Treating service users with dignity and respect is one of the most basic and fundamental tenets of the care framework. Whilst most people will know intrinsically what to do to ensure they treat people with dignity and respect, it is useful to review the legislation to highlight key elements under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the “Regulations”).
Regulation 10 of the Regulations states that providers and their staff must provide care and treatment in a way that ensures people’s dignity and treats people with respect at all times. This includes making sure that people have privacy when they need and want it, providing the support they might need to be autonomous, independent and engaged in their local community and emphasises the importance of treating people as equals. We discuss each of these three requirements below, with reference to CQC’s Guidance which details what CQC will be looking for at their inspections, to remind providers about how they can ensure they meet and maintain the highest levels of care in this respect.
- (a) ensuring the privacy of service users:
o Each person’s privacy must be maintained at all times including when they are asleep, unconscious or lack capacity.
o All reasonable efforts should be made to make sure that discussions about care treatment and support only take place where they cannot be overheard.
o Staff must make sure that people have privacy when they receive treatment and that they are supported to wash, bath, use the toilet and hold private conversations.
o Each person’s privacy needs and expectations should be identified, recorded, and met as far as is reasonably possible.
o 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.
o People using services should not have to share sleeping accommodation with others of the opposite sex, and should have access to segregated bathroom and toilet facilities without passing through opposite-sex areas to reach their own facilities. Where appropriate, such as in mental health units, women should have access to women-only day spaces.
- o If any form of surveillance is used for any purpose, providers must make sure this is in the best interests of people using the service, while remaining mindful of their responsibilities for the safety of their staff. Any surveillance should be operated in line with current guidance.
(b) supporting the autonomy, independence and involvement in the community of the service user:
o People who use services must be offered support to maintain their autonomy and independence in line with their needs and stated preferences. When offering support, staff should respect people’s expressed wishes to act independently but also identify and mitigate risks in order to support their continued independence as safely as possible.
o People must be supported to maintain relationships that are important to them while they are receiving care and treatment.
o People must be supported to be involved in their community as much as or as little as they wish. Providers must actively work with people who wish to maintain their involvement in their local community as soon as they begin to use a service. The provider must make sure that people are not left isolated unnecessarily.
(c) having due regard to any relevant protected characteristics (as referred to in the Equality Act 2010) of the service user:
o People using services must not be discriminated against in any way and the provider must take account of protected characteristics (age, disability, gender, gender reassignment, pregnancy and maternity status, race, religion or belief and sexual orientation), as set out in the Equality Act 2010. This means that providers must not discriminate, harass or victimise people because of these protected characteristics.
Whilst it is convenient to isolate each aspect of Regulation 10 in order to identify what good care looks like, carers will be aware that, in reality, elements of good care are not delivered in isolation. Good care should flow from treating and respecting people as individuals who have their own history outside of the care environment. If providers and their staff can do this, good care which promotes dignity and respect should follow.