Level 2 Health and Social Care Candidate Book

Yvonne Nolan
with Colette Burgess and Colin Shaw
HEALTH &
SOCIAL CARE 3rd edition
www.pearsonschoolsandfe.co.uk
i
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Text copyright © Yvonne Nolan 2011 for Units SHC 21, SHC 22, SHC 23,
SHC 24, HSC 024, HSC 025, HSC 026, HSC 027, HSC 028, HSC 2003, HSC
2014, HSC 2002 and HSC 2013
Text copyright © Colette Burgess and Colin Shaw 2011 for Units IC 01,
HSC 2007, HSC 2012, HSC 2015 and HSC 2028
Text copyright © Julia Barrand, Royal National Institute of Blind People
(RNIB) 2011 for Unit SS MU 2.1
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Contents
Acknowledgements iv
Introduction v
How to use this book vi
SHC 21 Introduction to communication in health, social care or children’s and

young people’s settings Yvonne Nolan 1
SHC 22 Introduction to personal development in health, social care or children’s
and young people’s settings Yvonne Nolan 33
SHC 23 Introduction to equality and inclusion in health, social care or children’s
and young people’s settings Yvonne Nolan 61
SHC 24 Introduction to duty of care Yvonne Nolan 81
HSC 024 Principles of safeguarding and protection in health and social care Yvonne Nolan 93
HSC 025 The role of the health and social care worker Yvonne Nolan 131
HSC 026 Implement person-centred approaches in health and social care Yvonne Nolan 151
HSC 027 Contribute to health and safety in health and social care Yvonne Nolan 185
HSC 028 Handle information in health and social care settings Yvonne Nolan 239
IC 01 The principles of infection prevention and control Colette Burgess and Colin Shaw 257
HSC 2002 Provide support for mobility Yvonne Nolan with Colette Burgess and Colin Shaw 291
HSC 2003 Provide support to manage pain and discomfort Yvonne Nolan with
Colette Burgess and Colin Shaw 311
HSC 2014 Support individuals to eat and drink Yvonne Nolan with Colette Burgess
and Colin Shaw 327
HSC 2015 Support individuals to meet personal care needs Colette Burgess and Colin Shaw 351
Glossary 373
Legislation 377
Unit numbers by awarding organisation 379
Index for pages 1–372 381
HSC 2007 Support independence in the tasks of daily living Colette Burgess and Colin Shaw 1–26
HSC 2012 Support individuals who are distressed Yvonne Nolan with Colette Burgess
and Colin Shaw 1–23
HSC 2013 Support care plan activities Yvonne Nolan with Colette Burgess and Colin Shaw 1–23
HSC 2028 Move and assist individuals in accordance with their plan of care Colette Burgess
and Colin Shaw 1–35
SS MU 2.1 Introductory awareness of sensory loss Julia Barrand, RNIB 1–27
iii
Acknowledgements
The publisher would like to thank Jane Kellas for providing the further reading features for each unit.
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iv
Introduction
Welcome to the Level 2 book to accompany the Diploma in Health
and Social Care. Your studies for the qualification will give you the
chance to learn about the major changes in the way social care and
support services are delivered. The transformation of services and
the personalisation agenda has put people in control of their own
care and support planning and budgets, and given people real
choice in how money is spent on their services. People are at the
centre of all your work, and services are now designed to fit around
people’s lifestyles, abilities and existing informal support networks.
All this means that this is a very exciting time to be working in social
care. You will be able to play your part in making real changes in
people’s lives and giving them opportunities to make decisions and
choices for themselves that they may never have experienced.
Working in social care is always challenging but is always a privilege.
The book is designed to give you knowledge linked to the learning
outcomes in the Diploma, so it is easy to follow and should support
you throughout your studies. You should also find it a useful
reference even after you have gained your qualification.
I am delighted that you have chosen to work in this most
challenging, but also most rewarding, career and I wish you every
success.
Yvonne Nolan
v
How to use this book
Look out for the following special features as you work through the book.
Case study Case study

Real-life scenarios that explore key issues and broaden your
understanding
Activity
Activity
A pencil and paper icon marks opportunities for you to consolidate
and/or extend learning, allowing you to apply the theoretical
knowledge that you have learned to health and social care situations
Doing it well
Doing it well
Information around the skills needed to perform practical aspects of
the job. These are often in the form of checklists that you can tick
off point by point to confirm that you are doing things correctly
Reflect
Reflect
Reflect features have thought bubbles, to remind you that they are
opportunities for you to reflect on your practice
Key term
Key term
Look out for the keyhole symbol that highlights these key terms –
clear definitions of words and phrases you need to know
Functional skills
Functional skills
The building blocks icon indicates where you can demonstrate your
English, mathematics or ICT skills while carrying out an activity or
answering a case study
Getting ready for assessment

Information to help you prepare for assessment, linked to the
learning outcomes for the unit
Legislation
Legislation
Summarises all the laws referred to in a unit
Further reading and research

Useful for continuing professional development, including
references to websites, books and agencies
vi
Unit SHC 21
Introduction to
communication in health,
social care or children’s and
young people’s settings
Working in health and social care is about communication and relationships. It is simply
not possible to provide support and care services without developing relationships with
those you support, and good communication is an essential part of relationship
building. Communication is much more than talking. It can include touch, facial
expression, body movements, dress and position.
You will also need to think about the different ways in which people communicate and
the barriers which some face. You will need to be able to respond to a range of
different approaches to communication.
Developing and keeping the trust of the people you work with is an essential part of
providing effective support; maintaining confidentiality is a key part of trust. You will
need to understand what information must remain confidential, how to ensure that it
is and the rare occasions when it is necessary to break confidentiality.
In this unit you will learn about:

1. why communication is important in the work setting
2. how to meet the communication and language needs, wishes and
preferences of individuals
3. how to overcome barriers to communication
4. how to respect equality and diversity when communicating
5. how to apply principles and practices relating to confidentiality at work.
1
Level 2 Health and Social Care Diploma
1. Understand why
communication is important
in the work setting
1.1 The different reasons people
communicate
In general, human beings like to live with other human beings. Most
of us are sociable creatures who want to reach out to other people
around us. Very few humans lead completely solitary lives.
People also communicate for specific reasons; in order to express
emotions such as:
•• fear
•• anger
•• pain
•• joy
•• love.
People want to get views, wishes and information across to others for
all kinds of reasons. Sometimes this can be essential – even life saving
in the case of a warning. It can be vital to make a person’s quality of
life better if they are communicating that they are in pain or it can be
to make emotional contact with others to express feelings.
People live and communicate within a range of different groups and
communities, including:
•• families •• interest/activity groups
•• neighbourhoods •• commercial settings
•• workplaces •• users of professional services.
•• schools and colleges
How do you think intimate communications can be identified?
2
Introduction to communication Unit SHC 21
The nature of communication is very different dependent on the

circumstances. Some communications are personal and very intimate;
these are usually with people to whom we are very close.
Other communications are for a wider audience and are aimed at
groups of people. Communication can be formal, such as in a
courtroom setting, or informal, such as friends chatting.
Good
morning.
Can you see how this is different from intimate communication – for a much wider audience?
Reflect Activity 1
You are the most important tool Recording communication
you have for doing your job. Care
and support workers do not have Over a period of just one day, keep a record of the people you
carefully engineered machinery or communicate with. Next to each record, write down the type of
complex technology – your own communication. You may find that most of your communication
ability to relate to others and to is informal, or mostly formal, or like most of us, it will be a mix of
understand them is the key you the two.
need.
3
1.2 How effective communication affects

all aspects of the learner’s work
In your job you need to communicate with people all the time. First
and foremost is the person you are supporting, but there are also
their family and friends, who are likely to be involved in the support
plan. You will also have to communicate with colleagues and with
other professionals.
The way in which you communicate will be different depending on
the person with whom you are communicating and the purpose of
the communication. As the case study opposite shows, different
approaches to communicate the same information are appropriate
for different people.
Activity 2
Functional skills
English: Writing Producing a report
Your task in this activity is to produce a report just as you would when
Report writing requires you to use a
working in a care setting. You should work individually on your report,
suitable format that is fit for purpose
but share and discuss your results in a group if you are able. If not,
and contains set information. You
look at your own results and see what you can learn.
must pay careful attention to the
layout of the document using 1. Read the following scenario carefully.
appropriate headings. This report is
You are working in Jasmine House, a 38-bed residential facility
going to be used to give information
for older people. You worked on the late shift: you came into
to other professionals in your place
work at 2pm and left at 9.30pm. Mrs Jerrold, an older person,
of work and should be written in a
had been very agitated throughout your shift. She kept asking
factual way. Careful attention needs
to go home and had tried to leave several times. She had gone
to be given to spelling, punctuation,
out through the front door on one occasion and you had
grammar and sentence construction
managed to persuade her to come in from the garden. Mrs
to ensure that it is accurate. You will
Jerrold is quite mobile with the aid of a walking frame and her
need to proofread your work to
eyesight is poor; otherwise she is well and, until this latest
check for errors before submitting a
episode, had seemed settled and happy.
final copy to your tutor.
She has a daughter who comes in to visit her several times
each week.
2. Write this record up as if you were at work and include everything

you normally would if this was your report for the records to hand
over to the next shift.
3. Write a report about Mrs Jerrold for a review meeting that your
supervisor has arranged in order to discuss this episode and
concerns about her current condition.
4. Write a note for Mrs Jerrold’s daughter when she comes in the
next day, to let her know about what has happened with her
mother.
5. Compare the differences in records written for different purposes
and see what you can learn from each other. Give and receive
feedback between everyone in the group about their records.
4
Case study
Communicating the same information to different people

Mrs Henson was a long-term resident in a residential to let you know straight away. We went in to see her
care home. She had been unwell for some time, and just before handover, and she had died. As you know
had been treated for a bad dose of flu. Her heart was from yesterday, it wasn’t unexpected – I just wish one
failing and it was known that her death was a of us had been with her.’
possibility. One morning, the staff went in to find that
To her niece: ‘Hello, Mrs Johnson? This is Sue from
she had died in her sleep. The information was passed
Redcroft. I’m afraid I have some sad news about your
on by phone to various people involved in the following
aunt. She passed away a short while ago. It was very
ways.
peaceful, she just slipped away in her sleep – she didn’t
To the GP: ‘Hello, this is Redcroft. A patient of suffer at all. I know you were expecting it, but it’s still
Dr Williams’, Mrs Henson, has just died. Could we have upsetting isn’t it? As you asked, we’ve put all the
someone out to certify, please? Dr Williams saw her arrangements in hand. You don’t have to worry about
only yesterday. He was expecting this.’ anything, but there will be papers for you to sign later
on if you feel up to calling in.’
To the funeral director: ‘Hello, this is Redcroft. One of
our residents, Sarah Henson, died this morning. 1. What is it about each of these calls that makes
Dr Williams from the health centre will be out to do the them appropriate to the person receiving the call?
certificates. Can you call later this morning? Thank you.’ 2. Which call do you think the care home would have
had to consider most carefully first?
To the social worker: ‘Hello, Gill, this is Sue from
Redcroft. Just to let you know that Sarah Henson died
this morning. I know you were fond of her, so I wanted
1.3 Why it is important to observe

an individual’s reactions when
communicating with them
All communication has an effect on the person you are
communicating with. It is a two-way process called an interaction,
and it is important that you watch the effects so that any problems
can be identified and dealt with.
Any relationship comes about through communication. In order to be
effective in providing care and support, you must learn to be a good
communicator. But communication is about much more than talking
to people. People communicate through:
•• speaking
•• facial expression
•• body language
•• position
•• dress
•• gestures.
You will have to know how to recognise what is being communicated
to you, and be able to communicate with others without always
having to use words.
5
Activity 3
Communicating emotions
Do this with a friend or colleague.
1. Write the names of several emotions (such as anger, joy, sadness,

disappointment, fear) on pieces of paper.
2. One of you should pick up a piece of paper. Your task is to
communicate the emotion written on the paper to your partner,
without saying anything.
3. Your partner then has to decide what the emotion is and say why.
4. Change places and repeat the exercise. Take it in turns, until all the
pieces of paper have been used. Make sure that you list all the
things that made you aware of the emotion being expressed.
5. Discuss with your partner what you have discovered about
communication as a result of this exercise.
Key term When you carried out the previous activity, you will have found out
that there are many factors that told you what your partner was
Non-verbal communication – trying to communicate. It is not only the expression on people’s faces
body language, the most important that tells you about how they feel, but also the way they use the rest
way in which people communicate of their bodies. This area of human behaviour is known as non-
verbal communication. It is very important for developing the ability
to understand what people are feeling. If you understand the
importance of non-verbal communication, you will be able to use it to
improve your own skills when you communicate with someone.
Recognising the signals

Look at a person’s facial expression. Much of what you will see will be
in the eyes, but the eyebrows and mouth also contribute.
Notice whether someone is looking at you, or at the floor or at a
point over your shoulder. Lack of eye contact should give a first
indication that all may not be well. It may be that they are not feeling
confident. They may be unhappy, or feel uneasy about talking to you.
You will need to follow this up.
Look at how a person sits. Are they relaxed and comfortable, sitting
well back in the chair, or tense and perched on the edge of the seat?
Are they slumped in the chair with their head down? Posture can
indicate a great deal about how somebody is feeling. People who are
feeling well and cheerful tend to hold their heads up, and sit in a
relaxed and comfortable way. Someone who is tense and nervous,
who feels unsure and worried, is likely to reflect this in the way they
sit or stand.
Observe hands and gestures carefully. Someone twisting their hands,
or playing with hair or clothes, is displaying tension and worry.
Frequent little shrugs of the shoulders or spreading of the hands may
Can you see the different message from
each of these photos? indicate a feeling of helplessness or hopelessness.
6
Case study
Identifying body language

Mrs Morrison is very confused. She has little recognition no idea where she is. She does not know anyone, and
of time or place and only knows her daughter, who has she keeps asking to go home.
cared for her over many years. As Mrs Morrison became
1. What would you expect Mrs Morrison’s body
increasingly frail and began to fall regularly, she finally
language to be?
stopped eating and drinking, and her daughter had to
2. What would you look for in her facial expression?
arrange for her admission to hospital for assessment.
3. As her support worker, how do you think you might
Mrs Morrison is in a large psycho-geriatric ward. Many
make her feel better?
of the patients are aggressive and disinhibited in their
4. How would you communicate with her?
behaviour. She is quiet, gentle and confused, and has
5. How might you help her daughter?
Reflect
Research shows that people pay far more attention to facial
expressions and tone of voice than they do to spoken words. For
example, in one study, words contributed only 7 per cent towards the
impression of whether or not someone was liked, tone of voice
contributed 38 per cent and facial expression 55 per cent. The study
also found that if there was a contradiction between facial expression
and words, people believed the facial expression.
Giving out the signals

Being aware of your own body language and what you are
communicating is just as important as understanding the person you
are talking to.
Doing it well
Communicating with people if appropriate. Many people find it comforting to

•• Maintain eye contact with the person you are talking have their hand held or stroked, or to have an arm
to, although you should avoid staring at them. around their shoulders.
Looking away occasionally is normal, but if you find •• Be aware of a person’s body language, which should
yourself looking around the room, or watching tell you if they find touch acceptable or not.
others, then you are failing to give people the •• Always err on the side of caution if you are unsure
attention they deserve. about what is acceptable in another culture and do
•• Be aware of what you are doing and try to think why not use touch as a means of communication until
you are losing attention. you are sure that it will be acceptable.
•• Sit where you can be easily seen. •• Think about age and gender in relation to touch. An
•• Sit a comfortable distance away – not so far that any older woman may be happy to have her hand held
sense of closeness is lost, but not so close that you by a female carer, but may be uncomfortable with
invade their personal space. such a response from a man.
•• Show by your gestures that you are listening and •• Ensure that you are touching someone because you
interested in what they are saying. think it will be a comfort, and not because you feel
•• Use touch to communicate your caring and concern helpless and cannot think of anything to say.
7
2. Be able to meet the

communication and language
needs, wishes and preferences
of individuals
2.1 Finding out an individual’s
communication and language needs
and preferences
Not everyone communicates in the same way and it is important that
you make sure that you are able to communicate with the people you
support in the best way for them. People have a wide range of
communication needs that involve the consideration of many
different factors such as:
•• sensory ability
•• cultural background
•• language
•• self-confidence
•• level of learning ability
•• physical ability.
As a professional, it is your responsibility to make sure that your
communication skills meet the needs of the people you support.
You should not expect people to adjust their communication to fit
in with you.
The best way to find out about what people want and need, of
course, is to ask! The person concerned is always your first and best
source of information about their needs and the best way to meet
them. But asking is not always possible. You can discover some
information about communication needs, wishes and preferences by
observing someone or by talking with other colleagues who have
worked with the person previously, and often by talking to family or
friends. They are likely to have a great deal of information about the
communication needs of that person. They will have developed ways
of dealing with communication, possibly over a long period of time,
and are likely to be a very useful source of advice and help.
Passing on information
There would be little point in finding out about effective means of
communication with someone and then not making an accurate
record so that other people can also communicate with that person.
8
You should find out your employer’s policy on where such

information is to be recorded – it is likely to be in the person’s case
notes. Be sure that you record:
•• the nature of the communication needs, wishes and preferences
•• how they show themselves
•• ways that you have found to be effective in meeting their needs.
Information recorded in notes may look like this.
Mr Perkins has communication difficulties following

his stroke. He is aphasic, with left-side haemaplaegia.
Speech is slurred but possible to understand with care.
Most effective approaches are:
a) allow maximum time for communication responses
b) modify delivery if necessary in order to allow
understanding
c) speak slowly, with short sentences
d) give only one piece of information at a time
e) offer physical reassurance (holding and stroking
hand) as this seems to help while waiting for a
response
f) use flashcards on bad days (ensure they are placed
on the right-hand side)
g) check Mr Perkins has understood the conversation.
This is important in order to ensure all that colleagues do not

continually have to go through a process of establishing the
communication needs of each person.
Doing it well
Identifying communication needs
•• Check what each person’s communication needs, wishes and
preferences are.
•• Remember they can be dictated by cultural as well as physical
factors.
•• Examine the effects of the communication for each person.
•• Use all possible sources to obtain information.
•• Make sure you have all the skills necessary to communicate, or look
for extra support where necessary.
9
Communication needs people have

Reflect
Language
Try renting a DVD in a language
other than your own, or watch a When someone speaks a different language from those who are
subtitled film on TV, covering the providing support, it can be an isolating and frustrating experience.
lower half of the TV screen where The person may become distressed and frightened, as it is very
the subtitles are. Try to make sense difficult to establish exactly what is happening, and they are not in a
of what is shown in the film. How position to ask or to have any questions answered. The person will
difficult is it to understand what is feel excluded from anything happening in the care setting and will
happening and how frustrating is it? find making relationships with support staff extremely difficult. There
How quickly do you lose interest and is a strong possibility of confusion and misunderstanding.
decide that you will not bother to Hearing loss
watch any more? Imagine how that
feels if you are ill or in need of care, A loss or reduction of ability to hear clearly can cause major
and everyone around you is differences in the ability to communicate.
speaking in a language you do not Communication is a two-way process, and it is very difficult for
understand. somebody who does not hear sounds at all or hears them in a
blurred and indistinct way to be able to respond and to join in. The
result can be that people may feel very isolated and excluded from
others around them. This can lead to frustration and anger that may
cause people to present behaviour that provides you with some
challenges.
Profound deafness is not as common as partial hearing loss. People
are most likely to suffer from loss of hearing of certain sounds at
certain volumes or at certain pitches, such as high sounds or low
sounds. It is also very common for people to find it difficult to hear if
there is background noise – many sounds may jumble together,
making it very hard to pick out the voice of one person. Hearing loss
can also have an effect on speech, particularly for those who are
profoundly deaf and are unable to hear their own voices as they
speak. This can make communication doubly difficult.
Visual impairment
Visual impairment causes many communication difficulties. Not only
is a person unable to pick up the visual signals that are being given
out by someone who is speaking, but also, because they are unaware
of these signals, the person may fail to give appropriate signals in
communication. This lack of non-verbal communication and lack of
ability to receive and interpret non-verbal communication can lead to
misunderstandings about somebody’s attitudes and behaviour. It
means that a person’s communications can easily be misinterpreted;
they may seem to be behaving in a way that is not appropriate.
Key term Physical disability
Aphasia (or dysphasia) – a Depending on the disability, this can have various effects. People who
reduced ability to understand and to have had strokes, for example, may have communication difficulties,
express meaning through words not only in forming words and speaking, but also possibly from
aphasia (or dysphasia). People can lose the ability to find the right
10
words for something they want to say, or to understand the

meanings of words said to them. This condition is very distressing for
the person and for those who are trying to communicate. Often this
is coupled with a loss of movement and a difficulty in using facial
muscles to form words.
In some cases, the communication need is a symptom of a condition.
For example, many people with cerebral palsy and motor neurone
disease have difficulty in controlling the muscles that affect voice
production, and so clear speech becomes very difficult. Other
conditions may have no effect at all upon voice production or the
thought processes that produce spoken words, but the lack of other
body movements may mean that non-verbal communication is
difficult or not what you would expect.
Learning disability
Dependent upon severity, a learning disability may cause differences
in communication in terms of the level of understanding of the
person and their ability to respond appropriately to any form of
communication. This will vary depending on the degree of learning
disability of the person, but broadly the effect of learning disabilities is
to limit the ability of someone to understand and process information
given to them. It is also possible that some people will have a short
attention span, so this may mean that communications have to be
repeated several times in an appropriate form.
Dementia/confusion
This difficult and distressing condition is most prevalent in older
people and people who live with Alzheimer’s disease. The confusion
can result ultimately in the loss of the ability to communicate, but in
the early stages it involves short-term memory loss to the extent of
being unable to remember the essential parts of a conversation or a
recent exchange. It can mean the constant repetition of any form of
communication. This can be frustrating for you as you try to
communicate, but is equally frustrating for the person. You will need
to make sure your frustration is under control and that you do not
allow it to influence how you relate to the person.
Communication disorder
Key term Someone with a communication disorder, such as people who are on
Autistic spectrum – a spectrum the autistic spectrum, may have difficulty in communication, social
of psychological conditions interaction, and may show some repetitive and obsessive behaviours.
characterised by widespread As each person who has a communication disorder will behave
abnormalities of social interactions differently, you will need to find out about the person you are
and communication, as well as supporting and the particular aspects of communication and social
severely restricted interests and highly interaction that are affected.
repetitive behaviour
11
2.2 Communication methods that meet

an individual’s needs
Overcoming language differences in communication
Where you are supporting someone who speaks a different language
from you, it is clear that you will need the services of an interpreter
for any serious discussions or communication.
•• Your work setting is likely to have a contact list of interpreters.

•• Social services departments and the police have lists of
interpreters.
•• The embassy or consulate for the appropriate country will also
have a list of qualified interpreters.
You should always use professional interpreters wherever possible. It
may be very tempting to use other members of the family – very
often children have excellent language skills – but it is inappropriate
in most situations. This is because:
•• the family member’s English and their ability to interpret may not
be at the same standard as a professional interpreter’s, and
misunderstandings can easily occur
•• the person may not want members of their family involved in very
personal discussions about health or care issues.
It is unlikely that you would be able to have a full-time interpreter
available throughout somebody’s period of care, so it is necessary to
consider alternatives for encouraging everyday communication.
Can you see how you could use these cards?
12
Be prepared to learn words in the person’s language. You could try to

give the person some words in your language if they are willing and
able to learn them.
There are other simple techniques that you may wish to try which can
help basic levels of communication. For example, you could use
flashcards and signals, similar to those you would use for a person
who has suffered a stroke. The person can show a flashcard to
indicate their needs. You can also use these cards to find out what
kind of assistance the person may need.
The suggestions shown on the previous page are not exhaustive and
you will come up with others that are appropriate for the person and
the particular setting. They are a helpful way of assisting with simple
communication and allowing people to express their immediate
physical needs.
The most effective communication with a person who speaks a
different language is non-verbal communication. A smile and a
friendly face are understood in all languages, as are a concerned
facial expression and a warm and welcoming body position.
However, be careful about the use of gestures – gestures that are
acceptable in one culture may not be acceptable in another. For
example, an extended thumb in some cultures would mean ‘great,
that’s fine, OK’, but in many cultures it is an extremely offensive
gesture. If you are unsure which gestures are acceptable in another
culture, make sure you check before using them.
Meeting communication needs for someone with a

hearing impairment
Ensure that any means of improving hearing (for example, a hearing
aid) which the person uses is:
•• working properly
•• fitted correctly
•• installed with fresh, working batteries
•• clean
•• doing its job properly in terms of improving the person’s hearing.
Ensure that you are sitting in a good light, not too far away and that
you speak clearly, but do not shout. Shouting simply distorts your
face and makes it more difficult for a person with hearing loss to be
able to read what you are saying.
Some people will lip read, while others will use a form of sign
language for understanding. This may be BSL (British Sign Language)
or Makaton, which uses signs and symbols. The person may rely on a
combination of lip reading and gestures.
If you are able to learn even simple signing or the basic rules of
straightforward spoken communication with people who have
hearing loss, you will significantly improve the way in which they are
able to relate to their care environment.
13
Telecommunication services such as minicom or typetalk are very

useful for people with hearing loss. These allow a spoken
conversation to be translated in written form using a form of
typewriter, and the responses can be passed in the same way by an
operator who will relay them to the hearing person. These services
have provided a major advance in enabling people who are hard of
hearing or profoundly deaf to use telephone equipment. For people
who are less severely affected by hearing impairment, there are
facilities such as telephone handsets with adjustable volume. Texting
using a mobile phone has proved to be a very useful means of
communication for people with a hearing impairment, and its use is
by no means confined to young people. All age groups are making
full use of technology to improve communication.
Meeting communication needs for someone with a

visual impairment
One of the most common ways of assisting people who have visual
impairment is to provide them with glasses or contact lenses. You
need to be sure that these are clean and that they are the correct
prescription. You must make sure that people know they should have
their eyes tested every two years and regularly update their glasses or
lenses. A person whose eyesight and requirements for glasses have
changed will obviously have difficulty in picking up many of the
non-verbal signals that are part of communication.
Doing it well
Meeting the needs of people with be appropriate to touch someone’s hand or arm, at
visual impairments the same time as saying you are concerned and
sympathetic.
•• Let them know that you are there by touching and
•• Ask the person what system of communication they
saying hello, rather than suddenly beginning to require – do not impose your idea of appropriate
speak to someone. systems on the person. Most people who are visually
•• Make sure that you introduce yourself when you impaired know very well what they can and cannot
come in to a room. It is easy to forget that someone do, and if you ask they will tell you exactly what they
cannot see. A simple ‘hello John, it’s Sue’ is all that is need you to do.
needed so that you do not ‘arrive’ unexpectedly.
•• Do not decide that you know the best way to help.
•• You may need to use touch more than you would Never take the arm of somebody who is visually
when speaking to a sighted person, because the impaired to help them to move around. Allow the
concerns you will be expressing through your face person to take your arm or shoulder, to ask for
and your general body movements will not be seen. guidance and tell you where they want to go.
So, if you are expressing concern or sympathy, it may
14
Meeting communication needs of people with a

physical disability
Physical disability or illness has to be dealt with according to the
nature of the disability or the illness. For example, if you were
communicating with somebody who had a stroke, you might have to
work out ways of coping with dysphasia. This is best dealt with by:
•• using very simple, short sentences, speaking slowly, and then

being prepared to wait while the person processes what you have
said and composes a reply
•• using gestures – they make it easier for people to understand the
idea you are trying to get across
•• using very simple, closed questions which only need a ‘yes’ or ‘no’
answer. Avoid long, complicated sentences with interrelated ideas
(for example, do not say, ‘It’s getting near tea time now, isn’t it?
How about some tea? Have you thought about what you would
like?’ Instead say, ‘Are you hungry? Would you like fish? Would
you like chicken?’ and so on, until you have established what sort
of meal the person wants)
•• drawing or writing or using flash cards to help understanding.
Other illnesses, such as motor neurone disease or cerebral palsy, can
also lead to difficulties in speech, although not in comprehension. The
person will understand perfectly what you are saying but the difficulty
may be in communicating with you. There is no need for you to
speak slowly, although you will have to be prepared to allow time for
a response, owing to the difficulties the person may have in
producing words.
You will also have to become familiar with the sound of the person’s
voice and the way in which they communicate. It can be hard to
understand people who have illnesses that affect their facial, throat or
larynx muscles. The person may have been provided with assistive
technology that will enable them to communicate through producing
an electronic ‘voice’.
Meeting the communication needs of people with a

learning disability
Where people have a learning disability, you will need to adjust your
methods of communicating to take account of the level of disability
that they experience. You should have gathered sufficient information
about someone to know the level of understanding they have – and
how simply and how often you need to explain things and the sorts
of communication which are likely to be the most effective.
Some people with a learning disability respond well to physical
contact and are able to relate and communicate on a physical level
more easily than on a verbal level. This will vary between people and
you must find out the preferred means of communication for the
person you are supporting.
15
Sometimes touch can be helpful.
Communication through actions

For many people, it is easier to communicate by actions than by
words. You will need to make sure that you respond in an appropriate
way by recognising the significance of a touch or a sudden movement
from somebody who is ill and confined to bed, or a gesture from
somebody who speaks a different language. A gesture can indicate
needs and what sort of response the person is looking for from you.
You may be faced with a person with challenging behaviour who
throws something at you – this is a means of communication. It may
not be a very pleasant one, but nonetheless it expresses much of the
person’s hurt, anger and distress. It is important that you recognise
this for what it is and respond in the same way you would if that
person had been able to express their feelings in words.
2.3 How and when to seek advice about

communication
Do not assume that you can do everything yourself without any help.
You should always be ready to ask for advice and support when you
are unsure or when situations are highly complex. The best people to
ask for advice are, of course, the person themselves and their family
and friends. However, sometimes you may need to talk to your line
manager to get specialist advice. Your manager will be able to advise
you about how to contact specialist organisations who will have
information about communication with people with particular
conditions such as a stroke or Alzheimer’s disease, or organisations
with specific knowledge about communication with people with
sensory loss. There is plenty of expert information available, so make
sure that you find out about it and never guess what to do or think
that you will be able to manage. Your professional duty is to find
whatever expert advice you may need in order to provide the best
possible service.
16
3. Be able to overcome barriers

to communication
3.1 Identifying barriers to effective
communication
Not all communication is straightforward – on many occasions there
are barriers to overcome before any effective interaction can take
place. Barriers can exist for all sorts of reasons, some to do with the
physical environment, some to do with the background and
circumstances of the person, and some to do with your approach.
The first barriers to check out are those that you could be creating.
You may think that you are doing everything possible to assist
communication, but be sure that you are not making it difficult for
people to understand what you say.
As professional care workers, you will use all kinds of shortcuts to
speak with colleagues. Using initials (acronyms) to refer to things is
one of the most common ways in which professionals shortcut when
talking to each other. Some acronyms are commonplace and others
are particular to that work setting. Often, particular forms or
documents are referred to by initials – this is obviously useful in one
workplace, but not in any others! Referring to medical conditions,
types of medication or therapies, or activities by initials or professional
jargon can make it difficult for someone to understand because this is
terminology they do not use everyday. Many of us would have
difficulty following the explanation of a mechanic as to what is wrong
with a car – similarly people and their families may have difficulty
following communication littered with jargon and technical terms.
It is not that unusual to hear something on the lines of: ‘Right – we’ve
checked your BP – that’s fine; your Hb came back OK so that means
we can do an RF down to Gill our OT. She’ll come and see you then
fill out a 370 – that’ll go to social services who’ll send a CCM out to
do an UA and formulate a support plan – OK?’
It may have been more useful to say: ‘Your blood pressure’s fine, the
blood test showed that you’re not anaemic, so that means you’re
well enough for us to contact Gill, the occupational therapist. She will
see you and assess what you can do and what help you may need.
After that she’ll contact social services, and one of the community
care managers will visit you to talk about the sort of help and support
you would like to have.’ It takes a little longer, but it saves time and
confusion in the long run.
Some barriers to communication can be caused by failing to follow
some of the steps towards good communication, such as those
shown on the diagram on the next page.
17
Four communication barriers. Can you identify any others?
There are many factors that can get in the way of good
communication. You will need to understand how to recognise these
and to learn what you can do to overcome them. Until you do this,
your communication will always be less effective than it could be. It is
easy to assume that everyone can communicate, and that any failure
to respond to you is because of someone’s unwillingness rather than
an inability. There are as many reasons why people find
communication a challenge as there are ways to make it easier.
Reflect Thinking about the obstacles
Choose two different ways in
Never assume that you can be heard and understood, and that you
which you communicate with
can be responded to, without first thinking about the person and
people, for example, talking, writing,
their situation. Check to ensure you are giving the communication the
telephone, email – you can probably
best possible chance of success by dealing with as many barriers as
think of others. Consider the most
possible. Do not just go in and decide that you will deal with
important element in each one. For
obstacles as they arise; some forward planning and thinking about
example, for talking it could be
how you will deal with barriers will result in far better outcomes.
language, for telephone it could be
hearing, and so on. Now think 3.2 Ways to overcome barriers to
about how you would manage that
communication without that effective communication
important element. List the problems
Encouraging communication
you would have and the ways you
could try to overcome them. Do you The best way to ensure that somebody is able to communicate to the
begin to see how difficult it can best of their ability is to make the person feel as comfortable and as
sometimes be for people to relaxed as possible. There are several factors to consider when
communicate? thinking about how to make people feel confident enough to
communicate. Table 1 (see next page) summarises these.
18
Communication Encouraging actions

difference
Different language •• Smile and maintain a friendly facial expression.
•• Use gestures and pictures.
•• Be warm and encouraging – repeat the person’s words with a smile to check
understanding.
Hearing impairment •• Speak clearly, listen carefully, respond to what is said to you.
•• Remove any distractions and other noises.
•• Make sure any aids to hearing are working.
•• Use written communication where appropriate.
•• Use signing where appropriate and understood.
•• Use properly trained interpreter if high level of skill is required.
Visual impairment •• Use touch to communicate concern, sympathy and interest.

•• Use tone of voice rather than facial expressions to communicate mood and
response.
•• Do not rely on non-verbal communication such as facial expression or nodding
your head.
•• Ensure that all visual communication is transferred into something which can
be heard, either a tape or somebody reading.
Confusion or dementia •• Repeat information as often as necessary.

•• Keep re-orientating the conversation if you need to.
•• Remain patient.
•• Be very clear and keep the conversation short and simple.
•• Use simple written communication or pictures where they seem to help.
Physical disability •• Ensure that surroundings are appropriate and accessible.

•• Allow for difficulties with voice production if necessary.
•• Do not patronise.
•• Remember that some body language may not be appropriate.
Learning disability •• Judge appropriate level of understanding.

•• Make sure that you respond at the right level.
•• Repeat things as often as necessary.
•• Remain patient and be prepared to keep covering the same ground.
Table 1: Ways of encouraging communication.
Key term 3.3 Ways to ensure that communication

Accessible – able to be obtained, has been understood
used or experienced without
Although it is unacceptable to talk down to people, it is pointless
difficulty
trying to communicate with them by using so much jargon and
medical terminology that they do not understand anything you have
said. You must be sure that your communication is being understood.
The most straightforward way to do this is to ask someone to recap
on what you have discussed.
You could say something like, ‘Can we just go over this so that we are
both sure about what is happening? You tell me what is happening
19
tomorrow’, or you can rephrase what you have just said and check
with the person that they have understood. For example:
‘The bus is coming earlier than usual tomorrow because of the trip. It
will be here at eight o’clock instead of nine – is that OK?’
‘Yes.’
Reflect ‘So, you’re sure that you can be up and ready by eight o’clock to go
Think about a time you have talked on the trip?’
to someone you felt was really
interested in what you were saying
Listen effectively
and listening carefully to you. Try to As already mentioned, communication is a two-way process. This
note down what it was that made may sound obvious, but a great deal of communication is wasted
you so sure they were really because only one of the parties is communicating. Think about
listening. Did the fact you thought setting up communication between two radios – when
they were really listening to you communication is established, the question is asked: ‘Are you
make it easier to talk? receiving me?’ The answer comes back: ‘Receiving you loud and
clear.’ Unfortunately, human beings do not do this exercise before
they talk to each other!
You can communicate as much information as you like, but if no one
is listening and receiving the information, you are wasting your time.
Learning how to listen is a key task for working as a professional
support worker.
You may think that you know how to listen and that it is something
you do constantly, that you are listening to all sorts of noises all day
long – but simply hearing sounds is not the same thing as actively
listening.
For most people, feeling that someone is really listening to them
makes a huge difference to how confident they feel about talking
and thus improves the chances of them being clearly understood.
You will need to learn about ways in which you can show people that
you are listening to what they are saying.
Using body language

You have already looked at non-verbal communication earlier in this
unit. It is an essential part of ensuring that communication is
understood. Although you may think that you do most of your
communicating by speaking, in fact over 90 per cent of what you
communicate to others is done without speaking a word. Body
language, or non-verbal communication, is the way in which we pick
up most of messages people are trying to convey – and some that
they are not!
The way in which you use your body can convey messages about
your:
•• feelings •• interest
•• attitudes •• concern
•• intentions •• attention.
20
Can you see how the actions and words do not match?
The messages are made clear by such things as facial expression,

maintaining eye contact, sitting forward when you are listening or
having an open and relaxed posture.
Remember: body language backs up the words you use – or can
make a liar of you!
Your body language will let people know that you are really listening
to what they are saying and are understanding what they trying to
communicate. Practise your listening skills in just the same way you
would practise any other skill – you can learn to listen well.
Doing it well
Practising your listening skills
•• Look at the person who is talking to you.
•• Maintain eye contact with them, but without staring.
•• Nod your head to encourage them to talk and show that you
understand.
•• Use ‘aha’, ‘mm’ and similar expressions which indicate that you are
still listening.
•• Lean slightly towards the person who is speaking, as this indicates
interest and concern.
•• Have an open and interested facial expression, which should reflect
the tone of the conversation – happy, serious and so on.
Using verbal communication

Body language is the key to effective listening, but what you say is
also important. You can back up the message that you are interested
21
and listening by checking that you have understood what has been
said to you. Using ‘So…’ to check that you have got it right can be
helpful. ‘So… it’s only since you had the fall that you are feeling
worried about being here alone.’ ‘So… you were happy with the
service before the hours were changed.’ You can also use phrases
such as ‘So what you mean is…’ or ‘So what you are saying is…’
You can use short, encouraging phrases while people are talking to
show concern, understanding or sympathy. Phrases such as ‘I see’,
‘Oh dear’, ‘Yes’ and ‘Go on’ all give the speaker a clear indication
that you are listening and want them to continue.
Using questions
Sometimes questions can be helpful to prompt someone when they
are talking, or to try to move a conversation forward. Asking the right
questions can help you to understand what is being communicated.
A closed question can be answered with ‘yes’ or ‘no’ – for example,
‘Would you like to go out today?’
An open question needs more than ‘yes’ or ‘no’ to answer it – for
example, ‘What is your favourite kind of outing?’ Open questions
usually begin with:
•• what •• when
•• how •• where.
•• why
Depending on the conversation and the circumstances, either type of

question may be appropriate. For example, if you are encouraging
someone to talk because they have always been reluctant, but have
suddenly begun to open up, you are more likely to use open
questions to encourage them to carry on talking. On the other hand,
if you need factual information or you just want to confirm that you
have understood what has been said to you, then you may be better
off asking closed questions.
Activity 4
Open and closed questions
What type of question is each of the following?
1. ‘Are you feeling worried?’

