Transcript

Interviewer

Why do you need to know about the law in your role? Can you give any examples?

Natalie

Law underpins all of a social worker’s practice from the assessments that we undertake, for example the assessments that I undertake in my role are underpinned by the Social Services and Well-being (Wales) Act. That helps to guide me when I am looking at a person’s situation to have an understanding about what their needs are and whether or not they are eligible for support from the local authority. When I am working with an individual I always have human rights in my mind about protecting a person’s human rights, thinking about times where you might be interfering with somebody’s autonomy or you might be interfering with their privacy and you need to be able to justify why you are doing that. Particularly in my role I need to have a really good knowledge of the Mental Capacity Act. We are assumed to have capacity but if you are going to start to assess the capacity you need to be able to justify why you have done that and then if you have assessed somebody as lacking capacity you need to be following the principles outlined in the Mental Capacity Act about making a decision in the person’s best interests. So it’s about being able to protect someone’s human rights, be able to justify the decisions that you make and it’s about keeping the person safe really.

Interviewer

And what about you, Robyn?

Robyn

For us as a company, we comply to all the laws set within the health care profession to ensure that we as a company and individuals are protected. The law is set to protect the clients who we care for as well. It is essential that the staff have a good knowledge and understanding of the law, for example, GDPR and confidentiality, so that their individual rights are protected and that of our clients. The staff have online training which broadens their knowledge and understanding of all these various laws and regulations. Myself and all of the staff at the Garth have access as well to all our policies and procedures so they can either gain that access from the Garth office itself, so that’s the paper copies, or every member of staff at the Garth Care Services have a login detail to QCS which is the system that we use online which has got everything on it. I love it, I go on it all the time, if something comes up that I’m not sure of, I just log into QCS.

QCS is an online system which the Garth Care Services pay for and provide to all the staff. So you have access to all our policies and procedures, which are set in there so you don’t have to go into the office and go through files and files of all the paper copies. I use it a lot. It’s for the staff and the clients, anything really. Anti-bullying, so I can go on and have a look at the bullying policy, racism policy. I did have to look at the racism policy sadly, because we had a lady who worked in the community who was Indian, and we had some clients – and it wasn’t actually the client, it was the client’s family that didn’t want her because of her race. So obviously I had to look at the racial policy. So that again goes to equality and diversity and looking at the ways of working and how to resolve that situation. So sadly, I had to remove the carer from that client, so that carer then couldn’t attend that client’s visits due to, obviously, the racial abuse that, you know, she hadn’t suffered but she could potentially suffer. So actually it was in her best interests not to go there, so I put her on a different round so she had other clients that were happy to have her care. Thankfully, that’s only ever happened once and it was only this one particular client’s family and actually they were quite difficult for us anyway, not just with that carer, with other carers as well. I spoke to her; she did know, not in a way that I said to her they were racist to her. I just said that they didn’t feel comfortable about having her there, and she was happy with that because she didn’t feel comfortable being there either. So she was happy to go to other clients where, obviously, they appreciated her care, care-giving more.

Thankfully, this hasn’t come up again, and actually that client and that client family left us and went to another agency, so that situation hasn’t occurred again and it won’t occur again. But I did get good learning from it because obviously I had never come across it before. And you hear so much about equality, diversity and, you know, not being racist, so that you just can’t really believe that it goes on. But sadly it still does and it was a challenge to try and deal with it. But yes, I had the best interests of my client but I also had the best interests of my staff, and I wasn’t going to put my staff through any racial abuse.

Interviewer

Can you give an example of where you have succeeded in promoting the rights and interests of service users, Natalie?

Natalie

So I worked with a couple that were both in hospital at the same time with different needs that needed different approaches, really, but it was quite clear that it was important to them both to remain together. That wasn’t necessarily achievable for them to return home together, but it was about making sure that the one accessed advocacy to be able to make sure that they could express their feelings and wishes. And my role really was to undertake assessments, represent them in a way to help them to achieve that outcome, which was that they ended up moving on together and living within a care home setting. So they were able to maintain their relationship and they’d had opportunities to have their voices heard, and really I was able to support them to have their needs met but ensure that they maintained their relationship, really, moving forward.

Interviewer

And what about you, Robyn?

Robyn

I have had to do this quite recently. So a lady, another lady in the community when we took on her care, obviously one of the questions I always ask them is their future wishes so their sort of preferences of how their end-of-life care, how they would like it to look. So this lady, her preference was to go into the Garth nursing homes into the nursing home side and be looked after there until she passes away. Sadly, she’s recently had a stroke and she’s gone into hospital and she’s not as able-bodied as she was: obviously the outcome of the stroke. So her family contacted me, they desperately want to send her home and obliviously come back to the domiciliary care side. But she’s specifically said to them no I want to go into the care home and spend the rest of my days there. I’ve had a bit of debate with her family about this because, obviously, as much as I would love her to come back to the domiciliary side care, obviously looking after her at home, I know that her future wish was to go into the care home, so I have debated with her family and they have listened to me and I have promoted her rights and her wishes and she is going to be coming into the Garth.

Interviewer

How do you respect individual rights at the same time as making sure that people do not harm themselves or others, Natalie?

Natalie

Human rights are at the base of every action or every communication that we make with people. Being open and honest with individuals about what their actions or their choices can mean for them and others, and making sure that people understand what choices they have and promoting choice and respecting when individuals might be making an unwise decision. It is a difficult balance because there are times where you can be very concerned about someone causing themselves or others harm and then that would be appropriate to think about safeguarding and there are procedures in place that support us with that. Making sure that people have advocacy and somebody to represent them and I think, you know, for me I am often working within the Mental Capacity Act and thinking about whether someone has capacity to make a decision or not, and that can also affect what action you might take next for somebody. But I do think the most important thing to remember, or to stay committed to, is being open and honest and making sure that people have all the facts and understand what’s happening and what might happen if they continue to behave or take choices that they are currently making.

It can be quite a challenge. You’ve always got someone’s human rights in your mind, but if I can give you an example. If I am thinking about somebody’s right to a private family life and they may be self-neglecting and becoming unwell and at significant risk, you have to balance that really and there may be times where you need to be persistent about your intervention. But there is that internal struggle and I think what you need to remember is that there is always someone to talk to about it, such as your colleagues or safeguarding team, and to make sure that you’re working, you’re following legislation, you’re doing things in the correct way, following procedures, making sure that anything that you do is based on evidence and that it’s justifiable really to protect that individual or others. But it is not easy. It is uncomfortable, and I do think it should be uncomfortable because when, you know, our human rights are protected and anything that you do that might challenge that needs to be done in a way that you can justify and that is defensible so it should be uncomfortable.