Models of practices that underpin equality

1.1- Explain models of practices that underpin equality, diversity and inclusion in own area of responsibility?

My role as a senior care assistant requires me to support individuals from a diverse range of backgrounds and cultures. At all times, I am expected to uphold and promote equitable practice and offer equality of opportunity while taking into account peoples political, economical, social and civil rights while promoting diversity and inclusion.

I must consider my own areas of responsibility within my workplace and how my practice underpins the values and principles of equality, diversity and inclusion.

In addition to this, my role is to support and influence the practice of my staff, to ensure that staff and residents are treated equally and fairly without discrimination. This is done by using a person centred approach, which is a model of practice that ensures individuals are central to the planning of their support, and are empowered to identify personal choices about how they want to live their lives.

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This also relates to the service users, as it enables them to be actively involved in all aspects of their care.

Equality is ensuring that everyone is treated equally and fairly regardless of their ability, religion, beliefs, gender, race, age, social status or sexual orientation. Diversity recognises that although people have things in common with each other, they are also different and unique in many ways. Diversity is about recognising and valuing those differences, and consists of visible and non-visible factors.

These include, personal characteristics such as background, culture, personality and work style in addition to the characteristics that are protected under discrimination legislation in terms of race, gender, disability, religion and belief, sexual orientation and age.

By recognising and understanding individual differences and embracing them, a productive environment whereby everyone feels valued can be created, known as inclusion.

The policies and procedures within my workplace are underpinned by a variety of legislation and current codes of practice. These provide me with a framework for ensuring that I uphold the principles and ethics of equality, diversity and inclusion.(see appendix)

The Equality Act 2010 is the law that bans discrimination and helps achieve equal opportunities in the workplace and in the wider society. The Act brought together and replaced previous equality legislation, such as the Disability Discrimination Act 1995 (DDA), the Race Relations Act 1976 and the Sex Discrimination Act 1975. It simplified and updated the law and strengthened it in important ways. The Act protects people from discrimination on the grounds covered by the previous equality laws. These are now called “protected characteristics”, and are; age, disability, gender reassignment, marriage nd civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation. The Act also promotes equality of opportunity to prevent discrimination arising in the first place.

The Equality Act also protects people from various forms of discrimination relating to disability, and also discrimination and harassment: Direct discrimination is when you are treated less favourably than another person because of your disability. This also extends to people who are discriminated against because of their association with someone who has a disability or because they are thought to be disabled. Discrimination arising from disability is when you’re treated less favourably because of something connected with your disability (rather than the disability itself). But it’s not discrimination if the employer or service provider can justify how they treat you, or if they didn’t know that you are disabled. Indirect discrimination happens when a rule, policy or practice is applied to everyone, but it has a particular disadvantage for disabled people.

But it’s not discrimination if it can be justified. Failure to make reasonable adjustments is when you need a reasonable adjustment so you are not at a 'substantial disadvantage', but the adjustment has not been made. The duty to make reasonable adjustments covers the way things are done, a physical feature (such as steps to a building), or the absence of an auxiliary aid or service (such as an induction loop or an interpreter). Harassment is unwanted behaviour that has the purpose or effect of violating your dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment. Victimisation – when you're treated badly because you've made or supported a complaint under the Equality Act.

The Mental Capacity Act 2005 (MCA) creates a framework to provide protection for people who cannot make decisions for themselves. It contains provision for assessing whether people have the mental capacity to make decisions, procedures for making decisions on behalf of people who lack mental capacity and safeguards. The underlying philosophy of the MCA Is that any decision made must be in their best interests. The MCA is governed by 5 core principles. These can be summarised as follows: Presumption of capacity (section 1(2) MCA).Every adult has the right to make their own decisions if they have the capacity to do so. Family carers and healthcare or social care staff must assume that a person has the capacity to make decisions, unless it can be established that the person does not have capacity Maximising decision making capacity (section 1(3) MCA). People should receive support to help them make their own decisions.

Before concluding that someone lacks capacity to make a particular decision, it is important to take all possible steps to try to help them reach a decision themselves. Right to make unwise decisions (section 1(4) MCA). People have the right to make decisions that others might think are unwise. A person who makes a decision that others think is unwise should not automatically be labelled as lacking the capacity to make a decision. Best interests (section 1(5) MCA). Any act done for, or any decision made on behalf of, someone who lacks capacity must be in their best interests. Least restrictive option (section 1(6) MCA). Any act done for, or any decision made on behalf of, someone who lacks capacity should be the least restrictive option possible.

