Supporting, weighing up, and reflecting on often difficult decisions is part of everyday practice in adult social care.
The knowledge, skills and experience of this will be an important underpinning for social care practitioners as the expected pressure and demand for resources increases as a result of the current coronavirus (COVID-19) pandemic. The evolving nature of the pandemic, the national and local responses, and legislative changes mean that practitioners working across health and social care systems are being required to respond in ways that may feel unfamiliar and outside of the usual frameworks and parameters.
The Department of Health and Social Care (DHSC) have issued an ethical framework for adult social care to support the planning and organisation of adult social care during the COVID-19 outbreak. This guidance states that every decision is multifaceted requiring considerations around individual wellbeing, overall public good, and resources available. It also iterates that ethical values and principles are equally relevant to people needing support and people working in practice.
The framework should be used alongside existing legislative, regulatory and professional codes. The values and principles within the ethical framework mirror those of adult social care, and certainly they are reflective of the principles describes within the Care Act 2014 statutory guidance, and in particular safeguarding. These direct parallels create a strong foundation for good decisions.
The values and principles within the ethical framework are:
- minimising harm
The next section provides some reflections on existing social care practice areas, and some of the Research in Practice resources that link to the ethical framework, and support the application of the ethical framework in practice. Whilst things are new and challenging, we hope this blog will help strategic leaders and practitioners consolidate the existing knowledge skills and experience across adult social care.
Listening to and respecting individual and personal choices is part of the adult social care practice and policy. Recent developments around strength based working, including the Department of Health and Social Care Practice Framework support the implementation of the ethical framework. These Podcasts discuss how to communicate in a strengths-based way and can help with supporting people to understand what may be happening, and inform decisions about what they would like to do.
Existing skills and practice around ‘risk enablement’, where offering people as much independence and control over daily life as possible, whilst also reducing risk and promoting their safety may be useful to reflect on in this context. Part of this is also the recognition that professionals can become involved in emotionally charged situations about fundamental aspects of how people live their lives, which can cause them to face conflicts between their individual ethical frameworks and the boundaries and duties of their professional role, often with no simple way of reconciling the two. This Research in Practice Podcast explores the impact of our own values and ethics when we are working with people, particularly when we are considering working with risk.
Evidenced and defensible decision-making
Evidenced and defensible decision-making are a key part of social care practice, remembering the importance of demonstrating a clear rationale for decisions, based on legislation, policy, models of practice, evidence and recognised decision-making tools may help in this context. Kemshall (2003) describes the elements of a defensible decision as:
- Reasonable steps are taken;
- Reliable assessment methods are used;
- Information is thoroughly evaluated;
- Decisions are recorded and carried through;
- Processes and procedures are followed.
Whilst this may feel ambitious in an ever-changing policy context, reflecting on and being clear about the decisions being made and why, is something is that social care practitioners are experienced in.
Adult social care has a long history in supporting and reflecting on practice through supervision. Using this as a foundation to adapt to the current context when people are working in new and different ways, often remotely and without regular contact puts the sector in a strong position to respond. Evidence suggests that ‘wellbeing supervision' demands a relationship of trust and honesty between supervisee and supervisor. It also demands critical (deep) reflection about yourself, others and the system that you work in (Nosowska, 2018). Research in Practice will be tweeting useful open access ‘tools’ for supporting supervision practice over the coming weeks. In the meantime the open access Practice Supervisor Development Programme, and Social Work Organisational Resilience Diagnostic (SWORD) may be useful.
The Coronavirus Act 2020 and Care Act easements: guidance for local authorities state that ‘Local Authorities will remain under a duty to meet needs where failure to do so would breach an individual’s human rights under the European Convention on Human Rights.’ (DHSC, 2020). The British Institute of Human Rights (2013) identifies five practical benefits from adopting a human rights approach, these include being more person centred, improved decision-making, meaningful engagement, involvement, reduced risk of complaints. The Research in Practice Leaders Briefing describes a five step guide to implementing this approach; consultation, identifying rights, creating a quality standard, supporting staff, monitoring success (Elliot, 2017).