Chapter 4 – Imelda Rea (D1SOP4)
Domain 1 Standard of Proficiency 4
Be aware of current guidelines and legislation relating to candour and disclosure.
|
KEY TERMS Standard Candour Disclosure Relating Connecting Being Aware – Up to date guidelines and Legislation
|
Social care is … a delicate balance of holding on and letting go when caring for the whole person, family, or group at any or all stages of life’s continuum. When prevention or intervention is required, it is not just a doing for others process, but an enabling of others from a non-judgemental strengths-based perspective. |
TASK 1
Describe a recent experience when you had to speak openly and honestly but the topic made you feel uncomfortable. Why was this conversation needed?
Standard
Before we consider how we can improve our awareness of guidelines and legislation we should begin with a clear understanding of the meanings of key terms used to guide us in standard 4, specifically candour and disclosure.
The online Cambridge Dictionary defines candour as the quality of being honest and telling the truth, especially about a difficult or embarrassing subject and disclosure as the act of making something known or the fact that is made known. In my practice in social care, the term disclosure has come to be used most often in relation to a child or vulnerable adult revealing abuse perpetrated on them. In other words ‘disclosure’ is what others do, while we, the worker, receive the information. Given that specific circumstance, we would be correct in this thinking. However, when the social care professional is ready to report what has been entrusted to their care, how and to whom they disclose the information is of equal importance: their retelling of the information must be candid, accurate and honest, especially about something difficult or painful.
TASK 2
Consider a time when the most appropriate response to a situation is to withhold or provide inaccurate information. How can you justify this?
Candour and Disclosure
Candour in social care is a more general term. It helps to provide the full picture of the event and an opportunity to evaluate and learn from this. Candour should be ever-present in the culture of the organisation. It is important for social care workers to examine the culture of their service to ensure that they do not find themselves in a negative workplace where blame and defensive tactics are the standard response to an incident. Historically, this was common in many workplaces and the lack of candour in documentation left its own scars. The current requirement of transparency, and supportive practices such as professional supervision, enable openness and honesty to thrive and barriers to be broken down. Considered together, candour and disclosure are tools to help us focus on and improve the culture in social care organisations and to build stronger and more equal relationships with people who use social care services.
Case Study 1
It is the last hour of the final day of a week-long summer camp for inner-city pre-teens. Youth worker Jane (pseudonym) is beginning to pack away sports equipment when Seamus (pseudonym), who had said he was tired today and did not want to take part in the physical activities, begins to help Jane with the packing.
When they are both at one side of the sports hall, they sit down for a short break. It is then that Seamus discloses information about a serious physical assault by his mother the previous day. He raises his sleeves to reveal fresh bruises along the length of both arms. Seamus begins to cry when he states that his mother will collect him at the end of today’s camp.
Jane reassures Seamus that she can help him and begins to implement the protocol for child protection, when Seamus’s mother arrives. Jane tells her that Seamus is part of the ‘clean- up team’ and they have not finished yet, so she should wait outside – this is not true, but it provides the time needed for additional support to arrive.
Jane was not comfortable with telling this lie, but felt it was acceptable under the circumstances.
Registering with CORU and adhering to the Code of Professional Conduct and Ethics requires you to maintain high standards of conduct and to act in the best interest of the service user. Those on the register are required to ‘do everything, insofar as within your control, to enhance the health, safety or welfare of a service user … protect service users if you believe they are or may be at risk from another professional’s conduct, performance or health’.
Relating/Connecting
Mistakes can happen in any place of work. In social care, if a mistake occurs, by accident or through an act or omission, it is the social care worker’s professional duty of care to report it. Policies in the organisation should both facilitate and prevent obstruction of such reporting.
The value of candour is significant. Even in well-managed services things can go wrong, e.g., losing an individual’s belongings, providing incorrect information, misuse of equipment or not acting quickly enough on concerns raised by an individual. Actions or inactions may result in consequences, ranging from minor to more serious, with possible long-term implications for those concerned.
Candour links with our duty of care; we demonstrate respect to our service users by being honest, open and transparent when something goes wrong. When we inform others of our failures or wrongdoings, despite the negative impact an accident, omission or incident may have on the individual, their family and others, an honest, open disclosure and acknowledgement of the error can enable a better resolution and faster rebuilding of confidence in the service and staff, while also providing valuable learning to ensure that similar events do not occur in the future.
Being Aware – Up to Date
Being aware of current information relating to this standard of proficiency is difficult at this time. Much has been achieved by CORU in professionalising the role of the social care worker, but legislation in relation to candour and disclosure has yet to proceed beyond the medical healthcare arena, e.g., the Civil Liability (Amendment) Act 2017 provides a legal framework for voluntary open disclosure of all patient safety incidents, including near misses and no-harm events. It provides for an open and consistent approach to communicating with patients and their families and offering an apology, as appropriate, when things go wrong in healthcare. In 2018, the government approved the general scheme of the Patient Safety Bill, for mandatory open disclosure and external notification of patient safety incidents; clinical audit guidance; and extending the remit of the Health Information and Quality Authority (HIQA) to private hospitals.