2. ‘What sorts of things worry you?’
3. ‘What have you got planned for when your daughter comes
to visit?’
4. ‘Is your daughter coming to visit?’
5. ‘Why were you cross with Marge this morning?’
6. ‘Were you cross with Marge this morning?’
7. ‘Do you want to join in the games tonight?’
8. ‘Do you live here alone?’
9. ‘How do you feel about living alone?’
22
One of the main points to remember is that whatever you say, there
Reflect
should not be too much of it! You are supposed to be listening in
Think about two particular occasions order to understand, not speaking. Some ‘do nots’ for good listening
when you have been involved in are as follows.
communicating with people you
were supporting. Write a brief
•• Do not interrupt – always let people finish what they are saying;
wait for a gap in the conversation.
description of the circumstances,
and then write notes on how you
•• Do not give advice – even if asked. You are not the person
concerned, so cannot respond to a question beginning, ‘If you
showed that you were listening to
were me…’ Your job is to encourage people to take responsibility
them. If you have not yet had
for their own decisions, not to tell them what to do.
enough experience of working with
people to be able to think of two
•• Do not tell people about your own experiences. These are relevant
to you because they teach you about how they have made you
occasions, think about times when
the person you are, but your role is to listen to others, not talk
you have listened effectively to a
about yourself.
friend or relative and write notes
about that instead.
•• Do not ever dismiss fears, worries or concerns by saying, ‘That’s
silly’ or ‘You shouldn’t worry about that.’ People’s fears are real
and should not be made to sound trivial.
3.4 Sources of information and support

or services to enable more effective
communication
Sometimes, you will need to find specialist advice because a person’s
communication needs are too complex for you to deal with alone.
Someone who has an illness that affects their ability to produce
sounds or control their neck and facial muscles may need to speak
using a piece of assistive technology. For these sorts of complex
issues, you will need the advice of a speech and language therapist
who is an expert and can advise on any kind of specialised
communication needs.
Where there are language issues, you may need to use the services of
an interpreter. You should be able to find details of how to contact
one from your line manager. Social services and the police will also
have a list of language interpreters and, if necessary, the embassy or
consulate of the relevant country will also have a list.
There is the NRCPD (National Registers of Communication
Professionals working with Deaf and Deafblind People). This includes
sign language interpreters, lip speakers, deaf-blind communicators
and note takers. The register can be accessed on www.nrcpd.org.uk
There are condition-specific organisations such as the Alzheimer’s
Society (www.alzheimers.org) and the Stroke Association
(www.stroke.org.uk) that can help with expert advice on
communication with people with specific issues related to their
conditions. Specialist organisations exist for most conditions and can
provide much useful advice and information.
23
4. Be able to respect equality and

diversity when communicating
4.1 How people from different
backgrounds may use and/or interpret
communication methods in different ways
Communication is about much more than words being exchanged
between two people – it is influenced by a great many factors.
People’s background, what they believe in and the culture in which
they live has a significant effect on communication.
Culture is about more than language – it is about the way that people
live, think and relate to each other.
It is also important that you always communicate at a language level
that people are likely to understand, but do not find patronising.
Everyone has the right to be spoken to as an adult and not be talked
down to.
Talking to carers over someone’s head is infuriating and insulting to
the person – commonly known as the ‘Does he take sugar?’ attitude.
Can you imagine how angry this would make you?
24
What words mean

Be aware that the words you use can mean different things to
different people and generations – for example, words like ‘cool’,
‘chip’, ‘wicked’ or ‘gay’. Be aware of particular local words that are
used in your part of the country, which may not mean the same to
someone from another area.
Think carefully about the subject under discussion. Some people from
particular cultures, or people of particular generations, may find some
subjects very sensitive and difficult to discuss. These days, it is not
unusual among a younger age group to discuss how much people
earn. However, people of older generations may consider such
information to be highly personal.
4.2 Communication that respects

equality and diversity
You will need to be aware of cultural differences between you and
the person you are talking to. For example, using first names, or
touching someone to whom you are not related or a very close friend
with, can be viewed as disrespectful in some cultures. Talking in a
familiar way to someone of a different gender or age group can be
unacceptable in some cultures. For example, some young Muslim
women do not talk at all with men to whom they are not related.
Many older men and women consider it disrespectful to address
Activity 5 people by their first names. You will often find older people with
Checking cultural neighbours they have known for 50 years, who still call each other
‘Mrs Baker’ or ‘Mrs Wood’.
preferences
In some cultures, for example, children are not allowed to speak in
Find out the policy in your
the presence of certain adults. Beliefs in some cultures do not allow
workplace for checking on people’s
women to speak to men they do not know.
cultural preferences. Ask who
establishes the information about Some people may have been brought up in a background or in a
the cultural background of people period of time when challenging authority by asking questions was
who use your service, and what the not acceptable. Such people may find it very hard to ask questions
policies are to ensure their needs of doctors or other health professionals and are unlikely to feel able
are met. to raise any queries about how their care or treatment should be
carried out.
25
5. Be able to apply principles

and practices relating to
confidentiality at work
5.1 Explaining the term confidentiality
Confidentiality means not sharing information about someone
without their knowledge and agreement and ensuring that written
and electronic information cannot be accessed or read by people who
have no reason to see it. Confidentiality is important because:
Key term
•• people may not trust a support worker who does not keep
information confidential
Self-esteem – how people •• people may not feel valued or able to keep their self-esteem if
value themselves; how much their private details are shared with others
self-respect and confidence •• people’s safety may be put at risk if details of their property and
they have habits are shared publicly.
A professional service that maintains respect for people must keep
private information confidential. There are legal requirements under
the Data Protection Act 1998 to keep personal records confidential
(see page 240). There are also professional requirements laid down by
the regulators that make it the duty of professionals to keep
information confidential.
5.2 Confidentiality in day-to-day

communication
The basic rule is that all information someone gives, or that is given
on their behalf, to an organisation is confidential and cannot be
disclosed to anyone without the consent of that person.
There are, however, circumstances in which it may be necessary to
pass on information.
In many cases, the passing on of information is routine and related to
someone’s care. For example, medical information may be passed to
a hospital, to a residential home or to a private agency. It must be
made clear to the person that this information will be passed on in
order to ensure they receive the best possible care.
The key is that only information that is required for the purpose is
passed on. For example, it is not necessary to tell the hearing aid clinic
that Mr Smith’s son is currently serving a prison sentence. However, if
he became seriously ill and the hospital wanted to contact his next of
kin, that information would need to be passed on.
26
Each organisation should have a policy which states clearly the

circumstances in which information can be disclosed. According to
government guidelines (Confidentiality of Personal Information 1988)
the policy should state:
•• who the members of senior management designated to deal with

decisions about disclosing information are
•• what to do when urgent action is required
•• what safeguards are in place to make sure that the information
will be used only for the purpose for which it is required
•• arrangements for obtaining manual records and computer records
•• arrangements for reviewing the procedure.
The most common way in which workers breach confidentiality is by
chatting about work with friends or family. It is very tempting to
discuss the day’s events with your family or friends over a drink or a
meal. It is often therapeutic to discuss a stressful day, and helps get
things into perspective. But you must make sure that you talk about
issues at work in a way that keeps people’s details confidential and
anonymous.
For example, you can talk about how an encounter made you feel
without giving any details of the other people involved. You can say,
‘Today this person accused me of stealing all their money – at first I
was so angry I didn’t know what to say! What would you have
done?’ You can discuss the issue without making reference to
gender, ethnicity, age, physical description, location or any other
personal information that might even remotely identify the person
concerned. The issue is how you felt and what you should do, and
you are always free to discuss yourself.
Reflect
Think of a time when you have
told someone something in
confidence and later discovered that
they had told other people. Try to
recall how you felt about it. You
may have felt angry or betrayed.
Perhaps you were embarrassed and
did not want to face anyone. Note
down a few of the ways you felt.
1. Have you ever betrayed

someone’s confidence – even
accidentally?
2. Are you honestly always as
careful as you should be about
what you say and to whom you Do you discuss your day with friends?
say it?
27
It might be considered a breach of your professional code of conduct

to discuss a person’s details with people who do not have a need to
know. The essential issue is trust; even if no one can identify the
name of the person involved, others might perceive you as displaying
a lack of respect if you talk in public places about the personal
characteristics of the people you work with.
Imagine you were in a restaurant and you overheard staff from a local
clinic saying: ‘You wouldn’t believe how ugly some of the patients
are! The other day we had this 40-year-old, dark-haired woman –
lives in Meadow Close – she had a face like the back of a bus. Well,
the operation went wrong – but I mean, what’s she got to live for
anyway?’ Now imagine that you were about to attend that clinic.
Functional skills Would you want those staff to look after you? The principle of
confidentiality is about trust and confidence in professional workers,
English: Speaking and
not only about protecting the identity of someone.
listening
You also need to be sure you do not discuss one person you support
Have a discussion with the team you with another whom you also support. You may not think you ever
are working with about the would, but it is so easy to do, even if you do not mean to.
importance of maintaining
confidentiality for people in your
Imagine the scene. A woman says, ‘Ethel doesn’t look too good today’,
place of work. This discussion could
and your well-meant response is, ‘No, she doesn’t. She’s had a bit of an
include when/if confidentiality needs
upset with her son. She’d probably be really glad of some company
to be broken. You will need to take
later, if you’ve got the time.’ This response could cause great distress
an active role in this discussion to
and, above all, distrust. If the woman later says to Ethel, ‘Sue said you
show that you can both present
were a bit down because of the upset with your son’, Ethel is not going
information and pick up on points
to know how much you have said. As far as she is aware, you could
made by others, and that all your
have given her whole life history to the woman who enquired. The
contributions are presented clearly
most damaging consequence of this breach of confidentiality is the loss
using appropriate language.
of trust. This can have damaging effects on someone’s self-esteem,
confidence and general well-being.
In this case, the best way to respond to the woman’s comment would
have been, ‘Don’t you think so? Well, perhaps she might be glad of
some company later if you’ve got the time.’
Case study
Security and confidentiality

Orchard Way Care Home is a 14-bed residential unit for was being discussed in general at a family occasion. Her
older people with moderate care needs. Mrs Reynolds niece had given examples of some of the people at the
has been there for five years. Her daughter visits most home who had had money in the bank when they
days and she has regular visits from former neighbours, first arrived, but now it had all been spent on fees.
so has been able to stay in touch with her local Mrs Reynolds’ daughter was furious and demanded
community. that the member of staff be sacked immediately.
One day, her daughter arrives and is extremely angry. 1. What are the confidentiality issues in this situation?
She said that one of the neighbours was discussing how 2. What action should be taken over the member of
awful it was that her mother’s money had now almost staff?
gone on the residential fees. She explained that the 3. What actions could be taken to improve
woman’s niece worked in the home and the subject understanding of confidentiality at Orchard Way?
28
Policies of the organisation

Every organisation will have a policy on confidentiality and the
disclosure of information. You must be sure that you know what
both policies are in your workplace.
The basic rule is that all information someone gives, or that is given
disclosed to anyone without the consent of that person. You will
need to support people in contributing to and understanding records
and reports concerning them, and ensure they understand how the
rules of confidentiality affect them.
5.3 Situations where normally confidential

information might need to be passed on
There are several reasons why decisions about disclosing information
without consent may need to be made, and you should inform the
person about what has been disclosed at the earliest possible
Key term
opportunity. Information may be required by a tribunal, a court or by
Ombudsman – a public officer the ombudsman. Ideally this should be done with the person’s
who investigates complaints about consent, but it will have to be provided regardless of whether the
poor service or unfair or improper consent is given.
actions from public services
You may have to consider the protection of the community, if there is
a matter of public health at stake. You may be aware that someone
has an infectious illness, or is a carrier of such an illness and is putting
people at risk. For example, if someone was infected with salmonella,
but still insisted on going to work in a restaurant kitchen, you would
have a duty to inform the appropriate authorities. There are other
situations where you may need to give information to the police. If a
serious crime is being investigated, the police can ask for information
to be given. Not only can information only be requested in respect of
Reflect a serious offence, it has to be asked for by a senior-ranking officer of
at least the rank of superintendent. This means that if the local
Disclosure without consent is constable asks if you know whether Mr Jenkins has a history of
always a difficult choice. Your mental health problems, this is not information you are free to
decision must be taken in discuss.
consultation with your supervisor
and in line with your organisation’s There may also be times when it is helpful to give information to the
policy. Remember the following media. For example, an elderly confused man, who wanders regularly,
main reasons why you may need to may have gone missing for far longer than usual. A description given
do this: out on the local radio and in the local paper may help to locate him
before he comes to any serious harm.
•• if it is in the person’s interest
•• if there is a serious risk to the If you have been given information by a child concerning abuse, you
have to pass on the information to your line manager, or whoever is
community
•• if there has been a serious crime, named in the alerting procedures. This is not a matter of choice; even
if the child refuses to agree, you have a duty to override their wishes.
or if the risk of one exists
•• in the case of an official/legal There are no circumstances in which disclosures of abuse of children
must be kept confidential.
investigation.
29
The situation with an adult, perhaps an older person, who is being

abused is different. You can only try to persuade them to allow you
to pass on the information.
You may be faced with information which indicates that someone
intends to harm themselves. In that situation, you would be justified
in breaking a confidence to prevent harm.
If someone is threatening to harm someone else, you should pass on
the information immediately to your line manager, who will inform
the police. It is not appropriate to contact the threatened person
directly.
People who need to know

It can be difficult when people claim to have a right or an interest in
seeing someone’s records. Of course, there are always some people
who do need to know, either because they are directly involved in
supporting the person or because they are involved in some other
support role. However, not everyone needs to know everything, so it
is important that information is given on a ‘need to know’ basis. In
other words, people are told what they need to know in order to
carry out their role.
Relatives will often claim that they have a right to know. The most
famous example of this was Victoria Gillick, who went to court in
order to try to gain access to her daughter’s medical records. She
claimed that she had the right to know if her daughter had been
given the contraceptive pill. Her GP had refused to tell her and she
took the case all the way to the House of Lords, but the ruling was
not changed and she was not given access to her daughter’s records.
The rules remain the same. Even for close relatives, the information is
not available unless the person agrees.
It is difficult, however, if you are faced with angry or distressed
relatives who believe that you have information they are entitled to.
One situation you could encounter is where a daughter, for example,
believes that she has the right to be told about medical information in
respect of her parent. Another example is where someone is trying to
find out a person’s whereabouts. The best response is to be clear and
assertive, but to demonstrate that you understand that it is difficult
for them. Do not try to shift responsibility and give people the idea
that they can find out from someone else. There is nothing more
frustrating than being passed from one person to another without
anyone being prepared to tell you anything. It is important to be clear
and say something like, ‘I’m sorry. I know you must be worried, but I
can’t discuss any information unless your mother agrees’ or ‘I’m sorry,
I can’t give out any information about where Jennie is living now. But
if you would like to leave me a name and contact details, I will pass
on the message and she can contact you.’
30
Proof of identity
You should always check that people are who they claim to be. It is
not unknown for newspaper reporters, unwanted visitors or even a
nosy neighbour to claim that they are relatives or professionals from
another agency. If basic precautions are not taken to confirm their
identity, then they may be able to find out a great deal of confidential
information.
5.4 How and when to seek advice about

confidentiality
If you are in a situation where you are unsure about how or if to
maintain confidentiality, then you must discuss it with your manager.
Every organisation will have policies on information sharing and
confidentiality and you will be able to access advice to ensure that
you are working within policy guidelines. Maintaining trust and
relationships with people while taking care of their best interests or
risks to others involves decisions you should not make alone. You
always need to discuss and think about these carefully, but these
situations are rare. The general rule is always that people’s
information is not shared with others without a very good reason.
Doing it well
Passing on confidential information safely
In person: if you do not know the person who is claiming On the telephone: unless you recognise the voice of the
to have a right to be given information, you should: person, you should:
•• find out whether they are known to any of your •• offer to take their telephone number and call them
colleagues back after you have checked
•• ask for proof of identity – if they claim to be from •• arrange a password if various family or friends are
another agency involved in providing care, they will likely to be telephoning about a particular person
have an official ID (identity card); otherwise, ask for a •• generally only give the information with consent
driving licence, bank cards and so on. •• only give people the information they need to know
to do their job
•• ensure the information is relevant to the purpose for
which it is required
•• check the identity of the person to whom you give
information
•• make sure you do not give information carelessly.
31
Case study
Giving out information

Mr Roberts is 59 years old. He is a resident in a nursing paternal grandfather died ‘insane’ and he has now
home, and he is now very ill. He has Huntington’s heard about his father being in a nursing home. He is
disease, which is a disease causing dementia, loss of terrified that his father has a hereditary disease and that
mobility and loss of speech. It is incurable and he may also have it. He has young children and is
untreatable, and it is hereditary. Mr Roberts was desperate to know if they are at risk too.
divorced many years ago when his children were very
1. What can you tell Mr Roberts’ son?
young and he has had no contact with his family
2. Does he have a right to know?
for over 30 years. A young man who says he is
3. What do you think should happen?
Mr Roberts’ son comes to the nursing home in great
4. Whose rights are your concern?
distress. He is aware, through his mother, that his

LO1 Communication is so fundamental to being an effective
care and support worker, that it is essential in all the
This requires you to show that you understand why
work you do. Assessors will be looking to see that you
communication is important. Other parts of this unit are
treat people with respect and that you recognise and
about demonstrating skills, but for this outcome you will
value diversity. You will need to show that you use a
need to show that you understand the theories behind
method of communication that the person chooses and
communication. You may be asked to prepare an
not use a ‘one size fits all’ approach. You will need to
assignment or a presentation, but you will need to be
show that you are able to overcome barriers to
able to show your assessor that you know why people
communication and that you can use techniques and
communicate, how people communicate and what can
approaches to make it possible for people to
get in the way of good communication.
communicate. You can do this by asking people, and by
LO2–4 using other sources of information to find out the best
These outcomes are about demonstrating your skills. way to communicate. Your assessor will be looking to
It is likely that you assessor will observe your see what approaches you are using and is likely to ask
communication skills while observing other skills. you about the reasons for using particular methods.
Functional skills
Legislation
English: Reading
Use the websites here to extend your
•• Confidentiality of Personal Information 1988
knowledge on the types of illnesses/

•• Data Protection Act 1998
disabilities that people you support

may have. Ensure that you Further reading and research
understand the terminology within
the texts and make notes on new •• www.alzheimers.org (the Alzheimer’s Society)
information to help you with your •• www.nrcpd.org.uk (National Registers of Communication
Professionals working with Deaf and Deafblind People)
work. By reading a range of texts,
you will develop your vocabulary and •• www.stroke.org.uk (the Stroke Association)
see different writing styles.
32
Unit SHC 22
Introduction to
personal development in
health, social care or
children’s and young
people’s settings
The care sector is constantly benefiting from new research, new

developments, policies and guidelines. You need to make sure
that you are up to date in work practices and knowledge, and
aware of current thinking. As a social care worker, you have a
responsibility to review and improve your practice constantly. It
is the right of people to expect the best possible quality of
support and care from those who provide it.
The knowledge and skills addressed in this unit are key to
working effectively in all aspects of your practice. It is essential
to know how to start to evaluate your work, how you can
improve on what you do, and understand the factors that have
influenced your attitudes and beliefs. The information in this
unit will help you to identify the best ways to develop and
update your own knowledge and skills.

1. what is required for competence in own work role
2. how to reflect on own work activities
3. how to agree a personal development plan
4. how to develop knowledge, skills and understanding.
33
1. Understand what is required

for competence in own work role
1.1 Duties and responsibilities of your role
The specific duties and responsibilities of your job will vary depending
on your role and the employer you work for. If you work for a large
Key term employer, whether in the public, private or voluntary sectors, you will
Induction – a formal briefing and probably have had a period of induction, where you will have
familiarisation for someone starting learned about:
at an organisation •• the policies and procedures of the organisation
•• how the structures work
•• the people who are your managers and supervisors.
If you work for a large organisation in the private, voluntary or
independent sector, such as a large charity or a private company with
many establishments across the country, you will also be likely to have
had a similar induction experience.
Working for smaller private or voluntary organisations, or working as
a personal assistant directly employed by the person you are
supporting, may mean that your initial induction was less formal and
you learned more ‘on the job’.
Regardless of how it happened, you will have been given an idea of
the duties and responsibilities of your job and what your employer
expects of you, and what you can expect in return.
However, the duties and responsibilities required by your employer
are not the only requirements of working in social care. The regulator
in the UK country in which you work will require that you follow the
Code of Practice that lays out the duties and expectations for
everyone who works in the sector.
Having Codes of Practice is important; in social care you work with
some of the most vulnerable people in society, who have a right to
expect a certain standard of work and a certain standard of moral
and ethical behaviour.
In order to work in social work anywhere in the UK and in social care
in some parts (soon to be all) of the UK, there is a requirement to be
registered. This means having, or working towards, a minimum level
of qualification and agreeing to work within the Code of Practice that
sets out the behaviour required. Employers have to ensure that
everyone who works for them is registered and eligible to work in
social work or social care. Currently, only social care practitioners in
Scotland and Wales are registered, but England and Northern Ireland
will be following in the near future. In any event, abiding by the
Codes of Practice is a good way of making sure that your practice is
following ethical and professional guidelines.
34
Introduction to personal development Unit SHC 22
Case study
Dealing with theft

Joanne works as a personal assistant to Esme, who lives involvement. Eventually Joanne broke down and
in Cardiff and has cerebral palsy. Esme is a regional admitted that she had been stealing the items because
organiser and fund-raiser for a large charity; she has a her boyfriend had a drug habit and he kept demanding
very busy and active life. She needs support workers to more and more money.
accompany her during all her business time in order to
Esme dismissed Joanne from her post and reported the
support her personal needs and to take notes at
matter to the police. She reported Joanne to the Care
meetings. Esme has recruited a team of support workers
Council for Wales, where she was interviewed by a
and they work in shifts. Several months after Joanne
disciplinary panel and was banned from working in
started working for her, Esme noticed that items were
social care for three years.
going missing from her house. Initially this was just
small things like CDs, then larger items, and money also 1. Do you think that Esme took the right actions?
started going missing from her purse. It always seemed 2. What else could she have done?
to link in to when Joanne had been working. Esme 3. What would have been the consequences of these
confronted Joanne, who initially denied any other courses of action?
1.2 Standards that influence the way your

role is carried out
Your job may have come with a job description, but while that tells
you what you need to do, it does not usually tell you how you need
to do it. To find that out, you need to look at the Standards that
apply to your work.
Standards and Codes of Practice will vary depending on the UK
country in which you work. Each UK country has National Minimum
Standards that are used by inspectors to ensure that services are
being delivered at an acceptable level. The National Minimum
Standards apply to all organisations that deliver social care, so your
employer will have to make sure that the services are up to the
necessary standards. The inspections are carried out by different
bodies for each of the UK countries, but they cover similar areas. The
examples in Table 1 are from the Care Quality Commission, which
inspects provision in England for all nursing homes, residential care
homes and domiciliary services. Their work is carried out under the
Health and Social Care Act 2008.
Key term Finally, and most importantly, in terms of how you carry out your
National Occupational Standards work are the National Occupational Standards. These apply across
– UK standards of performance that the whole of the UK, and explain what you need to be able to do,
people are expected to achieve in and what you need to know in order to work effectively in social care.
their work, and the knowledge and
skills they need to perform effectively
35
Area Required outcome
Care and welfare of people People experience effective, safe and appropriate care, treatment and support
who use services that meets their needs and protects their rights.
Assessing and monitoring People benefit from safe, quality care because effective decisions are made and
the quality of service because of the management of risks to people’s health, welfare and safety.
provision
Safeguarding people who People are safeguarded from abuse, or the risk of abuse, and their human rights
use services from abuse are respected and upheld.
Cleanliness and infection People experience care in a clean environment, and are protected from acquiring
control infections.
Management of medicines People have their medicines when they need them, and in a safe way. People are
given information about their medicines.
Meeting nutritional needs People are encouraged and supported to have sufficient food and drink that is
nutritional and balanced, and a choice of food and drink to meet their different
needs.
Safety and suitability of People receive care in, work in or visit safe surroundings that promote their
premises well-being.
Safety, availability and Where equipment is used, it is safe, available, comfortable and suitable for
suitability of equipment people’s needs.
Respecting and involving People understand the care and treatment choices available to them. They can
people who use services express their views and are involved in making decisions about their care. They
have their privacy, dignity and independence respected, and have their views and
experiences taken into account in the way in which the service is delivered.
Consent to care and People give consent to their care and treatment, and understand and know how
treatment to change decisions about things that have been agreed previously.
Complaints People and those acting on their behalf have their comments and complaints
listened to and acted on effectively, and know that they will not be discriminated
against for making a complaint.
Records People’s personal records are accurate, fit for purpose, held securely and remain
confidential. The same applies to other records that are needed to protect their
safety and well-being.
Requirements relating to People are kept safe, and their health and welfare needs are met, by staff who
workers are fit for the job and have the right qualifications, skills and experience.
Staffing People are kept safe, and their health and welfare needs are met, because there
are sufficient numbers of the right staff.
Supporting workers People are kept safe, and their health and welfare needs are met, because staff
are competent to carry out their work and are properly trained, supervised and
appraised.
Cooperating with other People receive safe and coordinated care when they move between providers or
providers receive care from more than one provider.
Table 1: Examples of standards in areas of social care.
36
The National Occupational Standards form the basis for all the
qualifications in the social care sector. They are divided into units of
competence – some of these are mandatory, and everyone should be
able to demonstrate competence in these areas. Other units are
optional and you should be able to demonstrate competence in those
units relevant to your job role.
Functional skills Activity 1

English: Reading Linking your work to the National
Use the websites listed in Activity 1 Occupational Standards
to gather information that shows Each of the units of assessment in the Level 2 Diploma is based on
you have met the requirements for units of competence from the National Occupational Standards.
your area of expertise. From your Choose any of the units of assessment from your Diploma qualification
reading, make notes to show the and find the matching unit of competence. Can you see the links to
links between the work you are the work you are doing for your qualifications? You will be able to find
doing and the skills you have the Standards from your relevant Sector Skills Council as follows.
developed from working in the
care sector.
•• England: Skills for Care (www.skillsforcare.org.uk)
•• Wales: Care Council for Wales (www.ccwales.org.uk)
•• Scotland: Scottish Social Services Council (www.sssc.uk.com)
•• Northern Ireland: Northern Ireland Social Care Council
(www.niscc.info)
How can you show that you have met the requirements set out in the
National Occupational Standards?
National Occupational
Standards
National Minimum
Regulators
Standards
Good
practice
Inspectors Codes of Practice
Assessors
All of the standards and people who support good practice.
37
Competence
Key term
In general terms, competence means that you are able to do
Competence – demonstrating
something well, but when it applies to performing your job role, it
the skills and knowledge required
has a quite specific meaning. Competence means that you have been
by National Occupational
able to provide evidence that you can demonstrate the skills and the
Standards
underpinning knowledge contained in the National Occupational
Standards. It is important to understand that competence is not only
about doing the job, it is also about understanding why you do what
you do and the theories that underpin the work.
1.3 How to ensure that your attitudes or

beliefs do not obstruct your work
Everyone has their own values, beliefs and preferences. They are an
essential part of who you are. What you believe in, what you see as
important and what you see as acceptable or desirable are as much a
part of your personality as whether you are shy, outgoing, funny,
serious, friendly or reserved.
People who work supporting others need to be more aware than
most of how their work can be affected by their own beliefs. If you
are working in a factory producing electronic chips, the production
line will continue to operate regardless of whether you view your job
as interesting or boring; it will still continue if you shout abuse at it –
your opinion will have no effect on the end result of the work. As
long as you continue to play your part in the process, the chips will be
turned out and the job will be completed satisfactorily.
If you work in a library, people will still continue to borrow and read
books that you consider boring, poorly written or distasteful. With the
exception of a small number of those who might ask your advice,
most of the people for whom you provide a service will remain
unaware of your beliefs, interests or values. However, if you work
supporting others and your work involves you making relationships
with vulnerable people and carrying out tasks which affect their
health and well-being, then your own attitudes, values and beliefs are
very important.
The way in which you respond to people is linked to what you believe
in, what you consider important and the things that interest you. You
are likely to find that you respond warmly to people who share your
values and less warmly to people who have different views. When
you develop friendships it is natural to spend time with people who
Reflect share your interests and values, those who are ‘on your wavelength’.
Think about the people that you If you are a person who enjoys a night out where there is plenty of
get on with. You are likely to find lively activity, modern music and dancing, you are not likely to choose
that they have similar interests and to spend time with someone whose perfect evening is to stay in with
views to your own. This will certainly a bottle of wine and listen to opera. Everyone is different and while
be true of those to whom you are you can recognise and respect the enjoyment that someone may
closest. achieve from an evening with Mozart, you may not choose to share it
or feel that you have much in common.
38
Have you noticed how you have friendships with people who reflect your own
values, interests and beliefs?
However, the professional relationships you develop with people you

support are another matter. As a professional social care worker, you
are required to provide the same quality of care for all, not just for
those who share your views and beliefs. This may seem obvious, but
knowing what you need to do and doing it well are not the same
things.
Case study
Dealing with differing views

Frank is providing support for a young man, Greg, who Ellie believes that a healthy lifestyle is very important
has a degree of autism and a learning disability, but he and that everyone has a responsibility to themselves,
is very capable and functions well. Greg’s parents, their families and to society to eat well and to stay as fit
however, believe that he needs to be looked after and as possible. She is supporting Kate, a wife and mother,
that he will never be able to do anything for himself whose family smoke, drink, eat fast food every day and
or have any degree of independence. Frank believes spend their time either watching TV or playing
very strongly that everyone should be able to live life computer games. They are all obese and have difficulty
to the full and to make their own decisions about their getting around; as a result, none of the family is able to
future. do much to support Kate, who has personal care needs.
1. How would this affect Frank’s relationship with the 2. How would Ellie be able to work with this family?
parents?
You may believe that you treat everyone in the same way, but there
can often be differences in approach or attitude of which you may be
unaware. For example, you may spend more time with someone who
is asking your advice about a course of action which you think is
sensible than you would with someone who wanted to do something
you considered inadvisable. There are many ways in which your
beliefs, interests and values can affect how you relate to people. A
useful first step is to identify and understand your own views and
values.
39
Belief, value or interest Situation Possible effect

People have a responsibility to look Someone being supported has You find it difficult to be
after their health. heart disease but continues to sympathetic when they complain
smoke and eats a diet high in fried about their condition and make
foods and cream cakes. limited responses.
War and violence are wrong and An older man being supported You try to avoid spending time
people who fight should not be constantly recalls tales of his days chatting with him and limit your
glorified as heroes. as a soldier and wants his bravery contact to providing physical care.
and that of his comrades to be
admired.
You like modern chart and disco One person being supported You find it hard not to ask them to
music. constantly plays country and turn it down or off. You hurry
western music very loudly. through your work and your
irritation shows in your body
language.
Table 2: Example beliefs, values or interests and their potential effects.
There are many other situations in which you may find that you are
behaving differently towards different people. There is nothing
wrong, or unusual in this. However, it is important that you are aware
of it, because it potentially makes a difference to the quality of your
work. Being aware of the factors that have influenced the
development of your personality is not as easy as it sounds. You may
feel that you know yourself very well, but knowing who you are is
not the same as knowing how you got to be you.
Activity 2
Exploring your values
1. Take a range of items from a newspaper, about six or seven. Make
a note of your views on each of them: say what your feelings are
on each one – does it shock or disgust you, make you sad, or
angry, or grateful that it has not happened to you?
2. Try to think about why you reacted in the way you did to each of
the items in the newspaper. Think about what may have
influenced you to feel that way. The answers are likely to lie in a
complex range of factors, including your upbringing and
background, experiences you had as a child and as an adult, and
relationships you have shared with others.
Thinking about these influences is never easy, and you are not being
asked to carry out an in-depth analysis of yourself – simply to begin to
realise how your development has been influenced by a series of
factors. Everyone’s values and beliefs are affected to different degrees
by the same range of factors.
40
These include:
•• life stage
Functional skills •• housing
English: Speaking and •• lifestyle
listening •• recreational opportunities
•• health
Have a discussion with your peers •• income
about the major factors that have •• the effects of relationships
affected the way you work and •• social class
relate to people you support. Use the •• employment
headings listed in the bullet points as •• education
a guide to help you prepare for and •• cultural background
focus the discussion. Present your •• religious beliefs and values.
ideas clearly, using appropriate
language, and allow others to give Thinking about the major factors that have influenced your
their opinions and feedback. Show development will help you to look at how they affect the way you
that you are listening to others in the work and how you get along with colleagues and the people you
group by giving them feedback on support. This way you can constantly be aware of the risk that the
their points. quality of your work is being affected by your personal views and take
action to deal with it.
41
2. Be able to reflect on own work

activities
2.1 Why reflecting on practice is an
important way to develop knowledge,
skills and practice
and
2.3 Reflect on work activities
In order to be an effective practitioner and to provide the best
possible service for those you support, you need to be able to reflect
on what you do and the way you work, and to identify your strengths
and your weaknesses. It is important that you learn to use reflection
on your own practice in a constructive way. Reflection should not be
used to undermine your confidence in your own work – rather you
should use it in a constructive way to identify areas which require
improvement.
Being able to recognise areas of your work that need improvement is
not an indication of poor practice, it is an indication of excellent
practice. Any worker in social care who believes that they have no
need to improve their practice or to develop and add to their skills
and understanding is not demonstrating good and competent
practice, but rather an arrogant and potentially dangerous lack of
understanding of the nature of work in the social care sector.
Becoming a reflective practitioner is not about torturing yourself with
self-doubts and examining your weaknesses until you reach the point
where your self-confidence is at zero! But it is important that you
examine the work that you have done and identify areas where you
know you need to carry out additional development. A useful tool in
learning to become a reflective practitioner is to develop a checklist
which you can use either after you have dealt with a difficult situation
or at the end of each shift or day’s work which will allow you to:
•• look at the way you approached the situation or your work
•• consider the effect your approach appeared to have on those you
were working with – you should include both clients and
colleagues in this reflection
•• make an honest assessment of the quality of the work that you
have produced that day, or in the situation. This will need to be
an honest reflection or it is of little value, but you also need to
allow for the fact that nobody produces first-class work every day
– everyone has days when they are less effective than they would
like to be, so be careful that you are not too hard on yourself
when reflecting on this area.
42
Checklist to evaluate practice

1. How did I approach my work?
2. Was my approach positive?
3. How did the way I worked affect the people I support?
4. How did the way I worked affect my colleagues?
5. Did I give my work 100 per cent?
6. Which was the best aspect of the work I did?
7. Which was the worst aspect of the work I did?
8. Was this work the best I could do?
9. Are there any areas in which I could improve?
10. What are they, and how will I tackle them?
Taking time out to think and reflect is important.
The purpose of reflective practice is to improve and develop your

practice, skills and knowledge by thinking about what you are doing.
Reflection involves thinking things over, a bit like reflecting ideas
inside the mind like light bouncing between mirrors. Reflection helps
us to realise new ideas and make new sense of practice issues.
Sometimes it can be as simple as remembering a detail that suddenly
makes a situation become clear. Other times reflection can involve
much more complex thinking, such as thinking about how someone
43
may have been feeling, or how you were feeling and why that might
have been. It can also involve thinking about wider issues; perhaps
realising that there are areas where you need to learn more and new
skills that you have not yet developed.
Reflection means thinking about situations and learning from what
you have discovered.
2.2 How well your knowledge, skills and

understanding meet standards
There is a range of ways in which you can ensure that you keep up to
date with new developments in the field of care, and particularly
those which affect your own specialist area of work. However, you
should not assume that your workplace will automatically inform you
about new developments, changes and updates which affect your
work – you must be prepared to actively maintain your own
knowledge base and to ensure that your practice is in line with
current thinking and emerging theories.
Fortunately the area of health and care is topical and relatively easy to
find out information about in respect of new studies and research.
You will need to be aware when watching television programmes or
listening to radio news bulletins of new developments, legislation,
guidelines and reports which are being reported in relation to health
and care clients and workers. These items regularly occur in news and
current affairs television and radio programmes, and you are also
likely to find a wide range of documentary programmes about
relevant issues on television.
Newspaper articles and articles in professional journals are also
Activity 3 excellent sources of information. Where they are reporting on a
recently completed study, they will always give a reference at the end
News references to
of the article that will enable you to obtain a copy of the study
health and social care or report. Professional journals are also places where you will find
For one week, keep a record of
every item which relates to health
and care services which you hear
on a news bulletin, in a television
programme, or in a newspaper or
magazine article. You may be
surprised at the very large number
of references that you find. This is
not to suggest that you should be
able to watch or listen to every
programme that you are able to
identify in the programme listings,
but it will give you a good idea of
the amount of information that is
regularly available.
Have you thought about how many TV programmes are relevant to social care?
44
advertisements for conferences and training opportunities; in

addition, you may find that information about such opportunities is
circulated at your workplace. There is often a cost involved with
attending these sorts of events and so it may not always be possible
within the training budget of your workplace. However, it is valuable
to pass on information about conferences or seminars which appear
to be of interest, as it may be possible for one person to attend and
to pass on (or cascade) the information to others, or it may be
possible to obtain conference papers and handouts.
The Internet provides a vast resource for information, views and
research. However, you will need to be wary of the information that
you obtain in this way and unless it is from an accredited source such
as a government department, a reputable university or college, or an
established research establishment, you should make every effort to
check out the validity of what you are reading. Anyone can publish
information on the Internet; there is no requirement for it to be
checked or approved through any central agency. This can mean that
people are able to produce their own views and opinions which may
not have any basis in fact. These views and opinions from a wide
range of people are valuable and interesting in themselves, but be
careful not to assume anything to be factually correct unless it is from
a very reliable source.
Never overlook the obvious and one of the sources of information
which may be most useful to you could also be one of those which is
closest at hand – your own workplace supervisor and colleagues may
have many years of experience and knowledge which they will be
happy to share with you. They may also be updating their own
practice and ideas, and may have information that they would be
willing to share.
Journals
Colleagues Books
Sources of
information
Internet Newspaper
articles
Documentaries Current affairs

programmes
Which of these sources of information do you use?
45
Reflecting is closely connected with learning; you do something, then

you reflect on it and learn from it, so that the next time you are
involved in the same situation you will be able to deal with it better
and more effectively. It is difficult to separate reflection and learning
as they are closely linked.
Functional skills
English: Writing Reflect
Keep a reflective diary for a week by Keep a reflective diary for a week. At the end of each working day,
writing down notes on issues that spend half an hour writing down one or two key issues that concerned
concern or irritate you during your you or irritated you – or even that you did well. How did you respond to
working day. Use the appropriate these issues? How could you learn from this experience to take your
level of detail to cover the own practice forward?
requirements of the task set by your Examples might include an incident such as noticing a wastepaper
tutor and ensure that all your basket placed where someone could trip over it, failing to move it
information is written clearly and because you were in a hurry, then returning with a jug of water and
coherently. Present your information tripping over the basket yourself. The result might be that you had to
in a logical way, choosing a suitable spend much more time cleaning up your water spill than it would have
format and language fit for your taken to move the basket in the first place. Or perhaps there was a
level of NVQ. Proofread your work difficult interaction with someone with whom you do not get along
for accuracy of spelling, punctuation very easily – perhaps nothing significant, but a niggling feeling that
and grammar. you could have done better.
3. Be able to agree a personal

development plan
3.1 Sources of support for your learning
and development
Support for your learning and development can come from a wide
range of sources, including:
•• formal support networks
•• informal support networks
•• supervision
•• appraisal
•• in-house and external training and development.
Many of you will be connected to a computer network at work; all of
our public transport is usually described as a network – a network of
railway lines, or a network of roads; most of us communicate through
a mobile telephone network and so on. Essentially networks are
about the routes by which things link together. Social networks are
about how people link together.
46
Formal support networks

Your employer is likely to set up formal networks, or they may be part
of the service offered by a professional organisation. They may
include your immediate supervisor and possibly other more senior
members of staff on occasion, or they may be made up of other
colleagues doing similar work to you. Network meetings could be at
differing intervals depending on the system in your particular
workplace; some networks operate online for people who find it
difficult to make time for meetings.
Action learning sets are a type of formal network where people share
issues and there is a general discussion around problem solving and
how to deal with issues. Often you can discover that problems are
shared and others are experiencing the same concerns and issues.
Formal networks will usually have a set meeting time, and someone
who coordinates and sends out agendas and notices of meetings.
Minutes may be taken and usually the same group of people meet
regularly.
Informal support networks

Informal support networks are likely to consist of your work
colleagues. These can be major sources of support and assistance.
Part of the effectiveness of many workplace teams is their ability to
provide useful ideas for improving practice, and support when things
go badly.
Some staff teams provide a completely informal and ad hoc support
system, where people give you advice, guidance and support as and
when necessary. Always be sure to make the most of these
Feedback from colleagues can help put things in perspective.
47
opportunities to ask for help – there is likely to be a wealth of

Activity 4 knowledge and experience among your colleagues. Do not feel that
Formal and informal people will think less of you if you ask for help; sometimes people are
support networks concerned that they need to know everything and be able to do
everything without help. Colleagues are usually only too pleased to
Identify the formal and informal offer support and advice, and would always rather you asked about
support networks in your something when you are unsure than went ahead and got it wrong.
workplace. Note down the ways in
which you use the different types There can also be informal networks for support among candidates
of network and how they support for a qualification, so if you are working for your Diploma with a
your development. If you identify group of other people, there will be plenty of opportunities for
any gaps or areas where you feel informal networking and sharing newly acquired knowledge.
unsupported, discuss this with your
Supervision
supervisor or manager.
Your supervisor’s role is to support and advise you in your work and
to make sure that you know and understand:
•• your rights and responsibilities as an employee
•• what your job involves and the procedures your employer has in
place to help you carry out your job properly
•• the beliefs, values and attitudes of your organisation about how
Activity 5 social care is delivered and how people are supported
•• your career development needs – the education and training
Your workplace’s requirements for the job roles you may progress into, as well as
supervision policy for your current job.
Ask your supervisor for a copy of Supervision is extremely useful in giving you the opportunity to
the relevant policy or plan at work benefit from feedback from your supervisor, who will be fully aware
on the supervision of staff. of the work you have been doing, and able to identify areas of
practice that you may need to improve and areas in which you have
Read the plan and note down what
demonstrated strength.
it covers, for example, how you will
be supervised, how often you can You should have the opportunity to meet on a regular basis with your
expect to be formally supervised supervisor to discuss the individual people you support and any
and what kinds of things your general issues relating to your practice, including any training and
supervisor will be able to help you development needs. The frequency will vary between employers but
with in your work role and career. is usually every six weeks or so.
If the plan is not clear, make a list Make sure that you are well prepared for sessions with your
of the things on which you would supervisor so that you can get maximum benefit from them. This will
like your supervisor’s support and mean bringing together your reflections on your own practice, using
agree a time and place to discuss examples and case notes where appropriate. You will need to
these. demonstrate to your supervisor that you have reflected on your own
practice and that you have begun identifying areas for development.
If you can provide evidence through case notes and records to
support this, this will help your supervisor to work with you to
develop your practice.
Appraisal
This is different from supervision; it may take place with your usual
supervisor or it may be with a more senior manager or someone who
specialises in appraisals. It normally takes place at 12-monthly
48
There should be a regular, uninterrupted session with your supervisor.
intervals and is only about you and your practice, not directly about
the people you support. You will have the opportunity to discuss your
work since your last appraisal and to look at how you have
progressed towards any of the goals you identified last time. One of
the key areas will be your professional training and development, and
you will be able to look at the training you think you are going to
need in order to achieve your goals.
In-house or external training and development

