1.1 Explain models of practice that underpin equality, diversity and inclusion in your area of responsibility Our organisation is built upon person centred practice and which I uphold this in my daily practice. Person centred practice is defined as the belief in the others potential and ability to make the right choices for him or herself, regardless of the therapist’s own values, beliefs and ideas (BAPCA, 2013). In applying this to people who access our service users this means that care plans are designed with the individual at the centre presenting both choice and control to our clients. This is reflected in legislation produced by the UNCRC which states that people have the right to say what they think should happen when making decisions that affect them and that people with any kind of disability should have special care and support so that they can lead full and independent lives (2011). This model celebrates diversity and conforms to the idea of egalitarianism by recognising that everyone is equal in social status; therefore people are treated in the same way because although people differ they all equally deserve (Arneson, 2013).
Conversely this also means removing the inequalities that affect people so that they can achieve similar life circumstances and present be presented with equal life standards. This is applied to my practice by considering a person’s preferences, for example the way each individual prefer to communicate and be communicated with and their likes and dislikes in relation to community activities. Taking individual’s preferences into account when designing and operating a service recognises a service user’s wishes, needs and rights. Therefore this helps to diminish the production of a generic ‘one size fits all’ provision which does not value the individual. This way of designing services also gives power to the client, moving away from the idea of the professional as the expert, and takes into account their desired level and type of involvement within the community activities.
By valuing and including the individual at every level of their service from design to implementation and then regularly reviewing their service maintains client position of being in control of and truly involved in their service. These personal choices connect to making sure that everyone receives the same rights relating to inclusion within the community and a provision that treats each individual with dignity and respect. Another model of practice that underpins our service is the Social Model of Disability which sites disability as a creation of society’s shortcomings by resisting adapting and changing to include people with disabilities (Carson, 2009).
Society is therefore the cause of a person’s disablement rather than solely belonging to the person themselves. With this in mind, my area of responsibility encompasses accessing mainstream services and including service users in daily activities within the community to establish connections, build familiarity and promoting independency. This is not without obstacles as services and locations must be risk assessed, taking into account an individual’s personal preferences as well as the suitability of a place, to ensure that service users have fair and equal access to environments and opportunities.
Arneson, R. (2013) Stanford Encyclopedia of Philosophy. Available from: http://plato.stanford.edu/entries/egalitarianism/ [Accessed 25 August 2014] BAPCA (The British Association for the Person-Centred Approach) (2013) What is the Person-Centred Approach? Available from: http://www.bapca.org.uk/about/what-is-it.html [Accessed 19 August 2014] Carson, G. on behalf of the Scottish Accessible Information Forum (2009) The Social Model of Disability. Available from: http://www.ukdpc.net/site/images/library/Social%20Model%20of%20Disability2.pdf [Accessed 25 August 2014] UNCRC (The United Nations Convention on the Rights of the Child) (2013) Your Rights. Available from: http://www.uncrcletsgetitright.co.uk/index.php/right [Accessed 19 August 2014]
1.2 Analyse the potential effects of barriers to equality and inclusion in your area of responsibility Potential barriers to equality and inclusion within my area of responsibility exist on several levels due to working with disabled service users engaging within the community. In reference to the matrix of oppression (Hardiman and Jackson, 1997) social oppression is maintained and operationalised at three levels: the individual, the institutional and the societal. It explains that these can be displayed through behaviours and/or attitudes both consciously and unconsciously. The effects of these barriers can be the reduced access to certain environments because of lack of lift or necessary aids or the implementation of processes by organisations that do not allow for the differences amongst all people within society.
Barriers within my area of responsibility can come from the prejudgement that people with impairments cannot operate within mainstream society which is a form of social exclusion that upholds segregation. By seeking separate services or opportunities that are specifically designed to eliminate all risk denies individuals the possibility of inclusion within mainstream services. This again links to the social model of disability placing the issues with society’s reluctance to change and adapt to incorporate everyone rather than with an individual’s personal medical diagnosis (Carson, 2009). This is not helped by the media portrayal of disabled people as being helpless or subject to positive discrimination or by being excluded from many public forums altogether. Bronfenbrenner (1979) viewed the social environment as a great influence on people and that being subjected to other people’s attitudes and perceptions of disability, especially from people who are non-disabled, helps individuals to influence perceptions of oneself.