The Human Rights Act is a UK law passed in 1998. It means that any person can defend their rights in the UK courts and that public organisations (including the government, police and local councils) must treat everyone equally, with fairness, dignity and respect. The human rights that are contained within this law are based on the articles of the European Convention, and does two things; judges must read and give effect to legislation in a way which is compatible with the Convention Rights, and it is unlawful for a public authority to act in a way which is incompatible with a Convention right. The rights that are protected by the HRA are;

The right to life
The prohibition of torture and inhuman treatment
Protection against slavery and forced labour
The right to liberty and freedom
The right to a fair trial and no punishment without law
Respect for privacy and family life and the right to marry
Freedom of thought, religion and belief
Freedom of expression
Free speech and peaceful protest
No discrimination
Protection of property, the right to an education and the right to free elections

GSCC Codes of practice- Although the GSCC closed in July 2012, the codes of conduct are still used in care homes. The document contains agreed codes of practice for social care workers and employers of social care workers describing the standards of conduct and practice within which they should work.

1.2 – Analyse the potential effects of barriers to equality and inclusion in own area of responsibility? Equality in the workplace is about more than simply giving equal treatment to all employees and complying with the Equality Act. Within the home, we work to remove the barriers which affect recruitment and progression. These barriers can include age, gender, race, sexual orientation, religion or belief, social background, physical or mental disabilities, marital or parental status, gender identity, communication and language.

All policies and practices within the organisation create equal opportunities for personal and professional growth- from establishing fair pay structures offering equal access to benefits to ensuring that promotion and progression is fair. At the very minimum, employers are required to eliminate discrimination from the whole employment cycle, starting from the application stage and throughout an employee’s career.

Barriers that prevent equality and inclusion are as follows;
Physical- Buildings and access, personal physical health, sensory loss
Attitudinal- Personal feelings, thoughts and behaviours
Structural- Economic, environmental, social systems
Institutional- Policies and procedures where some people are disadvantaged over others e.g. maternity leave

Examples of inequality in the workplace include;

Direct discrimination- when an employer treats an employee less favourably than someone else because of a protected characteristic Indirect discrimination- when a working condition or rule disadvantages one group of people more than another. E.g. saying that applicants for a job must be clean shaven puts members of some religious groups at a disadvantage. Indirect discrimination is unlawful whether it is done on purpose or not.

Equality laws may be jeopardised if training and promotion is targeted at younger members of the team, assuming that older workers are not as interested in career progression as their younger colleagues. Failure to provide adequate facilities for disabled people in the workplace, or failure to tackle bullying and harassment against an employee from a different ethnic origin may contribute towards a tribunal claim. Discriminatory tactics in screening of potential staff members, e.g. deliberately choosing male staff over female staff regardless of their ability to do a job.

Effects of this type of discrimination include; diminished life chances, social exclusion, marginalisation, poor interpersonal interactions and communication, disempowerment, and low self-esteem and self-identity.

Oppression is another barrier that can affect equality, diversity and inclusion. It is the consequence of five different factors including; stereotyping, prejudice, discrimination (as stated above), oppression and internalised oppression. It is defined as the “unjust or cruel exercise of power” (Webster, 2013). Standing up and taking action when this type of behaviour occurs is a way to eliminate oppression. Also, being aware about what oppression is as well as methods of prevention can be used as an effort to reduce, if not eliminate, and enables staff to work in an anti- oppressive manner. Oppression happens in many atmospheres, especially in a working environment.

Prevention is the main key to avoiding this type of hostility. This can be done with enforcement of policies, including written disciplinary actions that will be utilised if this occurs, as well as a chain of authority. Having a written policy clearly sets out the expectations of employees by the employers, not only of what is acceptable and unacceptable, but what consequences are to be enforced on to non- compliant employees. This should be read and signed by all employees as a preventative measure to avoid further problems.

The chain of authority is listed so employees are aware of who they will have to answer to in this situation, and who will be enforcing the consequences of their actions. The mechanics of oppression are described as participating, turning a blind eye and denial. Staff who witness this type of behaviour, being well aware but not taking action or altogether denying that the behaviour is occurring are examples showing how oppression continues to exist.

Failure to uphold equality, diversity and inclusion through practice will breach European and UK law and codes of practice and incur penalties such as loss of registration and significant damage to reputation. Consequences for the individual range from low self-esteem, poor mental and physical health and risk of harm and abuse. Therefore, it is paramount that regular training, supervisions and discussions take place to ensure that staff do not display this type of behaviour, or are victimised by others. As a senior, it is important that I notice these barriers and act quickly to prevent any issues from developing.

