1. Introduction

Everyone deserves to be treated with kindness, compassion and respect. Staff in all organisations should care for adults with care and support needs in the same way they would want their own relatives or themselves to be treated in such circumstances.

Kindness, compassion and respect should be a part of the everyday care given to adults with care and support needs. Managers should make sure that staff are given the time to not only perform their duties, but to build relationship with the adults they are working with and their families. The care, compassion and empathy they give should be genuine; this is only possible if the right people have been recruited for the right post (see Safer Recruitment chapter) and the service has strong values at its centre.

There are too many distressing cases of adults with care and support needs who have not been treated with kindness, compassion, dignity or respect, for example Whorlton Hall , the Edenfield Centre  and Winterbourne View. Some staff received criminal convictions and prison sentences as a result of their abuse and neglect (see also Ill Treatment and Wilful (Deliberate) Neglect chapter).

2. Kindness, Compassion and Dignity in Delivering Services

Services which are regulated and inspected by the Care Quality Commission, will be assessed against the following the quality statement:

‘We always treat people with kindness, empathy and compassion and we respect their privacy and dignity. We treat colleagues from other organisations with kindness and respect.’

Quality statements set out what the CQC expect each service to deliver. It is also very relevant for services who are accountable to other inspectorates or commissioners. Related issues also include privacy and confidentiality and emotional wellbeing (see Information Sharing and Confidentiality and Promoting Wellbeing chapters).

Skills for Care note the following factors in relation to kindness, compassion and dignity:

• ‘We can evidence that people feel cared for and that they are treated with respect and dignity. This is reflected in both day-to-day support and their care plans.
• We get to know what is important to each person we support to meet their emotional wellbeing needs and what they value about dignity and respect.
• We create an environment where people who need care and support feel that they belong to and are proud about the service.
• We ensure our residential environments and/or offices are well maintained with high standards of décor to provide people a dignified place to live, visit, and work.
• We create an empowering culture where people who need care and support are confident and comfortable around those who care for them.’

All staff should:

• recognise the diversity, values and human rights of each adult and their family members (see also Equality, Diversity and Human Rights and Providing Culturally Appropriate Care chapters);
• uphold and maintain the adult’s privacy, dignity and independence at all times, treating them as equals;
• provide care, support and treatment to adults in a way that ensures their dignity, and treats them with compassion and respect at all times;
• provide any support that adults might need to be independent and involved in their community, as appropriate;
• help adults maintain relationships with people who are important to them;
• put adults at the centre of their care and support by supporting them to make decisions;
• make sure that all communication with adults and their families is respectful and compassionate. This includes using the adult’s preferred means of communication and respecting their right to engage – or not engage – in communication;
• provide information that supports the adult’s involvement in safeguarding processes;
• address them in the way they wish, including their preferred name.

3. Person Centred Care and Support

Adults should be involved in and receive care and support that respects their right to make or influence decisions about their lives and the services they receive, or their representative if they do not have mental capacity.

Staff providing care and support should:

• explain and discuss their care and support options with the adult and their family, in a way that makes sense to them;
• respect the adult’s right to take informed risks, while balancing the need for preference and choice with safety and effectiveness;
• ensure that things that the adult’s wishes and needs in relation to their care and support are established as part of their assessment and when developing and reviewing their care and support plans;
• promote and respect the adult’s autonomy, privacy, dignity, compassion, independence and human rights at all times by:
  • placing their needs, wishes, preferences and decisions at the centre of their care and support (see also Providing Culturally Appropriate Care chapter);
    • respecting their personal preferences, lifestyle and care choices;
    • respect the preferences of adults who need intimate or personal care, including making every reasonable effort to make sure that this can be provided by a staff member of a specified gender;
  • actively listen to and involve adults, or others acting on their behalf, in decision making and ensure there are clear records that evidence the decisions made and methods in which the decision was achieved;
  • provide information to adults to help them, or others acting on their behalf, to understand their care and support, including the risks and benefits, and their rights to make decisions;
  • know how to raise a concern or complaint about the organisation, and how it will be dealt with (see Complaints, Comments, Compliments and Questions chapter).

4. Staff Concerns

If a member of staff has concerns that a colleague/s is not treating adults in their care with kindness, compassion and respect, they should speak to their manager or a senior manager, if they think their manager is involved in any way. The manager should investigate the concerns and take action as required.

If the member of staff does not feel that the manager has taken their concerns seriously or investigated them properly, they should raise their concerns through other methods (see Whistleblowing chapter).

5. Further Reading

5.1 Relevant chapters

Equality, Diversity and Human Rights

Knowsley Safeguarding Adults Board Procedures

Providing Culturally Appropriate Care chapter

5.2 Relevant information

Kindness, Respect and Compassion (CQC) 

Warmth and Kindness to bring Dignity in Care (SCIE)

Good and Outstanding Care: Inspection Toolkit (Skills for Care) 

1. Introduction – What is Culturally Appropriate Care?

Culturally appropriate care (also called ‘culturally competent care’) is about understanding and being sensitive to people’s cultural identity or heritage, especially when arranging or providing care and support. It involves staff working in a person-centred way (see Personalisation chapter), to recognise, consider and respond sensitively to a person’s beliefs or conventions.

Cultural identity or heritage covers different things. For example, it might be based on a person’s ethnicity, nationality or religion, or it might be about their sexuality or gender identity. Lesbian, gay, bisexual and transgender people have their own cultures, as do Deaf people who use British Sign Language. However, it is important to note that people’s cultural identity or heritage may include a number of different cultures; they may identify with more than one.

In order to provide culturally appropriate care, staff must not provide standardised care – which involves giving the same service to everyone – instead they should always adapt their practice and interventions in line with the cultural values of the adult.

