wellbeing of others. In the medical context, this means taking actions that serve the best interests of patients. Social care professionals have a duty to act in an individual’s best interest at all times. This can involve balancing the benefits of medical treatment against the risks and costs. Health care professionals quite often have to weigh up arguments over cost, the effectiveness of treatment and the benefit that patients gain from the proposed course of action. For example, the cancer drug Herceptin could cost £30,000 for one person – would this money be better spent on saving multiple heart attack victims?
Social justice
All individuals should have equal access to medical treatment and be fully aware of their legal rights. Practitioners have to make sure that relevant legislation is put into practice. The Children Act 1989, for instance, states that local authorities must act in the ‘best interests’ of all children, and that each child has a fundamental right to housing, health care and education. However, there are times when social justice is not available to all individuals – for example, asylum seekers’ children who are being detained at Yarl’s Wood Detention Centre without access to adequate medical care.
Empowerment and autonomy of the individual
Empowering an individual means ensuring that they know enough to make an informed choice about decisions that could affect the quality of their life. This helps individuals to have control over their own lives. Vulnerable people who receive health and social care services rely on professional carers to ensure their independence. It is important that care workers empower individuals and don’t use benevolent oppression to make decisions for individuals in their care, especially when it might seem that risky behaviour is involved. While staff might appear to be acting in ‘the best interest’ of individuals, they could in fact be denying a person’s right to act as an independent individual and control their own life. Examples of benevolent oppression include:
Not allowing relationships to develop between consenting adults
Limiting alcohol intake of individuals
Leaving the bathroom door open; not ‘allowing’ an individual to take a bath/shower in private
Preventing individuals with physical/learning disabilities from going out alone Choosing activities that are thought to be suitable, but are not the choice of the individual
Not providing resources to encourage independence and autonomy.
Promotion of dignity, independence and rights of the individual
It is very important when working with vulnerable people, especially when undertaking personal care activities, that dignity, independence and the rights of individuals are taken into consideration. For example, when supporting an older women to bathe and dress, make sure that the task is undertaken in a way that protects her dignity. This involves letting her choose the toiletries she wants to use and providing ways in which her independence can be encouraged and her rights recognised.
Moral status of the individual
When working in health and social care, professionals will meet a diverse range of people who hold a variety of different values and attitudes. These can quite often be in conflict with those of other people. For example, people hold very different views on abortion and euthanasia. Professional practitioners have to be sensitive to the moral status of the people they are working with, and not cause offence by making comments that undermine the views of other people. All principles are equal – one is not more important than another. In recent years there has been a closer focus on individual autonomy and it has become essential to offer choice and empower individuals. However, does respect for autonomy mean that a patient can request treatment that a health care practitioner does not think is in his/her best interests, or that they think will not work? If this occurs, respect for autonomy can come into conflict with nonmaleficence or justice. Cases, a doctor may not wish to prolong the situation and may therefore resort to withholding treatment, known as an act of omission.
Rights, responsibilities and duties
Legislation, policies and codes of practice provide clear guidelines as to the rights and responsibilities of care workers and these should be adhered to at all times. The duties of the care worker are clearly laid out in such documents, as well as in their contract of employment. In most situations a care worker’s duties are clear and there is no conflict of interest. However, at times there can be a conflict of rights and ethical principles to consider. For example, the rights of one person may clash with the rights of others. For instance, in a supported housing project there may be a resident who likes to play music late into the evening, while another resident likes to retire early and get up early. In other cases, one person may have two rights that conflict with each other. For example, in certain situations an individual’s right to privacy and confidentiality may clash with the right to be protected from harm. Cultural or religious values may also conflict with the right to be protected from harm. For example, a Jehovah’s Witness (who does not agree with blood transfusions) may find themselves in hospital with a medical condition where a blood transfusion offers the only means of saving their life. In these situations the rights and duties of the care workers may also conflict with those of the individual using the service, and a decision will have to be taken as to which is the best course of action.
4.2 Explain the principle of informed choice
Informed choice involves the exchange and understanding of relavent information so that an informed, reasoned and unpressured decision can be made by someone who has the competence and legal capacity to make such choices. Informs choice is a pre condition of informed consent. It emphasises the autonomy of the individual, and involves respect for the rights of individuals to make decisions about actions, which affect them. Making an informed choice and giving informed consent are parts of process: they are not isolated events. Informed choice can help to:
Increase peoples control over their own lives, and increase their autonomy and integrity
Promote trust and partnership between the health care user and the health care provider
Encourage individuals to accept responsibility for their health
The principles of informed choice and consent are autonomy, responsibility and accountability. Adoption of these principles is based on assumptions that health care services should be:
Provided by health care providers who have the relavent knowledge, skills and competence
and
Provided in way that the rights of all health service users are respected
The provision of information may enable a person to become informed, but it may play little part in enabling an autonomous choice to be made. Although comprehensive information is a prerequisite for informed choice, a person can be informed without having (or indeed wanting) a choice. Equally, a person may want to make an autonomous choice without the use of information.