1.3 – Analyse the impact of legislation and policy initiatives on the promotion of equality, diversity and inclusion? It is important that I am familiar with the Acts of Parliament, regulations, guidance and codes of practice in order to promote best practice within the home and to inform staff, ensuring they are up to date on any changes. As a qualified social worker, I already have some background knowledge on different acts and legislation within the health and social care sector, and have put these into practice in two six month placements throughout my academic career, and also my current job in the care sector.

Equality, diversity and inclusion are addressed within the essential standards set out by CQC which are underpinned by the Health and Social Care Act 2008. Regulation 17(2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 says that : “the registered person must…take care to ensure that care and treatment is provided to service users with due regard to their age, sex, religious persuasion, sexual orientation, racial origin, cultural and linguistic background and any disability they may have”. This regulation relates to Outcome 1 – respecting and involving people who use services. However, the wording of this regulation suggests that these equality characteristics should be considered in all aspects of care, treatment and support.

This is also the approach taken by CQC in the essential standards. In addition, Regulation 9(1)(b)(iv) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 says that: “The registered person must take proper steps to ensure that each service user is protected against the risks of receiving care or treatment that is inappropriate or unsafe, by means of… the planning and delivery of care and, where appropriate, treatment in such a way as to— avoid unlawful discrimination including, where applicable, by providing for the making of reasonable adjustments in service provision to meet the service user’s individual needs.” This regulation relates to Outcome 4.Regulation 17(1) a of the Health and Social Care Act 2008 (regulated activities) regulations 2009 says that: “The registered person must, so far as is reasonably practicable, make suitable arrangements to ensure…the dignity, privacy and independence of service users.” Regulation 17(2) (a) says that: “the registered person must treat service users with consideration and respect” This regulation relates to Outcome 1.

The Disability Discrimination Act 1995 has now been repealed and replaced by the Equality Act 2010. Formerly, it made it unlawful to discriminate against people in respect of their disabilities in relation to employment, the provision of goods and services, education and transport. The DDA 1995 departed from principles of older UK discrimination law (the Sex Discrimination Act 1975 and the Race Relations Act 1976). These acts, also repealed and replaced by the Equality Act 2010, made direct and indirect discrimination unlawful. The core concepts of the DDA 1995 are instead: less favourable treatment for a reason related to a disabled person's disability; and failure to make a "reasonable adjustment".

"Reasonable adjustment" or, as it is known in some other jurisdictions, 'reasonable accommodation', is the radical concept that makes the DDA 1995 so different from the older legislation. Instead of the rather passive approach of indirect discrimination (where someone can take action if they have been disadvantaged by a policy, practice or criterion that a body with duties under the law has adopted), reasonable adjustment is an active approach that requires employers, service providers etc to take steps to remove barriers from disabled people's participation.

The National Minimum Standards sets out the standards for care homes for older people, which form the basis on which the new National Care Standards Commission will determine whether such care homes meet the needs, and secure the welfare and social inclusion of the people who live there. The standards set out in this document are core standards which apply to all care homes providing accommodation for older people. They acknowledge the unique and complex needs of individuals, and the additional specific knowledge, skills and facilities needed in order for a care home to deliver an individually tailored and comprehensive service.

As stated in outcome 1.1 I have discussed the Equality Act 2010, the Human Rights Act 1998 and the Mental Capacity Act 2005.

It is also essential that all staff are familiar with the homes own policies on diversity, equality and inclusion (see appendix) If these policies are not adhered to, it could result in guidelines, legislations and requirements also not being adhered to, which could result in the residents and staff being subjected to abuse.

2.4- How do you support others to challenge discrimination and exclusion? As a senior, I have an important role to play in championing diversity, equality and inclusion in my workplace. I am expected to articulate my own beliefs and values regarding diversity, recognise equality, respect and tolerance, and encourage non- judgemental attitudes and anti- discriminatory practice in order to inspire and lead my team. It is also important to encourage a positive culture within the workplace that promotes the principles of good practice.

Examples of opportunities include; Developing and delivering training and CPD reviews so that the team is kept up to date with new developments Providing a safe environment where people feel empowered and supported to challenge discrimination and poor practice Ensure all staff are aware of the “whistleblowing” policy and other policies in place to challenge discrimination. (see appendix)

I am also the workforce representative, so this means that staff can openly discuss any issues or concerns they have which could include issues of discrimination and exclusion. I have received some complaints that staff feel they are being victimised, as there has recently been a divide between night/day staff, with each day/ night members complaining that the other are not pulling their weight, or they are not assisting the residents in meeting their personal care needs to a high standards e.g. wet beds, soiled pads not being changed etc.