One of the other formal and organised ways of reflecting on your
own practice and identifying strengths, weaknesses and areas for
development is during formal training opportunities. On a course, or
at a training day, aspects of your practice and areas of knowledge
that are new to you will be discussed, and this will often open up
avenues that you had not previously considered. This is one of the
major benefits of making the most of all the training and education
opportunities that are available to you. Some training may be
organised in-house by your employer, perhaps through the training
department if you work for a large employer, through a local national
training provider, or through your supervisor or line manager in
smaller organisations. Formal training can be very useful for
developing your career and helping you to gain the knowledge and
skills to move ahead. Formal training can be:
•• single days on specialist areas
•• ongoing courses with several sessions
•• attendance at college or a training provider for formal
qualifications.
Formal training and development are not the only ways you can learn
and expand your knowledge and understanding. There are plenty of
other ways to keep up progress towards the goals you have set
yourself.
49
Case study
Identifying opportunities to improve practice

Emil is a support worker in a unit for young adults with felt far more confident, as not only had he learned a
disabilities, run by a leading charity. He was aware that great deal during the course itself, but also he had been
his knowledge of disability legislation was not as given some handouts and been informed about useful
comprehensive as it ought to be and he felt uncertain textbooks and websites.
about answering some of the questions that the young
1. How will Emil benefit personally from taking this
people put to him.
training?
Emil raised this issue with his line manager, who 2. How will those he works with benefit?
immediately found that training days were provided by 3. Are you confident about your knowledge of
the local authority that would help Emil to learn about legislation relating to your own work? If not, what
the relevant legislation. Following his training days, Emil steps are you taking to improve it?
Not everyone learns best from formal training. Other ways people
learn are from:
•• being shown by more experienced colleagues
•• working and discussing issues as a team or group
•• reading textbooks, journals and articles
•• following up information on the Internet
•• making use of local library facilities or learning resource centres
•• asking questions and holding professional discussions with
colleagues and managers.
Reflect
Write down the different ways of learning that you have experienced.
Have you, for example, studied a course at college, completed a
distance learning programme or attended hands-on training sessions?
Tick the learning methods which have been the most enjoyable and
most successful for you.
Here is a checklist of ways of learning that you might find useful:
•• watching other people

•• asking questions and listening to the answers
•• finding things out for yourself
•• going to college and attending training courses
•• studying a distance learning course or a course on the Internet.
How could you use this information about how you best like to learn in
order to update your workplace skills?
50
Can you identify the different ways in which you could learn in this centre?
3.2 and 3.3 Agreeing a personal

development plan and who should be
involved, and drawing it up
A personal development plan is a very important document as it
identifies your training and development needs. Also, because the
plan is updated when you have taken part in training and
development, it also provides a record of participation. A personal
development plan should be worked out with your supervisor, but it
is essentially your plan for your career. You need to think about what
you want to achieve, and discuss with your supervisor the best ways
of achieving your goals.
There is no single right way to prepare a personal development plan,
and each organisation is likely to have its own way. However, it
should include different development areas, such as practical skills
Key term and communication skills, the goals or targets you have set – such as
Dementia – a disease that affects being competent in working with people with dementia – and a
the brain, especially the memory timescale for achieving them. Timescales must be realistic; for
example, if you were to decide that you needed to achieve
competence in dementia in six months, this would be unrealistic and
unachievable. You would inevitably fail to meet your target and
would therefore be likely to become demoralised and demotivated.
But if your target is to attend a training and development programme
on dementia during the next three months and to work with two
people with dementia by the end of the following three months,
those goals and targets would be realistic and you would be likely to
achieve them.
When you have set your targets, you need to review how you are
progressing towards achieving them – this should happen every six
months or so. You need to look at what you have achieved and how
your plan needs to be updated.
51
Development plans can take many forms, but the best ones are likely
to be developed in conjunction with your manager or workplace
supervisor. You need to consider carefully the ‘areas of competence’
and understand which ones you need to develop for your work role.
Identify each as either an area in which you feel fully confident, one
where there is room for improvement and development, or one
where you have very limited current ability. The headings in Table 3
are suggestions only.
Development plan
Area of competence Goals Action plan
Time management and Learn to use computer Attend two-day training and use study pack.
workload organisation recording and information Attend follow-up training days. Use computer
systems instead of writing reports by hand
Review date: 3 months
Professional development priorities
My priorities for training and development in the next IT and computerised record systems
6 months are:
My priorities for training and development in the next As above and single assessment training
6 to 12 months are:
Repeat this exercise in: 6 months and review the areas of competence and priorities
Table 3: A sample development plan.
Once you have completed your plan, you can identify the areas on
which you need to concentrate. You should set some goals and
Activity 6
targets, and your line manager should be able to help you ensure
Preparing a personal they are realistic. Only you and your line manager can examine the
development plan areas of competence and skills that you need to achieve. This is a
personal development programme for you and you must be sure that
Your task is to prepare a personal
it reflects not only the objectives of your organisation and your job
development plan. You should use
role, but also your personal ambitions and aspirations.
a computer to do this, even if you
print out a hard copy in order to Training and development
keep in your personal portfolio. This section of your plan helps you to look at what you need to do in
Use the model on these pages to order to reach the goals you recorded in the first section. You should
prepare your plan. make a note of the training and development you need to undertake
Complete the plan as far as you in order to achieve what you have identified.
can at the present time. Note Goals Development needed
where you want your career to be
in the short, medium and long Short term
term. You should also note down
the training you want to complete Medium term
and the skills you want to gain.
Update the plan regularly. Keep on Long term

reviewing it with your supervisor.
Table 4: Short-, medium- and long-term goals.
52
Milestones and timescales

In this section you should look at the development you have identified
in the previous section and plan some timescales. Decide what the
milestones will be on the way to achieving your goal. Make sure that
your timescales are realistic.
Development Milestone By when
Table 5: Development milestones.
Reviews and updates

This section helps you to stay on track and to make the changes
which will be inevitable as you progress. Not all your milestones will
be achieved on target – some will be later, some earlier. All these
changes will affect your overall plan, and you need to keep up to date
and make any alterations as you go along.
Milestone Target date Actual achievement/revised

target
Table 6: Targets for milestones.
The style of plan you use is up to you and your supervisor. However
you do it, the important thing is to make sure that you do one and
that you continue to use it. In this way you can keep you career on
track and have a record of the training and development you have
undertaken.
53
4. Be able to develop knowledge,

skills and understanding
There is little point in reading articles, watching TV programmes and
attending training days if your work practice is not updated and
improved as a result. With the enormous pressures on everybody in
the health and social care services, it is often difficult to find time to
keep up to date and to change the practices you are used to. Any
form of change takes time and is always a little uncomfortable or
unusual to begin with. So when we are under pressure because of
the amount of work we have to do, it is only normal that we tend to
rely on practices, methods and ways of working which are
comfortable, familiar, and can be done swiftly and efficiently.
You will need to make a very conscious effort to incorporate new
learning into your practice. You need to allocate time to updating
your knowledge, and incorporating it into your practice. You could try
the ways on the following pages to ensure that you are using the
new knowledge you have gained.
New knowledge is not only about the most exciting emerging
theories. It is also often about mundane and day-to-day aspects of
your practice, which are just as important and can make just as much
difference to the quality of care you provide for the people you
support. It is also about taking your practice forward by developing
your knowledge across a range of situations.
Case study
Identifying your own training needs

Meena works as a care worker at a big, busy day
centre and meets the families of people of all ages. Really tired tonight. All day at work and then
One day she was chatting to the daughter of one of two hours at the clinic. Spent half an hour with
the people at the centre and mentioned the problem
a young girl who was crying because her dad
of teenage pregnancy, expressing her disapproval of
the extreme youth of some new mothers. ‘It’s funny has threatened to kick her out. Helped her fill
you should say that,’ replied the woman, ‘but my in some forms and arrange to see social
daughter Louise is pregnant. I’m not that happy – services. All this is making me more aware,
she’s only 16 – but what can you do?’ Meena felt
embarrassed, but decided she needed to be better and I hope a better all-round carer.
informed on the issue. She got in touch with the
local family planning clinic and spoke to the 1. What benefits do you think will come from Meena’s
manager, explaining that she would like to learn self-directed training?
more about the sexual health services available to 2. Who will benefit from her new experience?
young people. She arranged to spend some time on 3. How can training help to overcome prejudice?
a self-directed work experience placement at the
clinic, and is now a volunteer there, helping to run
the crèche. In her reflective diary she writes:
54
Doing it well
Applying new skills and knowledge in practice
•• Plan out how you will adapt your practice on a day-to-day basis,
adding one new aspect each day. Do this until you have covered all
the aspects of the new information you have learned.
•• Discuss with your supervisor and colleagues what you have learned
and how you intend to change your practice, and ask for feedback.
•• Write a checklist for yourself and check it at the end of each day.
•• Give yourself a set period of time, for example, one month, to alter
or improve your practice, and review it at the end of that time.
4.1 and 4.2 Show how a learning activity

and reflecting on a situation has improved
your knowledge, skills and understanding
Everything you do at work is part of a process of learning. Even
regular tasks are likely to be important for learning because there is
always something new each time you do them. A simple task like
taking someone a hot drink may result in a lesson – if, for example,
you find that they tell you they do not want tea, but would prefer
coffee this morning, thank you! You will have learned a valuable
lesson about never making assumptions that everything will be the
same.
Learning from working is also about using the huge amount of skills
and experience which your colleagues and supervisor will have. Not
Reflect only does this mean they will be able to pass on knowledge and
advice to you, but you have the perfect opportunity to discuss ideas
You have already begun the process
and talk about day-to-day practice in the service you are delivering.
of keeping a reflective diary (see
page 46). Build on this to use your Finding time to discuss work with colleagues is never easy; everyone
reflection to enhance your practice. is busy and you may feel that you should not make demands on
Plan a feedback session with your their time.
manager. You may have
Most supervision will take place at scheduled times but you may also
straightforward questions, or more
be able to discuss issues in the course of hand-over meetings or team
complicated issues to do with
meetings, and other day-to-day activities. Use supervision time or
appropriate decisions about rights
quiet periods to discuss situations which have arisen, problems you
and risks, such as, ‘How did you
have come across or new approaches you have noticed other
make the decision that it was safe
colleagues using.
enough for Mr Jackson to go out to
the shops by himself, when there Using your mistakes
are obvious risks?’ Everyone makes mistakes – they are one way of learning. It is
Try discussing such issues with important not to waste your mistakes, so if something has gone
different experienced colleagues – wrong, make sure you learn from it. Discuss problems and mistakes
you may be surprised at what you with your supervisor, and work out how to do things differently next
learn. time. You can use reflective skills in order to learn from situations
which have not worked out the way you planned.
55
It is important that you consider carefully why things turned out the
way they did and think about how you will ensure that they go
according to plan next time. There are real people on the receiving
end of our mistakes in care, and learning how not to make them
again is vitally important.
Using your successes

Talking to colleagues and supervisors is equally useful when things
work out really well. It is just as important to reflect on why
something worked, so that you can repeat it.
Key terms Personal and professional development

Personal development – Personal development is to do with developing the personal
developing the personal qualities and qualities and skills that everyone needs in order to live and work with
skills needed to live and work with others, such as understanding, empathy, patience, communication
others and relationship-building. It is also to do with the development of
self-confidence, self-esteem and self-respect.
Professional development –
developing the qualities and skills If you look back on how you have changed over the past five years,
necessary for the workforce you are likely to find that you are different in quite a few ways. Most
people change as they mature and gain more life experience.
Important experiences such as changing jobs, moving home, illness or
bereavement can change people.
Professional development is to do with developing the qualities
and skills that are necessary for the workplace. Examples are
teamwork, the ability to communicate with different types of people,
time management, organisation, problem solving, decision making
and, of course, the skills specific to the job.
Continuing professional development involves regularly updating the
skills you need for work. You can achieve this through attending
training sessions both on and off the job, and by making the most of
the opportunities you have for training by careful planning and
preparation.
It is inevitable that your personal development and your professional
development are linked – your personality and the way you relate to
others are the major tools you use to do your job. Taking advantage
of every opportunity to train and develop your working skills will also
have an impact on you as a person.
How to get the best out of training

Your supervisor will work with you to decide on the types of training
that will benefit you most. This will depend on the stage you have
reached with your skills and experience. There would be little point,
for example, in doing a course in advanced micro-surgery techniques
if you were at the stage of having just achieved your First Aid
certificate! It may be that not all the training you want to do is
appropriate for the work you are currently assigned to – you may
think that a course in advanced therapeutic activities sounds
56
fascinating, but your supervisor may suggest that a course in basic

moving and handling is what you need right now. You will only get
the best out of training and development opportunities if they are the
right ones for you at the time. There will be opportunities for training
throughout your career, and it is important that you work out which
training is going to help you achieve your goals.
Can you think about the different types of training you have attended?
Case study
Choosing appropriate training

Michelle is a healthcare support worker in a large reluctant, Michelle decided to take the opportunity.
hospital, on a busy ward. She was very aware of the After six weeks of attending classes and working with
fact that she lacked assertiveness in the way she dealt the supportive group she met there, Michelle found
with both her colleagues and with many of the people that she was able to deal far more effectively with
she supported. Michelle was always the one who unfair and unreasonable requests from her colleagues
agreed to run errands and to cover additional tasks that and to deal in a firm but pleasant way with the people
others should have been doing. She knew that she she supported.
ought to be able to say ‘no’, but somehow she could
1. What difference is Michelle’s training likely to make:
not, and then became angry and resentful because she
a) to the people she supports
felt she was doing far more work than many others on
b) to herself?
her team.
2. Have you ever said ‘yes’ to extra work or additional
Her supervisor raised the issue during a supervision responsibility when you wanted to say ‘no’? How
session and suggested that Michelle should consider did this make you feel?
attending assertiveness training. Although initially 3. What could you have done about it?
57
How to use training and development

Doing it well
You should work with your supervisor to prepare for any training you
Training receive, and to review it afterwards. You may want to prepare for a
Make the most of training by: training session by:
•• preparing well •• reading any materials which have been provided in advance
•• taking a full part in the training •• talking to your supervisor or a colleague who has attended similar
and asking questions about training, about what to expect
anything you do not understand •• thinking about what you want to achieve as a result of attending
•• collecting any handouts and the training.
keeping your own notes of the Think about how to apply what you have learned to your work by
training. discussing the training with your supervisor later. Review the ways in
which you have benefited from the training.
Reflect
Think about the last training or development session you took part in
and write a short report.
1. Describe the preparations you made beforehand so that you could

benefit fully from it.
2. Describe what you did at the session. For example, what and how
did you contribute, and what did you learn? Do you have a
certificate to show that you participated in the session? Do you have
a set of notes?
3. How did you follow up the session? Did you review the goals you
had set yourself, or discuss the session with your supervisor?
4. Describe how you have used what you learned at the session. For
example, how has the way you work changed, and how have the
people you support and your colleagues benefited from your
learning?
4.3 Showing how feedback from others

has developed your knowledge, skills and
understanding
You will also need to be prepared to receive feedback from your
supervisor. While feedback is likely to be given in a positive way, this
does not mean that it will be uncritical. Many people have
considerable difficulty in accepting criticism in any form, even where
it is intended to be supportive and constructive. If you are aware that
you are likely to have difficulty accepting criticism, try to prepare
yourself to view feedback from your supervisor as valuable and useful
information that can add to your ability to reflect effectively on the
work you are doing.
Your response to negative feedback should not be to defend your
actions or to reject the feedback. You must try to accept and value it.
A useful reply would be: ‘Thank you, that’s very helpful. I can use that
58
next time to improve.’ If you are able to achieve this, you are likely to
Activity 7 be able to make the maximum use of opportunities to improve your
Constructive criticism practice.
Ask a colleague, or if you do not On the other hand, if criticism of any kind undermines your
feel able to do that, ask a friend or confidence and makes it difficult for you to value your own strengths,
family member, to offer some you should ask your supervisor to identify areas in which you did well,
constructive criticism on a task you and use the positive to help you respond more constructively to the
have undertaken – a practical negative feedback.
activity such as cooking a meal, or
work you have undertaken in the
4.4 Show how to record progress in
garden or in the house, would be relation to personal development
suitable.
When you have identified the areas in which you feel competent and
If you are able to practise receiving chosen your target areas for development, you will need to design a
feedback on something that is personal development log which will enable you to keep a record of
relatively unthreatening, you are your progress. This can be put together in any way that you find
likely to be able to use the same effective.
techniques when considering
In your plan, you may wish to include things as varied as learning sign
feedback on your working
language, learning a particular technique for working with people
practices.
with dementia, or developing your potential as a future manager by
learning organisational and human resources skills. You could also
include areas such as time management and stress management. All
of these are legitimate areas for inclusion in your personal and
professional development plan.

LO1 to write your views about the work you have done and
This unit is all about how you develop your skills and to show that you can think about what went well and
knowledge and improve your own practice, but for this what went badly, and suggest some reasons for this.
outcome you need to show that you understand what Alternatively, your assessor may ask you questions about
you need to do in order to be a competent care and the work you have been doing and you will need to be
support worker. You may be asked to prepare a able to talk about your work and your thoughts about
presentation or an assignment that will demonstrate to areas that are going well and areas for improvement.
your assessor that you know how competence is judged Your own personal development plan will show your
and that standards that are used as the basis for deciding assessor that you understand how to prepare one and
competence. You will not be expected to know the how to maintain it and keep it up to date. Your
National Occupational Standards off by heart! But you assessor will want to see it, whether it is paper based or
will need to show that you know how they influence kept electronically. You need to be able to show that
qualifications and form a basis for assessing competence. you are able to develop and improve your practice; this
will mean providing evidence that you have attended
LO2–4 training and that you are making use of supervision and
These outcomes will be assessed as you demonstrate that the learning opportunities in your own workplace. You
you can do the essentials of personal development. You will also have to provide your assessor with evidence,
will have to show your assessor that you can reflect on either through witness testimony or through
your work – this may be through keeping a reflective questioning of how your practice has changed as a
journal for a period of time. If you do this, you will need result of new learning and skill development.
59

The introduction to this section highlights your duty to make sure that
the service provided is the best it can possibly be. In order to do this it is
essential that you are constantly reflecting on your practice and striving
to develop the way you work. Here are some suggestions of further
reading and research to help you to do this.
•• www.gscc.org.uk (General Social Care Council (GSCC) – training

and learning)
•• www.dh.gov.uk (Department of Health – human resources and
training)
•• www.skillsforcare.org.uk (Skills for Care – workforce development
for UK social care sector)
•• www.skillsforhealth.org.uk (Skills for Health – workforce
development for UK health sector)
•• www.cwdcouncil.org (Children’s Workforce Development Council)
•• www.scie.org.uk (Social Care Institute for Excellence)
•• Hawkins, R. and Ashurst, A. (2006) How to be a Great Care
Assistant, Hawker Publications
•• Knapman, J. and Morrison, T. (1998) Making the Most of
Supervision in Health and Social Care, Pavilion Publishers
•• Shakespeare, P. Learning in Health and Social Care, journal,
Blackwell Publishing
60
Unit SHC 23
Introduction
to equality and inclusion
in health, social care or
children’s and young
people’s settings
This is a core unit that is common to several qualifications in

related areas of work, both in adult and children and young
people’s work. This is because ensuring that people are treated
equally and that people are not left out is vitally important if
support and services are to be provided fairly to all people in
need.
This unit will help you to understand how you can work in a
way that makes sure that everyone is able to use support
services. You will also find out about how discrimination
impacts on people’s lives and how to make sure that you are
not letting your own prejudices influence the way you work.

1. the importance of diversity, equality and inclusion
2. how to work in an inclusive way
3. how to access information, advice and support about
diversity, equality and inclusion.
61
1. Understand the importance of

diversity, equality and inclusion
1.1 What is meant by diversity
Diversity is about difference, and the value of diversity is the richness
and variety that different people bring to society.
‘All apples are red.’ That statement is clearly silly. Of course they are
not – some are green, some are yellow. When it comes to people,
everyone is different. There are so many ways in which people differ
from each other, including, for example:
•• appearance
•• gender
•• race
•• culture
•• ability
•• talent
•• beliefs.
Imagine how boring life would be if everyone was exactly the same.
Whole societies of identical ‘cloned’ people have been the central
theme of many films, and it is clear immediately how unnatural that
seems. However, we are not always very good at recognising and
valuing the differences in the people we meet.
You can see that the statement ‘all apples are red’ is not right.
Different sorts of diversity

You can think about diversity in different ways. There are specific
differences between people, all of the features that make each of us
an individual, and there are broader differences as you can see from
the list above. Both of these are important so you need to take
account of each of them, and value the contributions made by
different perspectives, different ways of thinking and different
approaches.
62
Introduction to equality and inclusion Unit SHC 23
Activity 1
Valuing differences
This exercise is best done with a group of colleagues, but how they behave, not on how they look. Older
you can also do it on your own. people can often bring a different perspective to a
situation based on years of experience and
1. List all the cultures and nationalities you can think of.
understanding. It is worth making some notes on
Write them down. Next to each one, write
each of the ideas you have. You may need to do
something that the culture has given to the world.
some research and may find some fascinating
For example, the Arabs gave us mathematics, the
information in the process.
Chinese developed some wonderful medicines, and
3. When you have done this, be honest with yourself
so on.
about whether you have really appreciated and
2. Next, think about the groups of people you support.
valued the differences in both individuals and
Note down the special angle of understanding each
cultures. How do you think your practice could be
group can bring to society. For instance, someone
different because of thinking about diversity?
who is visually impaired will always judge people on
Key term 1.2 What is meant by discrimination

Discrimination – treatment of one Discrimination is the result of unequal or excluding behaviour. It
group or person in a less or more describes the disadvantage that people experience because of being
favourable way than another on the unfairly treated or being excluded from society. People can be refused
basis of race, ethnicity, gender, access to society, services, employment or education because of
sexuality, age or other prejudice discrimination. Racial discrimination has some very famous examples
such as the apartheid regime in South Africa and the segregation
laws in the southern states of America.
Reflect
The London Marathon has a
separate wheelchair event. It would
not be possible for disabled
competitors to race among the huge
numbers of runners, but over the
same course the wheelchair athletes
are actually faster than the able-
bodied runners. It is just a question
of getting to the appropriate starting
line, by recognising that people who
use a wheelchair are not going to be
able to run, but if they compete in
their wheelchairs, then they can
have a fair chance.
Can you see how this race makes these wheelchair competitors more equal?
63
Discrimination on the basis of disability can be found in many places

where disabled people have no access or are required to use a
different entrance to non-disabled people. Education can often be
difficult to access because the necessary support may not be
available. Employers may also be reluctant to employ people with a
disability because they are not prepared to make the adjustments
necessary to enable someone to work.
Gender discrimination is still evident. Although the situation has
improved considerably in the past 10 years, women’s earnings are
still around 20 per cent less than men’s (source: Annual Survey of
Hours and Earnings 2009) and there are still fewer women in senior
positions. For example, out of 650 Members of Parliament, only 143
were women following the 2010 election. A report from the World
Economic Forum looking at 600 companies across 20 countries
showed that fewer than 5 per cent had women chief executives
(source: World Economic Forum Gender Gap Report 2010). Out of
the top 100 companies in the UK, only 12 per cent of board
members were women. In the public sector, women make up 65 per
cent of the workforce, but only 30 per cent of senior management
and 21 per cent of Chief Executives (source: Local Government
Association 2009).
It is easy to apply the same principles to a job. Someone who has
impaired vision or is in a wheelchair can do a job just as well, or
perhaps better, than someone who is able-bodied, provided they are
allowed the opportunity. That means removing physical barriers such
as steps or narrow doorways, and installing equipment that allows
someone with impaired vision to ‘read’ documents.
1.3 Ways in which discrimination may

deliberately or inadvertently occur in the
work setting
Generalisations and stereotypes
It is often easy to make broad, sweeping statements that you believe
apply to everyone who belongs to a particular group. It is the exact
opposite of valuing diversity, by saying that everyone is the same. This
is the basis of prejudice and discrimination, and you need to be sure
that you are not guilty of making generalisations and thinking about
people in stereotypes. People are often discriminated against because
of their race, beliefs, gender, religion, sexuality or age. Treating
everyone the same will result in discrimination because some people
will have their needs met and others will not. In order to prevent
discrimination, it is important to value diversity and treat people
differently in order to meet their different needs.
64
Direct discrimination is, for example, where someone is refused a job

because they use a wheelchair. Indirect discrimination would be
where they are told they can have the job but the work must be
carried out on the first floor and there is no lift.
Activity 2
Generalisations
Complete the following sentences.
•• Police officers are… •• Asians always…

•• Teenagers are… •• Men all…
•• Nurses are… •• Women are…
•• Politicians never… •• Americans are…
•• West Indians are all…
You can probably think of plenty of statements that you make as

generalisations about others. Think about how easy you found it to
come up with statements for each of the examples. How do you think
these generalisations could affect the way you work?
Stereotypes
Key term One of the main causes of discrimination is the fear and lack of
Stereotyping – making negative understanding of others that is spread because of stereotyping.
or positive judgements about whole Prejudice is what makes people think in stereotypes and, equally,
groups of people based on prejudice stereotypes support prejudice. Stereotypes are an easy way of
and assumptions, rather than facts or thinking about the world. Stereotypes might suggest that all people
knowledge about a person as an over 65 are frail and walk with a stick, that all black young people
individual who live in inner cities are on drugs, that all Muslims are terrorists, or
that all families have a mother, father and two children. These
stereotypes are often reinforced by the media or by advertising.
Television programmes will often portray violent, criminal characters
as young and black, and older people are usually shown as being
dependent and unable to make a useful contribution to society.
Activity 3
Stereotyping in adverts
Next time you watch television, note down the number of adverts for
cars that show trendy, good-looking young business people with a
wealthy lifestyle. The advertisers attempt to convince us into believing
that buying a particular brand of car will make us good-looking and
trendy, and give us the kind of lifestyle portrayed.
1. How many people do you know with those particular makes of car
that are anything like the people in the adverts?
2. How many do you know who wish they were?
65
What effect do stereotypes have?

The effect of stereotypes is to make you jump to conclusions about
people. How many times have you felt uneasy seeing a young man
with a shaved head walking towards you? You know nothing about
him, but the way he looks has made you form an opinion about him.
If you have a picture in your mind of a social worker or someone in
the police force, think about how much the media influences that
– do they really all look like that?
What do you instantly think about these people, just from looking at pictures of them?
66
Labelling
Labelling is slightly more complex than stereotyping, and happens
when someone thinks the factor which people have in common is
more important than the hundreds of factors which make them
different.
For example, the remark ‘We should organise a concert for older
people’ makes an assumption that being older is what is important
about the people concerned, and that somehow as you grow older
your tastes become the same as all other people your age! It would
be much better to say, for example, ‘We should organise a concert
for older people who like music from the shows’ or ‘We should
organise a concert for older people who like opera.’
It’s not funny
‘Have you heard the one about…?’
Telling jokes at the expense of particular groups of people is just
displaying prejudices. If someone has stereotypes about people being
mean, stupid or dangerous because of their nationality, they fail to
treat people as individuals and fail to recognise that there are
individuals everywhere and that all people are different. Of course,
some people will be just as the stereotype portrays them – but a lot
more will not be. Avoiding stereotypes and the discrimination that
they promote is essential if you want to succeed in social care.
Reflect
Stop yourself every time you make a generalisation and look at the
prejudice that is behind it. Reflect on why you think the way you do,
and do something about it. The next time you hear yourself saying,
for example, ‘Social workers never understand what is really needed’,
‘GPs always take ages to visit’ or ‘People who live here wouldn’t be
interested in that’, stop and think what you are really doing.
It may be true in some cases, but not necessarily all.
Perhaps most of the people you support would not be interested in

something you suggested, but some might. You cannot make that
assumption. You need to ask. You need to offer people choices because
they are all different. Do not fall into the trap of stereotyping people
based on factors such as gender, age, race, culture, dress or where
they live.
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1.4 How promoting equality and inclusion

reduces the likelihood of discrimination
Avoiding stereotypes at work
It is a key part of your job to find out the personal beliefs and values
of each person you support. Think about all the aspects of their lives,
such as:
•• diet •• worship
•• clothing •• language
•• personal hygiene •• relationships with others.
It is your responsibility to find out – not for the person to have to tell
you. It will be helpful for you, and for other support workers, if this
type of information is kept in the personal record.
Poverty and inequality

On a worldwide scale, poverty is defined by the World Health
Organization as living on less than US$1 a day. There is little doubt
that in many undeveloped countries, there are millions of people who
suffer great hardship and live in very real poverty. This is ‘absolute
poverty’. In a society such as ours in the Western world, poverty takes
on a different meaning and in the UK it is ‘relative poverty’, which
means that people are poorer than the majority of society.
People living in poverty are far more likely to experience the
conditions which will lead to ill health and a greater need for the
health and care services than those in higher social groupings who
are likely to live in better conditions. Some of the most obvious effects
of poverty are poor housing, a poor diet, the likelihood of living in a
poor area or neighbourhood with poor-quality local facilities. Socio-
economic factors are a major cause of inequality, for example:
•• infant and childhood death rates are significantly higher among
children whose families have low incomes
•• children from poorer families are four times more likely to die in
accidents as those from families with higher incomes
•• children in poverty have poorer attendance records at school and
are less likely to continue into further education
•• the highest incidents of mental health problems occur among
people who live in poverty
•• nutrition and eating habits show that poorer people tend to eat
less fruit and vegetables and less food which contains dietary
fibre. There is evidence that the diets of poorer families tend to
lack choice and variety and often contain inappropriate foods
such as crisps, sweets and soft drinks
•• only 44 per cent of babies born to mothers with low incomes are
breast fed, compared with 81 per cent of babies born to mothers
in higher-income families.
68
Poverty is not the only cause of inequality; it can also result from
issues around race, gender or disability. For example, there is a much
higher incidence of coronary heart disease and diabetes among the
Asian population of the UK where the death rate from heart disease
can be up to twice as high as that of the general population. There
also seems to a link between race and educational achievement.
Government figures show that Chinese and Indian students are more
than twice as likely to obtain five or more passes at GCSE than those
from African-Caribbean or black African ethnic backgrounds (source:
Office of National Statistics 2007).
Gender, disability and age can also be causes of inequality. This can
be made significantly worse by the effects of poverty – very large
numbers of older people live on very low incomes. Over 30 per cent
of pensioners entitled to higher levels of income through income
support do not claim it and as a result have a lifestyle of severe
deprivation.
Poverty and deprivation are among the underlying causes of
inequality in the UK. This is then reinforced by attitudes such as
racism, sexism and discrimination against people with disabilities.
If such attitudes go unchallenged, then inequality will continue.
Anti-discriminatory practice
Anti-discriminatory practice is what underpins the social care practice.
For you to carry out your practice in an anti-discriminatory way, much
of what you do in your day-to-day work must be based on anti-
discriminatory practice. You are likely to find that you have come
across these ideas before, but perhaps not in these terms or in this
context. You will need to understand the terms because you will hear
them used regularly and they have important implications for your
practice.
Activity 4
Anti-discriminatory practice
Find an example of each of the aspects of practice given in Table 1
(next page). The examples can be from work, from other parts of your
life or from fiction. For each example, look at how you could work in a
way that is anti-discriminatory.
Your day-to-day practice and attitudes are important in how effective

your anti-discriminatory practice will be. There is little point in
supporting someone to challenge stereotyping and then returning to
your own work setting ready to organise all the ‘ladies’ for a sewing
afternoon!
69
Term Description
Stereotyping This is when whole groups of people are assumed to be the same – for example, ‘these
sort of people’, ‘old people love a sing-song’ or ‘black people are good athletes’.
Discrimination This is the process of treating people less favourably based on a feature of themselves
over which they have no control. Disabled people find it hard to get a job because
employers are reluctant to take them on; research has shown that people with Asian
names or from certain areas are told that job vacancies have been filled even though they
have not; and women still do 90 per cent of the world’s work, earn 10 per cent of the
world’s income and own 1 per cent of the world’s wealth.
Anti- This is about positively working to eliminate discrimination. It is about more than being
discrimination against discrimination, you must ensure through your practice that you protect people
from discrimination by identifying it and taking steps to eliminate or minimise it wherever
you can.
Oppression This is the experience which results from being discriminated against. People who are
oppressed are being prevented from receiving equal treatment and exercising their rights.
They often lose self-belief and self-confidence, and find it difficult to see a way out from
the oppression.
Anti-oppression This is about the practical steps you can take to counteract oppression. You will need to
make sure that people have all the information and support they need to know what
rights they have and how to exercise them. This may mean finding out about what they
are entitled to and the ways in which they can be helped, setting up appointments for
them and providing written information; it can also mean offering emotional support. It
also means recognising when people are being oppressed and denied their rights, either
by another person or by an organisation and working to challenge this, or supporting the
person to challenge it for themselves.
Table 1: Terms related to anti-discriminatory practice.
Case study
Understanding different attitudes

Tai is in her mid-30s and has a busy job in an be necessary. Tai is having difficulty making her
international finance company. She is from a Chinese non-Chinese friends, colleagues and even social services
family who have lived in a large city and run a understand her view that she is willing to do this for her
restaurant for the past 40 years. Her parents have now parents and that their welfare is a greater priority than
retired from the restaurant and have both suffered from her career.
ill health in the past year. They are too frail to continue
1. Can you see where the key differences are between
caring for themselves without support. Tai’s brothers
the attitude of Tai and the attitudes of many
are busy running the family business and Tai has
non-Chinese families?
decided to stop working in order to care for her
2. Would you encourage Tai to give up her job? Why?
parents. Her English friends and work colleagues are
3. How are the attitudes of her friends discriminatory?
horrified that she is prepared to give up such a good
4. How do you think they may make Tai feel?
career to do this. The local social services department
5. What should the role of social services be in this
has offered to provide domiciliary care for Tai’s parents,
situation?
but the family have refused, explaining that it will not
70
Definitions of inclusive practice are varied, but broadly, it is about

Functional skills ensuring that there are no barriers that would exclude people, or
make it difficult for them to participate fully in society, because of
English: Writing
an illness or a disability. Traditionally, we have developed separate
Answer the case study questions in a worlds in order to meet people’s needs – for example, separate
clear and concise manner using an workshops, education groups, living accommodation for people with
appropriate format. Present all your mental health needs or any type of disability have kept people out of
written work in a logical sequence mainstream society. Older people have been separated with clubs,
using language that is fit for day centres and residential accommodation on the assumption that
purpose. As you complete each separate is best – but increasingly, we have come to see that separate
question, check your written work is not equal, and we should have an inclusive society that everyone
for accuracy of spelling, punctuation can enjoy.
and grammar.
Now, we ask a different question about how we organise society. We
do not ask, ‘What is wrong with this person that means they cannot
use the leisure centre or the cinema?’ but, ‘What is wrong with the
cinema or the leisure centre if people with disabilities cannot use it?’
Inclusive practice is about providing the support that people want in
order to live their lives as fully as possible. Examples of inclusive
practice are:
•• providing a ramp to give wheelchair access to a building
•• providing information in a range of languages and in audio format.
Ensuring that systems and processes for obtaining support are easy to
use and access allows people to work out the support they need and
find the best way to put it in place.
Overall, practising in an inclusive way means constantly asking, ‘What
changes need to happen so that this person can participate?’ and
then doing whatever is within your area of responsibility to make
those changes happen.
2. Be able to work in an inclusive

way
2.1 Legislation, codes of practice and
policies and procedures relating to equality,
diversity, discrimination and rights
Discrimination is a denial of rights. Discrimination can be based on
issues such as race, gender, disability or sexual orientation. The main
Acts of Parliament and Regulations relating to equality and human
rights in England, Scotland and Wales (Northern Ireland has its own
equality legislation) were the:
•• Equal Pay Act 1970
•• Sex Discrimination Act 1975
•• Race Relations Act 1976
71
•• Disability Discrimination Acts 1995 and 2005

•• Special Educational Needs and Disability Act 2001
•• Employment Equality (Religion or Belief) and (Sexual Orientation)
Regulations 2003
•• Employment Equality (Age) Regulations 2006
•• Racial and Religious Hatred Act 2006
•• Equality Act 2006.
All of these Acts and Regulations have been superseded by a single
Equality Act that came into force on 1 October 2010. The Equality Act
2010 covers all the present pieces of legislation and includes
requirements on public bodies to consider how to deal with
inequalities in health, education, employment and achievement.
The Equality Act 2010 provides a new Act to protect the rights of
people and equality of opportunity. It makes the legislation simpler as
there is now just one Act. Broadly, the Act covers:
•• the basic framework of protection against direct and indirect
discrimination, harassment and victimisation in services and public
functions, premises, work, education, associations and transport
•• changing the definition of gender reassignment, by removing the
requirement for medical supervision
Doing it well •• levelling up protection for people discriminated against because
they are perceived to have, or are associated with someone who
Providing support for has, a protected characteristic, so providing new protection for
rights people like carers
•• Hold regular staff meetings and •• clearer protection for breastfeeding mothers
have a regular item on your •• applying the European definition of indirect discrimination to all
agenda about rights. protected characteristics
•• Ensure that people are fully •• extending protection from indirect discrimination to disability
aware of complaints procedures •• introducing a new concept of ‘discrimination arising from
and know how to follow them. disability’, to replace protection under previous legislation lost as a
•• Make sure that you know your result of a legal judgement
organisation’s policies and •• applying the detriment model to victimisation protection (aligning
guidelines designed to protect with the approach in employment law)
and promote people’s rights. •• harmonising the thresholds for the duty to make reasonable
•• Ensure that you share with your adjustments for disabled people
colleagues any information that •• extending protection from third-party harassment to all protected
relates to people’s choices, characteristics
preferences and rights. •• making it more difficult for disabled people to be unfairly
•• Make sure that you discuss screened out when applying for jobs, by restricting the
choices and preferences with circumstances in which employers can ask job applicants
people. questions about disability or health
•• Support people to maintain •• allowing hypothetical comparators for direct gender pay
independence together with discrimination
other rights if necessary. •• making pay secrecy clauses unenforceable
•• Never participate in or encourage •• extending protection in private clubs to sex, religion or belief,
discriminatory behaviour. pregnancy and maternity, and gender reassignment
72
•• introducing new powers for employment tribunals to make

recommendations which benefit the wider workforce
•• harmonising provisions allowing voluntary positive action.
2.2 Interaction with individuals that

respects their beliefs, culture, values
and preferences
You also need to support your colleagues to work in ways that
recognise and respect people’s beliefs and preferences. Your work
setting should be a place in which diversity and difference are
acknowledged and respected. You need to set a good example and
to make it clear that behaviour such as the following is unacceptable:
•• speaking about people in a derogatory way
•• speaking to people in a rude or dismissive way
•• undermining people’s self-esteem and confidence
•• patronising and talking down to people
•• removing people’s right to exercise choice
•• failing to recognise and treat people as individuals
Activity 5 •• not respecting people’s culture, values and beliefs.
If you find that you have colleagues who are regularly practising in a
Values
discriminatory way, you need to seek advice from your manager or
1. Make a list of the things you supervisor.
believe in as values, such as
honesty, caring about others How to recognise your own prejudices
and so on. Then make a second One of the hardest things to do is to acknowledge your own
list of how they could affect prejudices and how they affect what you do. Prejudices are a result of
your work. your own beliefs and values, and may often come into conflict with
2. Examine whether they do work situations. There is nothing wrong with having your own beliefs
affect your work – you may and values – everyone has them, and they are a vital part of making
need the views of a trusted you the person you are. But you must be aware of them, and how
colleague or your supervisor to they may affect what you do at work.
help you with this.
Think about the basic principles that apply in your life. Here are some
This activity is very hard, and it will examples.
take a long time to do. It is often
•• You may have a basic belief that people should always be honest.
better done over a period of time.
Then think about what that could mean for the way you work –
As you become more aware of
might you find it hard to be pleasant to someone who you found
your own actions, you will notice
had lied extensively?
how they have the potential to
•• You may believe that abortion is wrong. Could you deal
affect your work.
sympathetically with a woman who had had an abortion?
Recording the results of this activity •• You may have been brought up to take great care of disabled
over a period of time may be useful people and believe that they should be looked after and
when you are being assessed on protected. How would you cope in an environment that
this unit. encouraged disabled people to take risks and promoted their
independence?
73
Exploring your own behaviour is never easy, and you need good
Functional skills support from either your supervisor or close friends to do it. You may
be upset by what you find out about some of your attitudes, but
knowing about them and acknowledging them is the first step to
listening
doing something about them.
Using the information you have
As a support worker, it will be easier to make sure that you are
gathered for Activity 5, have a
practising effectively if you are confident that you have looked at your
discussion about your notes with
own practice and the attitudes that underpin it. Remember that you
members of staff at your place of
can ask for feedback from people you support and colleagues too,
work or other learners. Verbalise
not only from your supervisor.
your findings clearly and ensure that
you listen to the feedback from
other people taking part in the
Beliefs and values of others
discussion and pick up on points that Once you are aware of your own beliefs and values, and have
they raise. Demonstrate that you can recognised how important they are, you must think about how to
listen and respond to others by accept the beliefs and values of others. The people you work with are
giving your opinions on what they all different, so it is important to recognise and accept that diversity.
say. Ensure that you use appropriate
language at all times. Respect for different people
If you are going to make sure you always respond to people in a
respectful way which ensures they are valued, you need to
understand what happens when people are not valued or respected.
It is also important that you recognise the ways in which good
practice helps to protect people from discrimination and exclusion.
Case study
Dealing with prejudice