2. Why is Culturally Appropriate Care Important?

Care and support which reflects a person’s culture must be at the heart of person-centred care that is delivered by social care staff.

Providing culturally appropriate care will better meet people’s needs and is therefore more likely to achieve positive outcomes for adults and their families; their physical health and emotional wellbeing will also benefit.

When adults are not provided with care and support which is culturally appropriate, they can:

• feel marginalised and discriminated against;
• experience low self esteem and low self confidence;
• have restricted opportunities;
• feel stressed and anxious; and
• experience a loss of rights.

Providing care which recognises and responds to cultural differences also helps build better relationships between social care staff and the adult and their family.

3. Key Considerations in Providing Culturally Appropriate Care

Understanding and communicating well with people from different cultures is an important part of providing person-centred care (see Personalisation chapter).

Everyone is part of a culture, and sometimes a number of different cultures. People are more likely to receive the care and support they need, and experience positive outcomes if their culture is recognised and their cultural needs are met.

It is often easier for people’s cultural needs to be met if they are closer to cultural norms in an organisation, so staff should carefully consider the needs of those who are not so close to these cultural norms.

Providing culturally appropriate care does not require staff to be experts on different cultures, but it does need them to understand how culture can affect aspects of care, and to be open, respectful, and willing to learn.

4. Recognising Cultural Values

Cultural values are the core beliefs in a culture about what is good or right.

All cultures have values. They are informed by the cultures that each person most associates themselves with. These values are neither positive nor negative – they are just differences.

Cultural values can influence the way people treat each other and want others to treat them.

4.1 Differences between and within groups

While different groups can have different cultural values, there can also be differences within groups as well. Therefore, it is important not to make assumptions about people or stereotype them.

Cultural values are not just based on a person’s ethnic background. Other social contexts influence them too – for example profession, age, gender or faith.

4.2 Cultural values are not always visible

We are not always aware of a person’s cultural values. As a result, there may be bias or discrimination; this may be unconscious – when someone does not realise they are being biased or discriminatory.

It is not always easy to see our own cultural values because we take them for granted. But assumptions we may make can be based on them, and therefore can affect other people, especially those who have different cultural values.

4.3 Being sensitive to cultural values makes a difference

When staff are aware of their own cultural values and recognise other people’s, it can have a positive impact on:

• relationships between people using the service and the staff;
• whether people take part in activities;
• how likely it is that people will speak up if they are unhappy about something.

Staff should be aware of their own cultural values and how they might sometimes be different from other people’s. It can help them understand people better.

To ensure a good working relationship between staff and the people they are working with, they should:

• be curious about how people are feeling;
• ask people questions;
• listen without judgement;
• check their own thoughts – try to be aware of assumptions and judgements that could come from bias or stereotypes.

5. Providing Culturally Appropriate Care –Practice Guidance

There are many different aspects and variations in culture. Providing care should always be based on an assessment of a person’s individual needs.

5.1 Key points

Often, small changes make a big difference to people. The most important things for staff to do are:

• spend time getting to know adults and their families; ask questions especially if you are unsure;
• be curious about what is important to the person, to help them live their fullest lives; every person is different.;
• try to understand and meet people’s preferences, and remember adults are the experts in their own lives;
• do not make assumptions; and
• be aware of your own cultural values and beliefs (see Section 4, Recognising Cultural Values).

 5.2 Providing person centred care which is culturally appropriate

• Look at people’s needs as a whole, including their cultural needs, and protect them from discrimination.

• People, their families and carers should be involved in developing their care plans, and these should  incorporate culturally appropriate care. Again, look at people’s needs as a whole, including identifying their needs on the grounds of equality characteristics (see Equality, Diversity and Human Rights chapter, Section 4.2, Protected characteristics) and looking at how they are met. It also includes finding out about their choices and preferences.

• Staff must support people in culturally sensitive ways. They should recognise when people’s preferences are not being taken on board or properly respected and take action accordingly, by raising it with managers for example.

• When carrying out strengths-based assessments, and developing and reviewing care and support plans, staff should support people to take part in activities that are culturally relevant to them, if they wish to do so.

• Cultural considerations may impact on a person’s decision to take medicines. Such issues should be recorded, and action taken as required.

• Cultural, ethical and religious needs should be taken into account when considering or discussing with diet and drinks. Cultural needs should also be reflected in how premises are decorated, for example.
• If someone lacks capacity for a particular decision, their cultural preferences should be taken into account when applying the Mental Capacity Act – for example, by consulting with people that know them and understand their cultural values, if the person is not able to fully respond.
• Staff should also ensure any cultural needs are also considered when working with carers and family members of an adult with care and support needs.

• In end of life care, people – and their families – should feel their cultural needs have been considered and provided for, as part of the planning process. Their religious beliefs and preferences must be respected.

5.3 Across the local authority

• Leaders, managers and staff should encourage people and their families, with whom they are working, to express their views and any concerns they may have. They should listen and act on such feedback to help shape the service and culture (see also Coproduction chapter).
• Staff should actively promote equality and diversity within the service in which they work.
• Staff should have access to training and learning and development opportunities to help them understand and meet people’s cultural needs. This should be considered as part of supervision and personal development appraisals.
• Staff should also feel that they are treated equally. The local authority should make sure it hears the voices of all staff and acts on them to help shape the service and culture (see Staff Engagement chapter).

See also Examples of culturally appropriate care – Care Quality Commission for more detailed examples of ways care can be adapted to reflect cultural differences around:

• religious or spiritual practice, including planning care and support around religious festivals;
• food and drink;
• healthcare;
• clothes and personal presentation;
• personal and shared space;
• shared activities;
• relationships and community connections.

