April 2020: Changes in relation to the Coronavirus Act 2020

See also Coronavirus Act 2020 chapter

During the COVID-19 outbreak, the care sector will be under a lot of pressure to deliver care and support to adults whilst experiencing a likely reduction in staff numbers due to sickness as well as an increase in the numbers of adults requiring services. During these challenging times the principles and values laid down in the Responding to COVID-19: the ethical framework for adult social care chapter must be adhered to.

1. Introduction

Staff in provider services must treat adults with care and support needs, and their carers, friends and family with dignity, compassion and respect at all times and in all circumstances. The organisation must adopt a culture of care that respects the privacy, dignity, culture and individuality of all patients under its care and staff (see also Equality, Diversity and Human Rights).

1.1 Principles

All staff must:

  • recognise the diversity, values and human rights of adults who use the service;
  • uphold and maintain their privacy, dignity and independence;
  • provide care, support and treatment in a way that ensures their dignity, and treats them with compassion and respect at all times;
  • ensure that they have privacy when they want it, treating them as equals;
  • provide any support they might need to be autonomous, independent and involved in their community;
  • help adults maintain relationships that are important to them whilst receiving care and support with the service, and ensure that they are not left unnecessarily isolated;
  • put adults at the centre of their care and support by enabling them to make decisions;
  • all communication with them and their families must be respectful and compassionate. This includes using or facilitating the most suitable means of communication and respecting their right to engage or not to engage in communication;
  • provide information that supports them, or others acting on their behalf, to make decisions about their care and support;
  • support adults, or others acting on their behalf, to understand the care and support provided, including risk and benefits and their rights to make decisions;
  • enable adults to care for themselves where possible;
  • encourage and enable adults to be involved in how the service is run;
  • address them in the way they prefer, including their favoured name;
  • encourage and enable them to be an active part of their community where possible and according to their wishes, promoting their autonomy and independence;
  • have regard for the protected characteristics as defined in the Equality Act 2010, that is: age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex; sexual orientation. Adults, their family members or friends must not be discriminated, harassed or victimised because of these protected characteristics; this includes direct and indirect discrimination. Staff should also have due regard to the person’s protected characteristics in relation to care and treatment reflecting their preferences or in relation to their involvement in the community.

Staff must make sure that they provide appropriate care and treatment that meets people’s needs, but this does not mean that care and treatment should be given if it would act against the consent of the person using the service (see Consent and Mental Capacity).

2. Personalised Care and Support through Involvement

Adults should be involved in and receive care and support that respects their right to make or influence decisions. Staff should:

  • explain and discuss their care and support options with them in a way that makes sense to them;
  • respect their right to take informed risks, while balancing the need for preference and choice with safety and effectiveness (see Positive Risk Taking and Risk Assessments);
  • promote and respect their autonomy, privacy, dignity, compassion, independence and human rights at all times by:
    • placing their needs, wishes, preferences and decisions at the centre of assessment, planning and delivery of care and support;
      • respect their personal preferences, lifestyle and care choices;
      • when providing intimate or personal care, the organisation must make every reasonable effort to make sure that they respect the preferences of individuals in relation to who delivers their care and treatment, such as requesting staff of a specified gender;
    • have clear procedures followed in practice, monitored and reviewed that ensure staff understand the concepts of privacy, dignity, independence and human rights and how they should be applied;
    • ensuring that the need to maintain confidentiality or disclose information is taken account in the assessment of the individual circumstances (see Information Sharing and Confidentiality);
    • actively listening to and involving adults, or others acting on their behalf, in decision making and ensuring there are clear records that evidence the decisions made and methods in which the decision was achieved.
  • provide information to help them, or others acting on their behalf, to understand their care and support, including the risks and benefits, and their rights to make decisions;
  • make adults aware of independent advocacy services wherever they are available, and cooperate with independent advocacy services (see Advocacy).

2.1 Meeting the needs of adults who use the service

Adults who use the service should have their care and support needs met as:

  • they are listened to by staff;
  • they, or those acting on their behalf, are involved in assessing, planning reviewing and carrying out their individualised care and support;
  • the things that are important to them in relation to their care and support are established as part of their assessment, development and review of their care and support plan;
  • the support to meet these needs, choices and decisions is provided;
  • staff are respectful of the decisions made by the adult and / or their representative.

2.2 Providing information to adults who use the service

Adults who use the service should be provided with information about:

  • the aims, objectives and purpose of the service;
  • the facilities that are available for their care and support;
  • how their individualised care and support is reviewed and frequency;
  • the cost of any service, where charges are applied and individual contracts where appropriate;
  • how to raise a concern or complaint about the service, and how it will be dealt with;
  • local advocacy services.

3. Ensuring Privacy, Compassion and Dignity

To ensure the privacy, dignity and compassionate treatment of all adults who use the service:

  • each person’s privacy must be maintained, and they must be treated with compassion at all times including when they are asleep, unconscious or lack mental capacity;
  • all reasonable efforts should be made to make sure that discussions about care, treatment and support only take place where they cannot be overheard;
  • staff must make sure that people have privacy when they receive treatment and that they are supported to wash, bath, use the toilet in private;
  • each person’s privacy needs and expectations should be identified, recorded, and met as far as is reasonably possible;
  • people’s relationships with their visitors, carer, friends, family or relevant other persons should be respected and privacy maintained as far as reasonably practicable during visits;
  • adults should not have to share sleeping accommodation with people of the opposite sex, and should have access to segregated bathroom and toilet facilities where possible, without passing through opposite-sex areas to reach their own facilities. Where appropriate, women should have access to women-only day spaces;
  • any surveillance used to monitor people with mental capacity that infringes their privacy in their place of residence must be with their consent. If they lack capacity, this decision must be made in their best interests. Any surveillance which results in a deprivation of liberty within the community would need to be authorised and in their best interests. If any form of surveillance is used, the service must ensure this is in the best interests of adults, while remaining mindful of their responsibilities for the safety of their staff. Any surveillance should be operated in line with Using surveillance: Information for providers of health and social care on using surveillance to monitor services, CQC, 2014.

4. Managing Risk through Effective Procedures about Involvement

Adults who use the service should receive care and support from staff who use procedures which are followed in practice, monitored and reviewed. These procedures must ensure that:

  • care and support options, and the risks and benefits of those options, are explained to the adult / their representative;
  • choices and preference of the adult are expressed by them or others acting on their behalf;
  • the choices of adults are respected and accommodated unless:
    • the choice places other people at risk of harm or injury;
    • it would not be reasonable to expect the service to have the resources needed to achieve the choice;
    • it is not within the stated aims, objectives and purpose of the service, to meet choice;
    • the adult does not have capacity to make that decision or is subject to a legal restriction that prohibits them making a choice (see Mental Capacity and Consent);
  • individualised assessments and plans of care and support are based on the adult’s needs, choices and preferences;
  • adults must not be neglected or left in undignified situations (see Preventing Abuse and Neglect);
  • arrangements must be in place for someone to act on the behalf of the adult where they agree to it or it is legally authorised or required;
  • any reasonable adjustments are made so that the adult is enabled to be involved in decision making;
  • risks, benefits and alternative options are discussed and explained and documented in a way that the adult is able to understand (for example via a mental capacity assessment and risk assessment forms);
  • the adult is given an opportunity to take part in the decision making, as appropriate, through:
    • general day to date communication and living;
    • periodic surveys / feedback of their views;
    • meetings with other adults in the service;
    • one to one individualised time;
    • participation in local forums and events;
    • involvement in service user led quality groups;
    • through relevant professionals and others involved in their care and support;
    • local advocacy groups;
    • the service complaints procedure.