Garth is a care worker in a residential setting for adults personal care. Both of these residents were young men
with disabilities. He is gay but had never discussed his in their late 20s and their action was supported by their
sexual orientation at work and it was not mentioned at parents. Comments and jokes at Garth’s expense began
the time of his appointment. His sexual orientation only to circulate within the setting, particularly when he was
became known when the parents of one of the on duty.
residents spotted him in a photograph of a gay pride
Garth felt that he was being unfairly discriminated
event printed in a national newspaper.
against and intended to obtain the support of his trade
Garth had always been a popular member of staff and union.
had an excellent work record, with appraisals which
1. What are Garth’s rights in this situation? Consider
showed that his skills and abilities were developing and
the Employment Equality (Sexual Orientation)
progressing. However, following the discovery that he
Regulations.
was gay, the atmosphere in the setting began to
2. What are the rights of the residents in this sort of
change. Two of the residents complained about being
situation? How do rights and responsibilities balance
cared for by someone who was gay and said they were
here?
not prepared to have Garth provide them with any
3. How could this be approached by management?
74
People should make choices about how they want to live their lives.
For some people, choices may be about things like how they will
spend their Direct Payments or Individual Budget and the people they
will choose to employ. For others, choices may be more limited as in
some of the suggestions in Table 2. The ability to make choices of any
sort is an important part of exercising rights and being valued.
Functional skills
English: Reading
Read through the case study on the previous page carefully to extract
the information you need to answer the set questions. Extend your
knowledge of different texts by finding a copy of the Employment
Equality Regulations and using information from it to expand on your
answers. By doing this you will develop your skills of extracting relevant
information from a variety of texts and using it for a purpose. If you
need clarification of words, use a dictionary or talk to others to find your
answers.
Support service Choices
Personal hygiene •• Bath, shower or bed bath

•• Assistance or no assistance
•• Morning, afternoon or evening
•• Temperature of water
•• Toiletries
Food •• Menu
•• Dining table or tray
•• Timing
•• Assistance
•• In company or alone
Table 2: Examples of choices available in support services.
Doing it well
Valuing diversity
•• The wide range of different beliefs and values that •• Think about the assets which have come to the UK
you will come across are examples of the rich and from people moving here from other cultures,
diverse cultures of all parts of the world. including music, food and entertainment, and
•• Value each person as an individual. The best way to different approaches to work, relaxation or medicine.
appreciate what others have to offer is to find out •• Think about language. The words and expressions
about them. Ask questions. People will usually be you use are important. Avoid using language that
happy to tell you about themselves and their beliefs. might suggest assumptions, stereotypes or
•• Be open to hearing what others have to say – do not discrimination about groups (see Table 3).
be so sure that your values and beliefs and the way you
live are the only ways of doing things.
75
Area Examples of negative language
Disability Some words such as ‘handicapped’ can suggest the discriminatory assumption that disabled
people are damaged versions of ‘normal’ people. In general, people prefer to be called ‘disabled
people’ rather then ‘people with a disability’. The term ‘disabled people’ is used to show that
people are disabled by the environment and the society in which they live and by the barriers
that prevent them from participating.
Race Some words and phrases may be linked to the discriminatory idea that certain ethnic groups
(white groups) are superior to others. For example, the ‘play the white man’ means to play fair,
and there are words that are associated with slavery in the past.
Age Some words and phrases make fun of older people. Do not address an older person as ‘pop’ or
‘granddad’ unless you are invited to do so. Terms such as ‘wrinklies’ or ‘crumblies’ are offensive.
Gender Some words and phrases are perceived as implying that women have a lower social status than
men. Addressing women as ‘dear’, ‘petal’ or ‘flower’ may be understood as patronising or
insulting. There is also the instance of always referring to people in high status roles as ‘he’ –
often heard when talking about doctors or lawyers.
Sexuality Gay and lesbian people often object to being catalogued using the biological terminology of
‘heterosexual’ and ‘homosexual’. Use the terminology that people would apply to themselves.
Table 3: Language that might suggest assumptions, stereotypes or discrimination.
As we have seen, promoting equality and rights is supported by the

practical steps you can take in day-to-day working activities to give
people more choice and more opportunities to take decisions about
their own lives. Much of this will depend on your work setting and
the particular needs of the people you support. Respecting people
and valuing them as individuals is always going to be an important
factor in promoting self-esteem and therefore well-being.
2.3 How to challenge discrimination in a

way that promotes change
There may be occasions when you have identified a person’s rights
and given them access to the information needed. However, they
may not be able to exercise those rights effectively. There can be
many reasons why people miss out on their rights, including:
•• their rights may be infringed by someone else
•• there may be physical barriers
•• there may be communication barriers
•• there may be emotional barriers.
Advocates
Key term When you need to support people to maintain a right to choice, control
and independence, it may be important to involve an outside advocate.
Advocate – a person responsible
An advocate is someone who argues a case for another person. They
for acting and speaking on behalf of
try to understand a person’s perspective and argue on their behalf. Your
someone who is unable to do so for
organisation may have procedures and advice to assist you in gaining
themselves
the services of people who will act as advocates for people.
76
Case study
The right to make choices

Mrs Sullivan lives alone on just her state pension. She 1. What are Mrs Sullivan’s rights?
has never claimed any pension credit, although there is 2. Should action be taken on her behalf?
no doubt she would be entitled to it. She struggles to 3. Would the situation be different if she had a son or
survive on her pension and, by the time she has paid all daughter with a learning disability who lived with
her bills and fed the cat, there is little left for herself. her? Would her rights and responsibilities still be the
She eats very little and is reluctant to turn the heating same?
on. Despite being given all the relevant information by 4. What would your responsibilities be if you were a
her home care assistant, Mrs Sullivan will not claim any support worker for Mrs Sullivan?
further benefits. She always says, ‘I shall be fine. There
are others worse off than me – let it go to those who
need it.’
You may also need to defend people’s rights in a more informal way
during your normal work. For example, people have a right to privacy,
and you may need to act to deal with someone who constantly
infringes upon that by discussing other people’s circumstances in
public. You will have to balance the rights of one person against
another, and decide whose rights are being infringed. You may decide
Key term that a right to privacy is more important than a right to free speech.
Active participation – when a Overall, the key to active participation is ensuring that you:
person participates in the activities •• do as much as possible to support only the parts of people’s lives
and relationships of everyday life as that they really cannot manage for themselves
independently as possible; they are •• provide support that will encourage them to take control and
an active partner in their own care make decisions that enable the maximum possible participation in
or support, rather than a passive every aspect of their lives.
recipient
Doing it well
Reducing discrimination
Reflect Think about language. The words and expressions you use are important.
A person’s right to rest may be •• Do not use words that degrade people with problems or disabilities,
infringed by someone who shouts all for example, words that are used as an insult such as ‘spaz’ or ‘crip’.
night. How would you balance the •• Avoid language that is racist or could cause offence, and think
rights of one person not to be about expressions such as ‘play the white man’ that suggests that
disturbed against the rights of white people are somehow superior.
another not to be given medication •• Older people should not be referred to as ‘grannies’ or ‘wrinklies’. It
that only benefits others? is not acceptable to call an older person ‘pop’ or ‘grandad’ unless
you are invited to do so.
•• Avoid using offensive terms to describe sexual orientation. Always
try to find out the terms which people find acceptable.
•• There are many words and expressions that help to reinforce
discrimination against women. Think before using ‘like a fishwife’ or
‘he’s a right old woman’.
77
Encourage people you support to take part in society fully and

achieve their full potential.
•• Do not assume that older people are only capable of quiet
activities that do not involve too much excitement.
•• Avoid the temptation to overprotect and thus encourage
dependence.
•• Support people to challenge barriers that stand in their way.
•• If you work with people with disabilities, try to think of ways you
can show employers what people are capable of achieving.
Reflect
•• Try to work with the local community. If you work in a facility that
Acts of Parliament do not change is surrounded by neighbours, make sure that they get to know
attitudes. Discrimination may be both the people being supported and staff. Knowledge removes
unlawful, but people still have the the fear that lies behind prejudice.
right to think, write and speak as •• Encourage people to behave assertively and to develop confidence
they wish. But does anyone have a in their own abilities.
‘right’ to view another person as •• Refuse to accept behaviour that you know is discriminatory.
inferior because of their race? •• Do not participate in racist or sexist jokes and explain that you are
Would it infringe a person’s rights to not amused by ‘sick’ jokes about people with disabilities or
take steps against them because of problems.
this view? •• If you are uncertain what to do in a particular situation, discuss
the problem with your supervisor.
78
3. Be able to access information,

advice and support about
diversity, equality and inclusion
3.1 and 3.2 Situations in which additional
information, advice and support may be
needed, and how and when to access it
Your workplace will have policies and information about diversity and
equality; there will be an inclusion policy. This is always a good
starting point if you need to find out more information. Your
supervisor will also be able to provide you with advice and signpost
you to further information if there is something you are unsure about.
The Equality and Human Rights Commission (www.
equalityhumanrights.com) has a statutory remit to promote and
monitor human rights; and to protect, enforce and promote equality
across the seven ‘protected’ grounds:
1. age
2. disability
3. gender
4. race
5. religion and belief
6. sexual orientation
7. gender reassignment.
Doing it well They are able to provide a wide range of resources, advice and
guidance about all areas of equality and rights. They produce
Respecting diversity guidance documents about legislation, particularly the Equality Act
•• Remember that stereotypes can 2010, and you can download these from the website above or
influence how you think about request a hard copy.
someone. There are likely to be local sources of information such as the Citizens
•• Do not rush to make judgements Advice Bureau, Welfare Rights or Law Centres. Local libraries also
about people. have plenty of information available both online and in hard copy.
•• Do not make assumptions.
If you need to talk to someone and your supervisor cannot help, then
•• Everyone is entitled to their own
your trade union is likely to have an equalities officer who will have
beliefs and culture. If you do not
current knowledge about how to handle equality issues.
know about somebody’s way if
life – ask. Knowing where to go and whom to ask when you need information
and advice is important. If you are unsure or have tried a few places
without success, do not give up. You owe it the people you support
to develop your knowledge and understanding so that you can pass
on advice and encourage people to insist on being treated equally
and to be able to access their rights.
79

LO1 and LO3 LO2
These outcomes will require you to show your assessor Your work will be observed for this outcome, probably
that you understand why equality, diversity and at the same time as observations for other units, and
inclusion are important. This could be through a you will need to show that you understand how to
presentation or an assignment, or your assessor may work in an inclusive way. This will mean showing that
undertake a professional discussion with you. You will you always deal with people as individuals and do not
need to show that you understand the consequences of make assumptions based on stereotypes. Asking people
discrimination for people who experience it. You are about personal preferences and making sure that plans
also likely to have to show your assessor that you know are person-centred will be an important part of
about the laws around equality, diversity and inclusion, showing that you work inclusively.
and how people can access support and information
about their rights.
Legislation
•• Disability Discrimination Acts 1995 and 2005
•• Employment Equality (Age) Regulations 2006
•• Employment Equality (Religion or Belief) and (Sexual Orientation)
Regulations 2003
•• Equal Pay Act 1970
•• Equality Act 2006
•• Equality Act 2010
•• Race Relations Act 1976
•• Racial and Religious Hatred Act 2006
•• Sex Discrimination Act 1975
•• Special Educational Needs and Disability Act 2001

•• www.cqc.org.uk (Care Quality Commission)
•• www.dh.gov.uk (Department of Health)
•• www.equalities.gov.uk (Government Equalities Office)
•• www.gscc.org.uk (General Social Care Council (GSCC))
•• www.legislation.gov.uk (Government legislation website)
•• Burgess, C., Shaw, C. and Pritchatt, N. (2007) S/NVQ Level 2 Health
and Social Care: Easy Steps, Heinemann
80
Unit SHC 24
Introduction
to duty of care
In this unit you will learn about how having a duty of care
affects all your work and is the basis for being a professional
care and support worker. Your duty of care does not mean that
you should make all the decisions for people. On the contrary,
your duty of care involves being able to balance people’s rights
to take risks and participate in life, ensuring that the risks are
not placing people in danger or in harm’s way.
This is a small unit, but it is important that you have a clear
understanding of your duty of care and how it affects your
practice.

1. the meaning of duty of care
2. dilemmas that may arise about duty of care and the
support available for addressing them
3. how to respond to complaints.
81
1. Understand the meaning of

duty of care
1.1 The term ‘duty of care’
A duty of care means that all health and social care professionals,
and organisations providing health and care services, must act in the
best interests of the people they support. They also have to do
everything in their power to keep people safe from harm and
exploitation. As a care professional, you must ensure that you do not
do something, or fail to do something, that causes harm to
someone. You have a professional duty of care to act only within
your own competence and not to take on something you are not
confident about.
Your duty of care underpins everything that you do; it is what
underlies the Codes of Practice and it should be built into your
practice on a day-to-day level. Exercising your duty of care is also a
legal requirement, and is tested in court in the event of a case of
negligence or malpractice. This is not to suggest that you should
always be worried about being sued, but you do need to recognise
that you are responsible for the welfare of a vulnerable person and
this brings with it certain duties.
It is no defence to say any of these things.
82
Introduction to duty of care Unit SHC 24
The responsibility to make sure that you have the knowledge and
skills to do the task required is yours as much as your employer’s. If
you know that you cannot do something, then you must say so. In
the same way, if you are asked to carry out a task that you know you
cannot do safely because you do not have the equipment, then you
must say so.
Functional skills
English: Speaking and Activity 1
listening
Understanding duty of care
Have a discussion with staff at work
about their understanding of the Ask three colleagues and three people who do not work in health and
term ‘duty of care’. Ensure that you social care to tell you what they understand by the term ‘duty of care’.
take an active role in the discussion Make a note of all the answers – check if there is a difference between
by contributing your opinions and the understanding of people who work in social care and people who
picking up on points made by others. do not. Then check if there are differences in your colleagues’ views
Speak clearly at all times and use about what it means.
appropriate language when If there are some differences, you could suggest to your manager that
speaking. it is discussed at a team meeting.
1.2 How duty of care affects your work

role
People have a right to expect that when a professional is providing
Key term
support, they will be kept safe and not be neglected or exposed to
Risk – the likelihood of a hazard’s any unnecessary risks. The expression is that we ‘owe’ a duty of care
potential being realised to the people we work with. ‘Owe’ is a useful word to describe the
nature of the duty of care because it is just like a debt: it is something
that you must pay as part of choosing to become a professional in
the field of social care.
Having a duty of care towards the people you work with is not
unique to social care; all professions who work with people have a
duty of care. This includes doctors, teachers, nurses, midwives and
many others. Other professionals, such as lawyers, architects and
engineers, also have a duty of care, and although it may be a little
different in the workplace, the principles remain the same.
Thinking about the duty of care that you owe to people is helpful
when you are planning your work. It makes you consider whether
what you were planning to do is in the best interests of the person
you are working with. This is not only about physical risks; you also
have a duty of care to treat people with dignity and respect.
83

English: Writing The effects of duty of care on your role
Answer the questions in Activity 2 in Try out the following scenarios. How does your duty of care in each
full sentences that have been situation affect what you do?
checked by proofreading for errors in
1. You are helping someone to have a bath. What do you need to
grammar, punctuation and spelling.
check and how will you carry out your duty of care?
Lay out your work using a suitable
2. You are accompanying a mildly confused person on a shopping
format and present your information
trip. What will you need to think about and what steps will you
in a logical sequence.
need to take to exercise your duty of care?
3. You are supporting someone to complete benefit claim forms.
What will you do to make sure that you have carried out your duty
Reflect
of care? What could go wrong?
Can you see how a duty of care 4. You are passing on a message to someone’s relative. What must
will apply to your own work role? you think about?
You may like to try Activity 2 in 5. You are on duty in a residential setting when the fire alarm goes
relation to the tasks you perform off. What is your duty of care?
at work.
What is the duty of care when helping to fill in forms?
84
2. Be aware of dilemmas that

may arise about duty of care and
the support available for
addressing them
2.1 Dilemmas that may arise between the
duty of care and a person’s rights
Potential conflicts or dilemmas
Exercising a duty of care is not about wrapping people in cotton wool
or preventing them from taking any risks. Just participating in
everyday life involves risks – for example, crossing the road is a risky
business. There has to be a balance and you need to consider risks.
You do have a duty of care for the people you support, but they also
have the right to make their own choices and to reach decisions
about actions they want to take. Sometimes there can be a conflict
between a person’s rights and your duty of care. Having a duty to act
in someone’s interests and also needing to ensure that they are not
placed in harm’s way can be very hard to balance with encouraging
people to take control of their lives and to make choices and
decisions about their lives. The following three case studies give some
examples of the sorts of dilemmas you may come across.
Case study
Backpacking in Australia
Kevin is 24. He has a mild learning disability and has 1. What are the issues for you, as Kevin’s support
always been protected by his parents. He wants to go worker?
backpacking around Australia with a friend whom he 2. What should you do?
has met at the restaurant where he works. His parents 3. What is your duty of care here?
are opposed to it, but his brother and sister are 4. Can anything be done to stop Kevin? Should it be?
supportive.
Case study
Stopping medication
George has a long history of schizophrenia. He has 1. What is your duty of care here?
been living in the community for over 10 years and is 2. Who else may have a duty of care?
doing well with regular medication. He has now 3. What can you do?
decided that he does not want to continue with his
medication because he has read that putting chemicals
into your body may be harmful.
85
Case study
Buying a scooter
Olga is 75 years old. She has severe osteoarthritis, poor the safety of others if she takes the scooter out on
vision and uses a hearing aid. She has recently decided the road.
to purchase a mobility scooter in order to be able to
1. What can you do?
get out more. You are concerned about her safety and
2. What is your duty of care?
These case studies are very different and you can see that your role
would be very different in each of the circumstances. They are quite
extreme situations, but they illustrate some of the difficulties and
dilemmas that you may face.
Of course, many situations will not be nearly so difficult to deal with;
the day-to-day situations may be around someone choosing to eat a
poor diet or to drink too much. You have a duty of care to make sure
that people know how and why they should follow a healthy lifestyle,
but you cannot force them to do so.
It is important to make sure that you give information about risks and
consequences to people in a way that they can understand. This
means thinking about:
•• the level of the language used
•• the use of graphics where that will help
•• the use of ‘easy read’ documents
•• providing information in different languages, including sign
language
•• providing information verbally
•• providing information in large print or Braille.
There is no point in giving people the information they need to make
decisions if it is not in a form that can be easily understood. After
giving people information, you should check that it has been
understood. Once you are sure that the information you have given
about the possible consequences of actions is understood, then
people have a right to make their own decisions.
There are some circumstances in which you can and should take
action, regardless of the wishes of the person concerned. These are if
someone is planning to do something that:
•• is criminal or illegal
•• will deliberately harm them
•• represents a serious risk to others.
In any of these circumstances, you must quickly seek advice from your
manager.
The vast majority of people you work with will be in a position to take
their own decisions about what they do in their lives. In order to
exercise your duty of care, you must ensure that any decisions and
86
choices people make are based on understanding the consequences

and potential risks of what they want to do. Your role is not to
prevent people from doing what they want, but to make sure that
they know the possible results.
This can result in some very finely balanced decisions, especially
where there are concerns about someone’s capacity to understand
the possible risks and consequences from their actions. The question
of capacity to make decisions is highly complex and must be
considered carefully. It is very easy to make the assumption that
because someone has dementia, or has a learning disability or a
long-term mental health problem, they lack the capacity to make
decisions about important issues affecting their own life. If you think
about it, the capacity to make a decision can often depend on how
much help we have.
For example, if a government minister has to choose between two
different highly advanced fighter aircraft to commission for the RAF,
they will ask for help from experts across the aviation industry, from
experienced civil servants from the relevant departments, and from
the pilots and senior officers who are going to use the aircraft. The
minister will make the final decision – but lacks the capacity to make
the decision alone, and so uses lots of help and support.
Similarly, most of us, if asked to make a choice between two different
types of central heating system, would need to ask for help from
experts before deciding – we would lack the capacity to make the
decision without advice and help.
So remember – capacity is relative to what has to be decided and
depends on the circumstances.
Mental Capacity Act 2005

The Mental Capacity Act sets out a framework for supporting people
to make decisions, and lays out the ways in which people can be
supported. The Act is underpinned by five key principles.
1. A presumption of capacity – every adult has the right to make
their own decisions and must be assumed to have capacity to do
so unless it is proved otherwise.
2. The right for people to be supported to make their own decisions
– people must be given all appropriate help before anyone
concludes that someone cannot make their own decisions.
3. People must retain the right to make what might be seen as
Reflect
eccentric or unwise decisions.
Think about decisions you have 4. Best interests – anything done for or on behalf of people without
had to make. List those where you capacity must be in their best interests.
have needed help or advice to 5. Least restrictive intervention – anything done for or on behalf of
make them. people without capacity should be the least restrictive of their
basic rights and freedoms.
87
The Act sets out clearly how to establish if someone is incapable of

Functional skills taking a decision; the ‘incapacity test’ is only in relation to a particular
English: Reading decision. No one can be deemed ‘incapable’ in general simply
because of a medical condition or diagnosis. The Act introduces a
Through your NVQ and your place of new criminal offence of ill treatment or neglect of a person who lacks
work, you will be required to read a capacity. A person found guilty of such an offence may be liable to
range of texts which are both formal imprisonment for a term of up to five years.
and informal. For your coursework
many of the set activities will require 2.2 Where to get additional support and
you to read information and then
extract the relevant parts for your
advice about dilemmas
written work. You will also be Your first port of call if you are unsure about how to respond to a
required to research to broaden your dilemma between your duty of care and a person’s rights is your
knowledge of issues relating to care manager. They should be able to advise you about the best
settings and to familiarise yourself approaches to take and give you the opportunity to discuss both sides
with Acts which affect the way you of the dilemma.
interact with and treat people. It is
If you are a member of a professional association or a trade union,
important for you to clarify words or
they will also be able to offer advice about the uncertainties you may
phrases that you do not understand
have about whether you are effectively exercising a duty of care
so you can fully grasp the subject.
towards the people you support.
Doing it well
Exercising a duty of care
•• Remember that this is not about
stopping people from doing
what they want.
•• Make sure people have
information about possible risks
and consequences.
•• Ask for advice if you are unsure.
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3. Know how to respond to

complaints
3.1 Why it is important that individuals
know how to make a complaint
and
3.2 The main points of agreed procedures
for handling complaints
‘Agreed procedures’ means the policies and procedures of the
organisation you work for.
If you work as a personal assistant to one person, then this will not be
something you will come across in your own workplace, but knowing
about it is valuable in case you need to support your employer to
make a complaint against another organisation at some time.
Your organisation should have a complaints policy, and it should be
publicised and information on it readily available in the form of
leaflets, posters, complaints form, web-based and printed.
All public service organisations are required to have a complaints
procedure and to make the procedure readily available for people to
use. Part of your role may be to support people in making complaints
or in handling complaints made to you. You may support people:
•• directly, by supporting them in following the procedure
•• indirectly, by making sure that they are aware of the complaints
procedure and are able to follow it.
There are principles of good complaint handling produced by the
Local Government Ombudsman and the Health Service Ombudsman.
They are as follows.
1. Getting it right.
2. Being customer focused.
3. Being open and accountable.
4. Acting fairly and proportionately.
5. Putting things right.
6. Seeking continuous improvement.
How complaints are approached can make all the difference between
people being satisfied and feeling that they have been listened to,
and people still feeling that their issues have not been recognised and
that nothing will change.
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Call centre
Website Service
reception area
Mailshots Ways of Staff

publicising
complaints
procedures
Publications Customer
services liaison
Advocacy and
information services Media
Ways of publicising complaints procedures.
Local authorities and NHS organisations need to:

•• make sure that the complaints procedure is publicised
•• offer to discuss a complaint as soon as it is received
•• investigate complaints thoroughly and efficiently
•• write to the person who made the complaint, explaining how it
has been investigated and the outcome
•• remind people of their rights to refer complaints to the relevant
Ombudsman if they are not satisfied
•• make sure that a senior manager is designated as being
responsible for dealing with complaints and for sharing
information about lessons that can be learned
•• make sure that the person complaining has all the support they
need in order to understand the procedure
•• produce an annual report with information about the numbers
and type of complaints received and how things have improved as
a result.
3.3 Your role in responding to complaints

as part of your duty of care
You may be asked by a senior manager to provide information for the
investigation of a complaint. You must do so promptly, because there
will be a time limit for responding to the complaint. You must give
clear and honest information. It is unlikely that you will be asked for
an opinion; it is usually just factual information that is needed. Do not
give your opinion unless you are specifically asked for it; just stick to
the facts. If you cannot remember some aspects, then say so – do not
make up or guess what you cannot recall. You will find out if the
result of the investigation means that lessons have been learned and
practice has been changed.
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Case study
Investigating a complaint
Tracey has a learning disability; she had been supported been concerns about this particular coach’s attitude
by a job coach in a work placement. She had been previously. It was agreed that the coach would
struggling to manage the till in the shop where she was undertake some additional training and Tracey would
working, and her job coach had shouted at her in front have a new coach allocated to her. The service manager
of customers and other members of staff. Tracey had met with Tracey and her mother and told them what
come home very upset and her mother had would happen – they were satisfied with the result.
subsequently complained to the service manager. She
1. Was Tracey’s mother right to complain on her
listened to Tracey’s mother and spoke to Tracey. She
behalf?
apologised about Tracey having been upset and
2. How did the service manager demonstrate good
promised to look into the complaint. When she spoke
practice in dealing with the complaint?
to the manager concerned, she found that there had
If a complaint is made to you, then you should:

•• make sure the person understands how to use the complaints
procedure
•• explain to them how it works and when they can expect to
receive a response
•• offer support in following the procedure if necessary
•• advise your manager that the complaint is being made.
Do not:
•• attempt to resolve complaints yourself
•• discuss the complaint with the person it is about
•• discourage people from making complaints
•• promise that you will ‘sort it out’
•• discuss the complaint with colleagues or anyone other than your
manager.
Reflect
Although it is not always easy to hear them, complaints are important

because they help everyone to improve the service they provide. Try to
think about a complaint by putting yourself in the complainant’s shoes
and seeing how an incident or a service has made them feel. This is a
good start to learning lessons about how to make your practice, and the
performance of the service, better.
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For this unit you will need to show your assessor better if you can give some examples of this from
that you understand the concept of having a duty your own work. If you do not have any personal
of care towards the people you support. You may examples, then you can always give examples you
have to produce an assignment or a presentation, have heard about from colleagues.
or your assessor may hold a professional discussion
This unit also requires that you know how to deal
about what a duty of care means. You will need to
with complaints. You may not be in a position to
show your assessor that you realise having a duty
deal with many complaints directly, but you do
of care can involve dilemmas, especially when you
need to understand the importance of complaints,
have to balance your duty of care with someone’s
how to handle them and how to learn from them.
rights to take risks and do what they want. It is
Legislation
•• Mental Capacity Act 2005

•• www.cwdcouncil.org.uk (Children’s Workforce Development
Council)
•• www.skillsforcare.org.uk (Skills for Care)
•• www.skillsforhealth.org.uk (Skills for Health)
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Unit HSC 024
Principles of
safeguarding and protection in
health and social care
In this unit you will look at some of the most difficult issues that
support workers face. Working in social care means coming to
terms with the fact that some people will be subjected to abuse
by those who are supposed to care for them. Knowing what
you are looking for, how to recognise it and how to respond, is
the best possible contribution to protecting people from harm
and abuse. You need to know how society handles abuse, how
to recognise it and what to do about it.
If you can learn always to think about the risks, always to be
alert to potentially abusive situations, and always to listen and
believe when you are told of harm and abuse, then you will
provide the best possible protection for people you support.

1. how to recognise signs of abuse
2. how to respond to suspected or alleged abuse
3. the national and local context of safeguarding and
protection from abuse
4. ways to reduce the likelihood of abuse
5. how to recognise and report unsafe practices.
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1. Know how to recognise signs

of abuse
Recognising risks
Many different factors will place people at risk, and it will not always
be possible for you to protect everyone from everything, neither is it
desirable. There are many situations in which you will have to balance
the rights of someone to place themselves in potential danger in
order to take control over their own lives. This does not necessarily
mean that every disabled person you work with will want to take up
wheelchair rock climbing, but the element of risk can equally apply to
a vulnerable adult with deteriorating memory function who wants to
go out alone on a shopping trip. There is undoubtedly a significant
risk, but this needs to be balanced against the importance of
empowerment, dignity and control.
There are vital differences between danger, harm and abuse. You
need to know how each relates to what you do.
•• Danger is about the possibility or risk of abuse.
•• Harm is about the results and consequences of abuse.
Have you thought about the balance between protection and restriction?
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Principles of safeguarding and protection Unit HSC 024
Whether your job role means that you are responsible only for your
own work, or whether you have some responsibility for the work of
colleagues, you will need to give some thought to your role in
protection. There are also likely to be differences depending on your
working environment, for example, the dangers and risks presented
in someone’s own home will be different from those in a residential
or healthcare setting. Clearly, the three concepts of abuse, danger
and harm are interlinked; someone who is abused may be in danger
and will be suffering harm – but not everyone who is exposed to
danger is being abused, and people can be harmed through accident
or carelessness rather than deliberate abuse.
Abusive situations
Abuse may happen just once, or it can be ongoing – either situation
should be viewed just as seriously. If abuse has happened once, the
risks of it happening again are far higher. It may be physical, sexual or
emotional abuse. Deliberate neglect or a failure to act is also abuse,
as is a vulnerable person persuaded to enter into a financial
arrangement or a sexual act to which they have not given or cannot
give informed consent.
A wide range of people, including family members, friends,
professional staff, care workers, volunteers or other people, may
abuse vulnerable adults.
Abuse may take place within the person’s own home, nursing,
residential or day care facilities or hospitals. Incidents of abuse can be
either to one person or to a group of people at a time. Some
instances of abuse will constitute a criminal offence – for example,
assault, rape, theft or fraud. The person responsible for this can then
be prosecuted, but not all abuse falls into this category.
1.1 Different types of abuse

Abuse can take many forms. These are usually classified under five
main headings:
•• physical
•• sexual
•• psychological
•• financial
•• institutional.
1.2 Signs and symptoms of abuse

Warning signs of harm or abuse
The following are indications for which you should consider harm or
abuse as a possible cause. However, each of them can be the result
of something other than abuse – so they are far from being foolproof
evidence, but they do act as pointers to make you look at the option
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of abuse being the answer. You and your colleagues will need to use
other skills, such as observation and communication with other
professionals, in order to build up a complete picture.
Different types of abuse have different remedies in law, and some
have no legal remedies, but are dealt with through other policies,
procedures and guidelines.
Signs of possible abuse in adults

Abuse can often show as physical effects and symptoms. These are
likely to be accompanied by emotional signs and changes in
behaviour, but this is not always the case.
Any behaviour changes could indicate that the person is a victim of
some form of abuse, but remember that they are only an indicator
and will need to be linked to other factors to arrive at a complete
picture.
Physical abuse includes:
•• hitting
•• slapping
•• pushing
•• pinching
•• force feeding
•• kicking
•• burning
•• scalding
•• misuse of medication or restraint
•• catheterisation for the convenience of staff
•• inappropriate sanctions
•• a carer causing illness or injury to someone in order to gain
attention for themselves (this might be associated with a condition
called fabricated and induced illness, or FII)
•• refusing access to toilet facilities
•• leaving people in wet or soiled clothing or bedding.
Potential indicators of physical abuse include the following. Any of
these factors are not evidence of abuse – they are a warning indicator
only.
•• Multiple bruising or finger marks (especially in well-protected
areas such as eye sockets, inner arms or thighs).
•• Fractures – especially twisting fractures – and dislocations –
especially when accompanied with bruising or finger marks.
•• Scratches or cuts.
•• Pressure ulcers and sores or rashes from wet bedding/clothing.
•• Black eyes or bruised ears.
•• Welt marks – especially on the back or buttocks.
•• Scalds or cigarette burns.
•• A history of unexplained minor falls or injuries or a history of
accidental overdoses/poisonings.
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•• Explanations not consistent with the injuries.

•• Clinical interventions without any clear benefit to the person.
•• Deterioration of health without obvious cause.
•• Loss of weight.
•• Inappropriate, inadequate or soiled clothing.
•• Withdrawal or mood changes.
•• Carer’s resistance to allowing people to visit.
•• Reluctance by the vulnerable adult to be alone with the alleged
abuser.
Sexual abuse
Sexual abuse, whether of adults or children, can also involve abuse of
a position of power. Children can never be considered to give
informed consent to any sexual activity of any description. For some
adults, informed consent is not possible because of a limited capacity
to understand its meaning. In the case of other adults, consent may
not be given and the sexual activity is either forced on someone
against their will or the person is tricked or bribed into it.
Physical signs Behavioural signs
•• Bruises, scratches, burns or •• Provocative sexual behaviour,

bite marks on the body promiscuity
•• Scratches, abrasions or •• Prostitution
persistent infections in the
•• Sexual abuse of others
anal/genital regions
•• Self-injury, self-destructive
•• Pregnancy
behaviour including alcohol
•• Recurrent genital or urinary and drug abuse, repeated
infections suicide attempts
•• Blood or marks on •• Behaviour that invites
underwear exploitation and further
physical/sexual abuse
•• Abdominal pain with no
diagnosable cause •• Disappearing from home
environment
•• Aggression, anxiety,
tearfulness
•• Reluctance by the vulnerable
adult to be alone with the
alleged abuser
•• Frequent masturbation
•• Refusal to undress for
activities such as swimming/
bathing
Table 1: Potential indicators of sexual abuse (any of these factors are not
evidence of abuse – they are a warning indicator only).
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Sexual activity is abusive when informed consent is not freely given.

This might involve one person using services who is abusing another
more vulnerable person. It is important to recognise the difference
between the freely consenting sexual activity of adults who also
happen to be supported by social care services, and those situations
where abuse is taking place because someone is exploiting their
position of relative power. The key is the capacity to give informed
consent.
Sexual abuse includes:
•• rape and sexual assault
•• masturbation
•• indecent exposure
•• penetration or attempted penetration of intimate areas
•• sexual harassment
•• involving a vulnerable adult in pornography
•• enforced witnessing of sexual acts or sexual media
•• participation in sexual acts to which the vulnerable adult has not
consented, or could not consent, or was pressured into
consenting.
Psychological abuse
All forms of abuse also have an element of psychological abuse. Any
situation which means that someone becomes a victim of abuse at
the hands of someone they trusted is, inevitably, going to cause
emotional distress. However, some abuse is purely psychological
– there are no physical, sexual or financial elements involved.
Psychological abuse includes:
•• emotional abuse •• blaming
•• bullying •• controlling
•• threats of harm or •• intimidation
abandonment •• coercion
•• ignoring •• harassment
•• shouting •• verbal abuse
•• swearing •• deprivation of privacy or
•• deprivation of contact with dignity
others •• lack of mental stimulation.
•• humiliation
Potential indicators of psychological abuse include the following. Any
of these factors are not evidence of abuse – they are a warning
indicator only.
•• Carer seeming to ignore the vulnerable person’s presence and
needs.
•• Reports from neighbours of shouting, screaming, swearing.
abuser.
•• Cared-for person fearful of raised voices, distressed if they feel
they may be ‘in trouble’.
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•• A culture of teasing or taunting which is causing distress and

humiliation.
•• Referring to the cared-for person in a derogatory way.
•• No valuing of basic human rights, for example, choice, opinion,
privacy and dignity.
•• Cared-for person being treated like a child – infantilisation.
Financial abuse
Many adults are very vulnerable to financial abuse, particularly those
who may have a limited understanding of money matters. Financial
abuse, like all other forms of abuse, can be inflicted by family
members and even friends as well as care workers or informal carers,
and can take a range of forms.
Financial or material abuse includes:
•• theft
•• fraud
•• exploitation
•• pressure in connection with wills, property, inheritance or financial
transactions
•• the misuse or misappropriation of property, possessions or
benefits.
Potential indicators of financial abuse include the following. Any of
these factors are not evidence of abuse – they are a warning indicator
only.
•• Someone not being allowed to manage own financial affairs.
•• No information being given where consent has been given to act.
•• Family unwilling to pay, from relative’s funds, for services,
although relative has sufficient capital/income.
•• Person not made aware of financial matters.
•• Enduring power of attorney set up without consulting a doctor
where the vulnerable adult is already confused.
•• Other people moving into person’s property.
•• Family regularly asking for money from personal allowance.
•• Very few or no personal possessions.
•• Unusual and unexplained change in spending pattern.
•• Unexplained shortage of money despite a seemingly adequate
income.
•• Unexplained disappearance of personal possessions or property.
•• Sudden changing of a will.
Neglect
Neglect happens when care is not given and someone suffers as a
result. There are broadly two different types of neglect: self-neglect
and neglect by others.
Self-neglect is different from abuse by others, but it is still a situation
that can place people at risk of harm and, potentially, place them in
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danger. People neglect their own care for a range of reasons; the
most common are:
•• increasing infirmity
•• physical illness or disability
•• memory and concentration problems
•• sensory loss or difficulty
•• mental illness and mental health problems
•• learning difficulties/disabilities
•• alcohol and drug misuse problems
•• a different set of priorities and perspectives.
However, what may appear as self-neglect may be an informed
lifestyle choice, and it is important that you do not attempt to impose
your standards and values on those who have made a decision to live
in a particular way. Decisions in these situations are very difficult and
a balance must be achieved between safeguarding and protecting
people who are vulnerable, and making sure that you are not
removing people’s ability to choose to live as they wish. Obviously,
where someone has a deteriorating mental or physical condition,
then you can, and should, act in order to protect them. A deliberate
choice to follow a particular way of living is an entirely different
matter.
Neglect by others occurs when either a support worker or a family
or friend carer fails to meet someone’s support needs. Neglect can
happen because those responsible for providing the support do not
realise its importance, or because they cannot be bothered, or choose
not, to provide it. As the result of neglect, people can become ill,
hungry, cold, dirty, injured or deprived of their rights. Neglecting
someone you are supposed to be supporting can result from failing to
undertake support services, for example:
•• not providing adequate food
•• not providing assistance with eating food if necessary
•• not ensuring that someone receives support with personal care
•• not ensuring that someone is adequately clothed
•• leaving someone alone
•• not supporting someone with mobility or communication needs
•• failing to maintain a clean and hygienic living environment
•• failing to obtain necessary medical/healthcare support
•• not supporting social contacts
•• not taking steps to provide a safe and secure environment.
In some social care situations, support workers may fail to provide
some support services because they have not been trained, or
because they work in a setting where the emphasis is on cost saving
rather than service provision. In these circumstances it becomes a
form of institutional abuse. Unfortunately, there have been residential
care homes and NHS trusts where people have been found to be
suffering from malnutrition as the result of such neglect. Individual
workers who are deliberately neglecting people in spite of receiving
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training and working in a quality caring environment are, fortunately,

likely to be spotted very quickly by colleagues and supervisors.
However, family and friend carers are in different circumstances,
often facing huge pressures and difficulties. Some may be caring for a
relative reluctantly because they feel they have no choice; others may
be barely coping with their own lives and may find caring for
someone else a burden they are unable to bear. Regardless of the
many possible reasons for the difficulties that can result in neglect,
it is essential that any suspicions or concerns are investigated and
followed up so that help can be offered and additional support
provided if necessary.
As with self-neglect, it is important that lifestyle decisions made by
people and their carers are respected. Full discussions should take
place with people and their carers where there are concerns about
possible neglect. Neglect and failure to care includes:
•• ignoring medical or physical care needs
•• failure to provide access to appropriate health, social care or
educational services
•• withholding the necessities of life, such as medication, adequate
nutrition and heating.
Potential indicators of neglect include the following. Any of these
factors are not evidence of abuse – they are a warning indicator only.
•• Medical condition deteriorating unexpectedly or not improving as
expected.
•• Hypothermia or person cold or dressed inadequately.
•• Supported person is hungry.
•• Living environment is dirty and unhygienic.
•• Risks and hazards in the living environment are not dealt with.
•• Person has sores and skin rashes.
•• Unexplained loss of weight.
•• Clothes or body dirty and smelly.
abuser.
•• Delays in seeking medical attention.
Discriminatory abuse
Discriminatory abuse includes:
•• racist and sexist abuse
•• abuse based on a person’s disability
•• harassment, slurs or similar treatment
•• abuse related to age, gender or sexual orientation
•• abuse directed towards religion.
It is also the case that discriminatory abuse can underpin other forms
of abuse – particularly physical or psychological.
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Potential indicators of discriminatory abuse include the following. Any

of these factors are not evidence of abuse – they are a warning
indicator only.
•• Exclusion from activities based on inadequate justifications.
•• Restricted or unequal access to healthcare and medical
treatment.
•• Person is not supported in challenging discrimination.
•• Unnecessary barriers restrict participation.
•• Person experiences fear, withdrawal, apathy, loss of self-esteem.
•• Many of the emotional indicators are similar to other forms of
abuse.
Institutional abuse
Institutional abuse is not just confined to large-scale physical or
sexual abuse scandals of the type that have been publicised regularly
in the media. Of course this type of systematic and organised abuse
has happened in residential and hospital settings, and must be
recognised and dealt with appropriately so that people can be
protected. However, people can be abused in many other ways in
settings where they could expect to be supported, cared for and
protected.
Abuse is not just carried out by individuals; groups, or even
organisations, can also create abusive situations. It has been known
that groups of care workers in residential settings can abuse those in
their care. Often people will act in a different way in a group than
they would alone. Think about teenage ‘gangs’, which exist because
people are prepared to do things jointly which they would not think
to do if they were alone. Many of the types of abuse described here
can also be identified in their individual categories of physical, sexual
or psychological abuse.
Abuse in a care setting may not just be at the hands of members of
staff. There is also abuse which comes about because of the way in
which an establishment is run, where the basis for planning the
systems, rules and regulations is not the welfare, rights and dignity of
the residents or patients, but the convenience of the staff and
management. This is the type of situation where people can be told
when to get up and go to bed, given communal clothing, only
allowed medical attention at set times and not allowed to go out.
The key factor in identifying institutional abuse is that the abuse is
accepted or ignored by the organisation, or that it happens because
an organisation has systems and processes that are designed for its
own benefit and not those of the people using the service. For
example:
•• people in residential settings are not given choice over day-to-day
decisions such as mealtimes or bedtimes
•• freedom to go out is limited by the institution
•• privacy and dignity are not respected
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•• personal correspondence is opened by staff