6. Further Reading

6.1 Relevant chapters

Personalisation

Equality, Diversity and Human Rights

6.2 Relevant information

Culturally Appropriate Care (Care Quality Commission)

Anti-Racism Resources (BASW England) 

People’s Experience in Adult Social Care Services: Improving the Experience of Care and Support for People using Adult Social Care Services (NICE) 

1. Introduction

This chapter outlines the main points of the Equality Act 2010, and also how it relates to working with people with care and support needs, including safeguarding adults. The Act ensures there is consistency in what a local authority does to provide services in a fair way and comply with the law. It covers all the people who use the local authority’s services, their family and friends and other members of the public, staff, volunteers and partner agency staff.

2. Equality Act 2010

The Equality Act contains nine contains ‘protected characteristics: all of which must be considered when implementing adult social care policies and procedures (see also Section 4.2, Protected characteristics). The Act covers both direct and indirect discrimination against people with the following characteristics:

• age;
• disability;
• gender reassignment;
• race;
• religion or belief;
• sex;
• sexual orientation;
• marriage and civil partnership;
• pregnancy and maternity.

A commitment to equality and diversity means that every person who is provided with support will have their individual care and support needs comprehensively addressed, and that they will be treated fairly and without discrimination. Staff must also demonstrate a commitment to protecting human rights. Failure to make reasonable adjustments for adults who have a protected characteristic (for example, a learning disability) may be a breach of the Equality Act.

3. Commitment to Equality, Diversity and Human Rights

A commitment to equality and diversity is shown by:

• respecting the ethnic, cultural and religious practices of adults who use services and making practical provision for them to be observed as appropriate;
• recognising that diversity enhances the quality of experience of everyone who lives and works in any service or setting;
• protecting people’s human rights – treating them and their family and friends, fairly and with respect and dignity;
• recognising each adult who uses services as an individual;
• supporting people to express their individuality and to follow their preferred lifestyle, also helping them to celebrate events, anniversaries or festivals which are important to them;
• positive leadership and promoting management and human resources policies and practices that actively demonstrate a commitment to the principles of equality and diversity;
• developing an ethos throughout the service that reflects these values and principles;
• expecting all staff to work to equality and diversity principles and policies and to behave at all times in non-discriminatory ways;
• provide training, supervision and support to enable staff to do this;
• having a code of conduct that makes any form of discriminatory behaviour unacceptable. This applies to both staff, people who use services and their family and friends, which is rigorously observed and monitored accordingly.

3.1 Human Rights

See also Appendix 1: Human Rights Legislation

‘As the regulator, our role is to make sure people have safe, high-quality care. Care that does not respect and promote human rights is neither safe nor high-quality.’ (Care Quality Commission)

The Care Quality Commission uses the FREDA principles in its assessment framework. These principles underpin rights-respecting care and help support compliance with the Equality Act 2010 and Human Rights Act 1998. They are:

• fairness;
• respect;
• equality;
• dignity; and
• autonomy (choice and control).

These principles and standards are key to providing ‘rights respected care’ and should be at the heart of planning and delivery of care and in any required safeguarding processes.

Staff must take swift action if they think an adult’s human rights are being breached or infringed in any way (including through abuse or neglect) and speak to their line manager or the adult safeguarding team.

4. Guidance

4.1 Types of discrimination

Discrimination can take the following forms:

• direct discrimination occurs when a person with a protected characteristic is treated less favourably than others;
• indirect discrimination occurs when rules or arrangements are put in place that apply to everyone, but put someone with a protected characteristic at an unfair advantage;
• harassment is unwanted behaviour linked to a protected characteristic that violates a person’s dignity or creates an offensive environment for them;
• victimisation is when a person is treated unfairly because they have complained about discrimination or harassment.

For more information see Discrimination:  Your Rights (gov.uk)

4.2 Protected Characteristics

Under the Equality Act 2010 these are as follows.

• Age: Where this is referred to, it refers to a person belonging to a particular age (for example 32 year olds) or range of ages (for example 18 – 30 year olds).
• Disability: Under the Act, a person is disabled if they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities. The Act includes a protection from discrimination arising from disability. This states it is discrimination to treat a disabled person unfavourably because of something connected with their disability.
• Gender reassignment: A transgender person is someone who proposes to, starts or has completed a process to change their gender. The Act does not require a person to be under medical supervision to be protected – so a woman who decides to live as a man but does not undergo any medical procedures would be covered. It is discrimination to treat transgender people less favourably because they propose to undergo, are undergoing or have undergone gender reassignment than they would be treated if they were ill or injured.
• Marriage and civil partnership: In England and Wales marriage is not restricted to a union between a man and a woman and includes a marriage between a same-sex couple. Same-sex and mixed-sex couples can also have their relationships legally recognised as ‘civil partnerships’. Civil partners must not be treated less favourably than married couples (except where permitted by the Act). The Act protects employees who are married or in a civil partnership against discrimination.
• Pregnancy and maternity: Pregnancy is the condition of being pregnant or expecting a baby. Maternity refers to the period after the birth. Protection against maternity discrimination is for 26 weeks after giving birth, and this includes treating a woman unfavourably because she is breastfeeding.
• Race: Race refers to a group of people defined by their race, colour, and nationality (including citizenship) ethnic or national origins.
• Religion or belief: Religion has the meaning usually given to it but belief includes religious and philosophical beliefs including lack of belief (for example atheism). Generally, a belief should affect life choices or the way a person lives for it to be included in the definition. In the Equality Act, religion includes any religion. It also includes a lack of religion.
• Sex: Both men and women are protected under the Act.
• Sexual orientation: Whether a person’s sexual attraction is towards their own sex, the opposite sex or to both sexes. The Act protects bisexual, gay, heterosexual and lesbian people.