If people with impairments are not expected or encouraged to progress in life they may assume that this is something that they are not capable of and internalise this oppression. On an individual level an individual’s behaviour and attitude towards their inability to progress could result in anger/frustration or passivity/ambivalence when consistently faced with supposedly unachievable goals. This is combated in our organisations by attempting to understand the abilities and needs of those who access our service and provide service users with the same social and civil rights through risk assessed opportunities to succeed and progress. Within our organisation barriers to inclusion can lie with members of staff being reluctant to join in with certain activities for their own personal reasons reducing the equality of opportunity for service users.
These can be formed by beliefs in of a negative outcome for the service user or a the reluctance to perform a task themselves. As part of my role each activity is risk assessed and the possibility of negative outcomes is managed and reviewed. From reading day reports and regularly talking to both staff and service users about the suitability of their timetables and the locations they are accessing helps to address any concerns and reinforce to staff that, as a person centred service, the outcomes are for the service user’s benefit. This is helped by critically reflecting on practice to see how services and positive outcomes can be improved.
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge: Harvard University Press. Carson, G. on behalf of the Scottish Accessible Information Forum (2009) The Social Model of Disability. Available from: http://www.ukdpc.net/site/images/library/Social%20Model%20of%20Disability2.pdf [Accessed 25 August 2014] Hardiman, R. and Jackson, B. W. (1997) Conceptual foundations for social justice courses, in Adams, M. A., Bell, L. A. and Griffin, P. (eds) Teaching for Diversity and Social Justice: A Sourcebook. New York: Routledge
1.3 Analyse the impact of legislation and policy initiatives on the promotion of equality, diversity and inclusion Services such as the one I work for aim to enable people to participate within society using a person-centred approach considering that all service users are experts in their own lives. Participation is a requirement reflected in policies created to ensure people with impairments have input into the creation of the services and mandates that directly affect people’s lives. Personalisation was introduced through legislation which is “primarily a way of thinking about services and those who use them, rather than being a worked out set of policy prescriptions” (Needham, 2014, p.92). Direct payments and personal budgets both upholding these principles and were detailed in The Community Care (Direct Payments) Act 1996 (Great Britain, 1996) introduced to ensure greater choice, control and independence for people with disability. By designing and assessing services from the ‘bottom-up’ this approach stems from the consumerist model of participation and empowers service users to gain information to choose and access their own services (Kemshall and Littlechild, 2000).
By giving service user’s choice rather than standard provision this recognises diversity and individual need which requires a service to be designed around a person. Having the ability to choose one’s services creates the equality of opportunity and helps adapt to each person’s wishes and ideals concerning inclusion. The allocation of personal budgets may not be suitable for all when considering the struggle of being responsible for locating and accessing provision for service users dealing with significant health issues. Also although budgets can be spent at the discretion of the service user, rising costs and diminishing resources can mean that affording essential care limits the prospect of community involvement and therefore reduces social inclusion. Another act of legislation to impact upon the promotion of equality, diversity and inclusion is the Equality Act (2010) which protects people with certain protected characteristics, including disability, from direct and indirect discrimination, harassment and victimisation.
This protects people from discrimination arising if this means that someone is treated unfavourably as a consequence of their disability. Equality in itself and the true meaning of the act ensures that everyone has the same chances to do what they can and consequently some people may need extra help to get the same chances. This act promoted the inclusion of a diverse range of people within jobs and communities and also the introduction of equality monitoring forms to evidence that workplaces and services were being opened to all.
The introduction of this legislation meant that people would be awarded positions based on merit and justify that all people would have a fair and equal chance opportunity not be treated less favourably. This is reflected in our company policies and the way we help connect those who access our service and their community. It also meant that public places had a duty to make reasonable adjustments to allow access to all by making structural changes where necessary to avoid any disadvantage. Subsequently the building we use is all on one floor containing no steps and is fitted with several appliances and aids to assist those who need help.