Key term •• the setting is run for the convenience of the staff
Advocacy – acting and speaking •• excessive or inappropriate doses of sedation/medication are given
on behalf of someone who is unable •• access to advice and advocacy is restricted or not allowed
to do so •• complaints procedures are deliberately made unavailable.
Patterns and nature of abuse

Activity 1 Patterns and the nature of abuse vary and can take place in different
ways.
Researching abuse Serial abuse is where the perpetrator seeks out and ‘grooms’
cases and risk factors vulnerable adults (sexual abuse and some forms of financial abuse
Research a case of abuse of a usually fall into this pattern). These are often, but not always, criminal
vulnerable adult. Ask your offences and are committed by people who deliberately prey on
supervisor or line manager about vulnerable people. This can range from the confidence trickster who
any situations they can tell you poses as an official in order to gain entry to an older person’s home
about from their own experience. to the abuser who will ‘befriend’ someone with mental health
Otherwise look at a case study or a problems through an Internet chat room, and later subject them to
report into an incident that took abuse or assault. It can also include those criminals who attempt to
place in another workplace. See commit fraud or threaten vulnerable people in connections with wills,
how many risk factors you can property or other financial assets.
identify. Before you start thinking Situational abuse is a result of pressures building up and/or because
that people should have seen the of difficult or challenging behaviour. This type of ‘acute’ and
potential risk, remember that immediate abusive situation normally results in physical abuse,
hindsight is always 20:20 vision! although it can result in verbal or emotional abuse and sometimes in
neglect where a carer no longer seeks out necessary medical
treatment or other support.
Functional skills
Long-term abuse may occur in the context of an ongoing family
English: Reading relationship, for example, domestic violence, or where a family
When researching for a case study, member with a physical or a learning disability is humiliated and
select a variety of texts to identify a belittled, or where an older relative has all their money and
range of risk factors. By doing this belongings gradually taken from them over a period of time. Neglect
you will use relevant information and of someone’s needs because others are unable or unwilling to take
compare sources. responsibility for their care is also likely to take place over a long
period of time.
Institutional abuse arises from poor standards of care, inadequate
staffing, lack of response to people’s complex needs, staff with
inadequate knowledge, skills, understanding and expertise. This
can also involve unacceptable treatment programmes including
overmedication, unnecessary use of restraint, and withholding food,
drink or medication.
Risk factors
People can be abused for many reasons, and it is important in
highlighting any contributing factors, to make it clear that the factors
alone do not mean that abuse is taking place. It is quite possible to
How vulnerable do you think this have any or several factors in place and for there to be no abuse –
woman is to strangers visiting?
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equally, there may be no obvious factors but, nonetheless, abuse is

happening.
Some of the factors that are known to contribute to the risk of harm
and abuse of adults by family and friend carers are:
•• poor communication between supported person and carer – this
could be because of a medical condition or a social/relationship
issue
•• challenging behaviour by the supported person
•• carer being young or immature
•• carer feeling unable to carry on
•• strong feelings of frustration on the part of the carer
•• carer and supported person having a history of a troubled
relationship
•• carer having an alcohol or drug dependency
•• carer believing that the cared-for person is being deliberately
difficult or ungrateful
•• caring role not having been taken on willingly
•• carer having had to make major lifestyle changes
•• carer having more than one caring responsibility – for example,
young children and an older relative
•• supported person being violent towards the carer
Can you see how stress builds up in •• carer having disturbed sleep
some situations? •• carer and supported person being socially isolated
•• financial or housing pressures
•• delays or insufficient resources to provide adequate support
•• isolated older people without family support or contact –
particularly in relation to financial abuse.
Case study
Caring at home
Sunita is 48 years old. She has Parkinson’s disease, because she feels people are looking at her. She is very
which has recently begun to develop very rapidly. Her angry about the way Parkinson’s has affected her, and
mobility has become very limited and she cannot be left has alienated many of the friends who tried to help
alone because she falls frequently. The number of initially, by being uncooperative and refusing much of
personal care tasks she can carry out has decreased the help they offered.
significantly, and she is almost totally dependent on her
1. How could you try to relieve some of the pressures
husband for care.
in this situation?
Sunita has two grown-up sons who live and work 2. Are there any warning signs in this situation that
considerable distances away. They both visit as often as would make you aware of the possibility of abuse?
they can, but are not able to offer any regular caring If so, what are they?
support. Sunita’s husband has given up his career as a 3. Can you think of a situation where you may have
ranger in the local country park, a job he loved, in order missed some signs like these?
to look after Sunita. She is very reluctant to go out
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Abuse by professionals
Reflect
Some of the factors which are known to contribute to the risk of
Look at your workplace. Do any harm and abuse by professional support workers can include:
of the points opposite apply? If any
of these are the case in your •• poor-quality staff training
workplace, you need to be aware •• lack of knowledge and understanding by staff
that people can be put under so •• inadequate staffing numbers
much stress that they behave •• lack of investment in continuing professional development
abusively. Remember that abuse is •• little or no staff support or supervision
not just about physical cruelty. •• low staff morale
•• lack of opportunity for care workers to form a relationship with
If none of these things happen in someone
your workplace, then try to imagine •• organisational culture which fails to treat people with dignity and
what work would be like if they did. respect as individuals
Sit down with a colleague, if you •• culture of bullying of staff members by management.
can, and discuss what you think the
effects of any two of the items in Recognising the signs
the list would be. If you cannot do
You have looked at several examples showing possible signs and
this with a colleague, you can do it
symptoms that may alert you to abuse or harm. One of the most
on your own by making notes.
difficult aspects of dealing with abuse is to admit that it is happening.
If you are someone who has never come across deliberate abuse
Functional skills before, it is hard to understand and to believe that it is happening. It
is not the first thing you think of when someone has an injury or
English: Speaking and displays a change in behaviour. However, you have to accept that
listening abuse does happen and is relatively common. Considering abuse
should be one of the options when someone has an unexplained
Use the list in the Reflect feature to
injury or a change in behaviour that has no obvious cause. That does
initiate a group discussion. Choose a
not mean it will be abuse, or that you should start formal reporting
minimum of two points as a basis for
procedures – it means that you should always consider it as a real
the discussion. You will need to take
possibility.
an active role as a participant and to
present your ideas clearly. Victims of abuse often fail to report it for a range of reasons. They:
•• are too ill or too frail
Doing it well •• do not have enough understanding of what is happening to them
•• are ashamed and believe it is their own fault
Recognising abuse •• have been threatened by the abuser or are afraid
If you want to be effective in helping
•• do not think that they will be believed
to stop abuse, you will need to:
•• do not believe that anyone has the power to stop the abuse.
Given the fact that relatively few victims report abuse without
•• believe that abuse happens
support, it is essential that those who are working in care settings are
•• recognise abusive behaviour
alert to the possibility of abuse and are able to recognise possible
•• be aware of when abuse can
signs and symptoms.
happen
•• understand who abusers can be Abuse can take place at home or in a formal care setting. At home, it
•• know the policies and could be a family or friend carer who is the abuser, or it could be a
procedures for handling abuse neighbour or regular visitor. It can also be a professional support
•• follow the person’s support plan worker who is carrying out the abuse. This situation can mean that
•• recognise likely abusive situations abuse goes undetected for some time because of the unsupervised
•• report any concerns or suspicions. nature of a support worker’s visits to someone’s home.
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In a residential social care setting, abuse may be more likely to be

noticed, although some of its more subtle forms, such as humiliation,
can sometimes be so commonplace that they are not recognised as
abusive behaviour.
Up to this point, we have looked at abuse by professional support
workers and by family and friend carers. But remember that in
residential or hospital settings, abuse can occur between residents or
patients, and it can also happen between visitors and residents or
patients. People can also abuse themselves.
Case study
Appropriate ways to care

For the past five years, Julie, aged 43, had been a senior Residents did not go out into the local town in the
support worker in a residential unit for people with a evenings because of the potential safety risk, but the
learning disability. She loved her job and was very staff would plan evenings of TV watching, choosing
committed to the residents in the unit. She was very programmes that they thought would interest the
concerned for the welfare of the people she supported residents. Sometimes simple games sessions or walks in
and did everything she could for them. Many of them the local park were arranged.
had been in the unit for many years and Julie knew
A new manager was appointed to the unit, and Julie
them well. The unit was not very large and had only a
and the other staff were very surprised to find that the
small staff who were able to work very closely with the
new manager was horrified by many of these practices,
resident group.
and wanted to make major changes.
Julie and the other staff were concerned that the
1. What changes do you think the manager may have
residents could easily be taken advantage of, as some
suggested?
were not able to make effective judgements about
2. Why do you think those changes may be needed?
other people and potentially risky situations.
3. Do you consider that Julie and the other staff
Regular mealtimes were arranged so that everyone members were practising in the best way for the
could share the day’s experiences and talk together, residents?
and bedtimes and getting-up times were also strictly 4. Think about, or discuss, whether this situation was
adhered to. The staff found that this was a good way of abusive.
keeping the residents organised and motivated.
Self-harm
The one abuser it is very hard to protect someone from is the person
themselves. People who self-harm should have the risk identified in
their plan of care, and responses to their behaviour will be recorded.
You must ensure that you follow the agreed plan for provision of care
to someone who has a history of self-harm. It is usual that a person
who is at risk of self-harm will be closely supported and you may
need to contribute towards planned activities or therapies.
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2. Know how to respond to

suspected or alleged abuse
2.1 and 2.2 What to do if there are
suspicions or someone alleges that they
are being abused
If someone makes an allegation of abuse to you, the first and most
important response is that you must believe what you are told. One
of the biggest fears of those being abused is that no one will believe
them – do not make this fear into a reality.
This is often harder than it sounds. If you have never been involved
with an abusive situation before, it is hard to believe that such cases
arise and that this could really happen.
You must reassure the person that you believe what you have been
told. Another common fear of people who are being abused is that it
is somehow their fault. You must therefore also reassure them that it
is not their fault and that they are in no way to blame for what has
happened to them.
When someone tells you about abuse or neglect, try not to get into
a situation where you are having to deal with a lot of detailed
information. After reassuring the person that you believe them, you
should report the allegation immediately to a senior colleague and
hand over responsibility. This may not always be possible because of
the circumstances or location in which the allegation takes place, or
because the person wants to tell you everything once they have
begun to talk. If you do find yourself in the position of being given a
great deal of information, you must be careful not to ask any leading
questions – for example, do not say, ‘And then did he punch you?’
Just ask, ‘And then what happened?’ Use your basic communication
and listening skills so that the person knows they can trust you and
that you are listening. Make sure you concentrate and try to
remember as much as possible so that you can record it accurately.
Remember that people tell you about abuse because they want it to
stop. They are telling you because they want you to help make it
stop. You cannot make it stop if you keep it secret.
Confidentiality
In general, of course, the right of every person to confidentiality is a
key part of good practice. However, abuse is one of the few
situations where you may have to consider whether or not it is
possible to maintain this. You will always need to be clear, when
someone alleges abuse, that you cannot promise to keep what they
tell you confidential. This is not always easy; very often, when
someone tells you about abuse they have suffered, they will start by
saying, ‘If I tell you something, will you promise not to tell anyone?’
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You cannot guarantee this, so do not make this promise – it is one

you cannot keep. It is never acceptable to tell someone one thing and
do another, so you must be clear from the start about what your
responsibilities are, and make it clear that you may have to share
what you are told with others. You can, however, reassure someone
by saying, ‘I can’t promise not to say anything to anyone, but I can
promise you that I will only tell people who will help you.’ You can
also promise that although some information may have to be shared,
it will be shared on a ‘need to know’ basis, and only among those
agencies directly involved in any investigation.
However, vulnerable adults are not children, and if they absolutely
refuse to allow you to share information, it is very difficult for you to
do so – beyond the absolute necessity to share the information with
your manager. All efforts then have to go into trying to encourage
the person to agree to sharing the information and pursuing an
investigation. However, if there is no question of capacity (see page
87), then you may have to accept that you can only monitor matters
carefully.
There can be some circumstances in which it is necessary for you to
break confidentiality; for example, if someone discloses that an officer
in charge in a residential care home is systematically stealing from the
people living there. You would be justified in breaking the
confidentiality of one person in order to protect other vulnerable
people. However, this must only be done in discussion with your line
manager, and any decisions taken must be fully recorded, giving
reasons why it is necessary. You must also make sure that the person
concerned knows to whom you have talked and why.
Why is it important for you to be clear that you may have to share what you
are told with others?
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The Data Protection Act 1998 (see page 240) requires you to ensure
that any written information is kept securely. Information about
abuse or potential abuse is very sensitive and it is important that
people have their right to privacy and confidentiality respected.
Information must be kept in a secure situation, password protected if
it is kept electronically and with any hard copies securely in a locked
cabinet. Make sure that only essential and necessary information is
kept, and that it is used for the abused person’s benefit and in their
best interests.
How do you respond?

According to organisations promoting good practice in safeguarding
vulnerable adults, there are four key priorities in responding to
concerns or allegations of abuse:
•• Priority 1: Protect
•• Priority 2: Report
•• Priority 3: Preserve
•• Priority 4: Record and refer.
Priority 1: Protect
The first and most important concern is to ensure that the abused
person is safe and protected from any further possibility of abuse.
Make sure that any necessary medical treatment is provided, and give
plenty of reassurance and comfort so that the person knows that they
are now safe. Even if the abuse happened a long time ago, or has
been going on for a long period, the process of making an allegation
can be very distressing as well as being a huge relief, so lots of warm,
kind and caring support is vital. When you find out, or suspect, that
someone is being abused or neglected, you have a responsibility to
take action immediately. Concerns, suspicions or firm evidence all
require an immediate response.
Functional skills Action to protect may mean taking someone to a safe place, or
removing the alleged perpetrator. It may mean getting medical
English: Writing
assistance or contacting trusted family or friends to provide support.
You will be practising your skills of
Priority 2: Report
writing and presenting information
in a logical and concise way. You must report any abusive situation you become aware of to your
Proofread your work to ensure line manager, or the named person in your workplace procedures for
accuracy of punctuation, spelling the Protection of Vulnerable Adults. You may have formal reporting
and grammar. By producing a report, procedures in place in your organisation, or you may simply make an
you will be using a range of sentence initial verbal referral. However, it will be essential that you make a
structures, including complex ones, full, written report as soon as you can after the event. In the
and ordering paragraphs to meantime, the checklist on the next page may help you to recall
communicate effectively. details you will need later, and make sure that you have done
everything you need to.
109
Checklist
made by
observation
Disclosure/
Date
How?
To whom?
by
Action taken
?
What action
, reasons Yes / No
If no action
adult seen?
Vulnerable
me)
(date and ti
When seen
list all
th e v u ln er able adult –
Who saw ealth
ification – h
form ation sharing/not
Consultatio
ns/in Yes / No
GP? Yes / No
District nurs
e? Yes / No
CPN? ices
– Social Serv
n sh aring/notification
io
ns/informat Yes / No
Consultatio
team? Yes / No
Community
Hospital team
? Yes / No
Police? Yes / No
op le ?
pporting pe Yes / No
Housing/su
encies?
Provider ag
Other Yes / No
ination?
Medical exam
When?
Where?
By whom? Yes / No
corded? Yes / No
All action re
corded?
non-action re Yes / No
Reasons for g?
ed in writin
e co n v er sa tions confirm Yes / No
Telephon
ting?
Strategy mee
ting
Date of mee
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Priority 3: Preserve
Preserve any evidence. If this is a potential crime scene, you must be
very careful not to destroy any potential evidence. If an incident of
physical or sexual abuse is recent and there is likely to be forensic
evidence, then you must preserve it carefully until the police arrive
and take over. For example:
•• do not clear up
•• do not wash or clean any part of the room or area in which the
alleged abuse took place
•• do not remove bedding
•• do not remove any clothes the abused person is wearing
•• do not allow the person to wash, shower, bathe, brush hair or
clean teeth
•• keep other people out of the room or area.
If financial abuse is alleged or suspected, ensure that you have not
thrown away any papers or documents that could be useful as
evidence. Try to preserve as much as possible, in order to hand it over
to those investigating the allegations.
The evidence for other types of abuse is different. Sadly, neglect
speaks for itself, but it will be important to preserve living conditions
as they were found until they can be recorded and photographed.
This does not include the person concerned; bearing in mind Priority
1, any treatment and medical attention needed must be provided
immediately. Make sure that you explain to any doctor or paramedic
that the situation may result in a prosecution, so they should record
any findings carefully in case they are later required to make a
statement.
Psychological or discriminatory abuse is likely to be dependent on
witnesses and disclosure from the abused person, rather than physical
evidence.
Priority 4: Record and refer
Any information you have, whether it is simply concerns, hard
evidence or an allegation, must be carefully recorded. You should
write down your evidence or, if you are unable to do so for any
reason, you should record it on audio tape and have it transcribed
(written down) later. It is not acceptable to pass on your concerns
verbally without backing this up with a recorded report. Verbal
information can be altered and can have its meaning changed very
easily when it is passed on. Think about the children’s game of
Chinese Whispers – by the time the whispered phrase reaches the
end of its journey, it is usually changed beyond all recognition.
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Your workplace may have a special report form for recording causes
Activity 2 for concern or allegations. If not, you should write your report,
Concerns about an making sure you include:
abuse situation •• everything you observed
Write a report on concerns about
•• anything you have been told – but make sure that it is clear that
an abuse situation that could occur
this is not something you have seen for yourself
in your workplace. If you are aware
•• any previous concerns you may have had
of abuse situations that have
•• what has raised your concerns on this occasion.
happened, you could report on one Record what has happened. This is vitally important, as you may
of them, making sure you do not need, at some stage to make a formal statement to police, or other
use people’s real names or any investigation team. Initially, however, you should make sure that you
other information that could have recorded all the key details for your own organisation. You may
identify them. If not, make up the also need to make a referral to another agency, for example, the
details. State to whom, in your police or social services. You will need to record all of the following
workplace, you would give the information carefully, including a detailed account of what actually
report. happened, what you saw or were told, and who said or did what.
Be clear that you do not mix fact and opinion, and make sure that
you state clearly what you actually know because you have seen or
heard it yourself, and identify what you have heard from others as
this is hearsay or third party evidence and it is important that others
know how reliable your information is. For example:
Mrs James was crying when I arrived.
This is a fact.
Mrs James should not have been living there with

him – everyone is aware of his bad temper.
This is an opinion.
Mrs James had been upset earlier in the morning

when her neighbour had visited.
This is hearsay from the neighbour, and not a fact that you have
witnessed first hand. This type of information can be useful in a
report, but you must identify it as hearsay, for example: ‘Mrs James’s
neighbour told me that she had been upset earlier in the morning
when she had visited.’
If you do have to make a formal statement or produce a report that
will be used in court, you cannot include any hearsay, and must only
report facts which you have seen or heard for yourself.
If you need to make a referral to another agency you will need to
include all the information shown opposite.
112
o rmation
Referral inf
used person
Details of ab
•• Name
•• Address
mbe r
•• Telephone nu
•• Date of birth
•• Gender nguage spoken
)
g principal la
ound (includin
•• Ethnic backgr ication needs)
lity (includin g any commun
•• Detai ls of any disabi
ours, friends
•• GP nt family m embers, neighb
rs and any significa
•• Details of care
ion
hom e/accommodat
•• Details about nts, etc.
ns with deta ils of any incide
ons for concer information
•• Reas n about susp icions, specific
abuse includ ing informatio
ged
•• Details of alle make safe and
protect
tion taken to
y immediate ac
•• Details of an
eatment
medical examination/tr
•• Details of any referral being
made
/is aware of
pers on has agreed to
•• Whether the w this has been
decided
rson – ho
pacity of the pe
•• The mental ca y involved
other prof essional/agenc Inspection,
•• Details of any mission for Social Care
es co pi ed in to referral (Com
r agenci
•• Details of othe are Trust, Hospital Trust, etc.)
C
Police, Primary
alleged abuser
•• Details of the
history
gr ou nd information or
•• Ba ck
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How to reduce individual risks

The types of attitude change needed to ensure whole communities
see that taking responsibility for the well-being of its vulnerable
members is a good thing is going to take time. In the meantime,
vulnerable people still need to be safeguarded and protected.
Whatever your role, and regardless of your work setting, you will be
able to have an impact in reducing the risks of harm and abuse for
vulnerable adults.
No one can guarantee to prevent abuse from happening – human
beings have always abused each other in one form or another.
However, using the information you have about possible abusive
situations, you are now able to work towards preventing abuse by
recognising where and how it can happen.
Working with carers

The 2001 census identified that there were 6 million carers in the UK.
This was 12 per cent of the adult population. The increasing number
of older people, along with the policy of empowering people to
remain active in the community for longer, means that the number of
carers is forecast to rise by over 50 per cent to almost 9.5 million by
2037, which is less than 30 years away.
Try to ensure that people in stressful situations are offered as much
support as possible. A carer is less likely to resort to abuse if they feel
supported, acknowledged and appreciated. Showing caring and
understanding of a person’s situation can often help to defuse
potential explosions. If you work directly with carers, you might
express this by saying, ‘It must be so hard caring for your mother.
The demands she makes are so difficult. I think you are doing a
wonderful job.’ Such comments, although simple and
straightforward, can often help a carer to feel that they do have
someone who understands and has some interest in supporting
them. So many times the focus is on the person in need of care and
the carer is ignored. If your role involves the management and
support of colleagues who are working directly in the community,
you can ensure that there is an awareness and focus on carers and
meeting their needs.
How carers are supported in law

The first National Strategy for carers – Caring for Carers – was
introduced in 1999. Since April 2001, carers have had further rights
under a new law: the Carers and Disabled Children Act 2000. This
entitles carers to an assessment of their needs if they wish. This can
be done when the person they care for is being assessed, or
separately. The carer can, with guidance from a social worker or care
manager, assess themselves.
The Carers (Equal Opportunities) Act 2004 came into force in England
on the first of April 2005. The Act gives carers new rights to
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information and ensures that work, life-long learning and leisure are
considered when a carer is assessed. The Work and Families Act 2006
extends the right of carers to request flexible working.
Working alongside carers is an essential part of protecting vulnerable
adults. Even if there are no immediate concerns, working with carers
to make sure that they are accessing their rights and having the
support they are entitled to reduces the risks that an abusive incident
can develop out of anger and frustration.
Supporting carers in the community

Some situations require much more than words of support, and giving
practical, physical support to a carer or family may help to reduce the
risk of abuse. The extra support provided by a professional carer can
do this in two ways: first, it can provide the additional help which
allows the carer to feel that they are not in a hopeless never-ending
situation; and second, it can provide a regular opportunity to check
someone where abuse is suspected or considered to be a major risk.
When resources are provided within the community rather than at
home, this also offers a chance to observe someone who is thought
to be at risk. Day centres and training centres also provide an
opportunity for people to talk to staff. Here they will feel that they
are in a supportive environment where they can talk about their fears
and worries, and be believed and helped.
Situation Solution
Carer needs to be able to Either regular or flexible breaks can

access breaks when be arranged. Some areas operate
necessary voucher schemes so carers can
organise breaks when it suits them;
others have regular planned breaks.
Carer needs aids, equipment Physical environment can be

and adaptations adapted to make caring easier.
Hoists, ramps, accessible bathrooms,
electronic equipment can all make
the caring task easier.
Carer needs support to work Carers can be provided with support

or undertake training for the cared-for person while they
are at work and they can be helped
to undertake training courses in
order to return to work.
Carers need some time and Carers can be provided with support
interests for themselves while they are involved in leisure
activity. Advice and information
about opportunities as well as
practical support is available.
Table 2: Identifying situations where carers need support.
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Vulnerable carers
Remember that sometimes, it is the carer who is the vulnerable
person. For example, an older parent caring for a son or daughter
with mental health problems, or who exhibits challenging behaviour,
may be very much at risk. It is important to look at the whole picture
when carrying out a risk assessment, and to offer support and
protection to any vulnerable adult who is at risk.
Case study
Identifying vulnerable people

Mrs Clarke is 75 years old. She is quite fit, although forehead, a black eye, a split lip and last week she
increasingly her arthritis is slowing her down and arrived at the day centre with a bruised and sprained
making her less steady on her feet. She has been a wrist. She finally admitted to the centre staff that
widow for 15 years and lives with her only son, Ronnie, Ronnie had inflicted the injuries during his periods of
who is 51. When Ronnie was 29, he had a motorcycle bad temper. She said that these were becoming more
accident. This caused brain damage, from which he has frequent as he became more frustrated with her
never fully recovered. His speech is slow and he slowness.
sometimes has problems in communication. His
Despite being very distressed, Mrs Clarke would not
coordination and fine motor skills have been affected,
agree to being separated from Ronnie. She was
so he has problems with buttons, shoelaces and writing.
adamant that he did not mean to hurt her. She would
Ronnie also suffers from major mood swings and can be
not consider making a complaint to the police. Finally,
aggressive. Mrs Clarke is Ronnie’s only carer. He has not
Mrs Clarke agreed to increasing both her and Ronnie’s
worked since the accident, but he goes to a day centre
attendance at their day centres, and to having some
three days each week. Mrs Clarke takes the opportunity
assistance with daily living.
to go to a day centre herself on those three days
because she enjoys the company, the outings and 1. What action can be taken?
activities. 2. What action should be taken?
3. Whose responsibility is this situation?
Recently, Mrs Clarke has had an increasing number of
injuries. In the past two months she has had a grazed
This kind of situation may cause a great deal of concern and anxiety
for the care workers, but there are limits on the legal powers to
intervene and there is no justification for removing Mrs Clarke’s right
to make her own decisions.
Activity 3
Mrs Clarke and Ronnie
Imagine that you are the support worker to Mrs Clarke and Ronnie.
Your work involves regular visits to their house to monitor the
effectiveness of the care package and provide support. One day you
arrive to find Ronnie screaming at Mrs Clarke and hitting her.
1. What would your immediate actions be?

2. Write a report covering the incident, including your actions.
3. To whom would you give your report?
4. Who else would need to be informed of this incident?
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Consent
A key issue in the protection of vulnerable adults is one of consent.
Vulnerable adults have a fundamental human right to decide how
and with whom they live. A person who is able to make decisions for
themselves is entitled to refuse protection and to limit what you are
able to do. In general, any action you take in relation to protecting a
vulnerable adult must be with their consent.
The issue of gaining consent before taking any action does not only
apply to reporting abuse, it also applies to providing evidence for any
prosecution and to having any medical examination to record and
confirm any injuries or other forensic evidence. If you are faced with
a situation where it is clear that abuse has taken place and the
vulnerable person is refusing to make a complaint, or to undergo
a medical examination, then your only way forward is to try to give
them as much clear information as possible and then to refer the
situation to your line manager for consideration as to whether any
further action is possible.
The steps you can take are limited; there is no legislation that gives
vulnerable adults a right of protection as there is for children.
Reasons for refusing consent

There are many reasons why people refuse to agree to any further
action being taken. If you can find out the reason, you may be able to
provide the information and support that people need. Some of the
reasons include those shown in Table 3.
Reason for refusal Information to give
Fear of reprisals from the abuser Reassure that it will be possible to make sure that there is no need to
have contact with the abuser, and the person can be protected.
Belief that it is own fault Emphasise that it is never the fault of the survivor, give information
and reassurance about rights and state that abuse is against the law.
Confirm that abusers are bullies and criminals.
Fear that services will be withdrawn Reassure that a complaint against a professional is taken very
seriously, and that services are a right. No one will remove services
because of a complaint. Assure that service provider is on the side of
the survivor, not the abuser – even if the abuser is the employee.
Fear of medical examination Ask medical staff to explain procedure and to reassure. Explain why
it is important to provide evidence, and show types of evidence that
can be found from examination.
Fear of police investigation/court Explain support available for police interviews and for court
appearance appearances.
Table 3: Possible reasons for refusing consent, and how to respond to these.
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Important difference
A refusal to undergo medical treatment following injuries is an
entirely different situation to refusing to undergo a medical
examination. If you are faced with someone who has been injured
and is refusing treatment, then you must refer the matter to a doctor
immediately, so that a decision can be made on the best way forward
depending on the nature and severity of the injuries. This is not a
decision for you to make without medical support.
3. Understand the national and

local context of safeguarding
and protection from abuse
Both nationally and locally, the protection of vulnerable adults forms
part of the Safeguarding Adults agenda. Local authorities now have
Safeguarding Adults Boards. These mirror the Local Safeguarding
Children Boards, except that they do not have the statutory basis and
powers of the Children’s Boards. The local boards are responsible for
delivering a multi-agency response to safeguarding adults and to
ensure that all the partner agencies are recognising and acting on
safeguarding issues at a strategic and an individual level. For example,
late-night transport or street lighting may be a strategic issue for
safeguarding adults, but it is equally important that systems are in
place to deal with individual allegations. The local boards will have
members from social services, the voluntary sector, police, housing
and health as a minimum, and possibly other areas such as leisure,
transport and highways. They are also responsible for conducting
Serious Case Reviews when someone has died as the result of abuse
and there are lessons to be learned.
Empower and protect

Current thinking in relation to policy for vulnerable adults is to focus
less on someone as ‘having a problem’ which needs to be resolved,
and more on empowering vulnerable people in their role as citizens. If
people are contributors to decision making and are a valued and
recognised vital part of a community, then abuse is less likely to
occur, or if it does, people feel more able to report it and to take
steps to stop it. Even the term ‘vulnerable adults’ tends to make
people sound as if they have no power and are a target for bullies.
It also sounds as if people need to be protected from harm and risk
– and they do.
This type of policy change will take time to come into effect; if you
have been around in the sector for many years, you may remember a
time when rights, dignity, choice and anti-discriminatory practice
were unheard of. Now all of these form a vital part of good practice
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and everyone understands how essential they are. The same thing will
happen to the concept of empowerment as a means of protection,
and it will become the basis for reducing the incidence of abuse and
protecting vulnerable people from it.
If you take a direct comparison with child abuse, you can see that for
over 20 years, the focus was on risk analysis, individual intervention
and the removal of children into ‘care’. Sadly, this often replaced one
type of abuse with another. The ‘Quality Protects’ initiative in the late
1990s began a change in attitude and professionals began to
recognise that improving the quality of children’s services was an
effective means of safeguarding against abuse, but it was the
introduction of Sure Start and Connexions which really made it clear
that children and young people are an integral part of society and
that there has to be a ‘whole system’ – rather than separate parts just
working together. The 2006 White Paper ‘Our Health, Our Care, Our
Say’, quickly followed by ‘Putting People First’, set out the agenda for
empowering people to take control of their services and support. This
is moving rapidly and, by 2011, everyone who uses social care
services will have the option to choose what services they want and
how and by whom they want them delivered.
Being strong, informed and active citizens is a good protection against abuse.
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Information is power
Giving people information and making sure that they are aware of
their rights is very important. It is surprising how often a vulnerable
adult who has been in an abusive situation did not even realise they
were being abused, or that there was anything that could be done
about it. After all, you have to be able to recognise abuse before you
can report it!
Ways to empower vulnerable adults

For people to feel that they are able to take control and deal with
difficulties, they need to have the means to do so. Many of the changes
that need to be made will be outside your area of responsibility, and
need to be undertaken by organisations at a strategic level. However,
your own practice can make a huge contribution, and you can make
suggestions and gain agreement to make improvements.
•• Awareness of abuse of vulnerable adults must be part of all
information that goes out. It should be available in a wide rage of
formats – print, audio, Braille, appropriate languages, in picture
format, large print and plain language.
•• Information should be available about what abusive behaviour is,
how to recognise it and how and where to report it.
•• Information should be available everywhere, leaflets in all
communications sent out by the agency, posters in libraries, leisure
centres, schools, hospitals, churches, community centres, cinemas,
pubs as well as in places providing services for vulnerable adults.
Knowledge is power – it makes people strong and less vulnerable.
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•• Reporting of abuse must be easily accessible – one easily

remembered free telephone number or a ‘one stop shop’ in a
central place.
•• Publicity could be carried out through local newspapers, TV
programmes and radio programmes.
•• Involvement of survivors of abuse in policy-making forums can
assist in looking at how to improve responses.
•• Involvement of vulnerable adults in decisions about how services
are planned and commissioned can raise their profile.
Case study
Reporting concerns
Kathy works in a post office in a small Midlands market A few weeks later, Kathy was walking past Mrs Morris’s
town. She has known Mrs Morris for many years and house and saw Paul and his wife carrying boxes out of
always stops for a chat when she collects her pension. the house. Mrs Morris was watching through the
Kathy also sees her at the local church every week. window and crying, obviously unhappy about what they
Mrs Morris has always been active in the local were doing. Kathy was very concerned and asked what
community and is very friendly and sociable. was going on. Paul shouted at her that he was having
to cope with looking after his mother who was too
Mrs Morris’s son and daughter-in-law have recently
confused to communicate and was unable to go out,
moved into her house. They have just moved from
and that he was doing his best and Kathy should mind
another part of the country and are not working.
her own business.
Mrs Morris had never spoken much about her son Paul,
and Kathy was quite surprised when she mentioned he Kathy left because she was quite frightened by his
was moving in – Mrs Morris just said that he had had a aggression, but she still felt that something should be
bit of trouble where he was, but did not seem keen to done.
talk about it. After Paul moved in, Mrs Morris did not
1. Should Kathy report her concerns and, if so, to
come to church or to the post office for a few weeks.
whom?
Eventually Paul came in to collect his mother’s money.
2. How could she find out what Mrs Morris wants?
When Kathy asked how she was, Paul said that she was
3. Is abuse everyone’s business?
very confused and unable to look after herself any
more. Kathy was surprised and sad, as Mrs Morris had
always been so well and such an active person.
Legislation
There are laws that provide the basis for dealing with abuse of
vulnerable adults. The legislation is not as clear-cut as it is for the
protection of children, and there are no specific laws in England that
deal exclusively with abuse, although the situation is different in
Scotland.
Table 4 identifies some of the laws, regulations and guidelines that
can be used in abusive situations.
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Act of Parliament/ Use Type of

regulation/guideline abuse
Criminal Justice Act 1998 Criminal prosecution by police for assault. Physical
Civil action by the victim For assault, battery or false imprisonment. Physical
Care Standards Act 2000 Regulation of residential and nursing homes – S10 – cancellation Institutional
of Registration, S11 – emergency cancellation, for breach of
regulations. However, it is the driving up of quality as a result of
this Act which offers the best protection against abuse.
Sexual Offences Act 2003 Police prosecution for rape, indecent assault and other sexual Sexual
offences. This Act has greatly increased the protection for people
with a learning disability or mental health problems because it has
defined ‘consent’.
Family Law Act 1996 Can provide injunctions and non-molestation orders. Physical,
sexual,
psychological
Offences Against the Person Prosecution by the police for more serious offences of actual Physical
Act 1861 bodily harm or grievous bodily harm.
No Secrets (England) and In Guidance documents that set out how local authorities must work All
Safe Hands (Wales) jointly with other agencies to make local arrangements to
safeguard and protect vulnerable adults.
Safeguarding Vulnerable Sets up vetting and barring scheme for people who work with All
Groups (Scotland) Act 2006 children and vulnerable adults in England and Wales.
Protection of Vulnerable Sets up a vetting and barring scheme for people who work with All in Scotland
Groups (Scotland) Act 2007 vulnerable adults in Scotland.
Adult Support and Protection Gives local authorities in Scotland the power to enter premises Physical, sexual
(Scotland) Act (ASPA) 2007 where they suspect abuse is taking place, and there are also
powers to remove perpetrators and ban them from returning to
the premises.
Criminal Injuries Can provide payments for survivors of abuse that was the result of Physical,
Compensation scheme a criminal act. sexual,
financial if
criminality
proven
Mental Capacity Act 2005 A criminal offence to ill-treat or neglect a person who lacks Physical,
capacity. sexual, neglect
Police and Criminal Evidence Gives police emergency powers to enter premises if they believe Physical
Act 1984 S17 there is danger to ‘life and limb’.
Mental Health Act 1983 S37 is about the powers of a local authority, relative or court to All
take out guardianship of a vulnerable adult.
S115 is about the powers of entry and inspection for Approved
Social Workers.
S117 is about providing after care for people with mental health
problems.
S135 is about powers to remove people to a ‘place of safety’.
S127 is about the ill-treatment of patients with mental health
problems.
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Act of Parliament/ Use Type of

regulation/guideline abuse
Protection from Harassment Provides protection from harassment and from fear of violence. Psychological
Act 1997
Theft Act 1968 Police prosecution for theft. Financial
National Assistance Act 1984 Local authority has responsibility for matters to do with protection Financial
S47 of property.
Fraud Act 2006 Has made it an offence to abuse a position of trust. Financial
Office of the Public Guardian Supports and promotes decision making for people who lack Financial
capacity.
Table 4: Acts of Parliament that relate to abusive situations.
Vetting and barring

Both England and Scotland now have legislation that sets up vetting
and barring schemes that are designed to ensure that people who are
unsuitable to work with vulnerable adults, or with children, are
prevented from doing so.
In England, the Act set up the Independent Safeguarding Authority
(ISA), which oversees the registration of people working, or who want
to work, with vulnerable adults or children. There are different levels
of activity, for those who work or volunteer occasionally with
vulnerable groups, and those who work with them on a day-to-day
basis. Criminal records checks are undertaken on everyone who
works or volunteers, and anyone found to have a record of offences
will be barred from working with vulnerable groups.
Information about people who have been barred is circulated to
employers so that they do not take on someone unsuitable. Under
the Act it is an offence for an employer to employ someone
they know has been barred. (For more information, see
www.isa-gov.org.uk)
Recognise the importance of

whistleblowing
Abuse by professional carers
Responding to an abusive situation in your own, or another,
workplace can be very difficult. There may be many reasons why you
feel that you should not intervene.
•• It will mean problems with colleagues – you will make yourself
unpopular.
•• It could jeopardise promotion – no one will trust you again.
•• You might be wrong.
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You may feel that you should leave matters to sort themselves out.
You should not and they will not.
‘Blowing the whistle’ about an abusive situation among colleagues is
never easy, but you have an absolute duty to do so; there are no if
and buts.
The government has recognised this, and following several well-
publicised cases, passed the Public Interest Disclosure Act 1998. This
protects whistleblowers and ensures that you cannot be victimised by
your employer for reporting abuse or any other illegal acts. The Act
protects people making disclosures about:
•• a criminal offence
•• the breach of a legal obligation
•• a miscarriage of justice
•• a danger to the health or safety of any person
•• damage to the environment
•• deliberate covering up of information tending to show any of the
above five matters.
The basis for being protected by the Act is that the worker is giving
information that they ‘reasonably believe tends to show that one or
more of the above matters is either happening now, took place in the
past, or is likely to happen in the future’.
It is important to realise that you must have reasonable belief that the
information tends to show one or more of the offences or breaches
listed above. You may not actually be right – it might be discovered
on investigation that you were wrong – but as long as you can show
that you believed it to be so, and that it was a reasonable belief in the
circumstances at the time of disclosure, then you are protected by the
law.
If you believe that your line manager will not take action, either
because of misplaced loyalty or an unwillingness to confront or
challenge difficult situations, then you must make a referral to a more
senior manager. You must keep moving through the management
chain until you reach the person you consider able and willing to take
action. If there is no one within your own organisation, then you
must make a referral to an outside agency.
Contact your local authority and make the referral to the social
services department.
If you believe that the abuse you are aware of is potentially a criminal
offence, such as physical or sexual assault, theft or fraud, then you
should refer the matter to the police. At the same time, you should
refer to the Care Quality Commission or inspectorate for the UK
country in which you work.
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How is this investigated?