5. Further Reading

5.1 Relevant information

Anti-Racism Resources (BASW England) 

Equality and Human Rights, Care Quality Commission

Equally outstanding: Equality and Human Rights – Good Practice Resource (CQC)

Social Work and Human Rights: A Practice Guide (BASW)

Culturally Appropriate Care (Care Quality Commission)

Appendix 1: Human Rights Legislation

See also Equality and Human Rights Commission 

1. Human Rights Act 1998 Overview

The Human Rights Act 1998 (HRA) lays down the fundamental rights and freedoms to which everyone in the UK is entitled. The rights set out in the European Convention on Human Rights (ECHR) are incorporated in the HRA. It sets out people’s human rights in different ‘articles’, which are all taken from the ECHR. They are:

• Article 2: Right to life;
• Article 3: Freedom from torture and inhuman or degrading treatment;
• Article 4: Freedom from slavery and forced labour;
• Article 5: Right to liberty and security;
• Article 6: Right to a fair trial;
• Article 7: No punishment without law;
• Article 8: Respect for private and family life, home and correspondence;
• Article 9: Freedom of thought, belief and religion;
• Article 10: Freedom of expression;
• Article 11: Freedom of assembly and association;
• Article 12: Right to marry and start a family;
• Article 14: Protection from discrimination in respect of these rights and freedoms;
• Protocol 1, Article 1: Right to peaceful enjoyment of property;
• Protocol 1, Article 2: Right to education;
• Protocol 1, Article 3: Right to participate in free elections;
• Protocol 13, Article 1: Abolition of the death penalty.

Human rights law applies to public bodies and other organisations carrying out functions of a public nature. A number of these articles relate to working with adults with care and support needs, in particular Articles 2; 3; 5; 8.

The HRA can be breached in three ways by public bodies if they:

• inflict explicit physical abuse or allow neglect of a person;
• intervene in a person’s life unlawfully and disproportionately;
• fail to intervene to protect a person from being abused or neglected by other persons.

2. Articles 2, 3, 5 and 8

2.1 Article 2 Right to Life

Article 2 applies in health and social care situations and requires an independent investigation into some deaths – coroner inquests – and may involve a breach of human rights with the state or public organisations implicated.

2.2 Article 3 Inhuman and Degrading Treatment

No one shall be subjected to torture or to inhuman or degrading treatment or punishment.

Degrading treatment would occur if it “humiliates or debases an individual showing a lack of respect for or diminishing his or her human dignity or arouses feelings of fear, anguish, or inferiority capable of breaking and individuals moral and physical resistance.” Pretty -v- UK [2002] 2FC 97

Article 3 is breached most frequently when public bodies carry out or are responsible for abusive care and treatment; that is allowing or ignoring actions when they should not have done so.

There is a positive duty under Article 3 for a public body to intervene when abuse is performed by one private individual against another person.

3. Article 5: Deprivation of Liberty

Depriving an adult of their liberty as part of their care or treatment is a serious step, and the Mental Capacity Act 2005 (MCA) and the Mental Health Act 1983 and should be followed to avoid a possible breach of Article 5.

4. Article 8: Respect for private and family life, home and correspondence

Article 8 protects a person’s right to respect for their private life, their family life, their home and correspondence (for example, letters, telephone calls and emails).

4.1 Private life

A person has the right to live their life privately without government interference. This is a broad concept as interpreted by the courts, and covers areas such as:

• sexual orientation;
• lifestyle choices;
• how someone chooses to look and dress;
• the right for someone to control who sees and touches their body. In health services, for example, staff cannot leave someone undressed in a ward, or take a blood sample without the person’s permission;
• the right to develop a personal identity;
• to make friendships and other relationships;
• a right to participate in essential economic, social, cultural and leisure activities. In some circumstances, public bodies, such as the local authority, may need to help someone enjoy their ability to participate in society;
• the media and others being prevented from interfering in someone’s life.
• personal information (including official records, photographs, letters, diaries and medical records) being kept securely and not shared without the person’s permission, except in certain circumstances (see Data Protection: Legislation and Guidance chapter).

4.2 Family life

People have the right to enjoy family relationships without interference from government. This includes the right to live with their family and, where this is not possible, the right to have regular contact. This includes couples who are not married, between an adopted child and adoptive parent and a foster carer and fostered child.

If a local authority makes an unjustified intervention in the life of person lacking mental capacity it may also breach Article 8- London Borough of Hillingdon v Neary [2011] EWHC 1377 (COP)

4.3 Home life

Everyone has a right to enjoy their existing home peacefully. Public bodies, therefore, should not stop a person from entering or living in their home without very good reason. They also cannot enter it without the person’s permission.

A right to home life does not mean, however, a right to be given housing.

4.4 Restrictions to Article 8

There are times when public bodies can interfere with someone’s right to respect for private and family life, home and correspondence. In such situations, the authority must be able to show that such action is lawful, necessary and proportionate in order to:

• protect national security;
• protect public safety;
• protect the economy;
• protect health or morals;
• prevent disorder or crime; or
• protect the rights and freedoms of other people.

Article 8 is not an absolute right. Interference with private life and family life is legally permissible but must be justified within the terms set out above.

A breach of Article 8 would occur if interventions are taken which are:

• inconsistent with the relevant law;
• consistent with the law but disproportionate and therefore unnecessary; or
• for a purpose other than the criteria listed above.

Audio & Quick Read Summary

1. Introduction

Data protection legislation should not be seen as an obstacle to sharing information, but as a framework of best practice which helps to ensure that when the local authority uses, records and shares information it does so safely and in a way which is transparent and in line with the law.

The local authority collects, uses, stores and retains (for specified time periods) information about people with whom it works. This includes:

• adults and their families who use the service, including their families and any children, and those who no longer in receipt of services;
• current, past and prospective staff; and
• current, past and prospective staff; and
• suppliers.