To rectify this issue, staff members were expected to complete a night/ day shift that was opposite to their usual shift pattern, in hopes to highlight what the different shift patterns and routines entailed and what was expected from staff members. The work “clique” was also used which has serious connotations as can be linked to bullying, which is a form of victimisation and exclusion. There was a management meeting held to discuss these issues and ways to rectify them. A “team building” night out was arranged, in hopes to bring all staff together.

When discrimination and exclusion occur in policy and practice, I have a duty of care to challenge it, by reviewing and monitoring situations to identify and give examples of best practice. This can be done by undertaking supervisions, encouraging reflective practice to consider individual roles and accountability, maintaining quality assurance systems and record keeping, monitoring and evaluating processes and regular training. Ensuring staff are familiar and adhere to policies and procedures (see appendix) is also a positive way to address issues of discrimination and exclusion, as it ensures staff are fully aware it will not be tolerated within the care home.

In relation to the residents there are many laws and policies that are aimed to prevent this. The “No secrets” white paper is a UK Government initiative from the Department of Health which provides guidance on developing and implementing policies and procedures to protect vulnerable adults from abuse. Abuse can be defined as: Physical, sexual, psychological, financial, neglect and discriminatory. The Protection of Vulnerable Adults (POVA) policy also states the duty of care placed on local authorities and organisations to protect older people from abuse and harm. As the care home specifically caters for residents with Alzheimer’s and dementia, there is a higher chance that these residents can face widespread discrimination for a number of reasons.

There is significant misunderstanding and stigma attached to dementia that manifests itself in widespread discriminatory attitudes. Age discrimination is also a factor that they could face, and potentially more at risk of discrimination and infringements on their human rights because they may not have the capacity to challenge or report what has occurred, meaning they face a poorer quality of life. At the care home, we ensure that this type of discrimination is challenged by offering high quality care based on individualised care and support which builds on a person’s abilities and strengths, treating people with dignity and respect offering choice and safeguarding privacy, and that staff are properly trained in caring for residents with dementia and who are fully supported in their role. If a resident or a member of their family feel they are being discriminated against, the complaints procedure enables them to formally complain, and feel fully supported in doing so. The “residents charter of rights” policy is available to all residents, their families and visitors, and details how they should be treated according to the Health and Social Care Act 2008, and also the essential standards set out by CQC.

3.1- Analyse how systems and processes can promote equality and inclusion or reinforce discrimination and exclusion? Every organisation has policies and procedures in place that are informed by legislation and national guidelines, in hope to promote anti- discriminatory practice. At the care home, we have a mission statement that details the way we intend to create a positive working environment whereby the shared principles and values of good quality support are upheld throughout the organisation. The statement reads; Vision Statement: We strive to be at the forefront of delivering exceptional standards of care and establishing ourselves as a leading and innovative care group in the United Kingdom. Mission Statement: We believe in a holistic care approach supported by dedicated and motivated staff team who are specifically trained to deliver a quality service.

Our ethos encourages independence of residents in a friendly, welcoming, and safe environment with a “home from home” atmosphere. Philosophy of Care: QCG philosophy encompasses five basic principles of care which are; Quality of care with a holistic approach ensuring psychological, spiritual and physical well-being of residents A motivated, enthusiastic and specifically trained staff team to deliver this care Ensuring dignity and respect of residents in a non-discriminatory way in accordance with the resident’s charter of rights. (see appendix) Encouraging an independent and supported lifestyle with well-structured activities and social programmes A homely care approach fostering friendships, family involvement, local community interaction and
support.

The effectiveness of these systems and processes will need to be monitored, and this can be done through; A regular review and audit of policies and practice will identify areas to be addressed Individual and family questionnaires can identify areas that require improvement, but also highlight areas of good practice and provide the benchmarks for reviewing and monitoring practice within the workplace. In depth and thorough induction training to ensure new employees are aware of their job roles and responsibilities Complaints procedures can contribute to providing evidence in particular cases. Developing and maintaining effective complaints procedures will enable areas to be identified relating to diversity and equality which require improvement.

4.1- Describe ethical dilemmas that may arise in own area of responsibility when balancing individuals rights and duty of care?

Confidentiality

My duty of care towards the resident, and my responsibility to safeguard individual privacy could cause legal and ethical tensions. Ethical dilemmas arise frequently throughout the social care sector, particularly within my role as a senior carer, and it is my duty and the duty of the home to ensure that individuals are protected from harm. A number of factors need to be considered including the residents need to be informed as to how information about them is used and consent should be sought to share information with outside agencies.

