Duty of care

What does The term ‘duty of care’ mean in practice? CSP professional advisers Rebekah Middleton and Pip White explain.

Physiotherapists and the services in which they work are under pressure.

With so many patients to treat, making decisions can be difficult. We might, for example, feel either that we are not doing enough or that the quality of our service is not reaching ‘five star’ status.

While we know we have a duty of care to our patients, do we really know what this means and what significance it has in today’s health climate?

This article will give you an introduction to the legal concept of duty of care and its implications for clinical practice.  

Keeping our patients safe and preventing harm

We would all agree with the following statement: ‘safety should be at the heart of all care’. It appears in NHS Employers Speaking up charter, which was launched in October.

Marc Searle, chief executive of the Health and Care Professions Council (HCPC), says the council’s role is to ‘protect the public from professionals who do not meet our standards’. He stresses that ‘we take this commitment extremely seriously’.

Physiotherapists are regulated and therefore registrants have a clear set of HCPC duties to fulfil. The role of the HCPC, every registrant and the purpose of HCPC standards have clear and strong connections to our duty of care.

Opting out is not an option

Duty of care (see box above) is a legal obligation and is not optional. You are obliged to use reasonable skill in providing treatment to patients.

Offering any form of disclaimer to deflect this responsibility is unacceptable. All physiotherapy care should be agreed with patients and they should never be asked to participate ‘at their own risk’. Your duty of care requires you to assess and advise patients accordingly.

When your duty starts

The duty is created as soon as a patient is accepted into a service. This might be when a referral is accepted and placed on a waiting list, when an appointment is created, and when you have one-to-one contact (either in person or indirectly)with your patient.

Fulfilling your duty of care

Physiotherapy staff fulfil their duty of care to patients by taking a range of actions. These include:

  • engaging in CPD to keep your skills, knowledge and competence up to date
  • delivering the best possible service that you can to your patients
  • raising concerns about duty of care with their manager promptly
  • ensuring familiarity with workplace policies and procedures to support your safety, the safety of your colleagues and yourpatients (such as infection control policy)   
  • thinking critically about the tasks and activities delegated to others
  • maintaining confidentiality at all times unless your duty of care requires and permits you by law to disclose the information to another professional 

Responding to your duty of care

If there is an immediate issue in which a patient’s safety is, or could be, at risk, your duty of care means that you must act immediately to protect the patient as far as is reasonably possible.

Removing an unsafe piece of equipment from use and informing colleagues is one example. 

Duty of care and the resources available

Although you may not be able to do everything that is needed, for example treat all of the patients or undertake all of the identified tasks, this doesn’t mean that duty of care has been breached.

As resources are not limitless, it’s important for employees and employers to ensure that any actions are safe, timely and of a reasonable standard of care.

Anything not completed should recorded clearly.

A reasonable standard of care can be described as the standard that would be expected of someone having certain skills, job role and responsibilities.

Therefore, what would be deemed reasonable for a senior staff member would be different to that of a less experienced practitioner. 

Raising concerns about services and duty of care

A duty of care, as described previously, means that you have a legal responsibility to provide care to the best of your ability and keep your patients safe.

If you are worried, however, that the situation in your workplace threatens your ability to achieve this, it is important to know how to raise and escalate your concerns appropriately.

The HCPC standards of conduct, performance and ethics outline the expectations of registrants in a clear way.

Every physio must be fully conversant with these standards.

As every registrant must reach these standards to remain registered, and therefore be legally entitled to practice, these standards are very important.

They are a key resource to help you think carefully about the significance of the situation.

If it is necessary to raise concerns in the workplace, the following guide may be useful;   concerns would usually be raised with your direct line manager.

Putting them in writing enables you to fulfil your duty of care and be able to prove this should it be necessary prepare your written record of the issues carefully.

Gather the appropriate evidence to clearly outline where either your duty of care or ability to comply with HCPC standards is at risk other resources such as local service standards, policies and procedures, or other recognised best practice evidence or quality markers may be of value to demonstrate what may be breached or risked.Resources including CSP Quality Assurance Standards may be helpful raise any concerns with your local steward or safety rep early on as problems can often impact on colleagues.

Employers and managers and duty of care
Employers and managers have a duty of care to employees and service users.

This means they are responsible for enabling staff to work safely and effectively and listen to the concerns of staff.  

The role of the manager may also reasonably include making the decision on new ways of working or elements of care to be suspended until they can be provided safely and to the required standard. It may be difficult to bring up issues, but if there is cause for concern, this is absolutely necessary. fl

What is duty of care?

It is a legal duty to provide a reasonable standard of care to your patients and to act in ways that protect their safety.

A duty of care exists when it could reasonably be expected that a person’s actions, or failure to act, might cause injury to another person.

This means that everyone working in health and social care – whether they are a registered professional, a student or a support worker – has a duty of care to their patients, and also to his or her colleagues and employer.

Want to know more?

If you need further guidance you could talk to your local steward, or contact the professional advice service at the CSP.

The CSP is developing guidance for members on duty of care. Look out for more information on the website next month. Visit: www.csp.org.uk        

To download copies of NHS Employers Speaking up charter’, visit: www.nhsemployers.organd search for‘speaking up charter’.

To view the HCPC standards of conduct, visit: www.hpc-uk.org/publications/standards/index.asp?id=38

Rebekah Middleton and Pip White

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