Kemshall, H. and Littlechild, R. (eds) (2000) User Involvement and Participation in Social Care. London: Jessica Kingsley. Needham, C. (2014) Personalization: From day centres to community hubs? Critical Social Policy, 34(1): 90-108.
Great Britain (1996) Community Care (Direct Payments) Act 1990 (London: HMSO), ch. 30. Great Britain (2010) Equality Act (London: The Stationery Office) ch. 15.
3.1 Analyse how systems and processes can promote equality and inclusion or reinforce discrimination and exclusion Systems and processes are constantly being updated externally by governments and councils and should often be reviewed internally to make sure that businesses are adhering to any changes and to make sure that the internal processes are working for those attending the company. By not adapting to current legislation are not upholding the law this can be for a number of reasons such as not keeping up to date with new amendments or legislation, that their way of working is more convenient for the workers or management or by becoming set if their ways. This can mean that service users are not receiving the best quality service or that certain outdated procedures are no longer approved and therefore should not be practiced.
Setting a standard and equal level for all service users’ community provision means that everyone is treated equally, at the same time this means that personal differences are not being taken into account and therefore this reinforces discrimination by not allowing each person to engage in their own way. Excluding individuals from certain activities because they are unsuitable for other people means that they are not being given the full scope to expand engage in their interests which in turn excludes options based on the assessment of others. As an example when attempting to gain information on how to improve services a questionnaire may be designed to capture the views of clients and their families on how a service is meeting people’s needs. This questionnaire may have been designed with the idea in mind to promote equality and inclusion and help to tailor future ideas to those directly in contact with the service.
Conversely supplying only a paper questionnaire excludes the views of anyone who cannot read or write and therefore will only capture the views of a certain number of people. This process would be better suited to a method of capturing data whereby it is decided upon what information needs to be gathered and then setting about producing flexible and varied methods to ensure everyone is included in the consultation. By reviewing services and auditing practice in line with current legislation companies can avoid providing a generic and outdated service. Having regular staff meetings to ensure that good practice can be shared and to create a strong working partnership where everyone understands and issues and consents to any ideas to do with working patterns and initiatives.
Another idea in line with ensuring that systems and processes are working properly and promote equality is by involving external assessors to get a fair view of how well staff are trained and are up to date on their practice and can they check that all staff understand the ways that they are working in line with the companies philosophies. This reduces nepotism and negates any personal feelings within a workforce by having impartial assessors take facts on face value, such as is paperwork all being completed accordingly, checking training records and reviewing processes.
3.2 Evaluate the effectiveness of systems and processes in promoting equality, diversity and inclusion in your area of responsibility There are several systems and processes in my area of responsibility that promote equality, diversity and inclusion including making specific improvements to individual clients service provision and liaising with staff to ensure they feel competent at performing their roles. Firstly, by getting feedback from staff, service users and their families and through direct observation improvements can be made to aid clients in providing a better service. This can only be done through a process of collecting evidence and evaluating the outcomes and benefits for service users. Substantial evidence is required in order to make changes with service users that honour their personal preferences and act in their best interests.
Making a case for change through a set system and by taking time over helping to discover and explore the best options takes time; this of course is over ruled in a case where a service user is at risk of harm where we will act as soon as possible to remove that risk. By building up a profile, with service user’s help, our company can adapt to changes for each individual and help to review care plans and timetables to provide the most fluid and coherent service possible. This method is effective as it is based on solid and substantial evidence from many sources and helps service users to express informed choice about how they can best access the community. This is also a slow process, which can cause frustrations but by ensuring that the correct improvements are made the first time limits unnecessary change.