Each local authority must have a multi-agency Local Safeguarding
Adults Board for the protection of vulnerable adults. This committee
is responsible for setting out procedures and policies, identifying and
protecting those at risk, and ensuring each agency has an appropriate
response to abuse. It is likely that the procedure for your workplace in
relation to abuse by a professional carer will involve:
•• immediate suspension of the person accused
•• investigation by police if appropriate
•• investigation led by an independent agency
•• disciplinary procedures following the outcome of any police or
protection investigation.
Case study
Abuse by a care professional

Mr Patel is 89 years old and has lived alone in his One day, Selina arrives at the door and hears someone
three-bedroomed house since his wife died several years shouting, ‘Get on with it – you are not trying at all, you
ago. He has impaired sight and hearing, and mobility is are so lazy.’ As Selina walks into the hall, the
limited after a recent fall in which he hurt his back. He physiotherapist looks shocked to see her and says that
has had twice-weekly visits from a physiotherapist she is just leaving. After she leaves, Selina tackles
from the local Primary Care Trust, for the past month. Mr Patel and asks if everything is going well with the
Mr Patel has daily social care support from a private physio’s visits. He says that there is a long waiting list
provider contracted by Social Services. for physio and he is very lucky to have anyone.
Selina has been Mr Patel’s support worker for the past 1. What can Selina do?
year. She has noticed that over the past few weeks he is 2. What barriers may she face in trying to deal with
losing weight and that his meals, which are delivered this issue?
daily, are largely uneaten. Mr Patel will only say that he 3. Is this abusive behaviour?
is feeling a bit down and has not felt very hungry 4. How would you try to empower Mr Patel?
recently.
When the organisation abuses

You may want to blow the whistle about the way an organisation is
run, or the quality of a service. You could find yourself working in an
organisation where standards are not being met and vulnerable
people are being abused because of the policies and procedures of
the organisation rather than through the behaviour of any particular
person. There may be a policy of overmedication, or vulnerable
people may not be given sufficient food. People could be left in wet
or soiled clothing or bedding, or the organisation may have a policy
of restricting rights or freedoms. There is further information about
institutional abuse on page 102. In this situation, you should contact
your local inspectorate or the Local Safeguarding Adults Board.
Public Concern at Work is a national organisation that provides legal
advice to those concerned about malpractice at work. The service
is free and strictly confidential. (For more information, see
www.pcaw.co.uk)
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Challenging the potential for abuse

All abusive behaviour is unacceptable. However, there are other sorts
of behaviour that you may come across which you may not be able to
define directly as abusive, but which is certainly close to it – or could
lead to an abusive situation if not dealt with.
Generally, you can define behaviour as unacceptable if:
•• it is outside what you would normally see in that situation
•• it does not take into account the needs or views of others
•• people are afraid or intimidated
•• people are undermined or made to feel guilty
•• the behaviour is likely to cause distress or unhappiness to others
•• someone is threatening violence
•• someone is subjecting another person to unwelcome sexual
harassment
•• someone is playing loud music in a quiet area, or late at night
•• there is verbal abuse, racist or sexist innuendo
•• a person is spreading malicious gossip about someone
•• someone is attempting to isolate another person.
Unacceptable behaviour from colleagues

You may come across unacceptable and oppressive behaviour in your
colleagues or other professionals in your workplace. While you may
see or hear a colleague behaving in a way which is not abusive as
such, it may be oppressive and unacceptable. This can take various
forms such as:
•• speaking about people in a derogatory way
•• speaking to someone in a rude or dismissive way
•• humiliating people
•• undermining people’s self-esteem and confidence
•• bullying or intimidation
•• patronising and talking down to people
•• removing people’s right to exercise choice
•• failing to recognise and treat people as individuals
•• not respecting people’s culture, values and beliefs.
In short, the types of behaviour that are unacceptable from workers
in care settings are those which simply fail to meet the standards
required of good-quality practitioners. Any support worker who fails
to remember that all people they support are individuals, and that all
people have a right to be valued and accepted, is likely to fall into
behaving in an oppressive or unacceptable way.
All of these types of behaviour are oppressive to others and need to
be challenged, whether it is behaviour by colleagues, visitors, carers
or those being supported. You can probably think of many other
situations in your own workplace that have caused unhappiness. You
may have had to deal with difficult situations, or have seen others
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deal with them, or perhaps you have wished that you had done
Activity 4 something to challenge unacceptable behaviour.
Unacceptable behaviour The effects of abuse
Ask three colleagues in your
Abuse can devastate those who experience it. It causes people to lose
workplace to state one behaviour
their self-esteem and their confidence. Many adults and children
that they would find unacceptable
become withdrawn and find it hard to communicate. Anger is a
in:
common emotion among people who have been abused. It may be
1. someone who was being directed against the abuser, or at those people around them who
supported failed to recognise the abuse and stop it happening.
2. a colleague.
One of the greatest tragedies is when people who have been abused
Compare the six answers and see if turn their anger against themselves, and blame themselves for
they have anything in common. everything that has happened. These are situations that require expert
Find out from your supervisor help, and this should be available to anyone who has been abused,
about the type of behaviour that is regardless of the circumstances.
challenged in your workplace, and
Some of the behaviour changes that can be signs of abuse can
behaviour which is allowed.
become permanent, or certainly very long-lasting. There are very few
survivors of abuse whose personality remains unchanged, and for
those who do conquer the effects of abuse, it is a long, hard fight.
The abuser, or perpetrator, also requires expert help, and this should
be available through various agencies, depending on the type and
seriousness of the abuse. People who abuse, whether their victims are
children or vulnerable adults, receive very little sympathy or
understanding from society. There is no public recognition that some
abusers may have been under tremendous strain and pressure, and
abusers may find that they have no support from friends or family.
Many abusers will face the consequences of their actions alone.
Support workers who have to deal with abusive situations will have
different emotional reactions. There is no ‘right way’ to react.
Everyone is different and will deal with things in their own way. If you
have to deal with abuse, these are some of the ways you may feel,
and some steps you can take that may help.
Shock
You may feel quite traumatised if you have witnessed an abusive
incident. It is normal to find that you cannot get the incident out of
your mind, that you have difficulty concentrating on other things, or
that you keep having flashbacks and re-enacting the situation in your
head. You may also feel that you need to keep talking about what
happened.
Talking can be very beneficial, but if you are discussing an incident
outside your workplace, you must remember the rules of
confidentiality and never use names. This way of talking does become
second nature, and is useful because it allows you to share your
feelings about things that have happened at work while maintaining
confidentiality.
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These feelings are likely to last for a fairly short time, and are a natural
reaction to shock and trauma. If at any time you feel that you are
having difficulty, you must talk to your manager or supervisor, who
should be able to help.
Anger
Alternatively, the situation may have made you feel very angry, and
you may have an overwhelming urge to inflict some damage on the
perpetrator of the abuse. While this is understandable, it is not
professional and you will have to find other ways of dealing with their
anger. Again, your supervisor or manager should help you to work
through your feelings.
Everyone has different ways of dealing with anger, such as taking
physical exercise, doing housework, punching a cushion, writing
feelings down and then tearing up the paper, crying or telling their
best friend. Whatever you do normally to express your anger, you
should do the same in this situation (just remember to respect
confidentiality if you need to tell your best friend – miss out the
names). It is perfectly legitimate to be angry, but you cannot bring
this anger into the professional relationship.
Distress
The situation may have made you distressed, and you may want to
go home and have a good cry, or give your own relatives an extra
hug. This is a perfectly normal reaction. No matter how many years
you work, or how many times it happens, you may still feel the
same way.
Some workplaces will have arrangements in place where workers are
able to share difficult situations and get support from each other.
Others may not have any formal meetings or groups arranged, but
colleagues will offer each other support and advice in an informal
way. You may find that work colleagues who have had similar
experiences are the best people with whom to share your feelings.
There is, of course, the possibility that the situation may have brought
back painful memories for you of abuse you have suffered in your
own past. This is often the most difficult situation to deal with,
because you may feel as if you should be able to help because you
know how it feels to be abused, but your own experience has left you
without any room to deal with the feelings of others. There are many
avenues of support now available to survivors of abuse. You can find
out about the nearest support confidentially, if you do not want your
workplace colleagues or supervisor to know. Try www.stopitnow.org.
uk or www.abuse-survivors.org.uk. Organisations such as your local
Citizens Advice Bureau, health centre or library will also have contact
details on posters and leaflets in case you do not want to ask.
There is no doubt that dealing with abuse is one of the most stressful
aspects of working in social care. There is nothing odd or abnormal
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about feeling that you need to share what you have experienced and
looking for support from others. In fact, most experienced managers
would be far more concerned about a worker involved in dealing
with abuse who appears quite unaffected by it than about one who
comes looking for guidance and reassurance.
Dealing with abuse is difficult and demanding for everyone, and it is
essential that you receive professional supervision from your manager.
This may be undertaken in a regular supervision or support meeting if
you have one. If not, it will be important that you arrange to meet
with your supervisor, so that you can ensure you are working in the
correct way and in accordance with the procedure in your setting.
Overview
Much of what you read about dealing with abuse may give you the
impression that this is an area full of rules and procedures. It is, and
for very good reasons. Abuse is extremely serious – it is potentially
life-threatening. Systems and rules have been developed by learning
from the tragedies that have happened in the past. Many of these
tragedies occurred because procedures were either not in place or not
followed. You must make sure that you and any staff you supervise
know what the procedures are in your workplace and follow them
carefully.
Working through this unit may make you feel as though abusive
behaviour is all around you, and that vulnerable people are being hurt
and frightened by carers all around you. Thankfully, the majority of
carers and support workers do not abuse; they provide a good
standard of care. And most vulnerable adults are not subjected to
harm. However, while that may be comforting to know, it is the case
that as more professionals develop understanding of abuse and are
aware of how to recognise and respond to abuse, the less likely it is
that abusers will be able to continue to harm vulnerable people.

This unit is about showing your assessor your be able to identify the legislation and to explain about
knowledge and understanding of safeguarding and how Local Safeguarding Children Boards work. There
protection. For obvious reasons, your assessor is not are some circumstances that make abuse more likely
likely to observe your practice. You are more likely to and you will need to show that you can identify what
have to produce an assignment or a presentation to steps to follow to make abuse less likely to occur. One
show that you can recognise abuse and know what of the most difficult areas is to know how to ‘blow the
signs to look for. You may have to describe these or find whistle’ when you identify poor practice or even abuse
examples to illustrate them. Your assessor will also want among your colleagues. Your assessor will probably ask
to know that you are familiar with the legal basis for ‘what if’ questions to see if you understand what you
safeguarding and that you know what steps to take if need to do.
someone makes allegations of abuse. You will need to
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Doing it well Legislation
Dealing with abuse •• Adult Support and Protection (Scotland) Act (ASPA) 2007
•• Care Standards Act 2000
•• Feeling upset is normal. •• Carers and Disabled Children Act 2000
•• Talk about the incident if that •• Carers (Equal Opportunities) Act 2004
helps, but respect the rules of •• Criminal Justice Act 1998
confidentiality and miss out the •• Data Protection Act 1998
names. •• Family Law Act 1996
•• Being angry is OK, but deal with •• Fraud Act 2006
it sensibly – take physical •• Mental Capacity Act 2005
exercise, do the housework, cry. •• Mental Health Act 1983
•• Do not be unprofessional with •• National Assistance Act 1984 S47
the abuser. •• No Secrets (England) and In Safe Hands (Wales)
•• If you are a survivor of abuse and •• Offences Against the Person Act 1861
you find it hard to deal with, ask •• Office of the Public Guardian
for help. •• Police and Criminal Evidence Act 1984 S17
•• Protection from Harassment Act 1997
•• Protection of Vulnerable Groups (Scotland) Act 2007
•• Public Interest Disclosure Act 1998
•• Safeguarding Vulnerable Groups Act 2006
•• Sexual Offences Act 2003
•• Theft Act 1968
•• Work and Families Act 2006

•• www.abuse-survivors.org.uk (Abuse Survivors, support and
information)
•• www.isa-gov.org.uk (Independent Safeguarding Authority)
•• www.pcaw.co.uk (Public Concern at Work)
•• www.stopitnow.org.uk (Stop It Now, an organisation fighting sexual
abuse against children)
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Unit HSC 025
The role of the
health and social
care worker
This unit looks at your role as a professional care and support

worker. The way in which you perform your role can have a
major impact on a person’s well-being and how they experience
the services they need.
As a support worker, you have a range of responsibilities.
Primarily you are responsible for delivering a quality service to
the person you are supporting. You must do this by working in
ways that your employer expects – of course, it may be that
your employer is the person whom you support. You will also
need to work in partnership with others, both professional
colleagues and family or friends who are also providing support.

1. working relationships in health and social care
2. how to work in ways that are agreed with the
employer
3. how to work in partnership with others.
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1. Understand working
relationships in health and
social care
1.1 Working relationships and personal
relationships
Most people have a wide range of relationships with different people
in different aspects of their lives. Relationships range from family to
work colleagues. Each of the different types of relationship is
important and plays a valuable role in contributing to the overall
well-being of each of us as individuals. However, the needs and
demands of different types of relationships are varied, as are the
effects that relationships can have on a person’s view of themselves
and the confidence with which they deal with the world.
Types of Features of relationship

relationships
Family relationships These are relationships with parents, grandparents, siblings and children. Depending
on the type of family, they can be close or distant.
Sexual relationships These relationships can be long term or short term, with a spouse or permanent
partner, or shorter-term non-permanent relationships. The impact of sexual
relationships is different from family relationships and more intense than the
demands of a friendship.
Friendships Friendships can be long term or can be short term but quite intense. Most people
have a few close friends and a much larger circle of friends who are not quite so
intimate or close. These may be friends who are part of a wide social circle but
perhaps not close enough to share intimate details of someone’s life. Close friends,
on the other hand, are often the ones who are an immediate source of support in
times of difficulty and the first person with whom good news is shared.
Working relationships These can be relationships with employers or with work colleagues. Some may stray
over the boundaries into friendships, but for most people the colleagues with whom
they work are related in a different way to that in which they would relate to
friends. For example, work colleagues may share very little information about
someone’s personal life even though they may have very close and regular day-to-
day contact. It is perfectly possible to spend a great deal more time with work
colleagues than with friends, but not be as close.
Table 1: Types and features of different relationships.
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The role of the H&SC worker Unit HSC 025
Family relationships
Family relationships are usually those that influence people most. For
most children the type of relationship they have within the family
where they grow up influences the rest of their lives and the kind of
people they become. Primarily it is the relationship with their parents
or main carers that is the most influential during childhood. For a
growing child, relationships with parents and other extended family
members, such as grandparents and siblings, provide the emotional
security that is important in establishing a positive self-image and in
developing confidence. As children grow through adolescence and
into early adulthood, family relationships become less dominant as an
influence; however, they remain significant for most people
throughout their lives. It is notable that most major occasions in
people’s lives, such as weddings, christenings and coming-of-age
birthdays, are regarded as ‘family occasions’, when members of the
immediate and extended family are usually involved and invited to
join the celebrations.
Sexual relationships
Most people who have a long-term sexual relationship would
probably view that as being the most significant relationship in their
lives. Even short-term sexual relationships can have a huge effect on
someone and how they regard themselves and their general health
and well-being. The physical closeness of a sexual relationship means
that the dynamics involved are significantly different from other
family relationships. Sexual partners are often close emotionally as a
result of their intimate physical relationship. Sexual relationships can
be long or short term, can be with an opposite or same-sex partner,
and can be exclusive – with just one partner – or non-exclusive –
where partners also have sexual relationships with others. These types
of sexual relationships will obviously have different effects and will
meet the needs of different people, possibly at different stages in
their lives. For example, teenagers and young adults may have
short-term and non-exclusive sexual relationships with a number of
partners, but many will eventually develop a long-term exclusive
relationship with one partner with whom they may remain for many
years.
Friendship
Friends become increasingly significant as children grow. For very
young children, pre-school individual friendships with other children,
while important for their social development, are relatively
insignificant as influences on their lives. Their relationships with other
members of their family or their main carer are far more important.
As children progress through school and into adolescence, their
friendships become more important and have a huge influence on
their behaviour. The ability to form friendships with others is an
important skill and is a need that most human beings have. An
133
inability of a child or young person to make friends or to be in a

situation in which they feel they do not have friends, or are being
bullied or excluded by others with whom they had hoped to be
friends, can be extremely distressing and have a serious effect on the
child’s self-image and self-confidence. Adults too find it difficult to
cope with being excluded and being unable to relate to others as
friends. Most people, regardless of circumstances, need to have a
close relationship with another person, through which they can share
confidences, worries and joy.
Family structures
As recently as the early part of the last century, family structures were
very different from how they are now. Less than a hundred years ago
the most common family structure was an extended family with
mother, father, grandparents, aunts and uncles living close to one
another, if not in the same house. Children would move between
different members of the family regularly and were equally at home
being cared for by a range of relatives. Fifty years ago the most
common family structure was a nuclear family, with mother, father
and children living in the same house but not necessarily living close
to other members of their family. While both nuclear and extended
families are still quite common, there is now a much wider range of
family structures and, as a result, a wider range of relationships and
patterns of communication within families. Table 2 shows family
structures and relationships within them.
Type of family Features
Traditional extended family Parents, grandparents, aunts, uncles, sisters, brothers, children, nieces
and nephews living together or in close proximity.
Traditional nuclear family Two parents and children living together. May or may not be close
contact with other members of the family, but less likely than in an
extended family.
Reconstituted family Parents both have children from previous relationships, and then possibly
children together.
Step-parent family A family where one parent has children from a previous relationship and
the other takes a step-parenting role.
Lone parent family One parent bringing up children without a partner.
Cohabiting family Unmarried partners who may also come into any of the categories
above.
Same-sex family Same-sex partners with or without children.

Table 2: Different types of family structure.
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Families can be structured in different ways.
Working relationships
Effective working relationships are extremely important both to
employees and to the organisations for whom they work. Businesses
use techniques designed to encourage work colleagues to work well
and effectively together. Usually, establishing good working
relationships with colleagues requires an effective use of
communication skills and a recognition of the value and significance
of work undertaken by colleagues. For most people, having a good
working relationship with colleagues is important, as it contributes
significantly to overall job satisfaction. There are significant
differences in a working relationship and the kind of personal
relationships you may have with your friends or family. A working
relationship is different because of:
•• specific objectives and purpose
•• boundaries
•• professional codes of conduct
•• employer policies and procedures
•• time limits
•• being in some cases a one-way relationship.
Key term In a working relationship the reasons why you are involved with a
Outcomes – the results that come particular person are clear. They will be in the outcomes of the
from the services provided to a support plan. This is different from choosing to be someone’s friend,
person for their visions of their life or having been born into a family. In a professional relationship, you
are in a relationship with someone because it is your job. You will
also have working relationships with colleagues and other
professionals. In the same way, these are relationships that are
necessary because they are part of your job and are in the interests
of the people you support.
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Professional relationships have clear boundaries; there are lines that

you must not cross. For example, you should never invite someone
you support to your home, nor should you visit them socially. You
must not accept gifts or any payments, nor should you take gifts or
give any of your own money to someone you are supporting. Sharing
personal information can be difficult sometimes, especially as you will
have a great deal of information about the people with whom you
work. This can be especially difficult if you see them very regularly
and they are friendly and show an interest in you. If people ask
questions, it is almost impossible not to give some information.
Sharing some basic information about yourself with someone who
has a genuine interest is acceptable, but it is not acceptable to discuss
any significant personal details about your life.
For example, telling someone that your daughter is sitting her GCSE
exams is fine – even telling them the results if they ask is acceptable
– but telling them about problems with your partner or that you think
your son may be getting in with a bad crowd is not.
Reflect
Professional codes of conduct set down by the regulators in each of
Have you ever felt that you would the UK countries spell out how relationships are to be conducted.
like to become a personal friend of Following your code of conduct is a requirement of being a
someone you support? Has there professional, and it is expected that everyone will practise in a way
been a person with whom you have that stays within the code.
got on really well? How did you
There is no written code of conduct for personal friendships or
handle it? Do you honestly feel on
families, even though you may sometimes think that there should
reflection that you were totally
be! The way we conduct our personal relationships follows an
professional and did not allow your
unwritten code about how people behave towards each other, but
personal feelings to cross the line a
it is not monitored by a regulator, nor a requirement of holding a
little? Think about what lessons you
professional position.
can learn from that experience.
Taking gifts is not permitted.
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Your employer will have policies and procedures around what is

acceptable; these are likely to follow the codes of conduct. However,
if your employer is the person you support, it may be a little less
formal and they may choose to have a more personal relationship.
In general, professional relationships are ‘one way’ in that you are not
looking for anything back from the person you are supporting. There
is no expectation that they will be supportive to you in return as you
would expect from a friend or family member.
You are the person who is offering support; you are not looking for
anything in return. In reality, of course, there are benefits that you
will get, but they are in the area of job satisfaction, not personal
friendship or support.
Information sharing is also one way in the other direction, as you are
likely to know a great deal more information about the person you
are supporting than they do about you.
1.2 Different working relationships

You have just been looking at how the relationship works with people
that you support, but they are not the only working relationships you
need to understand. You will also have relationships with colleagues
both in your own organisation and in other organisations.
In any setting, it is not just the people using the services who have to
be together for long periods of time – the staff have to learn to live
together too! This may be the first time you have worked in a team
with other colleagues, or it may be that you have moved to a new
team that will function differently from the last place you worked
– each team is different.
Teams take time to work well; they go through various stages as they
settle down and every time a new team member arrives, things
change. Not everyone will share the same views about how tasks
should be undertaken and the right course of action on every
occasion, and much will depend on how well the team is managed.
However, some ground rules to make sure that you can work well
with others can be used in most situations.
•• Find out the ways in which decisions are reached and the team
members who should be included.
•• Always ask for advice and clarify anything you are not sure about.
•• Do not assume that everything is the same in every workplace.
•• Recognise that every team member, regardless of their role and
status, has an essential contribution to make.
•• Value the input of all colleagues and recognise its importance.
•• Make sure that the way you work is not increasing the workload
of others or hindering them in carrying out their work.
Most workplaces have a means of decision making – this could be
planning and review meetings where decisions are made about
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service provision, staff meetings may be the forum for making

decisions about general practice matters, or there may be specific
staff development and training meetings for sharing best practice.
Organised staff meetings run by a line manager or supervisor are the
best place for airing differences about practice.
Supporting colleagues
‘Supportive working relationships’ is a very general term and can
mean a great many things depending on the context and the purpose
of the support. In the context of relationships with a work colleague
in a team, support could mean:
•• recognising when somebody is having difficulty in a particular area
of work
•• recognising when somebody is having difficulty in their personal
life which may be affecting their work
•• recognising and acknowledging when a colleague has worked
particularly well
•• noticing when people are overloaded with jobs to do and offering
to lend a hand
•• telling colleagues about information you have discovered or
something you have seen or read which you know would be of
interest to them
•• making sure colleagues know of opportunities for training courses
which you think are likely to interest them

English: Speaking and Receiving and giving support
listening Keep a calendar for a week or two, or even a month. For each day,
Using the information you have draw a stick figure which represents yourself. At the end of each
gathered for Activity 1, have a working shift, draw arrows:
discussion with other members of
•• outward from you for support which you have given to others in
your team about the support that
your team
you give to each other. Ensure that
•• inward for the occasions when support has been offered to you.
you take an active role in the
discussion but also take on board None of the items may seem large, but a series of small actions of
comments and opinions from other support is what is likely to contribute most effectively to successful
members of the team. Use teams.
appropriate language and present At the end of each week, count up the arrows inward and the arrows
your points clearly. outward. They should be in proportion to the people who work on the
team, and you should be giving and receiving support in equal
measure. If there are more arrows in than out, then you need to
explore for yourself additional ways in which you can support
colleagues. If there are more arrows out than in, then this is an item
that could usefully be placed on the agenda at a team meeting.
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•• noticing when a colleague is nervous or unsure of a new task or

procedure and offering help and encouragement
•• noticing if a colleague is being made uncomfortable by the way
in which they are being spoken to or treated by someone and
offering to help if it is needed.
This list will make a contribution towards effective working
relationships with other members of your team. If your team is
working well, your colleagues will be doing the same thing for you
and supporting you in your role.
Sometimes it is useful to offer a helping hand to a colleague who is supporting

somebody.
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2. Be able to work in ways that

are agreed with the employer
2.1 The scope of the job
Working within the boundaries of your job is important. There are
many different roles within social care, and your job should have a
clear job description so that you know the areas for which you are
responsible.
Usually, when an employer advertises a job, regardless of whether it is
placed by a large local authority, a voluntary organisation, a private
sector company or a person, there will be a job description that
explains the requirements of the job. The job description will form
part of your contract with your employer and is likely to include
information about:
•• the responsibilities of the role
•• where the work is to be done
•• who will supervise the work
•• who the line manager is for the work
•• any staff you will be responsible for.
It will also tell you the rate of pay for the job and the hours you will
need to work. The job description will vary depending on the
employer, but will probably look something the one below, which is
for a care assistant in day services for people with a learning
disability.
JOB DESCRIPTION: CARE ASSISTANT

Directorate: Adult and Community Services
Scale: Scale 2
Reporting to: Day Centre Officer
Responsible for:
Main purpose of role
•• To provide practical help and support to people with special needs under the supervision of the senior
member of the unit.
•• To participate in plans to promote an environment conclusive to a high standard of care according to
people’s needs and wishes.
•• You will be required to work in all areas of the Anytown Day Service including specialist areas with
those who display severe challenging behaviour.
Key accountabilities:
To work within the Day Opportunities Policy, which is based upon ‘ordinary life’ principles for people with
learning disabilities. This will involve at all times:
•• ensuring that people are treated with dignity and respect
•• ensuring that people have access to age-appropriate material and settings
•• encouraging self-advocacy among people
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•• acting as an advocate on behalf of people where and when necessary

•• providing opportunities for people to take calculated risks and practise learned skills as an aid to
further learning
•• linking people into ordinary community facilities in order to meet their support needs to promote the
local authority’s Equal Opportunities Policy
•• maintaining confidentiality in line with local authority policy and procedure.
Specific responsibilities are to:
•• assist people in meeting their physical and emotional needs
•• assist, under supervision, the administration of medication to people as required
•• assist in the implementation of their individual plans based on a needs-led day opportunities service
•• communicate effectively with those needing support, carers and other professionals
•• attend and participate in staff meetings
•• attend relevant training courses to further personal development and/or to improve the service to
those needing it
•• record information as necessary in a clear and precise manner, and in accordance with departmental
guidelines
•• ensure a healthy and safe environment for those being supported, other staff and themselves.
Other duties are to:
•• maintain personal and professional development to meet the changing demands of the job, participate
in appropriate training activities, and encourage and support staff in their development and training
•• undertake such other duties, training and/or hours of work as may be reasonably required and which
are consistent with the general level of responsibility of this job
•• undertake health and safety duties commensurate with the post and/or as detailed in the Directorate’s
Health and Safety Policy
•• participate in the Council’s emergency response arrangements as directed by the designated officer.
Contacts
In all contacts, the post holder will be required to present a good image of the Directorate and the
Council as well as maintaining constructive relationships.
Internal: colleagues, managers
External: individuals, voluntary agencies, carers, members of the public, other statutory organisations, for
example, Department of Health, Department of Education
Notes
The Council reserves the right to alter the content of this job description, after consultation to reflect
changes to the job or services provided, without altering the general character or level of responsibility.
The duties mentioned in this job description must be carried out in a manner which promotes equality of
opportunity, dignity and due respect for all employees and individuals, and is consistent with the
Council’s Equal Opportunities Policy.
Job description for a care assistant in day services for people who have a learning disability.
This description sets out very clearly what the employer expects of the
person doing the job. If you applied for this job, you would be in no
doubt as to what it entailed and what you would be required to do.
Some jobs may be a little less formal. If you are working as a personal
assistant for someone managing their own support, a description may
be more like the one on the next page.
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Job Description for Personal Assistant for D. F.

A Personal Assistant is employed to help me live my life the way I choose. Getting the right assistance
when I need it allows me to lead my life independently. A Personal Assistant will enable me to do this by
listening to what I want and following my instructions. It is therefore vital that an employee has good
communication and listening skills.
The job involves assisting me with a variety of tasks. As for most people, my day varies, so it is difficult to
list every task that is expected of a Personal Assistant.
After a period of familiarisation with the duties, you will be required to assist me with the following tasks,
sometimes without close supervision. The post holder will therefore need to be able to work on their own
initiative while at the same time being respectful of my wishes.
The post holder will work as part of a team and work on a rota so that I have support for 18 hours each
day. This will involve evening and weekend working, and the ability to work well with other team
members is essential as is the willingness to be flexible with working patterns.
The job involves moving and assisting/use of a hoist, etc. Previous experience is preferred, but training will be
given if necessary. You do not have to be strong to do the job well, but general good health is important.
The job requires providing assistance with the following.
Personal tasks
•• Assistance getting in and out of bed
•• Assistance with showering/bathing
•• Assistance with dressing and undressing
•• Assistance with brushing hair and teeth
•• Assistance with eating and drinking
Domestic tasks
•• Preparing and cooking food
•• Washing dishes and general cleaning of kitchen
•• Laundry and ironing
•• General cleaning and tidying of house
•• Assistance with shopping
Social tasks
•• Helping to go to pubs, cinema, theatre with or without friends
•• Assistance when going out for a walk
•• Helping to shop for pleasure
•• Assistance with correspondence – phone calls/letter writing
•• Assistance with other leisure activities, such as board games, music, reading
Other tasks
•• Assistance to maintain upkeep of equipment, such as wheelchairs
•• Assistance with gardening
•• Driving
•• Any other reasonable task
Pay: £7.56 per hour
Hours: 38 per week
Job description for a personal assistant to someone managing their own support.
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Both of the examples show how employers make the scope of the job
clear from the outset. There are good reasons for this; when an
employer is planning how to deliver services, they will work out:
•• what needs to be done
•• how much of it needs to be done
•• who needs to do it
•• where they need to do it.
The answers to these questions give employers what they need to
Activity 2 plan their workforce and ensure there are enough people doing the
right jobs at the right level in order to be able to deliver services. You
Your job description
will have been recruited to do a particular job at a particular level, and
Find the job description for your other people will have been recruited to do different jobs at different
job. If you no longer have it, ask levels. Everyone has their own area of responsibility and is
your line manager for a copy. accountable for what they do. If everyone started doing other
Compare the information on your people’s jobs, there would be chaos.
job description and see how well it
The other reason for working within the agreed scope of your job is
matches up to the job that you do.
that you are working at the level for your experience and
Make notes about any differences
qualifications. Other job roles may require specialist knowledge or
and discuss the reasons for this
training, and you would not be able to do these jobs until you had
with your manager.
been given the right training and gained relevant experience.
2.2 and 2.3 Agreed ways of working

Functional skills
Your employer identifies what you are to do in your job description,
English: Reading but sets out how it is to be done in the policies and procedures of the
organisation you work for.
Read your job description carefully to
check the similarity and differences Policies will cover all the key areas of practice, such as the examples in
between it and the job you are Table 3.
doing. Make notes of the key
Policy area Sets out…
differences between your actual job
and the information on the job Equal opportunities how the organisation ensures there is
description. By doing this, you will no discrimination in the way it works
have used the information contained
Bullying and harassment how the organisation will deal with staff
in the written text and showed that
found to be bullying or harassing other
you have understood the key points.
staff or those being supported
Confidentiality the steps to be taken to ensure that

people’s information is kept as
confidential as possible and only shared
on a need-to-know basis
Data protection how information will be handled to

ensure compliance with the law
Supervision how staff are to be given professional

support and supervision
Environmental policy how practice must look at the

environmental impact of activity
Table 3: Key areas covered by policies.
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These examples of policies are just a few of the many that most
employers will have in place. Policies will provide the broad outlines
for the way you should work; they set out the boundaries rather than
fill in the detail.
Detail is more likely to be found in procedures. Every employer will
have procedures to go along with the policies. The procedures set out
the detail of how to carry out day-to-day activities. For example, you
are likely to find procedures for how to:
•• deal with disciplinary issues
•• deal with allegations of abuse
•• assess and manage risk
•• allocate resources
•• respond to emergencies
•• administer medication
•• deal with a death
•• handle an admission.
Policies
Doing
your job
Procedures Job description

Can you see how each is important for doing your job?
Policies and procedures are an important way of knowing that you

are working in the way your employer requires. Working within policy
guidelines and following the laid-down procedures is a good
indication that you are carrying out your job in the right way.
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3. Be able to work in partnership

with others
3.1 The importance of partnership working
In doing your job effectively, you could work in partnership with
many different people. These may include, for example:
•• colleagues in your workplace
•• professional colleagues from other organisations
•• the person you are supporting
•• their informal support network.
Effective partnerships are about good teamwork, and in order to
work well, they require some basic ground rules. These need to
include agreements on the following.
Communication Information sharing
Agreed objectives Partnership/team Decision making
Resolving conflicts Roles and responsibilities
Can you see how there are many important aspects to effective team or partnership working?
Partnerships matter in delivering good-quality social care, because there

are so many aspects involved in supporting people that no one person
or organisation can deliver them alone. A support plan that will meet
someone’s needs requires cooperation and working together.
Having a shared purpose is a key part of good partnership working.
Usually, the shared purpose will be the support of the person at the
centre of the plan. Regardless of whether the partnership is all
professionals in a multidisciplinary team or involves family and friends,
an agreement on a shared purpose is the starting point.
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A team has an agreed purpose. What other teams can you think of?
The circumstances in which groups can form are almost endless.

However, if a group of people have a specific purpose that they are
setting out to achieve, then that group becomes a team. For example,
a group of friends who are a group because they all drink in a
Reflect particular pub become a team when they enter the annual tug-of-war
What is the difference between a contest and attempt to win. Similarly, the quiz team develops or the
gang and a team? Does a gang ever football team develops. If people are a group because they all go to
become a team? the same gym and talk to each other, but then decide to take on a
neighbouring gym in a squash match, then they become a team.
3.2 Improving partnership working

There are certain key steps that will help to ensure that any
partnership is able to work effectively.
Good communication
This is essential. Failure to maintain communication is fatal to
partnership working. Having a partner find out about a course of
action long after everyone else is likely to cause anger and mistrust,
along with a loss of the goodwill that is so important for partnerships
to work well. Ensure you keep everyone informed about actions and
decisions that may be of interest or importance to the partnership.
Respecting and valuing the work of others

Nothing is more likely to make people fed up with working in
partnership than feeling they are not appreciated or that their
contribution to the partnership is not valued. Remember that all
partners are essential; each person brings different skills, knowledge
and experience. Make sure that you find out about the contribution
of all of the partners and its importance to achieving the team
objectives. Always acknowledge and show that you respect and
value what people have to say.
146
Making clear decisions

All partners should feel confident that decisions being made within the
team are following the agreed process. There is likely to be serious
concern if partners feel that some decisions are being taken outside the
team and that not everyone is being involved in the process. If people
are not involved, then they will not take responsibility for the decisions
and they may not be prepared to abide by them. If there is an agreed
procedure for making decisions, then use it.
English: Writing Aims and objectives

For Activity 3, present your 1. Make a list of the aims and objectives of the organisation you work
information clearly and in an for. This should be contained in your organisation’s mission
organised way using sufficient detail statement or policy documents, or possibly a public plan or charter
to cover the task. Proofread your that your organisation has developed.
work to check that spelling, 2. Then make a list of your own aims and objectives in your work.
punctuation and grammar are They may include things like wanting to give the best possible
accurate, and that the language service to people, wanting to be of use to the people you support,
used is suitable. or wanting to improve your skills and understanding of the area
you work in.
3. Look at the people you support. What do they want from the
service and what are their aims in terms of their own lives? How
do they see that your support can assist them? Make a list of
these aims.
When you have completed all three lists, compare them and see to
what extent they match. You should check particularly how well the
list of your aims and objectives fits with those of your organisation. Do
not compare just the words on the list, but look at the overall effect of
what you and your organisation want to achieve, and see how far they
match.
3.3 and 3.4 Resolving issues and

difficulties and getting support for
working relationships
When you have begun to consider your relationship with the people
in your team, you will need to work out how you deal with any
problematic relationships. There are inevitably people in any team
who do not get on with each other. Bear in mind that a working
relationship does not require the same commitment or sharing of
ideals, values and understanding as a personal friendship. In order to
work with someone, it is sufficient that you recognise and value their
contribution to the team performance and that you always
communicate effectively and courteously when working. Although
many teams socialise together, this is not an essential requirement for
a successful team. The loyalty and camaraderie that is built up among
147
good team members can be based purely on their performance at

work and does not necessarily have to carry over into their personal
lives. And remember – everyone working at the same time is not the
same thing as everyone working together.
Activity 4
Improving working relationships
If you have to work with people with whom you feel you professional skills. You could try something like,
have little in common, try the following checklist to help ‘Where did you learn to move people so well?’ or
view them in a more positive light. take the trouble to find their opinions on current
issues. Perhaps you could ask, ‘What do you think
1. List all the positive things and only the positive things
about the new set of proposals for the shift rotas?’
about your colleague. For example…
4. Pick up on any comments that may lead to areas of
•• Do they have a nice smile?
common interest. For example, your colleague may
•• Are they very good with the clients?
comment about something they have done over the
•• Do they have a particular skill in one area of
weekend, or they may make a reference to reading
practice?
something or seeing a film or a play that you know
•• Are they good in a crisis?
something about. You should follow up on any of
•• Are they willing to accommodate swaps in shifts?
these potential leads which may allow you to find
•• Are they good at organising?
out more about the person.
•• Do they make good coffee?
5. Learn what you can, either by listening to others or
2. Make a positive comment to your colleague at least
by asking questions about the person’s background
once each day. This could range from ‘Your hair
and look at where their ideas and influences have
looks nice today’ to ‘I have learned such a lot from
come from. If you understand their culture, beliefs
watching you deal with…’
and values, it will be easier to see how and why they
3. Ask questions about your colleague and try to find
hold the opinions and views that they do.
out more about them. This does not have to be on a
6. Make a list of the positives that this particular
personal level. Questions could be about their
colleague brings to the team.
Doing it well
Team working
•• Agree and share a common purpose, aims and •• Praise and give credit to the work of all team
objectives. members.
•• Work on building relationships which value and •• Use your communication skills effectively when
respect all team members. working with other members of the team.
•• Contribute to the planning process for all team •• Ensure the team has dialogue and not debate.
activities. •• Work to identify and resolve conflicts within the
•• Make sure that all team members are involved in team.
decision making. •• Examine the way the team is operating and do not
•• Respect and value diversity of each team member. be afraid to initiate constructive and supportive
•• Value working together and recognise the difference criticism.
between working at the same time and working •• Contribute to the growth and development of the
together. team as a whole, the members of the team and
•• Support the goals agreed by the team. yourself as an individual.
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Asking for advice and support

Your manager or supervisor is your first line of support for partnership
working. Your organisation may have set policies and procedures for
setting up and working in a partnership. If so, these will need to be
followed.
It is also likely that your manager will have experience of partnership
working and will be able to share advice and their own experience. It
is a sign of a mature and reflective worker that they know when to
ask for advice and recognise when they need help. You will be
working in the best interests of the people you support by making
sure that you have the best possible guidance to work alongside
others.

This is only a small unit, but it is important as it helps Your assessor is likely to observe how well you are able
you to understand exactly what it is you need to do as a to work with others and to follow the policies and
social care worker. Your assessor will be wanting you to procedures of your employing organisation while they
show that you understand how working relationships are observing other areas of practice. They will be
operate. You may be asked to complete an assignment looking for you to explain how and why you are doing
or a presentation where you show that you understand things in ways that follow agreed procedures. They will
the nature of working relationships. One of the best also be looking for how well you work with others
ways to show this is by being able to discuss the through being supportive and sharing information,
different types of relationships that we all experience knowledge and experience.
and showing how they differ from the ways we relate to
work colleagues on a professional basis.

•• www.skillsforhealth.org.uk (Skills for Health)
149
Unit HSC 026
Implement
person-centred approaches
in health and social care
This unit is all about how you put people at the centre of
everything you do. Transforming the ways social care is planned
and delivered has meant that services are now built around
people’s needs. People who want to use services no longer
have to ‘fit in’ with whatever services happen to be available.
Person-centred working gives people more control over how,
when and by whom their services are delivered. Planning is now
in the hands of the person who is going to use the services,
with support from social care professionals where necessary.
Social care services are there to fill in the gaps in social care
needs that cannot be met by the person themselves or their
informal support.