When processing data in this way, the local authority must comply with the requirements of the Data Protection Act 2018 (DPA) and the UK General Data Protection Regulation (UK GDPR) (see Section 2, Legislation).

It must also ensure, through its procedures and working practices, that all employees, contractors, consultants, suppliers and partners who have access to any personal data held by or on its behalf, are fully aware of and abide by their duties and responsibilities under data protection legislation. Any contracts with service providers must be clear about the different parties’ responsibilities for data processing and information sharing.

Personal information must be handled and dealt with in accordance with data protection legislation however it is collected, recorded, stored and used, and whether it be on paper, on computer or digital records or recorded in any other way.

In addition, the local authority may also be required to collect and use information in order to comply with the requirements of central government, such as in the case of a Safeguarding Adults Review or Care Quality Commission inspection.

2. Legislation

2.1 Data Protection Act 2018

The Data Protection Act 2018 aims to ensure that UK data protection legislation keeps pace with technological changes, and the impact these have had on the collection and use of personal data.

The Act provides additional functions and clarification of the role of the Information Commissioner and the Information Commissioner’s Office.

2.2 UK General Data Protection Regulation

The UK GDPR is the UK General Data Protection Regulation (UKGDPR) sets out the key principles, rights and obligations for most processing of personal data (see UK GDPR: Guidance and Resources, ICO).

The UK GDPR:

• gives individuals greater control of their data by improving consent processes; and
• introduced the ‘right to be forgotten’ which enables the data subject to have their data ‘forgotten’ once it is no longer being used for the purpose which it was collected. This is not an absolute right, however; it applies only to data held at the time the request is received. It does not apply to data that may be created in the future.

If staff receive a query about the collection or processing of personal data, they should contact the Knowlsey Information Governance team for advice.

3. Principles of Data Protection: Article 5 GDPR

Anyone processing personal data must comply with the principles laid down in the DPA and UK GDPR.  These are legally enforceable and require that when personal data is processed (see also Section 3.2, What is personal data under Article 4?) it must be:

• lawful and fair and carried out in a transparent manner in relation to the data subject. (lawfulness, fairness and transparency principle);
• specified, explicit and legitimate and not further processed for other purposes incompatible with those purposes (purpose limitation principle);
• adequate, relevant and not excessive to what is necessary in relation to the purposes for which data is processed (the data minimisation principle);
• accurate and kept up to date (the accuracy principle);
• kept for no longer than is necessary for the purposes for which the personal data is processed (the storage limitation principle); and

• stored in a way that ensures appropriate security including protection against unauthorised or unlawful processing and accidental loss, destruction or damage, using appropriate technical or organisational measures (the integrity and confidentiality principle and the accountability principle).

3.1 Handling personal data and sensitive personal data

The DPA outlines conditions for the processing of personal data, and makes a distinction between personal data and sensitive personal data.

Personal data is any information relating to a living person who can be identified or who is identifiable, directly from that information, or who can be indirectly identified from that information in combination with other information.

3.2 What is personal data under Article 4 GDPR?

Personal data is:

• any information relating to an identified or identifiable natural person such as;
  • a name;
  • an identification number;
  • location data;
  • an online identifier such as an IP address or cookies; or
  • an email address.

3.3 Special categories of data (sensitive personal data):  GDPR Article 9

Special category data is personal data that needs more protection because it is sensitive. It includes personal data which reveals:

• racial or ethnic origin;
• political opinion;
• religious or other beliefs;
• trade union membership;
• physical or mental health or conditions;
• sexual life or sexual orientation.

3.4 Identifying a lawful basis for sharing information

Article 6 of the UK GDPR providers practitioners with a number of lawful bases for sharing information. At least one of these must apply whenever personal data is processed,

Where practitioners need to process and share special category data (sensitive personal data), they need to identify both a lawful basis for processing under Article 6 of the UK GDPR and a special category condition for processing in compliance with Article 9 (see A Guide to Lawful Basis, Information Commissioner’s Office).

4. Data Protection Practice

The local authority must:

• observe fully conditions regarding the fair collection and use of personal information;
• meet its legal obligations to specify the purpose for which information is used;
• collect and process appropriate information and only to the extent that it is needed to fulfil operational needs or to comply with any legal requirements;
• ensure the quality of information used;
• apply strict checks to determine the length of time information is held;
• take appropriate technical and organisational security measures to safeguard personal information;
• ensure that personal information is not transferred abroad without suitable safeguards;
• ensure that the rights of people about whom the information is held can be fully exercised under data protection legislation. These include:
  • the right to be informed that processing is being undertaken;
  • the right of access to one’s personal information within the statutory timescale;
  • the right to prevent processing in certain circumstances;
  • the right to correct, rectify, block or erase information regarded as wrong information.

In addition, the local authority should ensure that:

• there is someone with specific responsibility for data protection;
• everyone managing and handling personal information understands that they are contractually responsible for following good data protection practice;
• everyone managing and handling personal information is appropriately trained to do so;
• everyone managing and handling personal information is appropriately supervised;
• anyone wanting to make enquiries about handling personal information, whether a member of staff or a member of the public, knows what to do;
• queries about handling personal information are promptly and courteously dealt with;
• methods of handling personal information are regularly assessed and evaluated;
• performance with handling personal information is regularly assessed and evaluated;
• data sharing is carried out under a written agreement, setting out the scope and limits of the sharing. Any disclosure of personal data will be in compliance with approved procedures.

All employees should be aware of the local authority’s data protection policy and of their duties and responsibilities under the DPA.

All managers and staff will take steps to ensure that personal data is kept secure at all times against unauthorised or unlawful loss or disclosure and in particular will ensure that:

• paper files and other records or documents containing personal / sensitive data are kept in a secure environment;
• personal data held on computers and computer systems is protected by the use of secure passwords, which where possible have forced changes periodically;
• passwords must not be easily compromised and must not be shared with others;
• personal data must only be accessible to team members with appropriate access levels;
• data in all forms must be disposed of by secure means in accordance with local policies.