In the medical healthcare professional setting, the much-publicised cases of misdiagnosed cervical smears, and the subsequent delay in informing those affected, shone an intense light on the lack of candour and disclosure for those affected. The lack of timely information limited, for many women, the option to act earlier to attempt to mitigate their situation, proving life-changing for many, and in some cases life-ending.
Social care professionals must consciously embrace the ethos of candour and disclosure in their practice to ensure that their clients, service users, co-workers and others are not negatively affected in any way by the absence of candour and disclosure in the culture of the organisation and must be prepared to engage in open and honest dialogue if a mistake should happen.
Guidelines and Legislation
Similarities between how the United Kingdom and Ireland have progressed in this area are clear. Presently, however, there is no social care-specific legislation in Ireland on this topic. Students would be well advised to look towards the UK and European legislation to gain an insight into how Irish legislators may be guided when legislation of this kind is considered for enactment in the Republic of Ireland. The UK has legislated for candour and disclosure in both medical healthcare and social care. The duty of candour is specified in Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and applies to any organisation carrying out healthcare and/or social care activities that are regulated by the Care Quality Commission.
While there is currently (as of 2021) no Irish legislation on the topic of candour and disclosure in social care specifically, there are a number of guidance and legislative documents that require and promote candid disclosure of information. These include (but are not limited to):
- Safeguarding Vulnerable Persons at Risk of Abuse
- Children First Act 2015
- Children First Guidance 2017
- Protection for Persons Reporting Child Abuse Act 1998
- National Vetting Bureau Acts 2012 and 2016
- Freedom of Information Act 2014
- Data Protection Act 2018
- Safety, Health and Welfare at Work Act 2005
- Accident and incident internal/external reports
- Specific organisational reports.
With reference to information students may be required to make available to placement providers, employers or for professional registration, at no time should students misrepresent their qualifications or abilities. On completion of the appropriate degree and subsequent registration, much consideration should be given to the personal accountability the acquisition of professional status will have on the individual and those in their care.
Tips for Practice Educators
As the student progresses through their educational journey, it is important to stress at all stages of your interaction with them that today’s guidelines and legislation (requiring learning and assessment and exam recall) will be updated and added to. They will change with the times. What will not change will be the requirement to be aware of such changes.
The long-awaited professionalisation of social care rests on their shoulders – they must uphold the standards of proficiency in their chosen field – and on ours, as tutors and lecturers, to help guide the student to reach their best professional self.
Students’ ability to understand that it is they who will be the ‘professional’ in the care sector on completion of their degree, should be tested formally and informally in a safe space to allow them to make mistakes and learn from them. The lecture hall/college and placement are the learning spaces in which to firmly grasp the concept of their co-responsibility in upholding these standards. However, once in the workplace the student’s understanding of the requirement for candour and disclosure should be almost innate.
One important term in Domain 1 Standard 4 is to be ‘aware’; this awareness is required throughout the lifetime of your practice. Continuing professional development should run in tandem with continuing personal development. Students will benefit from a fuller understanding of where they are in terms of standards of proficiency and year of study. Supervision preparation further emphasises accountability of their role, whatever the entry level into the workplace. As the majority of guidelines, codes of ethics and conduct and legislative information can now be accessed online, encouraging students to sign up to newsletters/emails from reputable sources, e.g., the Health and Social Care Professionals Council (CORU), the Health Information and Quality Authority (HIQA), the Health Service Executive (HSE), etc. will go some way to keeping the student informed of significant changes and the impact changes have on candour and disclosure in their work area.
Promoting, in IT classes, the correct archiving systems for such documents can help students to easily access and update them when required.
References
Government of Ireland. Electronic Irish Statute Book (eISB) (online) <http://www.irishstatutebook.ie/> [accessed 18 October 2020].
Bullock, A., Browne, J., Poletti, C., Cserzo, D., and Russ, E. A Review of Research into Health and Care Professional Regulation. Professional Standards Authority (UK). Available online at: https://www.professionalstandards.org.uk/docs/default-source/publications/infographics/infographic- research-into-health-and-care-regulation.pdf?sfvrsn=869d7620_4 [accessed 03 October 2020].
Government of the United Kingdom. Health and Social Care 2008 (Regulated Activities) Regulations 2014 (2014 regulations), amended by the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2015 [accessed 03 October 2020].
Thomson Reuters, Duty of candour: openness and transparency in the provision of health and adult social care services. Available online at: http://publicsectorblog.practicallaw.com/duty-of- candour-openness-and-transparency-in-the-provision-of-health-and-adult-social-care-services/ [accessed 03 October 2020].