1. person-centred approaches for care and support
2. how to work in a person-centred way
3. how to establish consent when providing care or
support
4. how to encourage active participation
5. how to support the individual’s right to make choices
6. how to promote individuals’ well-being.
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1. Understand person-centred
approaches for care and support
1.1 Person-centred values
Unit HSC 024 has already looked at some of the key values that
underpin work in this sector. These include:
•• treating people as individuals
•• supporting people to access their rights
•• supporting people to exercise choice
•• making sure people have privacy if they want it
•• supporting people to be as independent as possible
•• treating people with dignity and respect
•• recognising that working with people is a partnership rather than
a relationship controlled by professionals.
Treating people as individuals

This is about recognising that everyone is different and has their own
needs. Not everyone likes doing the same things, eating the same
things, reading the same things or wearing the same things. Just
because a person is making use of support and care services does not
stop them being a unique person with very particular needs. You will
need to make sure that you do not make general assumptions about
people. For example, not all older people like to play bingo or want to
go out on coach trips. Some do and others do not. Not everyone
wants to eat an evening meal at 5pm, or go to bed at 9pm, or get up
at 7am. Some people do and others do not.
People can be excluded for many reasons.
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Implement person-centred approaches Unit HSC 026
You have looked at stereotyping in Unit SHC 23. Remember that

thinking in stereotypes is the exact opposite of treating people as
individuals.
Accessing rights
You have looked at rights in Unit HSC 024; this is about your role in
ensuring that people are able to participate in society as full citizens
and that they are not excluded from accessing their rights because
they have a disability or because they are older or are seen as
vulnerable in some way. You need to ensure constantly that people
are not being prevented from exercising their rights because of issues
such as physical barriers, complex paperwork, being made to feel a
nuisance or the actions of other people.
Making choices
People have the right to choose how they live and what they want to
do with their lives. They are also able to choose how they want their
social care support to be delivered and to make choices about whom
they want to deliver it and when.
Privacy
Everyone has a right to have some space where they can be alone if
they wish. Sometimes they may want to be private just to have some
time to themselves; on other occasions it may be because they are
having personal care or medical treatment. It is also important that
people have privacy if they want to talk to a professional and have
confidential information to discuss.
Supporting independence
This is about supporting people to do as much as they possibly can
for themselves. You need to make sure that you do not ‘take over’
and do things for people instead of allowing people to get on with
their lives as they wish. Independence is also about managing risk so
that people are able to participate in daily life and get on with living.
Dignity and respect

Everyone is entitled to be treated with dignity; this means all aspects
of life from support with personal care to how people want to be
addressed. It is also about listening to what people have to say and
being interested in them.
Can you see why having a private space Partnership

is important?
Social care is about working together with the person who uses the
service being in control. It is no longer the professional who controls
the money and the resources. This has made the whole relationship
far more equal and means much more working together to plan for
and achieve the outcomes that the person wants in order to improve
their lives.
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1.2 Why it is important to work in a way

that embeds person-centred values
The values that underpin your work have an impact on your day-to-
day work. All the tasks for which you may provide support, including
bathing, dressing, personal hygiene, preparing meals, shopping and
general domestic tasks, will be done better if you take into account
the person-centred values identified earlier – for example, providing
services at a time and in a way that suits the person – not you, nor
the system.
If someone decides they want a bath, even though you have gone
there with the intention of supporting them to prepare a meal, they
are quite within their rights to change their mind. Think about how
often you change your mind about plans and end up doing
something completely different. Just because someone needs some
additional support to accomplish a task does not mean that they
should lose control over that part of their lives. Being aware of all the
person’s values and making them a part of what you do each day will
ensure that you are not guilty of imposing your choices on people or
of robbing them of their rights to independence and choice.
1.3 Why risk-taking can be part of a

person-centred approach
Everyone is entitled to take risks. We all take risks in our daily lives.
Every time we get on a plane or cross the road, put money in a bank,
take part in a sporting activity or plug in a toaster, we are taking risks.
We assess all of these risks and make sure that they are managed. For
example, we know that there are stringent safety procedures in place
for aircraft, we know that there are regulations for banks, and we
take steps to maintain the electrical wiring in our houses so that we
can reduce the risk of disaster when we use appliances.
We take risks every day.
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Taking risks is part of being able to choose and being in control of

your life, so you need to ensure that concern about risks is not
getting in the way of people living their lives in the way they want to.
Often, a risk assessment can make it possible for someone to do
something that may seem unlikely in the first instance.
Case study
Reducing the risks

Alice, who has a learning disability, wants to move into be found through a housing association so that there
a flat with a friend she has met at her work placement. are no concerns about the safety and the maintenance
A risk assessment will look at ways of reducing the risks of the property.
to Alice from her move. The assessment may look at the
1. What benefits do you think taking these steps will
steps that can be taken for Alice to increase her
have for those who are concerned for Alice’s safety
independence in the way she wants to. There could be
and well-being?
a drop-in from a support worker and a link set up with
2. What benefits do you think taking these steps will
a local supported living unit where Alice could go if she
have for Alice?
feels she needs support. It may be possible for a flat to
Risk-taking is part of developing independence. If people never take

risks then they will never find out what they are able to achieve and
work out where their limits are.
Person-centred planning puts people at the centre of everything; it
looks at what people can do and identifies what they want to
achieve. Sometimes the things that people may want to achieve will
involve risks, which is not a problem as long as they are not actually
putting themselves in danger, or the dangerous activities can have the
risks reduced in some way. Alternatively, some people may need to
be encouraged to take some risks.
Case study
Encouraging someone to take risks

Henry, who is 75, was very active, despite having a risks in order to support Henry to get back to his daily
visual impairment caused by macular degeneration. He exercise. Initially, the support worker went with Henry
always walked for at least a mile each day regardless of each day, but she gradually reduced her support,
the weather. One day he slipped on some wet leaves although Henry’s wife would often go with him and
and broke his hip. After his recovery, he was very found that she enjoyed the exercise too. After a couple
reluctant to continue walking each day; he and his wife of months, Henry was back to his usual daily walks.
both felt it was too risky and so stayed indoors. This
1. Why was it important for Henry to take the risks
made him very depressed and put a strain on his
involved with walking outdoors again?
relationship with his wife. Their support worker spoke
2. How did the support worker help Henry to manage
to both of them about being prepared to take some
the risks?
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1.4 How using an individual’s care plan

contributes to working in a person-centred
way
Plans for how people want their support to be delivered are a vital
part of person-centred working. People should be in control of their
own plans and the planning process is a key way of ensuring that
they are at the centre of any support provided.
Care/support plans are now developed by the person themselves,
sometimes with support from family or friends. Plans are then agreed
by the social worker or care manager. During the planning process,
the person will:
•• look at what they want to achieve and identify the outcomes they
want
•• work out what they can already do for themselves, or with the
help of family and friends
•• look at what services they need in order to fill the gaps
•• identify how and when they need services to be provided.
The development of a support plan is the perfect example of how
person-centred working operates.
Instead of offering people a ‘choice’ of what is currently available and
finding what best fits their needs, person-centred working looks at
someone’s needs and builds the support package around them. One
of the important aspects of person-centred planning is to look at
what people are able to do for themselves and to ensure that services
are not taking over aspects of a person’s life that they could perfectly
well manage without support.
Informal networks are also an important part of people’s means of
support and any additional professional support should only be to
supplement, not replace, these.
Case study
The importance of informal networks

Pauline is 26 years old and has cerebral palsy; she to do and finally, the whole group could look at where
requires support 24 hours a day. When she was the gaps were and identify where professional support
working with Mike, her social worker, to develop her workers would be needed.
plan, she decided to hold the planning meeting in the
1. What benefits would this method of developing a
pub one evening and invited all her friends. Her friends
support plan have for Pauline?
all joined in the planning to explain what they were able
2. What benefits would it have for her friends?
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2. Be able to work in a person-

centred way
2.1 Finding out the history, preferences,
wishes and needs of the individual
Person-centred working means that the wishes of the person are the
basis of planning and delivering support and care services. Therefore,
you must find out exactly what people want and expect from the care
and support they are planning. Person-centred working means that
service provision fits around the person – not the other way around.
If you are going to work with someone, it is important that you know
as much about them as possible.
You have looked at ways to find out information about people in
earlier units; there are various ways of doing this, but the most
effective is always to ask the person concerned about whatever you
want to know. Try to find time to sit down with someone and ask
about their life. If they are able to tell you about their own history,
you will learn a great deal and it will help you to offer support in the
most appropriate ways. It is often easy to think about people,
especially older people, as you see them now and to forget that their
lives may have been very different in the past.
The following poem is said to have been found, after her death, in
the locker of Kate, a geriatric patient in the early 1970s.
What do you see, nurses, what do you see?
What are you thinking when you look at me?
A crabbit old woman, not very wise,
Uncertain of habit with far-away eyes
Who dribbles her food and makes no reply
When you say in a loud voice, ‘I do wish you’d try’
Who seems not to notice the things that you do
And forever is losing a stick or a shoe
Who, unresistingly or not lets you do as you will,
With bathing and feeding – the long day to fill.
Is that what you’re thinking? Is that what you see?
Then open your eyes nurse – you’re looking at me.
I’ll tell you who I am as I sit here so still
As I use at your bidding, as I eat at your will.
I’m a small child of ten with a father and mother
Brothers and sisters who love one another,
A young girl of sixteen with wings on her feet
Dreaming that soon a lover she’ll meet
A bride soon, at twenty my heart gives a leap
Remembering the vows that I promised to keep.
At twenty-five now I have young of my own
Who need me to build a secure happy home
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A young woman of thirty, my young now grow fast

Bound to each other with ties that should last.
At forty my young ones now grown will soon be gone
But my memory stays beside me to see I don’t mourn
At fifty, once more babies play round my knee
Again, we know children, my loved one and me.
Dark days are upon me as my husband is dead
I look at the future, I shudder with dread
For my young are all busy rearing young of their own
And I think of the years and the love I have known.
I’m an old woman now and nature is cruel
The body it crumbles, grace and vigour depart
There is now a stone where I once had a heart.
But inside this old carcass a young girl still dwells
And now and again my battered heart swells.
I remember the joys, I remember the pain
And I’m loving and living life over again
Remember that people have had many
life experiences. I think of the years – all too few – gone too fast
And accept the stark fact that nothing can last
So open your eyes, nurses, open and see
Not a crabbit old woman… look closer, see ME.
Reflect
Finding out what people want
Person-centred working is about putting people in control of their
The poem above demonstrates
lives. This may be a new experience for many people who have been
clearly how easy it is to forget that
using services for many years, but have always had to fit in with the
everyone has a history and that
system and the services that were available at the time. People often
people’s lives will have been very
find it hard to think about what they want and you can help by
different than their present
offering prompts such as, ‘Remember when you said you wanted
circumstances. Can you think of a
to…’, ‘What sort of time do you want to get up?’ or ‘What about
time when you may have forgotten
going out and meeting more people?’
this? Think about the people you
support and be honest about how Most workplaces will have a format for undertaking assessments,
much you know about them. Do where people have the opportunity to identify:
you really know about their history,
•• the goals they want to achieve
what sort of lives they had? When
•• what they are able to do for themselves
they fell in love? Got married? Had
•• areas where they need support.
children? What times were like
then? Forms will vary between local areas, but are likely to cover:
If you realise that you do not know •• personal care
enough about the history of the •• nutritional needs
people you support, now is the time •• practical aspects of daily life
to change and start to ask questions. •• physical and mental health and well-being
You may be surprised at the •• relationships and social inclusion
interesting lives people have had •• choice and control
and how much they have done. •• risk
•• work, leisure and learning
•• travelling
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•• caring/parenting
•• social support
•• unpaid carer support
•• religious/cultural needs.
2.2 Applying person-centred values in

day-to-day work
People and their needs should be at the centre of the support
process. Your role is to make sure that people have every opportunity
to state exactly how they wish their needs to be met. Some people
will be able to share this information personally; others will need an
advocate who will support them in expressing their views.
Seeing the whole picture

One of the essential aspects of planning care services is to have a
holistic approach to planning and provision. This means recognising
that all parts of a person’s life will have an impact on their support
needs and that you need to look beyond what you see when you
meet them for the first time.
All of the following factors will directly affect someone and you must
take all these into account when planning the best way to provide
services – they include:
•• health
•• employment
•• education
•• social
•• religious and cultural.
Health
The state of health of anyone has a massive effect on how they
develop as a person and the kind of experiences they have during
their lives. Someone who has always been very fit, well and active
may find it very difficult and frustrating to find suddenly that they
have restricted movement as the result of an illness such as a stroke.
This may lead to them being difficult and expressing their anger
against those who are providing support, or they may become very
depressed and unhappy. Alternatively someone who has not enjoyed
good health over a long period of time may be well adjusted to a
more limited physical level of ability, but have compensated in other
ways and be keen to follow and maintain intellectual activities.
Employment
Health is also likely to have had an impact on employment, whether
Key term making it possible at all or affecting the type of employment that
people have. Whether or not people are able to work has a huge
Self-esteem – how people value
effect on their level of confidence and self-esteem. Employment may
themselves
also have an effect on the extent to which people have socialised and
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mixed with others. This may be an important consideration when

considering the possible benefits of residential care where someone
would have to live in a community with others, as opposed to care
provided in someone’s home environment. Income levels are related
to employment and will have an effect on standards of living, the
quality of housing, the quality of diet and the lifestyle which people
are able to experience. Someone in a well-paid job is likely to have
lived in a more pleasant environment with lower levels of pollution,
more opportunities for leisure, exercise and relaxation and a better
standard of housing. It is easy to see how all of this can affect
someone’s health and well-being.
Education
The level of education of anyone is likely to have affected both their
employment and, in all likelihood, their level of income. It can also
have an effect on the extent to which they are able to gain access to
beneficial information about their health and lifestyle. It is important
that the educational level of a person is always considered so that
explanations and information are given in a way which in readily
understandable. For example, an explanation about an illness taken
straight from a textbook used by doctors would not mean much to
most of us! However, if it is explained in everyday terms, we are more
likely to understand what is being said. Some people may have a
different level of literacy to you, so do not assume that everyone will
be able to make use of written notes – some people may prefer
information to be given verbally, or recorded on tape.
o n al su p p o r t s e r v
f e s si ic e
Pro s
Un iversal ser vice s
n d frie n d s u p
i ly a po
F am rt
Self-care
Person
Person-centred support.
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Social
The social circumstances in which a person has lived will have an
immense effect on their way of life and the type of care provision that
they are likely to need. The social classification of society is based on
employment groups. However, the social groups in which people live
are also about relationships with family and friends.
Religious and cultural
Religious and cultural beliefs and values are an essential part of the
structure of the lives of all people. The values and beliefs of the
community people belong to and the religious practices that are part
of their daily lives are important in the planning of services. Any plan
that has not taken account of the religious and cultural values of a
person is doomed to fail.
Activity 1
Considering factors
Prepare a list of the different types of service provided by the setting in
which you work. Remember to include all the aspects of the service
you provide – if you work in residential care, you will need to list all
parts of your service such as social activities, providing food, providing
entertainment and personal care. if you work in a person’s own home,
you may need to list food preparation, cleaning, personal care and
so on.
Make a note about the factors of a person’s life you would need to
take into account in order to provide a holistic assessment of their
needs.
Record ways in which you may need to adapt the services you provide
because of some of the factors you are taking into account.
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3. Be able to establish consent

when providing care or support
3.1 The importance of establishing
consent when providing care or support
Giving consent for anything that is done to us is a basic human right.
If we did not need to give consent it would mean that anyone could
do anything to us. This is particularly important when it comes to
medical or social care support. Much of the treatment or support that
people receive is either invasive or personal.
Consent not only protects social care and health providers against
legal challenge, it is also vital because of the rights of the person and
the importance of recognising that people should determine what
happens to them. Being able to give consent or not is also part of
being treated with dignity and respect. There is nothing dignified
about someone removing your underwear and sitting you on a
commode without asking your permission. Neither is there anything
respectful about someone sticking a needle in your leg without asking
for your agreement or explaining why they are doing it.
Ensuring that people are in agreement with the support and care
tasks that you need to undertake is just as important and is a key part
of ensuring that you are working within person-centred values and
the codes of practice for social care.
Not all consent is formal or written down.
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As a broad principle, consent should be obtained before carrying out

any kind of activity. Even something as simple as moving somebody
or plumping their pillows should always be preceded by the question,
‘Would you like me to plump your pillows?’ In general, people need
to provide consent for the provision of personal care. An overall
agreement to the provision of care and support cannot be taken as a
blanket consent to all activities; someone may not want the planned
care on a particular day, so consent must always be obtained: ‘Are
you ready for your hair to be brushed?’ or ‘Do you want to go in the
shower now?’ are essential questions where agreement indicates
consent.
Historically, areas of clinical practice has always ‘acted in the best
interests’ of patients, and there are still many older people who
believe that the doctor or nurse ‘knows best’, and who would not
presume to question any medical suggestions about the way their
treatment should proceed. As the traditional view of the power of
medical practitioners has changed and it has become more common
to question and challenge the opinions of doctors, nurses and other
health workers, people have become more comfortable with the idea
of being asked their views and being asked for their consent.
3.2 How to establish consent for an

activity or action
If you are in the position where you are asked to obtain consent for
an activity, you must take great care that you:
•• answer any questions honestly and as fully as you can
•• never attempt to answer a question that you are not sure of
•• always refer the question on to somebody who has the
knowledge to give the person a full answer.
Ensure that wherever possible you direct your information to the
person concerned, even if there is a relative or friend with them. In
most cases it is the person’s consent that you must obtain, not that of
their friend or relative. Where there is an issue of capacity to
understand the information, then you should explain the procedure
carefully to the person who is acting as an advocate. This could be a
relative, friend or possibly a social worker or representative of the
court if the person is subject to guardianship or a court order.
If, however, the person is capable of understanding but has difficulty
with communication, then you must use the communication skills
that you have learned (see Unit SHC 21) in order to provide the
necessary information to make a decision. People who have sensory
impairments should not be prevented from making their own
decisions and asking their own questions by the limitations of either
your time or communication skills.
Where there are language difficulties, an interpreter should be used
as appropriate. You should always consider the nature of the consent
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being sought before a decision is made about whether or not to use

a member of the person’s family. It may be that in terms of either
confidentiality or the nature of the procedure being discussed, it is
not appropriate and the use of an interpreter is preferable.
When people are agreeing to potentially serious matters, such as
medical treatment, sharing information, handing over control of part
of their lives or changing accommodation, it is essential that they not
only consent, but understand what it is they are consenting to and
the implications of this. This is informed consent. Informed consent
means that the person has full information about what is to happen,
why it is to happen and the possible effects, both positive and
negative. All the risks should have been explained so that a person is
in a position to make a judgement about whether or not they wish to
go ahead. Informed consent can be written, as in the case of
somebody undergoing surgery, or it can be a verbal consent (for
example, if somebody is having blood taken, then the procedure, the
purpose of the blood test and what will be found out from the blood
test could be explained to them before they agreed to it).
Implied consent
It is reasonable to assume that someone implies their consent to you
taking their blood pressure if they present their arm when they see
you arriving and taking out the blood pressure cuff. If somebody
opens their mouth when you appear with a thermometer, it is
reasonable for you to assume that they are implying consent to you
taking their temperature. If people raise themselves up as you come
to help them from a chair, you may assume that they consent. For
these relatively minor and non-invasive procedures, implied consent is
perfectly acceptable, as it would be very overcomplicated if consent to
these types of activities had to be recorded on every occasion.
Written consent
This is most likely to be used in a clinical setting where there will be a
form for written consent. This requires patients, or their relatives in
the case of an emergency, to sign to say that they are willing for the
named clinical procedure to be undertaken. Generally, written
consent is likely also to be informed consent, as on most occasions
the procedures will have been explained carefully before signing.
Written consent will also be needed if someone is agreeing to hand
over control of part of their lives to someone else. For example,
someone may decide to allow a relative to handle their finances
because they are finding it too difficult. But doing this does not mean
that they are incapable of making the decision or of understanding
the consequences. In fact, that they know that they need someone
else to do it could be said to show that they understand the issues.
Other major matters such as the transfer of property or moving home
will also require written consent.
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Verbal consent
Verbal consent is normally understood to exist when a person
requests that a procedure be undertaken. For example, in a hospital,
someone asking for pain relief who has been told, ‘Yes, we will give
you an injection for pain but it will make you sleepy’, and the
response is, ‘Yes give it to me anyway’, is taken to be verbal consent
for the procedure and this consent must be recorded in the case
notes. This could also apply, for example, to someone who is severely
constipated and has asked for an enema, or to somebody who has
requested that they be moved from the bed to the chair using lifting
equipment.
3.3 Steps to take if consent cannot be

readily established
You must not proceed with any care or clinical activity without
consent. If someone refuses their agreement or changes their mind
after having said ‘yes’, you must stop what you are doing.
It may be useful to repeat the information again just to be sure that
any queries and concerns have been answered, but it is not your job
to persuade someone or to put pressure on them to agree.
You must immediately report any refusal of consent or any
reservations expressed by the person to your supervisor or to the
clinical practitioner responsible for the procedure.
Your organisation will have procedures in place to deal with refusal of
consent. Usually, this means that nothing further will be done, but
sometimes, where there may be some doubt about a person’s
capacity to understand the consequences of a refusal, further
assessments may be undertaken to decide whether it would be in
someone’s best interests to go ahead without agreement.
People have to give consent.
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4. Be able to encourage active

participation
4.1 How active participation benefits an
individual
Supporting people to do things that they want to do and that they
can do is your main role. Everyone should have the right to take a full
part in society and play their part as a citizen.
Having active participation in society is important for people’s self-
esteem and their well-being. We can all identify with the feeling of
having achieved something. It may be something quite small –
finishing decorating a room, doing a tough workout in the gym,
knitting a jumper, or something important like passing an exam or
achieving your Health and Social Care Diploma! Achievement is not
only about big things like winning a gold medal or swimming the
Channel. Anyone who has children will know of the sense of
achievement when they can tie their own shoelaces or count to 10.
We all participate in life because humans are not generally isolated
creatures. We live with other people and usually live in communities
alongside other people. In order to take part in community life and to
make relationships with others, people may need support to get over
some of the barriers.
Participation will mean different things to different people; it could be:
•• having lots of mates and going to the pub
•• going to the library or to the luncheon club
•• maintaining contact with relatives and visiting neighbours
•• being involved in sports
•• going shopping or just getting out and about
•• being on committees and political activity
•• being involved in faith groups.
There are so many ways in which all of us are part of society, and you
will need to work closely with the people you support to find out
what they want to do and what assistance they need.
Participating in activities with others and achieving goals usually
helps people to feel good about themselves and improves confidence
and self-esteem. How we value ourselves is key to our sense of
well-being. Feeling good and feeling confident are important ways
of improving people’s general and emotional health. There is more
about this later in the unit.
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Participation can mean many things.
Case study
Acting in somebody’s best interests

Dennis is 27 years old; he has a learning disability and is Dennis: I want to do my plan.
in a work placement supported by a job coach. He likes
Support worker: Mr Smith, this is about Dennis making
sports and wants to spend more time playing football
decisions for himself and us helping him to do
and doing athletics, which he enjoys. He has put
what he wants to with his life. I’m sorry if you
together a support plan, but his parents think that it will
don’t agree, but I do think that Dennis has to try
all be too much for him and that he needs to come
things his way. I think that your support is very
home and rest after a day at work.
important to him and it would be good if he
Father: This plan is hopeless, he’ll never do all this – you could try this plan with your help.
don’t understand, it’s just what he thinks he’d
Father: Well, we don’t want to stand in his way – but I
like to do.
don’t think you people really understand what
Dennis: No, this is what I want, I like playing football he’s like. We’ll give it a go, but I’m not
and doing running. I’m not tired. convinced.
Father: You’re just being silly son, I know it sounds Support worker: No, I understand that, but it has a
good now, but you won’t be able to do it. You better chance of working if you are backing it.
know you like your evenings at home with me What do you think, Dennis?
and your mum.
Dennis: Thanks Dad.
Dennis: No I don’t.
1. How do you think the initial response of the father
Father: Don’t be rude, Dennis. Do you see what I mean would have made Dennis feel?
– he doesn’t really know what he wants. I don’t 2. How does the support worker help the father to
know why you people want to let him decide, understand why doing things Dennis’ way is
it’s just irresponsible. preferable?
3. How do you think you would have acted in this
Support worker: What do you think about that, Dennis?
scenario?
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It is tempting to do things for people because this may be easier,

quicker and less painful and it may seem that this would be the most
helpful thing to do. In fact, doing tasks for people is far from helpful.
It results in people being deskilled and increases dependency. This in
turn decreases people’s confidence, self-esteem and sense of well-
being, thus resulting in people becoming more depressed and
isolated. It is all a vicious circle.
Working with people to support them where there are things that
they really cannot do for themselves is so much better than taking
over and doing tasks for people and making them dependent on you.
4.2 Barriers to active participation

What gets in the way of active participation? There can be many
things, for example:
•• issues over physical access
•• lack of information in accessible formats
•• emotional barriers such as lack of confidence
•• professional support staff taking over
•• family carers who find it hard to let go.
Any combination of these barriers can mean that people do not
participate in society as fully as they could and, as a result, lose out on
so much that they could be doing.
4.3 Ways to reduce the barriers and

encourage active participation
Issues over physical access
Where there are physical access issues for a public place, you may
need to support someone to request information about access for
disabled people, or possibly to make a complaint if there is no
suitable access. For some people it may be that access is not just
about a specific place, but more general in that their ability to walk
is limited. In this case, you may need to support people to access
transport or a disabled parking badge so that walking is reduced.
Lack of information in accessible formats

Information about facilities may be limited or only available in one
format. You may need to support the person to request information
in a format that is accessible for them, or you may be able to assist
them to access information in other ways – for example, on the
Internet.
Emotional barriers such as lack of confidence

Participation can be difficult for many people. They may lack
confidence or have low self-esteem. They may believe that they are
not able to make any efforts at participation and that no one would
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respond if they did. You may need to encourage people by helping

Activity 2 them to see the positive aspects of their lives, and reassuring them
that they will not fail and that they have the ability to achieve. Using
Active participation
examples of other barriers they have overcome and previous
plan achievements is a useful way of offering encouragement.
Think about someone with whom
you work regularly. Identify a task Professional support staff taking over
or activity that is carried out for It may be, for example, far easier, less painful and quicker for you to
them. Why are they unable to do put on people’s socks or stockings for them. But this would reinforce
this task themselves? Work with the fact that they are no longer able to undertake such a simple task
the person to draw up an active for themselves and remove the motivation to find a way to do it
participation plan to improve on independently. Time spent in providing a ‘helping hand’ sock aid,
this situation. This could be, for and showing them how to use it, means they can put on their own
example, enabling them to carry clothing and, instead of feeling dependent, have a sense of
out the task themselves or having achievement and independence.
more say in the way they are
It is tempting to undertake tasks for people you work with because
supported.
you are keen to care for them and because you believe that you can
make their lives easier. Often, however, you need to hold back from
directly providing care or carrying out a task, and look for ways you
Functional skills can enable people to undertake the task for themselves.
English: Speaking and Family carers who find it hard to let go

listening Families may want to protect people who they see as vulnerable and
Practise your verbal communication in need of care, and may have many concerns about the growing
skills by having a discussion with independence of loved ones who have always been dependent. Do
somebody you support about how not jump to the conclusions that families are being difficult or
to improve their ability to carry out obstructive; usually people believe that they are doing their best for
a specific task or activity they are their relatives by protecting them and by reducing the risks. Working
having difficulties with. Remember in partnership with people and their families to help them get used to
to use appropriate language and to new approaches and to see the benefits of active participation may
speak clearly at all times. Show your be a slow process that needs to be taken gently, but the long-term
ability to listen by picking up on benefits of people being able to participate in society as full citizens
points raised by the person and by are worth the effort.
making constructive suggestions to
them to improve their ability to
complete the task or activity.
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5. Be able to support the

individual’s right to make choices
5.1 Supporting an individual to make
informed choices
Where people want to make choices about their lives, you should
ensure that you do your best to help them identify any barriers they
may meet and then offer support in overcoming these. If you are
working with someone living in their own home, it is likely to be
easier for them to make day-to-day choices about their lives. In some
situations they may require help and support in order to achieve the
Doing it well choice, but it is generally less restrictive than a residential or hospital
Supporting people to setting, where the needs of many other people also have to be taken
make choices into account.
•• Always ask people about their For many people living in their own homes, the development of direct
needs, wishes and preferences payments and individual budgets has meant a far higher level of
– whether this is the service they choice and empowerment than was possible previously. This system
want and if this is the way they means that payments for the provision of services are made to the
want to receive it. person, who then employs support workers directly and determines
•• Ask if they prefer other their own levels and types of service. This changes the relationship
alternatives, either in the service between the person and the support workers, and puts the person in
or the way it is delivered. a position of power as an employer. Individual and personal budgets
•• Look for ways you can actively also give people the chance to control their lives. Here they have
support people in achieving the control over how resources are used and how money is spent, but do
choice they want. not have to be employers. You may need to offer some help initially,
so people can get used to directing their own services.
The process of making choices can also be about simple things – it
can just be a matter of checking with the person as you work, as in
the illustration on the next page.
The worker in the example on the following page has offered Mrs
Jones a choice about clothes. Mrs Jones has indicated that she is not
happy with the choice offered, and she has also identified the
possible barrier to having the clothes she wants. The care worker has
looked for a way that the barrier may possibly be overcome. This
process can be used in a wide range of situations.
You may be working with someone who is not able to fully participate
in all decisions about their day-to-day life because they have a
different level of understanding. This could, for example, include
people with a learning disability, dementia or brain injury. In this
situation, it may be that the person has an advocate who represents
their interests and is able to present a point of view about choices and
options. The advocate may be a professional one such as a solicitor,
social worker or rights worker, or they could be a relative or friend. It is
essential that you include the advocate in discussions, to make sure
that the wishes of the person they are supporting are followed.
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How do you think this interaction will have made Mrs Jones feel?
Information about choices

Earlier in this unit you looked at how to ensure people are able to
give informed consent. Making informed choices is similar.
One of your key roles is to provide information to the person and
their family about the choices they need to make. For example, it is
not reasonable to expect a person to agree to ‘attendance at a
project’ unless they have full information to make a choice. This will
include information about:
•• the exact nature of the project
•• the location of the project
•• the type of activities
•• the general atmosphere and ethos of the project
•• the number of people who will be attending
•• what the transport arrangements will be.
These are just a few of the questions that someone may have about
what will be provided. Informed choice requires full information.
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This same principle applies to any choices that people have to make
about, for example:
•• accommodation
•• money
•• medical treatment
•• support plans
•• relationships
•• leisure activities
•• aids and adaptations
•• education and learning.
All of us have the right to make informed choices about all aspects of
our lives. For example, you would not purchase a house simply
because the estate agents said, ‘Oh, I have got a nice house for you.’
You would want a great deal of information and to visit and look at
the house for yourself, and to carry out extensive planning and
questioning before you finally made that decision. Similarly, you
would not buy a holiday or a car simply because somebody said to
you, ‘I have got a nice holiday here that I am sure would suit you.’
You would want to ask questions about where, when, how much,
what type of accommodation and so on.
Functional skills
Would you buy a property without finding out information about it?
English: Writing
This activity will give you the Activity 3
opportunity to write in an organised
way. You will need to think about Providing choice
how you lay out your list and present Think about a person with whom you have recently worked. Consider
it. When writing full sentences, all of your actions and whether or not they were given a choice about
ensure that you are consistent with how to live their lives. If you believe that they were given every
tense, that spellings, punctuation possible choice, then list the ways in which you ensured that
and grammar are accurate, and that happened. If you believe that their choice was restricted in some way,
each sentence makes sense. identify the reasons why this happened and the steps you can take to
ensure it is not repeated.
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Exactly the same applies to people making choices about their lives.
Your role is to make sure they have the information they need, and
either get it for them or help them get it themselves.
Doing it well
Supporting people to make choices
•• Communicate all information to people and their •• Make sure that people and their families receive
families clearly and in a way that can be understood. information in a form that they can access and
•• Make sure that their views are clearly represented to understand.
any forum where decisions are being taken or •• Ensure that the person has the opportunity to
proposals being formulated. comment in their own time about options and in an
•• Support people to put forward their own views atmosphere where they feel able to make adverse
wherever possible. comments if necessary.
•• Clearly record information and options, and ensure •• Always provide people with the information they
that all of the relevant people involved receive them. need to make informed choices, even if that is
restricted by their circumstances.
5.2 Using agreed risk assessment

processes to support the right to make
choices
Risk assessments are used in several different ways in order to deliver
safe and effective services that have people at the centre. Table 1
shows some examples.
Activity Purpose of risk assessment

Moving and handling Reduce risk of injury to worker
and person being moved
Development activities Reduce risk of injury to person

undertaking the activity
Invasive treatment, managing Reduce risk of infection

open wounds
Finding appropriate resources Reduce risk of harm and abuse
for someone
Planning changes in support Reduce risk of distress or
arrangements concern
Table 1: Examples of risk assessments.
As you can see from the table above, risk assessments are carried out
for various reasons, but they are always used in order to protect
either the person using the services or the support worker, or both.
Risk assessments should never be used as a reason to prevent people
from making choices; they are there to protect and to ensure that
risks are reduced.
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A good risk assessment allows people to make choices that are based
Activity 4 on facts and on having the right information. It helps people to
understand the consequences so that they are making informed
Risky situations
choices.
Think about a time when you have
said ‘no’ or advised against 5.3 Why your personal views should not
something because you thought it
was too risky. If you are honest,
influence an individual’s choices
could you have done a risk Choices that other people make are not your choices. Regardless of
assessment? Think about people whether or not you agree or think that the choice is wrong, you
you currently support who may like should never let your own opinion influence what someone decides
to change their lives or get involved to do. It can be very tempting to try to influence someone to make a
in something that might be risky. particular choice because you believe it will be of benefit, or because
Plan out how the risks can be any other option is risky or unwise. You have to resist this temptation
reduced so that it may be able to and simply give factual information about the options available.
happen. You may be asked, ‘What would you do if you were me?’ As always,
your answer has to be, ‘Well I’m not you, so knowing what I would
do won’t be much help. Let’s look at the options for you.’
You have learned in Unit SHC 22 about the influences on your own
development and how factors in your life have resulted in you holding
certain views and beliefs. These are your views and beliefs that have
been shaped by your experiences; they are not necessarily right for
others who have different backgrounds and different life experiences.
Everyone needs to be able to make their own choices.
5.4 How to support an individual to

question or challenge decisions
concerning them
People who use social care services can find themselves the subject of
decisions made by professionals. They may not agree with the
decisions, but may not always feel able to challenge the decisions.
Decisions could be about:
•• accommodation
•• support plan
•• change in service provision
•• assessment
•• medication
•• development activities
•• personal care
•• leisure time.
Although good practice is that people should always be in control of
decisions, this does not always happen. Sometimes events just seem
to take over, such as the closure of a facility or financial spending
decisions, changes in family circumstances.
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Decisions are made in all aspects of people’s lives.
On other occasions it may be that the type of decision does not put
the person in control, such as decisions on benefits, immigration
status or employment issues. Or, of course, it could just be poor
practice!
People can find it hard to challenge a decision that has been made
for them. It can be difficult for a range of reasons – for example,
people:
•• feel intimidated
•• lack the confidence to make a challenge
•• do not believe that they have the right to challenge the decisions
of professionals
•• may have had poor experiences in the past when they challenged
decisions unsuccessfully
•• may simply not know how to go about it.
You can support people to overcome all of these barriers. You may
be able to provide encouragement and also practical help and advice.
The following case studies show two ways in which people can be
supported in exercising their rights to question and challenge
decisions.
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Case study
Reviewing Tony’s medication

Tony’s doctor decided to change his medication. Tony unhappy and disagreed with the change. Even when
was unhappy about this, but did not feel that he could the doctor got quite cross, Tony was still able to make
argue with the doctor. Carole, his support worker, his point.
spent time with Tony to talk through his worries and
1. How do you think Carole’s method of supporting
encouraged him to write some notes explaining his
affected Tony’s confidence?
concerns. She then agreed to go with Tony to see the
2. If you were Tony’s care worker, would you have
doctor, but only as a support while he raised the issues.
been tempted to speak up when the doctor got
In the event, Carole did not need to say a word; Tony
cross? When do you think you should intervene in
used his notes to explain to his doctor why he was
that sort of situation?
Case study
May’s Attendance Allowance

May has been told that she will only be eligible for May and her daughter visited the office and were very
Attendance Allowance at the lower rate. She thinks this pleased at how helpful the officers were, but May did
is unfair as her daughter has to help her in the night say to Davinda that she was sure they could not have
sometimes. Davinda, her support worker, explained that managed the appeal on their own without support, as
May could appeal against the decision. She told May the process seemed pretty daunting.
where to get the forms to do this and explained that
1. What barriers was May facing?
she could get help from the Welfare Rights office if she
2. How did Davinda support May to overcome these
needed someone to support her to make the appeal.
barriers?
Functional skills
English: Reading
When completing the questions
following case studies, you will be
practising your reading skills to use
information from the text and to
give suitable responses. When you
give your answers, you will show
that you have understood the facts
and identified the relevant points.
176
6. Be able to promote individuals’

well-being
6.1 How individual identity and self-
esteem are linked with well-being
Key term Identity/self-image
Self-image/self-concept – how Identity or self-image is about how people see themselves. Would
people see themselves you describe who you are in terms of what you do, for example, a
support worker? Or perhaps in terms of your relationships with
others, for example, a wife, a parent or a child? Have you ever
described yourself as ‘So-and-so’s mum’, or ‘So-and-so’s daughter’?
You might think of yourself in terms of your hopes, dreams or
ambitions. Or, what is more likely perhaps, all of these ways of
thinking about yourself play some part.
Activity 5
Your self-image
Think about the number of different ways you could describe yourself.
List them all. See how many relate to:
•• other people – for example, someone’s mum, sister, friend