All contractors, consultants, suppliers and partners must:

• ensure that they and all of their staff who have access to personal data held or processed for or on behalf of the local authority, are aware of this policy and are fully trained in and are aware of their duties and responsibilities under data protection legislation. Any breach of any provision of the legislation will be deemed as being a breach of any contract between the local authority and that individual, partner or firm (see Report a Breach, Information Commissioner’s Office);
• allow data protection audits by the local authority of data held on its behalf (if requested);
• indemnify the local authority against any prosecutions, claims, proceedings, actions or payments of compensation or damages, without limitation.

All contractors and suppliers who use personal information supplied by the local authority will be required to confirm that they abide by the requirements of data protection legislation in relation to such information supplied by the local authority.

The local authority must also:

• ensure data subjects are given greater control of their data by improving consent processes. Consent must be freely given, specific, informed and give a clear indication of their wishes. This must be provided by a statement or clear affirmative action, signifying the individual’s agreement to the processing of their personal data;
• must ensure that data subjects have the ‘right to be forgotten’ which enables them to have their data ‘forgotten’. This is not an absolute right, however; it only applies to information which is data held at the time the request is received. It does not apply to data that may be created in the future.
• keep a record of data operations (mapping data flow within the local authority) and activities and assess if it has the necessary data processing agreements in place, and take action to remedy if not;
• carry out data protection impact assessments (DPIAs) on its products and systems;
• designate a data protection officer (DPO) for the local authority;
• review processes for the collection of personal data;
• be aware of the duty to notify the Information Commissioner’s Office of a data breach (the relevant supervisory authority);
• ensure ‘privacy by design’ and ‘privacy by default’ in new products (such as a new case recording system) and assess whether existing products used by the local authority meets the new data protection standards and take action accordingly to ensure compliance.

5. Redaction of Third Party Data

Before sharing information, the local authority must redact (or remove) personal data relating to third parties, to protect their privacy. For example, where social work records include references to other people, such as the adult’s family and friends, it is like some of this information will need to be withheld (redacted) before the record can be shared.

Under the Data Protection Act, it is for each local authority to weigh up how ‘reasonable’ it is to share another person’s information in each case (for example it may be reasonable to share information about another family members’ health condition if is likely to be hereditary). The Act is clear however that any person who appears in records because they were employed to provide care or received payment for providing a service, or acted in an official capacity, should not be treated as ‘third party’. This means that the names and information of social workers and other professionals should not be redacted.

6. Rights of the Data Subject

Any person whose information is being processes by the local authority has the following rights:

1. to be informed of data processing (for example a privacy notice);
2.  to be able to access information free of charge (also known as a Subject Access Request) – there is a one month time limit for the local authority to respond to any request;
3. to have inaccuracies corrected;
4. to have information erased (although this is not an absolute right);
5. to restrict processing;
6. to have data portability;
7. intervention in respect of automated decision making;
8. to be able to withdraw consent;
9. to complain to the Information Commissioner’s Office (ICO).

6.1 Right to be informed (section 44 DPA)

A person whose information is being processed should have access to a privacy notice (available on the council website), setting out:

1. lawful basis for processing;
2. contact details for the Data Protection Officer (DPO);
3. what information will be processed;
4. who it will be shared with and why;
5. how long it will be held;
6. details of rights;
7. how to complain.

6.2 Rectification (Section 46 DPA)

A person whose information is being processed has the following rights:

• to rectify or correct inaccurate information;
• if information is incomplete it must be completed;
• rectification or correction can be achieved by the provision of a supplementary statement;
• where the rectification is of information maintained for the purposes of evidence, instead if rectifying, the processing should be restricted;
• be informed in writing if request has been granted and if not the reasons for this.

7. Action if there is a Data Breach

A breach of security which can be either accidental, deliberate or unlawful and can involve:

• destruction;
• loss;
• alteration;
• unauthorised disclosure;
• unauthorised access.

A breach covers accidental and deliberate causes and is more than just losing personal data.

7.1 Examples of data breaches

These are commonly occurring breaches:

• access by an unauthorised party, including a third party;
• deliberate or accidental action (or inaction) by a controller or processor;
• sending personal data to an incorrect recipient;
• computing devices containing personal data being lost or stolen;
• alteration of personal data without permission; and
• loss of availability of personal data.

7.2 What constitutes a serious data breach?

A serious data breach:

• is where it is likely to result in a risk to the rights and freedoms of individuals. If unaddressed such a breach is likely to have a significant detrimental effect on individuals – for example, result in discrimination, damage to reputation, risk of physical harm, financial loss, loss of confidentiality or any other significant economic or social disadvantage;
• must be assessed on a case by case basis;
• must consider these factors: detriment / nature of data / volume (detriment includes emotional distress as well as both physical and financial damage).

All serious data breaches must be reported to the ICO within 72 hours of becoming aware of the breach. See UK GDPR Data Breach Reporting (ICO) for further information.