Secondly, having regular meetings with staff and ensuring that any concerns or praise is received is essential to a good staff moral and how to maintain an inclusive working environment. Many of the opportunities I have to meet with staff are informally, either face-to-face or on the phone. I often have to address issues then and there and seek out information to assist within a set timescale. Timescales are essential as they provide staff with realistic measures to have their needs met or to be supplied with information, this helps to build confidence in an inclusive integrated working team. Processes are in place for new staff to make sure that they call read the care plans of the service users that they will be working with and sign them to signal that they have understood and will apply the contents in their practice.
This system is essential as it helps staff to get a picture of a person before they start to work with them and accept their personal preferences and adapt to suit each individual. This promotes equality, diversity and inclusion as all staff receive the same training and are accountable for recognising the specific ways to work with individuals with specific needs. By supporting staff directly and being willing to help when they need it in the different ways that it is required, even if this is by referring them to someone more experienced or competent than myself, means that staff recognise our efforts in helping them to work effectively. Consequently as part of the process, reviewing past issues or concerns with staff means that progress can be measured and confidence in their development can be confirmed.
3.3 Propose improvements to address gaps or shortfalls in systems and processes Recording and reporting is paramount when working with a service that cares for individuals who may not always be able to communicate their preferences and opinions clearly. Making sure the correct information is relayed and disseminated efficiently to create consistency for clients in our ways of working is essential. The importance of reporting and recording is that clear, comprehensive and up to date information is disseminated to anyone working with service users and that we can provide a linear and consistent way of working. In an attempt to try to record occurrences during each shift staff are asked to complete day reports at the conclusion of every service; this is to be done as soon as possible to retain any details even minute which may help to build a bigger picture of how to adapt to a service user’s needs.
As a part of my role I have been asked to redesign these day reports, seeking help from the individuals themselves, the Good Practice Manager and member of staff who regularly working to support the individuals. Sometimes this is required as part of a mandatory annual review of a service users care plan or because of concerns that our service is not meeting the needs of an individual. This process can be particularly slow and takes time to make sure that it is done correctly. Getting the chance to gather all staff together, including the individual and their family is often complicated. Redesigning each individual’s day report from the generic format means that we can gather a daily catalogue of the specific type of information necessary to helping bring about changes and provide an effective service.
One of the gaps I have found in logging these day reports is that not all staff completed them, let alone hand them in within the 48 hour window of when they should be received. This also negates the reasoning behind designing new day reports if they are not being filled in. I understand how important these reports are to helping support our service users but I also understand that after a long day of work completing these forms in your own time (unpaid) is not the most appealing prospect. Being part of every member of staff’s job role not completing these day reports can lead to disciplinary measures.
Alternatively I believe that a proposed improvement would be rewarding and recognising when staff have completed all their relevant forms and celebrating this as I myself understand the effort and dedication this requires. This approach of focusing on the positive helps to highlight good practice rather than reprimand bad practice. Also in giving staff equal opportunities if day reports are not being completed meeting to discuss the cause means adaptations can be made in light of personal requirements if necessary. Other than this, giving staff the paid time to complete these forms would also be appreciated although I understand that this also causes issues because if staff are then being paid to complete the day reports and are not doing so this creates a bigger issue for management.
4.1 Describe ethical dilemmas that may arise in your area of responsibility when balancing individual rights and duty of care When balancing individual rights and duty of care there are several points in relation to ethical dilemmas involved in ensuring that service users remain safe but are still accessing a full inclusive range of activities. For this question I will take an example I have not yet come into contact with but may well do in the course of my work. An ethical dilemma in my working practice could be a service user choosing not to take their medication. This crosses a lot of lines as it indicates personal choice but also can clash with a service user’s best interests. From the medication training I have had any medication I help to administer to a service user must be done with my full knowledge of the process of how to dispense it and why the service user is taking it. In some circumstances this medication is essential to a service user’s well-being on an emotional or physical level. This is a dilemma that I would need to seek advice on, firstly from the Good Practice Manager at work and the GP whose jurisdiction the service user belongs to.