However, information can be disclosed where there is an overriding public interest e.g. where abuse is suspected. In this circumstance, confidentiality can be broken if a resident is at serious risk of; harm to themselves, harm to others, exploitation or physical/ sexual/ verbal abuse, significant financial gain or loss. I would also need to assess whether or not the resident has capacity and adhere to the MCA 2005 framework. The five principles of assessment are; Presume capacity unless established otherwise

Take practical steps to enable decision making
Accept that people can make unwise decisions
Act in the persons best interests
Use the action least restrictive of the persons rights and freedom of choice

The use of sharing of service user information forms an essential part of the provision of health and social care, however the nature of this information needs to be in line with the legal duty to keep all personal information confidential. The relationship between staff and resident needs to be one of fidelity and trust, and residents have a legitimate expectation that private information will not be shared, used or disclosed without their consent. Therefore, all staff have strong legal and ethical obligations to protect resident information and the law and standards that govern practice and the handling of personal and confidential information are;

The Data Protection Act
The Human Rights Act 1998 (article 8)
The Freedom of Information Act (2000)
The Essential standards of quality and safety
The Equality Act 2010
The Public Interest Disclosure Act (1999)

Own Beliefs and values

Each person has a unique set of values and beliefs, and strive to live their lives by these. The same is true for the resident who are supported within the care home, and occasionally personal values and beliefs may be different from the residents and their families. If the resident has a Lasting Power of Attorney in place that has a say over their health and welfare, or if they had a living will in place prior to a decline in their mental illness than this can also cause an ethical dilemma. A resident in the care home had a living will in place where, in the event that they had a decline in their mental state and became very unwell, then they would not want to be treated for this illness.

The resident does now unfortunately have severe dementia; he became unwell with a chest infection, and his daughter, who has Lasting Power of Attorney, did not want him treated. Personally, I did not agree with this decision, as felt that it was not a severe illness as stated in his living will, and could be overcome with some antibiotics. His daughter did not want the GP contacted, however, I felt it was in the best interests of the resident to speak with the GP regarding this issue, as felt he could become seriously unwell without antibiotics, so I was therefore trying to protect him from harm. This was a serous ethical dilemma for me and a big learning curve. After a long discussion with the GP, it was decided that the GP would contact the daughter to explain the possible severity of the situation, and she eventually agreed to treatment.

Other factors that can cause ethical dilemmas include; the management of resources- balancing good support with available resources can be a challenge, organisational policies- While there may be solid reasoning’s behind the policies, some may impact negatively on a staff member if for example they are unable to work unsupervised due to disability, safeguarding- disclosing information of a safeguarding matter to the correct person if a resident and/or staff member has asked you not to disclose and balancing the needs of the family and the needs of the individual- sometimes challenging the families wishes to meet the needs of the individual may be necessary.

4.2- Explain the principle of informed choice?

Choice and control is about freedom to act, for example to be independent and mobile, as well as freedom to decide. Having choice and control over one’s life and involvement supports autonomy and self-esteem. The issues of choice, control, involvement and self-determination are at the forefront of current government policy. Department of Health research found that health and social care recipient’s value having information to make choices and decisions for themselves, and that feeling confident and maintaining control is important. Putting People First (2007) outlined a shared vision for social care and radical reform. Autonomy - through maximum choice, control and power for people over the services they receive – is central to the values outlined in the paper.

Information, advice, advocacy and support with decision-making, are all key to ensuring that people can exercise autonomy. Every resident in the care home has a consent to care and treatment form in place that they must agree to before care can be carried out. This means they agree to information sharing, intervention from GP’s and nurses etc. If the resident is unable to give signed consent but it appears they can give verbal consent than their next of kin can sign for them. However, if the resident is unable to give signed or verbal consent, than this would affect their informed choice as a Mental Capacity Assessment and Best Interests Assessment is carried out.

For most residents in the care home, making complex decisions and choices requires additional support as the majority have a diagnosis of Alzheimer’s or dementia. There are different processes for decision making when considering choices. An informed choice is when an individual is supported to make a decision, and as a senior, I have a responsibility to provide residents and their families with all the necessary information to make those decisions. It is important to be mindful of the range of accessible information the individual requires in order for them to make the decision, and this decision must be unbiased and evidence based. It is important to also consider how the resident communicates and who else may need to be involved such as family members, GP’S social workers etc.

Many of the residents have a Power of Attorney in place which covers finances, and approximately four residents have a Lasting Power of Attorney which covers health and welfare. In this case, decisions can be a lot harder to make as a family member may have the final say regardless of the residents values, which should always be upheld. This is because the resident may not be able to express their wishes due to a decline in their mental illness. The residents are however, protected by the Mental Capacity Act and the Deprivation of Liberty Safeguards.