8. Further Reading

8.1 Relevant chapters

Information Sharing and Confidentiality

Case Recording

8.2 Relevant information

Guide to Data Protection: for Organisations (Information Commissioner’s Office)

Working from Home (Information Commissioner’s Office) 

ePractice

1. General Principles

The Care and Support Statutory Guidance (Department of Health and Social Care) details a number of key principles and standards which the local authority must have regard to when carrying out adult social care activities or functions. They include:

• Promoting Wellbeing – local authorities must promote wellbeing when carrying out any of their care and support functions in respect of an adult. This is often called the ‘wellbeing principle’ because it is a guiding principle that puts wellbeing at the heart of care and support.  It applies whenever a local authority is carrying out a care and support function (including providing information and advice) or making a decision. It applies to both adults and carers. Wellbeing includes:
  • personal dignity;
  • physical and mental health and emotional wellbeing;
  • protection from abuse and neglect;
  • adults having control over their day to day life;
  • participation in work, education and training;
  • social and economic wellbeing;
  • domestic, family and personal wellbeing;
  • suitability of living accommodation;
  • contributing to society.
• The importance of beginning with the assumption that the adult is best placed to judge their own wellbeing. Building on the principles of the Mental Capacity Act 2005, the local authority should assume that the adult is ‘the expert in their own life’. They should be asked about their priorities and the outcomes they want to achieve. The local authority must not make assumptions as to what matters most to the adult.
• The adult’s views, wishes, feelings and beliefs. Considering the adult’s views and wishes is key to providing person centred care and support. Where the adult has particular views, feelings or beliefs (including religious beliefs) which impact on the choices they may wish to make about their care, these should be taken into account. This is especially important where an adult has expressed views in the past, but no longer has mental capacity to make their own decisions.
• The importance of preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist. At every interaction with an adult or carer, the local authority should consider whether or how the their needs could be reduced orand the development of other needs could be prevented or delayed. Effective interventions at the right time can stop needs from escalating, and help adults maintain their independence for longer (see Preventing, Reducing or Delaying Needs chapter).
• The need to ensure that decisions are made having regard to all the adult’s circumstances (and are not, for example, based only on their age or appearance, any condition they have, or any aspect of their behaviour which might lead others to make unjustified assumptions about their wellbeing). The local authority should not make judgements based on preconceptions about the adult’s circumstances, but should in every case work to understand their individual needs and goals (see Assessment).
• The importance of the adult participating as fully as possible in decisions about them and being provided with the information and support necessary to enable this. Care and support should be personal, and the local authority should not make decisions from which the person is excluded (see Assessment and Independent Advocacy).
• The importance of achieving a balance between the adult’s wellbeing and that of any friends or relatives who are involved in caring for them. Adults should be considered in the context of their families and support networks. The local authority should take into account the impact of the adult’s needs on those who support them (see Assessment chapter).
• The need to protect adults from abuse and neglect.  Ensuring adults are protected from abuse and neglect is a key part of promoting wellbeing (see Adult Safeguarding chapter).
• The need to ensure that any restriction on an adult’s rights or freedom of action are kept to the minimum necessary. . Where the local authority has to take actions which restrict an adult’s rights or freedoms, the course followed should be the least restrictive necessary (see Deprivation of Liberty Safeguards chapter).

These principles must be considered in relation to every adult. This will ensure an approach that looks at their life holistically, considering their needs in the context of their skills, ambitions, and priorities – as well as the other people in their life and how they can support the adult in meeting the outcomes they want to achieve. The focus should be on supporting adults to live as independently as possible for as long as possible.

These principles will vary in their relevance to individual adults. For some adults, spiritual or religious beliefs will be of great significance, and should be taken into particular account.  The local authority should consider how to apply these  principles on a case by case basis, reflecting the fact that every adult is different and the matters of most importance to them will vary widely.

2. Principles of Adult Safeguarding

See Adult Safeguarding.

In relation to the local authority’s duty to adults experiencing or at risk of abuse or neglect, the six key principles below underpin all adult safeguarding work. They are followed by the relevant ‘I’ statements (Revisiting Safeguarding Practice, Department of Health and Social Care).

• Empowerment: People are supported and encouraged to make their own decisions and give informed consent. People must always be treated with dignity and respect, and practitioners should work alongside them to ensure they receive quality, person-centred care which ensures they are safe on their own terms.
• “I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.”
• Prevention: It is better to take action before harm occurs. Prevention and early support are key to effective safeguarding. The principle of prevention recognises the importance of taking action before harm occurs and seeks to put mechanisms in place so they do not recur.
• “I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.”
• Proportionality: The least intrusive response appropriate to the risk presented. This means doing the least intrusive response appropriate to the risk presented.
• “I am sure that the professionals will work in my interest, as I see them and they will only get involved as much as needed.”
• Protection: This involves organising and delivering support and representation for those in greatest need who may not be able to do it themselves.
• “I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want.”
• Partnership: Effective safeguarding cannot be delivered in isolation and should involve other partners and systems that interact with or impact on a person. Local solutions are best achieved through services working with their communities, professionals and services as a whole.
• “I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.”
• Accountability: Accountability and transparency in delivering safeguarding. This recognises the importance of being open, clear and honest in the delivery of safeguarding and ensuring there are systems in place to hold practitioners, services and systems to account.
• “I understand the role of everyone involved in my life and so do they.”

For more information see Revisiting Safeguarding Practice (Department of Health and Social Care) 

3. Further Reading

3.1 Relevant chapters

Promoting Wellbeing

Preventing, Reducing or Delaying Needs

1. Introduction

The Care Act 2014 came into effect on 1st April 2015. The accompanying Care and Support Statutory Guidance (Department of Health and Social Care) contains detailed guidance to support local authorities to implement part 1 of the Act.

The Act sets out how care and support should be provided to adults and carers, and how it will be paid for. It supports the personalisation of care services, putting adults and carers at the centre of the care and support process, and aims to make it easier for those who need to access care and support to understand why things happen in a certain way.

2. Care Act Duties and Rights

2.1 General responsibilities and universal services

Promoting wellbeing: This principle applies to all functions under Part 1 of the Act (including care and support and safeguarding). Whenever a local authority makes a decision about an adult, it must promote the adult’s wellbeing.

Preventing, reducing or delaying needs: The local authority is required to ensure provision of preventative services which help prevent and / or delay the development of care and support needs or reduce such needs (including carer support needs).