As it is always a service user’s choice to take any type of medication the only intervention would be if a service user was at significant risk to themselves or others because of this reduction in medication. ‘Significant harm’ is defined as the threshold that justifies compulsory intervention relating to the impairment of a person’s health and development (Children Act, 1989). If I were informed of a situation like this I would require documentation of how regularly a service user has opted not to take medication and if they consistently refuse then medical professionals would need to be informed and the effects of doing so would need to be monitored. In extreme cases this may mean medical intervention or hospitalisation if a service user was deteriorating.
This relates to the issue of informed choice by helping to outline a service users options and discuss the possible outcomes as a part of risk management. When an individual understands the reasoning behind options by being given fair and balanced advice this can aid them in comprehending the outcomes of their actions. This being said there is often an ethical imbalance between our own personal views and beliefs and that of someone else. In these instances reflection can be useful to understand where feelings or ideas routed and help to understand my input in a situation and where I should step back to make sure I do not cause influence.
Also the instance outlined above breaches into confidentiality as well because I am required to record when a service user takes their medication and if they asked me not to inform anyone that they had ceased taking it I would still be required to pass on this information. Falsifying records is not acceptable within the remit of my role and this misinformation could lead to serious consequences for both myself and service users. Great Britain. Children Act [online].Chapter 41. (1989) legislation.gov.uk. Available from: http://www.legislation.gov.uk/ukpga/1989/41/contents [Accessed 29 August 2014].
4.2 Explain the principle of informed choice
In order for any services to be carried out by our company there needs to be informed consent from each individual to the implementation of such actions; in cases where individuals do not have the capacity to consent their guardian are required to do so. Informed consent can only be given if those accessing our services are allowed to make informed choices. Detailed in a relevant White Paper (OKDHS, 2002, p6) “informed choice involves the exchange and understanding of relevant information so that a knowledgeable, reasoned and un-pressured decision can be made” it stresses that the individual or their representative must have “the competence and legal capacity to make such choices”. In order to make an informed choice “one needs to build up a picture of the available options and compare the advantages and disadvantages of each” based on a range of high quality, un-biased and relevant information (Baxter, K., Glendinning, C. and Clarke, S., 2008).
Individuals are entitled to informed choices as experts in their own lives when making decisions. Putting this into context within my role this means supporting service users to make informed choices about the services they receive in an enabling environment; this being a place where individuals can experiment safely and voice their opinions without fear of repercussion. This can be done by supplying the individual with relevant information and discussing the outcomes of certain scenarios. This requires a non-judgemental stand point and the information given should be impartial and devoid of advice or personal connection. The understanding that individual’s may make different choices to you is an important part of risk management. Outcomes should be supported with the knowledge that all the necessary information has been provided and there is no risk of significant harm to the individual.
It is essential to consider both the short and long term outcomes with the service user and to compare the idea of their choice with the reality once undertaken to understand the benefits and potential harms as a result. Issues that arise when considering the impact of informed choice include ethical concerns about whether someone’s choice is in their own best interest, this relates to issues of power. These can be overcome by recognising that we all have the right to make our own choices but can become experts by experience given the opportunity. In relation to service users who are deemed to lack the mental capacity to make informed choices the Mental Capacity Act (Great Britain, 2005) allows individuals the right to select carers to make decisions on their behalf to be made in their best interests;
I will discuss this act more thoroughly in the next point (4.3). My role as a professional is to implementing their informed choice and assist by reviewing the impact of this through specific time measured outcomes. Baxter, K., Glendinning, C. and Clarke, S. (2008) Making informed choices in social care: The importance of accessible information,
Health and Social Care in the Community, 16, 2, 197-207 Great Britain (2005) Mental Capacity Act 2005 (London: The Stationary Office), ch 9. OKDHS (2002) Principles and Guidelines for Service Delivery Concepts of Informed Choice and Informed Consent. Available from: http://advantage.ok.gov/WhitePapers/InformedChoiceInformenConsent.pdf [Accessed 26 August 2014]
4.3 Explain how issues of individual capacity may affect informed choice Individual capacity impacts upon informed choice when a person is unable to make their own decisions. According to the Mental Health Act (2005) is a set of rules which protect you if you are not able to make decisions and mental capacity is the ability to make your own decisions. It states that in order to make a decision you need to be able to understand all the information relevant to making that decision, use or weigh up that information, keep or remember that information, have the means to communicate your decision to someone else. It also states that making an unwise decision is different than not being able to make a decision. Individual capacity must be assessed before deemed an individual is deemed to lack such capacity.
