Like children, elderly people are often vulnerable and at risk from themselves and others. The NHS and Community Care Act 1990, aims to enable elderly people to be cared for (or care for themselves) within the community. To achieve this safely health and social care practitioners need to assess a range of risks.
The NHS and Community Care Act also increased the number of people with mental health problems being cared for in the community rather than in a mental hospital. When deciding whether someone suffering from mental illness should be treated in the community, health and social care practitioners need to assess the possible risk to the person, the community and the person’s family. If the events are considered too great, the person can be ‘sectioned’ under the Mental Health Act 1983 – detained for treatment in a mental hospital.
Providing access to information
Health and social care practitioners have a duty to give service users information – from access to their medical records and explanations of procedures to information on hospital standards and clear guidelines on how to complain.
People can only make sensible decisions and choices if they have full accurate information on a situation.
Practitioners’ responsibilities to give service users access to information is laid down in two main pieces of legislation:
- the Access to Personal Files Act 1987. This gives individuals the right to look at information local authorities hold on them
- the Access to Health Records Act 1990. This gives individuals the right to look at their NHS medical records.
Maintaining the confidentiality of information
To do their job well, practitioners need a range of information about service users – from facts about someone’s physical well-being and financial situation to personal details about their feeling and relationships. Giving this information can be embarrassing and worrying, and people need to feel they can talk openly to their health and social care practitioners. This means trusting them to maintain the confidentiality of any information obtained.
Establishing ground rules is an important part of building trust. Before asking questions and recording personal details, practitioners should explain why they need the information and how they are going to use it. In turn, service users should be able to insist that details are kept completely confidential, and not shared with their family, friends other workers, and so on.
People’s rights to confidentiality are reinforced by several pieces of legislation:
- the Data Protection Act 1984 aims to ensure the confidentiality of information stored on computer. It sets rules on the personal information which can be held electronically, stating that information must be:
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obtained legally,
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used in the way specified when it was collected,
- kept accurate and up to date
- confidential, but available to those who have a right to see it.
- the Access to Health Records Act 1990 and the Access to Personal Files Act 1987 establish procedures for handling confidentiality data.
Empowering service users
Empowerment means enabling people to make choices and promoting their rights as individuals. Even making simple decisions – such as what to wear, who to sit next to at dinner and watch on TV – helps a person to maintain their independence and dignity. In line with this, health and social care practitioners should enable service users to make as many choices as possible in their day-to-day lives.
Recognising people as individuals is a major step towards empowerment. Practitioners must:
- identify the personal beliefs and values of everyone they work with
- respect the individual needs and choices of every service user
- avoid stereotyping, which denies people’s individuality
- consider people’s feeling at all times.
Often, information and knowledge is the key to empowerment. Without understanding and the different options open to them, people can’t make choices. People’s rights to be given information in order to play an active role in their own health and social care are laid down in professional codes of practice and charters.
Recent legislation has been founded on the importance of empowering service users, in particular the NHS and Community Care Act 1990. This:
- places new emphasis on people’s rights to choose their own health and care provision
- encourages people to live independently in the community, rather than in homes and hospitals.
Ethical issues and dilemmas
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An ethical dilemma involves making a decision when there is no definite moral right or wrong. It may be that there is a conflict between different people’s morals or beliefs. Or that an issue is so complex or difficult to understand that it raises moral questions, which are almost impossible to answer.
With people’s lives and well being in their hands. Many health and social care practitioners face ethical issues and dilemmas as part of their day-to-day jobs.
Agreeing the best interest of the users
Everybody involved will have his or her own views on a service user’s best interests, including:
- different health and social care practitioners
- the service user
- the service user’s family and friends
- the community in which the service user lives.
When making decisions about the best interests of service users, health and social care practitioners need to reach an agreement with all of these groups of people. This can mean careful balancing of a range of highly emotive issues and views.
Balancing the needs of individuals against those of others
In many cases, it is not enough to consider only the best interests of the service user. As decisions can also have repercussions for their family and friends, and society as a whole.
Allocating resources
Health and social care organisations are given a limited amount of money, and how to work out how to balance the budget while providing as good a service as possible.
To do this, they balance the needs of one group of service users against another, and decide who should receive priority. This may mean tackling ethical dilemmas such as:
- Is a heart operation on a child more important than a hip operation on an elderly person?
- Should resources be directed into buying vital new equipment, which might save hundreds, rather than continuing the treatment of a young person with leukaemia who has a slim chance of survival?
Giving information
A common dilemma faced by practitioners is deciding:
- What information people need to know
- Who needs to know it.
Everyone has the right to enough information to make decisions about their treatment. For example, before signing a consent form for major surgery, a patient needs to know the pros and cons of going ahead with the operation. Their surgeon should explain the operation using simple language, make notes and draw diagrams for the patients where needed.
As well as deciding what information to give, health and social care practitioners often face ethical dilemmas when it comes to passing on knowledge to other people. They have a responsibility to keep information confidential, but may feel the service user’s family has a right to know something. Or they may they can’t cope with a case on their own, and decide to ask a colleague for advice.
Handling conflicting values and beliefs
Everyone has their own set own set of values and beliefs. Some of these are personal preferences, while others are religious beliefs or cultural practices.
Health and social care practitioners have a responsibility to recognise and respect these values and beliefs at all times – even when they are in conflict with their own values, or the organisation’s practices.