It can be argued that there are three main aspects of choice in the context of healthcare in general and screening in particular. Firstly, there should be options available to choose from and people should know that they have a choice. Secondly, the person should be able to carry out their preferred choice. There may be barriers (for example, disability, language, poor health, access), which mean that, even though a choice is available in principle, it cannot be carried out in practice. Thirdly, the choice should be autonomous. The predominant theory of autonomy in relation to patient choice and healthcare is proposed by Fadden and Beauchamp. They define an autonomous action as one, which is performed intentionally, with understanding, and without controlling actions. However, this definition was largely for people making decisions about different treatment options.
Whether such notions of autonomy can exist within public health policies is perhaps open to debate.
Informed shared decision making has been described as “decisions that are shared by the organisation and service user and informed by best evidence, not only about risks and benefits but also service user specific characteristics and values”. In shared decision making, both the health professional and the service user are assumed to have a legitimate investment in their care decisions.
Informed choice is not just about the provision of relevant up-to-date information, it is also about making sure that the appropriate choices are available to people, and that the choice is autonomous and free from coercion. It should also be recognised that, even with the best of intentions, there are extraneous, unpredictable factors, which will prevent people from performing a behaviour, which is in keeping with their preferred choice. Thus there may be differences between the intended choice and the final behaviour. This difference needs to be taken into account when designing a measure of informed choice, before we can be sure of the impact of informed choice on uptake or other desired endpoints.
4.3 Explain how issues of individual capacity may affect informed choice
For persons consent to be valid, the person must be:
Able to comprehend and retain information material to the specific decision
Use and weigh information when making the decision
Acting voluntarily and without pressure or duress from anyone
Provided with enough information to enable them to make a decision
To communicate a decision by what ever means (Mental Capacity Act 2005)
A person’s capacity should always be determined in the context of a specific decision. It should never be assumed that because a service user is incapable of making certain kinds of decisions they cannot make some decisions about their own life. A service user’s capacity to consent should be assessed and the outcome of that assessment should be recorded. Life and support plans should reflect the extent and imitations on the service user’s capacity to make decisions. Individual plans should also identify the measures that need to be taken to develop and support the service user’s decision making abilities. A service user’s capacity to make a decision should not be confused with a judgement on the assumed reasonableness of the service users decision. A service user is entitled to make a decision, which is based on their own value system even if others perceive it as irrational. An irrational decision has been defined as “one which is so outrageous in it’s defiance of logic or of accepted moral standards that no sensible person who had applied his or her mind to the question could have arrived at it.” A competent person does, for example, have the legal right to refuse a life-saving procedure even if this might appear irrational to others. Consent may be expressed in writing, verbally and non- verbally. Normally consent to personal care is indicated by the service user’s speech and behaviour. For example, active co-operation with assistance to dress or bathe can be taken as an indication of the service user’s consent. A person with capacity is entitled to withdraw consent at any time.
When decisions have to be taken on someone else’s behalf, the decision must always reflect that persons best interests. The following factors should be taken into account:
The past and present wishes and feelings of the service user.
The need to permit and encourage the service user to
Participate as fully as possible in any decision affecting them.
The views of others whom it is appropriate consult about the service user’s wishes and feelings – and what would be in their best interests.
Whether the desired outcome from a specific decision can be achieved in a manner less restrictive of the service user’s freedom of action.
The need to be satisfied that the wishes of the service user were not the result of undue influence.
4.4 Propose a strategy to manage risks when balancing individual rights and duty of care in own area of responsibility
It is the responsibility of the Care Manager / Social Worker / Care Management Assistant / Approved Mental Health Practitioner to balance promoting safety and positive risk taking and therefore needs to:-
Build working relationships with individuals and their carers including where people prefer not to engage.
Help individuals understand how to identify risk and the potential consequences of them to self and or others via violence, self neglect, self harm, and suicide or hate crime so they can make validated decisions.
Complete clear and factual risk assessments, identifying risks to the individuals and or others
Ensure risk management strategies and plans define the agreed actions, roles and responsibilities and objectives to be gained.
Have safe and effective management of minimising potential risks
Be informed about national and local policies relating to assessing and managing risk.
Ensure practice is multi agency and multi disciplinary working with regard to assessing and managing risk.
Be informed of individual and service responses to address crises and reduce risks when occur.
People receiving services have an equal right to feel safe. The challenge is to support people in taking reasonable risks to accommodate choice while ensuring their safety in the process. Risk is defined as the exposure to harm or danger of the safety and well being, actual or potential, of people using the service, and the employment and others directly involved with services such as volunteers, or indirectly involved, such as any member of the general public.
Stages of Risk Management Process
Identifying if a risk exists
Assessing the nature of the risk
Developing a plan to manage the risk
Periodically reviewing the risk management plan for this person and changing it as and when the circumstances require.
Personal Risk Management Plan
The personal risk management plan is a tool designed to provide staff with guidance in how to consider the risks that are part of life’s experience for service users and then to examine the nature of those risks in order to develop an agreed approach to managing those risks with and for people using the services. The following diagram is a framework for assessing risk:
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