Information and advice: An information and advice service must be available to all people in the local authority area regardless of eligible care needs.

Market shaping and commissioning of adult care and support: The Act gives the local authority a general duty to promote choice and quality in the market of local care and support providers. Local authorities must ensure a range of care providers is available; shaped by demands of adults, families and carers, and that services are of high quality and meet needs and preferences of local people.

Managing provider failure: If a care provider fails, the local authority is required to temporarily meet an adult’s needs for care and support.  This applies regardless of whether there is a contract in place between the provider and the local authority, if the adults affected pay for their own care, or if other local authorities had made the arrangements to provide services.

Market oversight: The Care Quality Commission (CQC) has a duty to assess the financial sustainability of the most difficult to replace providers and support the local authority in ensuring continuity of care if providers fail.

2.2 First contact and identifying needs

Assessment: The local authority must carry out an assessment, referred to as ‘needs assessment,’ whenever it appears an adult may have care and support needs. The Act also sets out what should happen if an adult or a carer refuses to have a needs or carer’s assessment. All assessments must be proportionate to the level of need and consider the whole family. Self-assessments must also be offered.

Carer’s assessment: The local authority is required to carry out an assessment (‘carer’s assessment’) where it appears a carer may have needs for support now or in future.

Eligibility: Following a needs assessment or carer’s assessment, the local authority will determine if the person has eligible needs.  National eligibility criteria are provided in regulations, which set the minimum level of eligibility at which the local authority must meet care and support needs.

Advocacy: The Act specifies when the local authority must arrange an independent advocate to facilitate the involvement of an adult or carer in their assessment and care and support planning or review processes.

2.3 Charging and financial assessment

Charging: The Act gives the local authority a general power to charge for certain types of care and support if it chooses to do so.

Financial assessment: The local authority is required to undertake a financial assessment if it chooses to charge for particular services.

Deferred payments: Deferred payment schemes allow adults to enter into an agreement to delay or defer paying for the care and support services they receive. This helps avoid the need to sell property or possessions.

Recovery of charges, transfer of assets: This allows the local authority to recover as debt any sums owed, such as unpaid charges and interest.

2.4 Care and support planning

How to meet needs: To reflect the aims of the Care Act, local authorities should take a flexible approach to meeting people’s needs.

Duty to meet needs: The Act describes when the local authority will have a duty to meet an adult’s eligible needs for care and support.

Power to meet needs: This provides a broad power for the local authority to meet care and support needs in circumstances where a duty to meet needs (as above) does not arise.  It also enables the local authority to temporarily provide care and support without first carrying out a needs assessment, where it is needed urgently

Duty to meet carers’ needs: There is a legal obligation for local authorities to meet carer’s needs for support.

Care and support / support plan: The Act describes what must be included in a care and support plans (assessed adult) / support plan (carer).

Review of care and support / support plan: This requires the local authority to keep plans under review generally, and to carry out re-assessment / review if the adult or carer’s circumstances have changed. The adult can also request a review of their plan.

Personal budget: Under the Care Act, local authorities should provide a written personal budget to all people (including carers) who are assessed as eligible for care and support. The amount of the personal budget should reflect the money that is needed to cover the cost of the person’s care and support.

Direct payments: Adults with mental capacity can request a direct payment and, where they meet the conditions set out, the local authority must provide direct payments to meet their assessed eligible needs.

2.5 Safeguarding

Adult safeguarding: This sets out the local authority’s responsibility for adult safeguarding: including the responsibility to ensure enquiries into cases of abuse and neglect, and establishing a Safeguarding Adults Board.

2.6 Integration and partnership working

Integration: There is a duty on the local authority to carry out care and support functions with aim of integrating services with those provided by NHS or other health-related services.

Duty to cooperate: The Act places a general duty on local authorities to cooperate in relation to functions relevant to care and support. There is also a specific duty to cooperate where this is needed for an adult with care and support needs.

Delegation: This provides a power for local authorities to authorise a third party to carry out certain care and support functions.

Transition from childhood: This places a duty on the local authority to assess a child, young carer or child’s carer before they turn 18,  if likely to have needs once they (or the child they care for) turn 18, in order to help them plan and the assessment will be of ‘significant benefit’.

Prisoners: The Act clarifies responsibilities for the provision of care and support for adult prisoners and people living in approved premises (including bail accommodation).

2.7 Moving between areas: inter local authority and cross border issues

Continuity of care: The Act clarifies roles and responsibilities when an adult, and potentially their carer, notifies a local authority that they intend to move to another local authority area.

Ordinary residence: Ordinary residence is used to decide if a local authority is responsible for providing care and support. The Act provides a mechanism for local authorities to reclaim money spent providing care and support to someone for whom they were not in fact responsible.

Cross border placements: This makes provision for an adult with care and support needs who is ordinarily resident in England and requires residential accommodation, to meet those needs to be provided with accommodation in another part of the UK. It also allows for such placements in England for people ordinarily resident in Wales, or whose care and support is provided under relevant Scottish or Northern Irish legislation. There are similar arrangements for cross border placements not involving England that is, Wales / Scotland, Scotland / Northern Ireland and Northern Ireland / Wales.

Mental health aftercare: The Act clarifies aftercare services provided under section 117 of the Mental Health Act 1983 to meet need arising from / related to mental disorder of person concerned.

3. Further Reading

3.1 Relevant information

An Introduction to the Care Act 2014 – Video (SCIE) 

Care Act: Legal Duties and Impact on Individuals (SCIE training)

Care and Support Statutory Guidance (Department of Health and Social Care)

An Introduction to the Care Act 2014 (SCIE Video) 

Care Act: Legal Duties and Impact on Individuals (SCIE training)