Duty of Care Nursing Times Live Manchester 2005

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Duty of CareNursing Times LiveManchester 2005

• Gail Adams Head of Nursing UNISON
• 0207 551 1317
• gail.adams_at_unison.co.uk
• Agenda for Change
• www.unison.org.uk/health/a4c

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Introduction

• Definition of Duty of Care
• What does it mean in reality?
• Who does it apply to?
• Legal aspects of care
• How would you use it?
• What happens when things go wrong?

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Duty of Care

• Always act in the best interests of the clients
  their care needs
• Let no act or omission on your part be
  detrimental to their care
• Act within your competence and decline to take on
  something if you do not believe that you can
  safely expedite it.

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What does the Duty of Care imply?

• Keep knowledge skills up to date
• Provide service at the standard of the reasonable
  person
• Know what must be done to ensure that the service
  can be provided safely

• Keep accurate records as appropriate
• Only delegate work or accept it when it is safe
  to do so
• Protect confidential information except where it
  conflicts with public interest or safety.

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Who does it apply to?

• Every health worker has a duty of care not just
  towards clients but to themselves and their
  colleagues
• It can be applied to every aspect of your work,
  from duties that you undertake to equipment that
  you may need to use to carry out your work safely

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Its NO defence to simply claim...

• Oh!

• I was too inexperience to carry out the task.
• I was instructed to work unsafely.
• I had inadequate resources to do the job safely.

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Legal aspects of care (1)

• Whistle blowing - Public Disclosure Act 1998
• Health Safety Act 1974
• The Management of Health Safety at Work
  Regulations 1999
• The Employment Rights Act 1996

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Clinical Standards of Care

• National Institute of clinical excellence (NICE)
• Commission for Health Improvement (CHI) soon to
  be Commission for Health Audit Inspection
  (CHAI)
• Clinical Governance
• National Service Frameworks (NSF)

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Legal Aspects of Care (2)

• DoH guidance on consent in light of Bristol and
  Alderhey
• The courts normally apply the test of what could
  be expected of the reasonable man. However the
  phrase reasonable is seen in a different
  context with professionally trained individuals
  as a result of the standard of training, which
  they would have received
• UNISON publication Duty of Care seeks to
  reflect on all aspects of legislation, which is
  pertinent to this duty

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How can you use the Duty of Care? (1)

• Employment policies should exist within your
  organisation to cover the legislation referred to
  earlier. Be conversant with them.
• If you have concerns about a clients care needs
  not being met, a colleagues competence or
  equipment that may have a detrimental effect on
  client or staff care you should raise your
  concerns and make them known.

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How can you use the Duty of Care? (2)

• If you are unsure of how to express concern,
  speak to your UNISON representative, they may be
  able to do it for you.
• Document your concerns keep a copy for your own
  records.
• If you remain unhappy or if you do not feel that
  your concerns are being listened to, go higher.

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How can you use the Duty of Care? (3)

• If your manager asks you to do something and you
  dont feel competent to do so - speak out.
• It is acceptable to say that you are unable to
  carry out an instruction because you have not
  been trained or you dont feel you can do it
  safely.
• Client safety needs must come 1st, 2nd 3rd.

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Things can and do go wrong

• Bristol - higher infant mortality rates when
  compared to similar units. It took an
  anaesthetist to speak out - fear had to play a
  role in this.
• Alderhey, Harold Shipman, Victoria Climbié, David
  Bennett enquiry - have all contributed to the
  public questioning the profession... and health
  workers questioning themselves.
• All are tragic events, but should not have been
  allowed to happen.
• Confidentiality can be breached in the correct
  circumstances. When uncertain, seek advice.

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Bear in Mind

• Statutory rights e.g. health safety, whistle
  blowing, discrimination.
• Clinical governance, supervision, appraisals, CPD
  an open learning culture.
• NHS HR strategy - treating staff well improves
  patient care.
• Social partnership - staff should have influence
  over working environments.

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Conclusions

• Duty of Care is a right and an expectation for
  all staff and clients.
• If you have concerns regarding any aspect of
  client / staff care or safety speak out. If you
  are not sure how to do this then speak to your
  union representative.
• If youre not in a union join one NOW - come and
  see us on Stand E2
• If youre not being listened to, document your
  concerns go higher, give deadlines for
  responses to letters.
• Document, document, document keep your own
  records.

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Final Thoughts

• Our lives begin to end the day we become silent
  about things that matter.
• Martin Luther King Jnr