There is a test contained within the Mental Capacity Act which has to be completed for each decision that needs to be made as capacity can vary depending on the decision being made and is completed by a health care professional. The assessment entails being able to understand the information needed to make the decision, being able to remember and recall that information, being able to understand the result or outcome of the choice you are making, or being able to tell people your decision in any way, such as talking, sign language or squeezing someone’s hand. In the case where an individual is deems to lack in individual capacity to make an informed choice decisions others will have to make decisions on your behalf. This legislation protects carers and healthcare professionals.
If they think you need care or treatment and you lack capacity they have a legal right to treat you without your consent. The issues surrounding individual capacity and informed choice affect out care as we would have to direct our personal centred care based on information and decisions made by others rather than the individual who we care for. Ensuring that any individual in our care has a high level of service that respects their privacy and dignity is one of the philosophies that our company is based on so engaging, including and communicating any service user in their daily routine would still be our priority. That is not to say that we would inform an individual of their care plan and their engagement if this were deemed stressful for the client and a decision would need to be made on a case by case basis.
All information and facts gathered from the following pages: Mental Capacity Act (2005) cited in Rethink Mental Illness (2014) Mental capacity and mental illness. Available from: http://www.rethink.org/living-with-mental-illness/mental-health-laws/mental-capacity/principles [Accessed 26 August 2014]
4.4 Propose a strategy to manage risks when balancing individual rights and duty of care in your area of responsibility By completing risk assessments and creating appropriate procedures based on current knowledge and by pre-empting situations and management strategies before incidents occur help to uphold our duty of care as an organisation. Strategies that are used to manage risk include devising action plans including, where possible, service users and their families and friends. By using the knowledge of service users and their capacity to express what they like and dislike as well as their preferences is essential in designing a service around an individual. Documenting and disseminating current and up to date information to all staff working with any individual using are service means that we can provide continuity of service, information on how to manage certain risks and help to fulfil a service users wants and needs. Team meetings and regular core group meeting about a service, again preferably including service users, provide the opportunity to monitoring and review any changes and developments for a service user’s health and well-being.
By being clear about everyone’s role and responsibilities within a service and how best to record and report information, depending on its importance relaying it to people in the correct way and within the shortest time frame. Respecting individual’s rights can bring up ethical dilemma and concerns which staff are instructed to discuss as soon as possible and to record when reporting on each service to be assess and reviewed under our duty of care. This is to benefit individual’s attending our service by keeping them safe, in both the short and long term. Each individual has the right to informed choice and to have these choices supported even if they conflict with our own. Through proper assessment and review the impact of a service user’s choice can be monitored and justified based on their rights to be continued as long as they are not deemed to be causing harm to themselves of others.
Legislation is always changing and it is imperative that as an organisation we are up to date on current laws and policies that govern our service. An example of the balance of individual rights and duty of care may include a service user choosing not to wear their seatbelt when using their wheelchair. Legislation states that when the wheelchair is in motion the belt should be worn to prevent harm to the user. In this case a risk assessment should be carried out and the possible consequences of not wearing the belt explained to the user.
If their choice remains the same then advice must be sought depending on the usage of the chair and the necessity of them wearing the belt and if it is imperative then seeking consent from service user, or in relevant cases their family. If this is seen as restriction of rights then receiving signed confirm that this is their choice would be required. This information should then be relayed to all staff working with this service user and explained that caution must be used when using the wheelchair. Ideally asking staff to sign to say they have understood the new procedures and risk assessment and this should be reviewed regularly.
Disability Discrimination Act (1995)
Equality Act (2010)
Mental Health Act (1983)
NHS and Community Care Act (1990)
Websites and reading;
Care Quality Commission , www.cqc.org.uk