•• what you do – for example, care worker, volunteer at the youth
club, gardener
•• what you believe – for example, honest, loyal, a Christian, a
Muslim
•• what you look like – for example, short, brown hair, blue eyes.
You may be surprised when you see the greatest influences on how
you view yourself.
Identify is about what makes people who they are. Everyone has an
image of themselves, it can be a positive image overall or a negative
one, but a great many factors contribute to an person’s sense of
Reflect identity. These will include:
Think about just one person you •• gender •• family
have worked with. Note down all •• race •• friends
the influences on their sense of •• language •• culture
identity. Have you really thought •• religion •• values and beliefs
about it before? Think about the •• environment •• sexuality.
difference it may make to your
practice now that you have spent All of these are aspects of our lives that contribute towards our idea
some time reflecting about the of who we are. As a support worker it is essential that you take time
influences that have made a person to consider how each of the people you work with will have
who they are. developed their own self-image and identity, and it is important that
you recognise and promote this.
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You should ensure that you recognise that the values, beliefs, tastes
and preferences which people have are what define them; they must
be supported, nurtured and encouraged, not ignored and
disregarded because they are inconvenient or do not fit in with the
care system.
Self-esteem
Self-esteem is about how people value themselves – self-worth. It
results from the way people feel about themselves. It is important
that people feel that they have a valuable contribution to make,
whether it is to society as a whole or within a smaller area such as
their local community, workplace or own family.
Feeling good about yourself also has a great deal to do with your
own experiences throughout your life and the kind of confidence that
you were given as you grew up. All human beings need to feel that
they have a valuable place and a valuable contribution to make within
society.
The reasons why people have different levels of self-esteem are
complex. The way people feel about themselves is often laid down
during childhood. A child who is encouraged and regularly told how
good they are and given a lot of positive feelings is the sort of person
who is likely to feel that they have something to offer and can make a
useful contribution to any situation. But a child who is constantly
shouted at, blamed or belittled is likely to grow into an adult who
lacks belief in themselves, or finds it difficult to go into new situations
and to accept new challenges.
Do you see the factors that can influence how someone values themselves?
178
In the mid-1950s, a woman called Dorothy Law Nolte wrote this

poem about how children are influenced during their early years.
If a child lives with criticism, he learns to condemn…
If a child lives with hostility, he learns to fight…
If a child lives with fear, he learns to be apprehensive…
If a child lives with pity, he learns to feel sorry for himself…
If a child lives with ridicule, he learns to be shy…
If a child lives with jealousy, he learns to feel guilt…
But…
If a child lives with tolerance, he learns to be patient…
If a child lives with encouragement, he learns to be confident…
If a child lives with praise, he learns to be appreciative…
If a child lives with acceptance, he learns to love…
If a child lives with honesty, he learns what truth is…
If a child lives with fairness, he learns justice…
If a child lives with security, he learns to have faith in himself
and those about him…
If a child lives with friendliness, he learns the world is a nice
place in which to live.
Dorothy Law Nolte
Not all the reasons for levels of self-esteem come from childhood.
Many experiences in adult life can affect self-confidence and how
people feel about themselves, for example:
•• being made redundant
•• getting divorced
•• the death of somebody close
•• the loss of independence, possibly having to go into residential
care or into hospital
•• the shock of being burgled
•• having a bad fall, which results in a feeling of helplessness and a
lack of self-worth
•• being the subject of discriminatory or stereotyping abusive
behaviour
•• being the victim of violent or aggressive behaviour.
All of these experiences can have devastating effects. Very often,
people will become withdrawn and depressed as a result, and a great
Activity 6
deal of support and concentrated effort is needed to help them
Identifying criteria through these very difficult situations. People can be very vulnerable
that trigger a risk at these low points in their lives, and it is important that you make
assessment sure that you have followed the procedures in your organisation for
assessing and managing the risk of self-harm where you are aware
Check your organisation’s policies that someone is going through a period of very low self-esteem.
and procedures to identify the key
criteria which will trigger a risk Self-esteem is also very closely tied into the culture we live in, and the
assessment for someone who has values that particular culture has about what is important. For
been showing low self-esteem and example, among a group of young car thieves, the person most
feelings of worthlessness. admired might be the one who has stolen most cars, and the self-
esteem of that person is likely to be really high because of this
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admiration and approval; these are not values that would be shared
by other people in the community! So never forget the influences of
values and culture on self-esteem and on self-concept.
6.2 Attitudes and approaches to promote

an individual’s well-being
6.3 Supporting an individual in a way that
promotes identity and self-esteem
and
6.4 Ways to contribute to an environment
that promotes well-being
There are many practical ways in which people’s needs can be met
through the way in which you provide the services they need. Being
recognised and valued as an individual is hugely important for
people’s self-esteem. When somebody either requests, or is referred,
for a service, the assessment and planning cycle begins. Throughout
the consultation and planning which follows, the person and their
needs should be at the centre of the process. You will need to make
sure that the person has every opportunity to state exactly how they
wish their needs to be met. Some will be able to give this information
personally, while others will need an advocate who will support them
in expressing their views.
Feeling valued as an individual is vital to increasing self-esteem and
making people feel good about themselves. After all, it is very hard to
feel good about yourself, if you do not believe that anyone else thinks
much of you. If you are able to feel that people respect and value
you, then you are more likely to value yourself.
In your role as a care worker, you will come across situations where a
little thought or a small change in practice could give greater
opportunities for people to feel that they are valued and respected as
individuals. For example, you may need to find out how someone
likes to be addressed – do they consider that ‘Mr’ or ‘Mrs’ is more
respectful and appropriate, or are they happy for a first name to be
used? This, particularly for some older people, can be one of the ways
of indicating the respect that is important for anyone who uses care
services.
You will need to give thought to the values and beliefs which people
may have, for example:
•• religious or cultural beliefs about eating specific foods
•• values about forms of dress which are acceptable
•• beliefs or preferences about who should be able to provide
personal care.
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This will mean that you need to make sure that people have been
asked about religious, cultural or personal preferences and those
preferences are recorded so that all care workers and others providing
care are able to access them.
There may already be arrangements in your workplace to ask for and
record this information. If so, you must ensure that you are familiar
with the process and that you know where to find the information
for everyone you work with. If your workplace does not have
arrangements in place to find out about people’s choices and
preferences, you should discuss with your line manager ways in which
you can help to find this out.
Simple, open questions, asked politely are always the best way:
‘Excuse me, Mr Khan, the information I have here notes that you are
vegetarian. Can you tell me about the foods you prefer?’
Some information you can obtain by observation – for instance,
looking at someone can tell you a lot about their preferences
regarding dress. Particular forms of dress which are being worn for
religious or cultural reasons are usually obvious; a turban or a sari, for
instance, are easy to spot, but other forms of dress may also give you
some clues about the person wearing them. Consider how dress can
tell you about how much money people have or what kind of
background they come from. Clothes also tell you a lot about
someone’s age and the type of lifestyle they are likely to have had.
Beware, however – any information you think you gain from this type
of observation must be confirmed by checking your facts. Otherwise
it is easy to be caught out – some people from wealthy backgrounds
wear scruffy clothes, and some people in their 70s wear the latest
fashions and have face lifts!
Equally, be careful that you do not resort to thinking in stereotypes.
Rather, work with people as individuals, and avoid making
assumptions about them based on any of the factors that make them
similar to others, such as:
•• age •• skin colour
•• gender •• job
•• race •• wealth
•• culture •• where they live.
All of these factors are important in giving you information about
what may have influenced the development of each person – but
they will never, on their own, tell you anything else about that
person. The impact of stereotypical assumptions about people can
result in very low self-esteem and a negative self-image. After all, if
everyone assumes that just because you are 85 years old, you are too
old to be interested in current affairs, or the latest sports news, you
may decide that perhaps you are too old to bother; or, if employers
keep refusing to give you a job because you live in an inner city, are
16 years old, male and black, you may well decide that it is not worth
bothering to try any more.
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Activity 7
Filling in a form
Look at the form, or other means of recording information, that is
used in your workplace. Fill it in as if you were the person using the
service. Now note down all the factors which make you who you are.
For example, think about your:
•• gender
•• age
•• background
•• economic and social circumstances
•• nationality
•• culture
•• religion
•• sexual orientation
•• food preferences
•• entertainment preferences
•• relaxation preferences
•• reading material preferences.
Look at the form you have completed – would it tell anyone enough
about you so that they could ensure
that all your needs were met and you did not lose parts of your life
that were important to you? If not, think about what other questions
you need to ask, note them down and make sure that you ask them to
the people you support!
Functional skills Doing it well
English: Writing Putting person-centred values into practice

Filling in a form is a good way of
•• Your key focus is the person you support.
practising writing accurately. Check

•• Services revolve around the person, not the other way around.
that you use a suitable layout – for

•• Even in complex or difficult situation, the person is always at the
centre.
example, columns and bullet points
as suggested for Activity 7.
•• People must always be treated with dignity and respect.
Proofread your work to check that

•• Make sure that people have all the support they need in order to
make choices.
spellings, punctuation and grammar
are accurate.
•• Make arrangements for an advocate if necessary.
182

This unit is important because it is about the key aspects decide what they want you to do for them. Your
of how we deal with people who use social care assessor will check that you get consent before
services. The concept of person-centred working is at undertaking any activity with anyone, and you can
the heart of everything we do in social care. Most of the show this by always saying what you are going to do
assessment for this unit is observation of your practice. and checking that this is OK with the person.
Your assessor will want to be able to see that you have
As well as observing your practice, your assessor may
included all the aspects of person-centred working in
ask questions or ask you to complete an assignment to
the way you deal with the people you support. This
show that you understand the principles behind
means that you will need to let your assessor see that
person-centred working and why it is so important.
you support people to make their own choices about all
You may also be asked to look at how this approach
aspects of their lives and actively participate in their own
has changed how we think about the provision of social
support. You will need to show this by the way you
care support and how person-centred working is
show that people are in control of their own support by
different from previous approaches.
being able to change their minds if they wish to and to

•• www.alzheimers.org.uk (Alzheimer’s Society)
•• www.legislation.gov.uk (Mental Capacity Act)
•• www.nationalcareforum.org.uk (National Care Forum, Key principles
of person-centred dementia care)
•• www.nhs.uk (NHS Choices)
•• www.opsi.gov.uk (Government legislation website)
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Unit HSC 027
Contribute to
health and safety
in health and
social care
Every workplace is governed by regulations and legislation to protect the health and
safety of people who are supported and the workforce. You share part of the
responsibility for maintaining the workplace in a healthy, safe and secure way, and
knowing the key laws and guidelines that must be followed.
You must be aware of how to deal with risks such as moving and handling, disposal
of clinical waste and the maintenance of hygienic conditions, and you must know
how to deal with accidents and emergencies.
Working to support people can be stressful and demanding as well as rewarding,
so it is important that you know how to recognise the signs of stress and how to
deal with them.

1. own responsibilities, and the responsibilities of others, relating to health
and safety in the work setting
2. the use of risk assessments in relation to health and safety
3. procedures for responding to accidents and sudden illness
4. how to reduce the spread of infection
5. how to move and handle equipment and other objects safely
6. how to handle hazardous substances and materials
7. how to promote fire safety in the work setting
8. how to implement security measures in the work setting
9. how to manage own stress.
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1. Understand own
responsibilities, and the
responsibilities of others, relating
to health and safety in the work
setting
1.1 Legislation relating to general health
and safety in a health or social care work
setting
The settings in which you work are generally covered by the Health
and Safety at Work Act 1974 (HASAWA). This Act has been updated
and supplemented by many sets of regulations and guidelines, which
extend it, support it or explain it. The regulations most likely to affect
your workplace are shown in the following diagram.
As you work through this unit, you will see how the different
regulations under the Health and Safety at Work Act affect your
day-to-day activity.
d Safety at Work A
a n ct
alth
He
Manual Control of Health and

Handling Substances Reporting of Safety First
Management
Operations Hazardous to Injuries, Diseases Aid
of Health and
Regulations Health and Dangerous Regulations
Safety at Work
1992 Regulations Occurences 1981
Regulations
(as amended 2002 (COSHH) Regulations 1999
2002) 1995 (RIDDOR)
Can you see how the Health and Safety at Work Act is the overall Act for many other regulations?
186
Contribute to health and safety Unit HSC 027
1.2 Health and safety policies and

procedures agreed with the employer
and
1.3 Health and safety responsibilities of
yourself and others in the work setting
It sounds very simple and straightforward: make sure that the place in
which you work is safe and secure. However, when you start to think
about it – safe for whom? From whom? Safe from tripping over
things? Or safe from hazardous fumes? Safe from infection? Safe
from intruders? Safe from work-related injuries? You can begin to see
that this is a wide and complex subject.
You share the responsibility with your employer for your own safety
and that of all the people you support.
There are many regulations, laws and guidelines dealing with health
and safety. You do not need to know the detail, but you do need to
know where your responsibilities begin and end.
The laws place certain responsibilities on both employers and
employees. For example, it is up to the employer to provide a safe
place in which to work, but the employee also has to show
reasonable care for their own safety.
Employers have to:
•• make the workplace safe
•• prevent risks to health
Key terms •• ensure that machinery is safe to use, and that safe working
Risk – the likelihood of a hazard
practices are set up and followed
causing harm
•• make sure that all materials are handled, stored and used safely
•• provide adequate first aid facilities
Hazard – something that could •• tell you about any potential hazards from the work you do,
possibly cause harm chemicals and other substances used by the organisation, and
give you information, instructions, training and supervision as
needed
•• set up emergency plans
•• make sure that ventilation, temperature, lighting, and toilet,
washing and rest facilities all meet health, safety and welfare
requirements
•• check that the right work equipment is provided and is properly
used and regularly maintained
•• prevent or control exposure to substances that may damage your
health
•• take precautions against the risks caused by flammable or
explosive hazards, electrical equipment, noise and radiation
•• avoid potentially dangerous work involving manual handling and,
if it cannot be avoided, take precautions to reduce the risk of injury
•• provide health supervision as needed
187
•• provide protective clothing or equipment free of charge if risks

cannot be removed or adequately controlled by any other means
•• ensure that the right warning signs are provided and looked after
•• report certain accidents, injuries, diseases and dangerous
occurrences to either the Health and Safety Executive (HSE) or the
local authority, depending on the type of business.
As an employee, you have both rights and responsibilities in the
workplace. Your rights are:
•• as far as possible, to have any risks to your health and safety
properly controlled
•• to be provided, free of charge, with any personal protective and
safety equipment
•• if you have reasonable concerns about your safety, to stop work
and leave your work area, without being disciplined
•• to tell your employer about any health and safety concerns you
have
•• to get in touch with the Health and Safety Executive (HSE) or your
local authority if your employer will not listen to your concerns,
without being disciplined by them
•• to have rest breaks during the working day, to have time off from
work during the working week and to have annual paid holiday.
Your responsibilities are:
•• to take reasonable care of your own health and safety
•• if possible, to avoid wearing jewellery or loose clothing if
operating machinery or using equipment
•• if you have long hair or wear a headscarf, to make sure it is tucked
out of the way (it could get caught in equipment or machinery)
•• to take reasonable care not to put other people – fellow
employees and members of the public – at risk by what you do or
do not do in the course of your work
•• to cooperate with your employer, making sure that you get
proper training, and that you understand and follow the
company’s health and safety policies
•• not to interfere with or misuse anything that has been provided
for your health, safety or welfare
•• to report any injuries, strains or illnesses you suffer as a result of
doing your job (your employer may need to change the way you
work)
•• to tell your employer if something happens that might affect your
ability to work (for example, becoming pregnant or suffering an
injury); because your employer has a legal responsibility for your
health and safety, they may need to suspend you while they find
a solution to the problem, but you will normally be paid if this
happens
•• if you drive or operate equipment or machinery, to tell your
employer if you take medication that makes you drowsy – they
should temporarily move you to another job if they have one for
you to do.
188
Both the employee and employer are jointly responsible for

Activity 1 safeguarding the health and safety of anyone using the premises.
Health and safety policy Each workplace which has five or more workers must have a written
statement of health and safety policy. The policy must include:
Find out where the health and
safety policy is for your workplace •• a statement of intention to provide a safe workplace
and make sure you read it. •• the name of the person responsible for implementing the policy
•• the names of any other people responsible for preventing
particular health and safety hazards
•• a list of identified health and safety hazards and the procedures to
be followed in relation to them
•• procedures for recording accidents at work
•• details for evacuation of the premises.
1.4 Tasks that should not be carried out

without special training
All manual handling needs to be carried out by people who have had
training to do it. Employers are obliged to provide training in manual
handling, and you have to attend it once a year. Training is not a
one-off; it is important to be up to date with the latest techniques
and equipment, as well as any changes in regulations. This area of
work is very tightly controlled by legislation and regulations for very
good reasons; moving people without proper training is dangerous
both for them and for you. You will also need training for specific
pieces of equipment – for example, if a new hoist is to be used in
your workplace, no one will be able to operate it without training.
You may think that it looks very similar to the last one you used and
may be sure that it probably works in the same way – but you must
have specific training on that particular hoist before using it. This
applies to any piece of equipment that you have not used before.
Clinical tasks (including taking measurements like temperature or
blood pressure) will require training, as does changing dressings or
giving medication. There is more information about each of these in
Unit HSC 2014.
189
1.5 How to access additional support and

information relating to health and safety
You may find that you need some more information, or some further
advice. Sometimes it may not always be clear what the best course of
action may be. Health and safety is an important issue, and it is
always better to ask for more help than to make a guess and get
something wrong.
You may find that you need some additional help because you:
•• are unsure about what legislation and guidelines apply
•• do not know what action to take to ensure safety
•• are concerned about a particular situation or person
•• are unhappy about the risks from a piece of equipment or another
hazard
•• are unclear about who has responsibility.
Of course, your line manager is always your first choice for additional
information or support, but if your manager is unavailable or unsure,
and you cannot find what you need in your employer’s policies, then
the Health and Safety Executive (www.hse.gov.uk) should be able to
provide any information you need.
Trade unions are also a good source of information about heath and
safety issues, so you should always try asking your union steward if
you need advice.
Reflect
Think about a time you have had to deal with a health and safety
issue. Did you get all the information you needed? If so, think about
how it helped you to take the right action. If not, think about how
things could have been better.
If you have never had to deal with a health and safety issue, think
about health and safety in your workplace and work out the different
roles that people have to maintain health and safety. Can you see how
you can play your part to make the workplace safer? Note down the
actions you can take.
190
2. Understand the use of risk

assessments in relation to health
and safety
2.1 Why it is important to assess health
and safety hazards
Risk assessment in health and social care is important for everyone
whether they are employers, self-employed or employees, who are
required by law to identify and assess risks in the workplace. This
includes any situations where potential harm may be caused. There
are many regulations that require risks to be assessed and some are
covered by European Community directives. These include:
•• Management of Health and Safety at Work Regulations 1999
•• Manual Handling Operations Regulations 1992 (amended 2002)
•• Personal Protective Equipment at Work Regulations 1992
•• Health and Safety (Display Screen Equipment) Regulations 1992
(amended 2002)
•• Noise at Work Regulations 1989
•• Control of Substances Hazardous to Health Regulations 2002
(COSHH)
•• Control of Asbestos at Work Regulations 2002
•• Control of Lead at Work Regulations 2002.
There are other regulations that deal with very specialised risks such
as major hazards and ionising radiation. However, these are not
common risks in most workplaces.
There are five key stages to undertaking a risk assessment, which
involve answering the following questions.
1. What is the purpose of the risk assessment?
2. Who has to assess the risk?
3. Whose risk should be assessed?
4. What should be assessed?
5. When should the risk be assessed?
The Management of Health and Safety at Work Regulations 1999
state that employers have to assess any risks which are associated
with the workplace and work activities. This means all activities, from
Key term
walking on wet floors to dealing with violence. Having carried out a
Risk control measures – actions risk assessment, the employer must then apply risk control
taken in order to reduce an identified measures. This means that actions must be identified to reduce the
risk risks. For example, alarm buzzers may need to be installed or extra
staff employed, as well as steps such as providing extra training for
staff or written guidelines on how to deal with a particular hazard.
191
How many potential hazards can you see?
Risks in someone’s home

Of course, the situation is somewhat different if you work in a
person’s own home. Your employer can still carry out risk
assessments and put risk control measures in place, such as a
procedure for working in twos in a situation where there is a risk of
violence. What cannot be done is to remove environmental hazards
such as trailing electrical flexes, rugs with curled-up edges, worn
patches on stair carpets or old equipment. All you can do is to advise
the person whose home it is of the risks, and suggest how things
could be improved. You also need to take care!
2.2 How and when to report potential

health and safety risks
It is important that you develop an awareness of health and safety
risks and that you are always aware of any risks in any situation you
are in. If you get into the habit of making a mental checklist, you will
find that it helps. The checklist will vary from one workplace to
another, but could look like the one opposite.
192
Checklist for a safe work environment

Hazards Check
Environment
Floors Are they dry?
Carpets and rugs Are they worn or curled at the edges?
Doorways and corridors Are they clear of obstacles?
Electrical flexes Are they trailing?
Equipment
Beds Are the brakes on? Are they high enough?
Electrical or gas appliances Are they worn? Have they been safety checked?
Lifting equipment Is it worn or damaged?
Mobility aids Are they worn or damaged?
Substances such as cleaning fluids Are they correctly labelled?
Containers Are they leaking or damaged?
Waste disposal equipment Is it faulty?
People
Visitors to the building Should they be there?
Handling procedures Have they been assessed for risk?
Intruders Have police been called?
Violent and aggressive behaviour Has it been dealt with?
In your workplace, you have a responsibility to report any unsafe

Functional skills situation to your employer. For example, if you come to use a piece of
equipment – anything from a hoist to a kettle – and find that it is
Maths: Representing
unsafe or needs repair, you must report it. It is not enough to assume
Using the sections hazards and that someone will notice it or to say, ‘It’s not up to me – that’s a
equipment from the information on manager’s job.’ You have a share in the responsibility of making your
this page, devise a chart which workplace safe and secure.
allows you to represent your findings
However, there are some other situations which have to be reported
– for example, for mobility aids:
officially, not just to your employer, and there are special procedures
1. Are they worn? Yes / No to be followed:
2. Are they damaged? Yes / No
Reporting of Injuries, Diseases and Dangerous
Using your answers, look at the ratio
of yes answers to no answers and
Occurrences (RIDDOR) Regulations 1995
document your findings. Convert (amended 2008)
your answers to percentages, for Reporting accidents and ill-health at work is a legal requirement. All
example, 74% yes answers, 26% accidents, diseases and dangerous occurrences should be reported to
no answers. the Incident Contact Centre. The Centre was established on 1 April
2001 as a single point of contact for all incidents in the UK. The
193
information is important because it means that risks and causes of

accidents, incidents and diseases can be identified, and any necessary
risk assessments carried out. All notifications are passed on to either
the local authority Environmental Health department, or the Health
and Safety Executive, as appropriate.
Your employer needs to report:
•• deaths
•• major injuries
•• accidents resulting in more than three days off work
•• diseases
•• dangerous occurrences.
These are monitored and recorded at a national level so that risks in
different workplaces are understood and any trends can be identified.
2.3 How risk assessment can help address

dilemmas between rights and health and
safety concerns
If you work in someone’s home or long-term residential setting, you
have to balance the need for safety with the rights of people to have
their living space the way they want it. It may be your workplace, but
it is also the person’s home.
Both you and the people you support are entitled to expect a safe
place in which to live and work, but remember their rights to choose
how they want to live.
Concerns for security can also create difficult situations. Of course
people have a right to see whomever they wish, but there can be
situations where there may be concerns about vulnerable people
being exploited or placed at risk of harm. You cannot insist on the
levels of security that people adopt in their own homes, but you can
advise people of the risks of opening doors to strangers or inviting
unknown people in.
People also need to assess the risks involved in doing the things they
wish to do safely and without placing themselves at undue risk of
harm. For example, someone with dementia may wish to go out
shopping alone. This is potentially risky as they may become
disoriented and be unable to find their way back. A risk assessment
will help to look at the risks and the control measures that can be put
in place in order to reduce the risks of the activity; for example,
suggesting that a friend accompany the person, or cards with details
of address and contact numbers be placed in pockets and bags and
simple instructions with key landmarks are practised with the person
prior to the trip.
194
What risks would you take into account? How can this be balanced with someone’s rights?
A person with a visual impairment may be intending to take up a new

exercise regime at a local gym. A risk assessment carried out with the
person can identify any control measures needed such as liaison with
the gym to ensure that they can provide the necessary support on
using the equipment, offering a support worker if necessary and a
review of travel arrangements.
Reflect
Effective risk assessments make it possible for people to do things.
Risk assessments are not about restricting what people do, they are
about making sure that it is done safely. The potential for health and
safety concerns to limit people’s activities and restrict their rights can
be greatly decreased by good risk assessments that put sensible control
measures in place to reduce the risks. Life is full of risks, and all people,
regardless of age or ability, have the right to take risks in order to live
as they wish. But a well carried-out risk assessment can make it less
likely that any harm will result.
195
3. Understand procedures for

responding to accidents and
sudden illness
3.1 Different types of accidents and
sudden illness that may occur
If accidents or injuries occur at work, either to you or to someone you
are supporting, then the details must be recorded. For example,
someone may have a fall or slip on a wet floor. You must record the
incident regardless of whether there was an injury.
Your employer should have procedures in place for making a record
of accidents – either an accident book or an accident report form.
This is not only required by the RIDDOR regulations, but also by the
inspection bodies in all UK countries.
Make sure you know where the accident report forms or the accident
book is kept, and who is responsible for recording accidents. It is likely
to be your manager.
You must report any accident in which you are involved, or have
witnessed, to your manager or supervisor.
Any medical treatment or assessment which is necessary should be
arranged without delay. If someone has been involved in an accident,
you should check if there is anyone they would like to be contacted,
perhaps a relative or friend. If the accident is serious, and you cannot
consult the person – because they are unconscious – the next of kin
should be informed as soon as possible.
Complete a report, and ensure that all witnesses to the accident also
complete reports. You should include the following in any accident
report:
•• date, time and place of accident
•• person/people involved – bearing in mind the Data Protection Act
•• circumstances and details of exactly what you saw
•• anything that was said by the people involved
•• the condition of the person after the accident
•• steps taken to summon help, time of summoning help and time
when help arrived
•• names of any other people who witnessed the accident
•• any equipment involved in the accident.
196

English: Reading; Designing an accident report
Writing Imagine that your manager has asked you to design a new incident/
Research examples of accident report accident report form for your workplace. They have asked you to do
forms. Choose a format that best fits this because the current form does not provide enough information.
the information you need to show The purpose of the new form is to provide sufficient information to:
for Activity 2. By doing this, you will •• ensure the person receives the proper medical attention
be reading for a purpose and using •• provide information for treatment at a later date, in case of
information found in texts. Ensure delayed reactions
that the layout you use for the form •• give information to any inspector who may need to see the records
is suitable and that any information •• identify any gaps or need for improvements in safety procedures
on it is clear and accurate in spelling, •• provide information about the circumstances in case of any future
punctuation and grammar. Use legal action.
suitable language at all times.
Think about how you would design the new report form and what
headings you would include. Use the list above as a checklist to make
sure you have covered everything you need.
Date: 24.2.11 Time: 14.30 hrs Location: Main Lounge
Description of accident:
PH got out of her chair and began to walk across the lounge
with the aid of her stick. She turned her head to continue the
conversation she had been having with GK, and as she turned back
again, she appeared not to have noticed that MP’s handbag had
been left on the floor. PH tripped over the handbag and fell
heavily, banging her head on a footstool.
She was very shaken and although she said that she was not
hurt, there was a large bump on her head. P appeared pale and
shaky. I asked S to fetch a blanket and to call Mrs J, deputy
officer in charge. Covered P with a blanket. Mrs J arrived
immediately. Dr was sent for after P was examined by Mrs J.
Dr arrived after about 20 mins and said that she was bruised and
shaken, but did not seem to have any injuries.
She wanted to go and lie down. She was helped to bed.
Incident was witnessed by six residents who were in the lounge
at the time: GK, MP, IL, MC, CR and BQ.
Signed: Name:
Can you see how information about an accident is all in this report?
197
Types of accidents and sudden illness that may occur

in a health or social care setting
It is important that you are aware of the initial steps to take when
dealing with the most common health emergencies. You may be
involved with any of these emergencies when you are at work,
whether you work in a residential, hospital or community setting.
There are major differences between the different work situations.
•• If you are working in a hospital where skilled assistance is always
immediately available, the likelihood of your having to act in an
emergency, other than to summon help, is remote.
•• In a residential setting, help is likely to be readily available,
although it may not necessarily be the professional medical
expertise of a hospital.
•• In the community, you may have to summon help and take action
to support a casualty until the help arrives. It is in this setting that
you are most likely to need some knowledge of how to respond
to a health emergency.
This section gives a guide to taking initial action in a number of
illnesses or accidents that you may come across in your work. There
are many others, but the general guidance given here may assist you
in taking initial action until further assistance arrives in instances of:
•• severe bleeding
•• cardiac arrest
•• shock
•• loss of consciousness
•• epileptic seizure
•• choking and difficulty with breathing
•• fractures and suspected fractures
•• burns and scalds
•• poisoning
•• electrical injuries.
3.2 Procedures to follow if an accident or

sudden illness should occur
Severe bleeding
Severe bleeding can be the result of a fall or injury. The most
common causes of severe cuts are glass, as the result of a fall into a
window or glass door, or knives from accidents in the kitchen.
Symptoms
There will be apparently large quantities of blood from the wound. In
some very serious cases, the blood may be pumping out. Even small
amounts of blood can be very frightening, both for you and the
casualty. Remember that a small amount of blood goes a long way,
and things may look worse than they are. However, severe bleeding
198
requires urgent medical attention in hospital. Although people rarely

bleed to death, extensive bleeding can cause shock and loss of
consciousness.
Aims
•• To bring the bleeding under control
•• To limit the possibility of infection
•• To arrange urgent medical attention
Action for severe bleeding
You will need to apply pressure to a wound that is bleeding. If
possible, use a sterile dressing. If one is not readily available, use any
absorbent material, or even your hand. Do not forget the precautions
(see ‘Protect yourself’ below). You will need to apply direct pressure
over the wound for 10 minutes (this can seem like a very long time)
to allow the blood to clot.
If there is any object in the wound, such as a piece of glass, do not try
to remove it. Simply apply pressure to the sides of the wound. Lay the
casualty down and raise the affected part if possible. Make the
person comfortable and secure.
In a residential care setting, call for the senior registered nurse to
assess the severity of the injury. They will make a decision regarding
whether the wound is severe enough to call a paramedic.
Would you know how to apply pressure to bleeding in an emergency situation?
Protect yourself
You should take steps to protect yourself when you are dealing with
casualties who are bleeding. Your skin provides an excellent barrier to
infections, but you must take care if you have any broken skin such as
a cut, graze or sore. Seek medical advice if blood comes into contact
with your mouth or nose, or gets into your eyes. Blood-borne viruses
(such as HIV or hepatitis) can be passed only if the blood of someone
who is already infected comes into contact with broken skin.
199
Ideally, wear disposable gloves. If this is not possible, cover any areas
of broken skin with a waterproof dressing. If possible, wash your
hands thoroughly in soap and water before and after exposure to
blood. Take care with any needles or broken glass in the area. Use a
mask for mouth-to-mouth resuscitation if the casualty’s nose or
mouth is bleeding.
Cardiac arrest
Cardiac arrest occurs when a person’s heart stops. Cardiac arrest can
happen for various reasons, the most common of which is a heart
attack, but a person’s heart can also stop as a result of shock, electric
shock, a convulsion or other illness or injury.
Symptoms
•• No pulse
•• No breathing
Aims
•• To obtain medical help as a matter of urgency
It is important to give oxygen, using mouth-to-mouth resuscitation,
and to stimulate the heart, using chest compressions. This procedure
is called cardio-pulmonary resuscitation – CPR. You will need to
attend a first aid course to learn how to resuscitate; you cannot learn
how to do this from a book. Giving CPR is very hard work and correct
positioning is important, so you need the opportunity to try this out
with supervision. On the first aid course you will be able to practise
on a special dummy.
(a)
(b)
Mouth-to-mouth resuscitation (a) and chest compressions (b).
200
Action for cardiac arrest

Check whether the person has a pulse and whether they are
breathing. If not, call for urgent help from a senior registered nurse
who will assess the need for summoning emergency services.
Start methods of resuscitation if you have been taught how to do it.
The pattern is two breaths then 30 chest compressions. Repeat this
until help arrives if you have been trained to do it.
Shock
Shock occurs because blood is not being pumped around the body
efficiently. This can be the result of loss of body fluids through
bleeding, burns, severe vomiting or diarrhoea, or a sudden drop in
blood pressure or a heart attack.
Symptoms
The signs of shock are easily recognised. The person:
•• will look very pale, almost grey
•• will be very sweaty, and the skin will be cold and clammy
•• will have a very fast pulse
•• may feel sick and may vomit
•• may be breathing very quickly.
Aims
•• To obtain medical help as a matter of urgency
•• To improve blood supply to heart, lungs and brain
Action for shock
Summon expert medical or nursing assistance. Lay the person down
on the floor. Try to raise the feet off the ground to help the blood
supply to the important organs. Loosen any tight clothing.
Watch the person carefully. Check the pulse and breathing regularly.
Keep the person warm and comfortable, but do not warm the
casualty with direct heat, such as a hot-water bottle.
Raise the feet off the ground and keep the casualty warm.
Do not allow the casualty to eat or drink, or leave the casualty alone,
unless it is essential to do so briefly in order to summon help.
Loss of consciousness
Loss of consciousness can happen for many reasons, from a
straightforward faint to unconsciousness following a serious injury or
illness.
Symptom
A reduced level of response and awareness. This can range from
being vague and woozy to total unconsciousness.
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Aims
•• To summon expert medical help as a matter of urgency
•• To keep the airway open
•• To note any information which may help to find the cause of the
unconsciousness
Action for loss of consciousness
Make sure that the person is breathing and has a clear airway.
Maintain the airway by lifting the chin and tilting the head
backwards.
Look for any obvious reasons why the person may be unconscious,
such as a wound or an ID band telling you of any condition they may
have. For example, many people who have medical conditions that
may cause unconsciousness, such as epilepsy or diabetes, wear special
bracelets or necklaces giving information about their condition.
Place the casualty in the recovery position (see below), but not if you
suspect a back or neck injury, until expert medical or nursing help or
the emergency services arrive.
Do not:
•• attempt to give anything by mouth
•• attempt to make the casualty sit or stand
•• leave the casualty alone, unless it is essential to leave briefly in
order to summon help.
Open the airway.
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The recovery position

Many of the actions you need to take to deal with health
emergencies will involve you in placing someone in the recovery
position. In this position a casualty has the best chance of keeping a
clear airway, not inhaling vomit and remaining as safe as possible
until help arrives. You should not attempt this position if you think
someone has back or neck injuries, and it may not be possible if there
are fractures of limbs.
•• Kneel at one side of the casualty, at about waist level.
•• Tilt back the person’s head – this opens the airway. With the
casualty on their back, make sure that limbs are straight.
•• Bend the casualty’s near arm as in a wave (so it is at right angles
to the body). Pull the arm on the far side over the chest and place
the back of the hand against the opposite cheek (a in the
diagram).
•• Use your other hand to roll the casualty towards you by pulling on
the far leg, just above the knee (b in the diagram). The casualty
should now be on their side.
•• Once the casualty is rolled over, bend the leg at right angles to the
body. Make sure the head is tilted well back to keep the airway
open (c in the diagram).
(a)
(b)
(c)
The recovery position.
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Epileptic seizure
Epilepsy is a medical condition that causes disturbances in the brain,
which result in sufferers becoming unconscious and having
involuntary contractions of their muscles. This contraction of the
muscles produces the fit or seizure. People who suffer with epilepsy
do not have any control over their seizures, and may do themselves
harm by falling when they have a seizure.
Aims
•• To ensure that the person is safe and does not injure themselves
during the fit
•• To offer any help needed following the fit
Action for epileptic seizure
Try to make sure that the area in which the person has fallen is safe.
Loosen all clothing.
Once the seizure has ended, make sure that the person has a clear
airway and place in the recovery position. Make sure that the person
is comfortable and safe. Particularly try to prevent head injury.
If the fit lasts longer than 5 minutes, or you are unaware that the
casualty is a known epileptic, call an ambulance.
Do not:
•• attempt to hold the casualty down, or put anything in the mouth
•• move the casualty until they are fully conscious, unless there is a
risk of injury in the place where they have fallen.
Choking and difficulty with breathing

This is caused by something (usually a piece of food) stuck at the back
of the throat. It is a situation that needs to be dealt with, as people
can quickly stop breathing if the obstruction is not removed.
Symptoms
•• Red, congested face at first, later turning grey
•• Unable to speak or breathe, may gasp and indicate throat or neck
– this is severe choking and requires immediate action
If a person can speak in answer to a question such as ‘Are you
choking?’ then this is regarded a mild choking and they should be
encouraged to cough.
Aims
•• To remove obstruction as quickly as possible
•• To summon medical assistance as a matter of urgency if the
obstruction cannot be removed
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Action for choking

1. Ensure any dentures are removed. Sweep the mouth with one
gloved finger to clear any food, vomit or anything else from the
mouth.
2. Try to get the person to cough. If that is not immediately effective,
move on to step 3.
3. Bend the person forwards. Use the heel of the hand to give up to
five blows sharply on the back between the shoulder blades (a in
the diagram).
4. If this fails, use the Heimlich manoeuvre – also called ‘abdominal
thrusts’ – if you have been trained to do so. Stand behind the
person with your arms around them. Join your hands just below
the breastbone. One hand should be in a fist and the other
holding it (b in the diagram).
5. Sharply pull your joined hands upwards and into the person’s
body at the same time. The force should expel the obstruction.
6. You should alternate backslaps and abdominal thrusts until you
clear the obstruction.
(b)
(a)
Dealing with an adult who is choking.
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Fractures and suspected fractures

Fractures are breaks or cracks in bones. They are usually caused by a
fall or other type of injury. The casualty will need to go to a hospital
as soon as possible to have a fracture diagnosed correctly.
Symptoms
•• Acute pain around the site of the injury
•• Swelling and discoloration around the affected area
•• Limbs or joints may be in odd positions
•• Broken bones may protrude through the skin
Action for fractures
The important thing is to support the affected part. Help the casualty
to find the most comfortable position. Support the injured limb in
that position with as much padding as necessary – towels, cushions
or clothing will do.
Take the person to hospital or call an ambulance. Do not:
•• try to bandage or splint the injury
•• allow the casualty to have anything to eat or drink.
Burns and scalds
There are several different types of burn; the most usual are burns
caused by heat or flame. Scalds are caused by hot liquids. People can
also be burned by chemicals or by electrical currents.
Symptoms
Depending on the type and severity of the burn, skin may be red,
swollen and tender, blistered and raw or charred. The casualty is
usually in severe pain and possibly suffering shock.
Aims
•• To obtain immediate medical assistance if the burn is over a large
area (as big as the casualty’s hand or more) or is deep
•• To send for an ambulance if the burn is severe or extensive. If the
burn or scald is over a smaller area, the casualty could be
transported to hospital by car
•• To stop the burning and reduce pain
•• To minimise the possibility of infection
Action for burns and scalds
For major burns, summon immediate medical assistance.
Cool down the burn. Keep it flooded with cold water for 10 minutes.
If it is a chemical burn, this needs to be done for 20 minutes. Ensure
that the contaminated water used to cool a chemical burn is disposed
of safely.
Remove any jewellery, watches or clothing which is not sticking to the
burn. Cover it if possible, unless it is a facial burn, with a sterile or at
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least clean non-adhesive dressing. If this is not possible, leave the

Doing it well burn uncovered. For a burn on a hand or foot, a clean plastic bag will
Stop, drop, wrap, roll protect it from infection until an expert can treat it.
If a person’s clothing is on fire, STOP Do not:

– DROP – WRAP – ROLL. •• remove anything which is stuck to a burn
•• Stop them from running around. •• touch a burn, or use any ointment or cream
•• Get them to drop to the ground •• cover facial burns – keep pouring water on until help arrives.
– push them if you have to and
Poisoning
can do so safely.
•• Wrap them in something to People can be poisoned by many substances, drugs, plants, chemicals,
smother the flames – a blanket fumes or alcohol.
or coat, anything to hand. This is Symptoms
better if it is soaked in water.
•• Roll them on the ground to put Symptoms will vary depending on the poison.
out the flames. •• The person could be unconscious.
•• There may be acute abdominal pain.
•• There may be blistering of the mouth and lips.
Aims
•• To remove the casualty to a safe area if they are at risk, and it is
safe for you to move them
•• To summon medical assistance as a matter of urgency
•• To gather any information which will identify the poison
•• To maintain a clear airway and breathing until help arrives
Action for poisoning
If the casualty is unconscious, place them in the recovery position to
ensure that the airway is clear, and that they cannot choke on any
vomit. Dial 999 for a paramedic.
Try to find out what the poison is and how much has been taken.
This information could be vital in saving a life.
If a conscious casualty has burned mouth or lips, they can be given
small frequent sips of water or cold milk. Do not try to make the
casualty vomit.
Electrical injuries
Electrocution occurs when an electrical current passes though the
body.
Symptoms
Electrocution can cause cardiac arrest and burns where the electrical
current entered and left the body.
Aims
•• To remove the casualty from the current when you can safely
do so
•• To obtain medical assistance as a matter of urgency
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•• To maintain a clear airway and breathing until help arrives

•• To treat any burns
Action for electrical injuries
There are different procedures to follow, depending on whether the
injury has been caused by a high- or low-voltage current.
Injury caused by high-voltage current
This type of injury may be caused by overhead power cables or rail
lines, for example.
Contact the emergency services immediately. Do not touch the
person until all electricity has been cut off.
If the person is unconscious, clear their airway. Treat any other injuries
present, such as burns. Place in the recovery position until help
arrives.
Injury caused by low-voltage current
This type of injury may be caused by electric kettles, computers, drills,
lawnmowers and so on.
Break the contact with the current by switching off the electricity, at
the mains if possible. It is vital to break the contact as soon as
possible, but if you touch a person who is ‘live’ (still in contact with
the current), you too will be injured. If you are unable to switch off
the electricity, then you must stand on something dry which can
insulate you, such as a telephone directory, rubber mat or a pile of
newspapers, and then move the casualty away from the current
as shown below.
For an electrical injury, move the casualty away from the current.
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Do not use anything made of metal, or anything wet, to move the

casualty from the current. Try to move them with a wooden pole or
broom handle, even a chair. Alternatively, drag them with a rope or
cord or, as a last resort, pull by holding any of the person’s dry
clothing that is not in contact with their body.
Once the person is no longer in contact with the current, you should
follow the same steps as with a high-voltage injury.
Tasks that need training

The guidance above identifies situations where training is necessary,
for example, carrying out CPR. This is important because you can do
further damage to a casualty by attempting to carry out tasks you
have not been trained for. Helping following an accident or sudden
illness is about first aid, and you need to understand the actions you
should take if such an emergency arises.
The advice in this unit is not a substitute for a first aid course, and will
only give you an outline of the steps you need to take. Reading this
part of the unit will not qualify you to deal with these emergencies.
Unless you have been on a first aid course, you should be careful
about what you do, because the wrong action can cause more harm
to the casualty. It is always preferable to get suitably trained
assistance if possible.
Only attempt what you know you can safely do. Do not attempt
something you are not sure of. You could do further damage to
the ill or injured person. Do not try to do something outside your
responsibility or capability – summon help and wait for it to arrive.
What you can safely do

Most people have a useful role to play in a health emergency, even if
it is not dealing directly with the ill or injured person. It is also vital
that someone:
•• summons help as quickly as possible
•• offers assistance to the competent person who is dealing with the
emergency
•• clears the immediate environment and makes it safe – for
example, if someone has fallen through a glass door, the glass
must be removed as soon as possible before there are any more
injuries
•• offers help and support to other people who have witnessed the
illness or injury and may have been upset by it. Clearly this can
only be dealt with once the ill or injured person is being helped.
Summon assistance
In the majority of cases this will mean telephoning 999 and
requesting paramedic assistance. It will depend on the setting in
which you work and clearly is not required if you work in a hospital!
But it may mean calling for a colleague with medical qualifications,
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who will then be able to make an assessment of the need for further
assistance. Similarly, if you work in the residential sector, there should
be a medically qualified colleague available. If you are the first on the
scene at an emergency in the community, you may need to summon
an ambulance for urgent assistance.
If you need to call an ambulance, try to keep calm and give clearly all
the details you are asked for. Do not attempt to give information until
it is asked for – this wastes time. Emergency service operators are
trained to find out the necessary information, so let them ask the
questions, then answer calmly and clearly.
Follow the action steps outlined in the previous section while you are
waiting for help to arrive.
Assist the person dealing with the emergency
A second pair of hands is invaluable when dealing with an
emergency. If you are assisting someone with first aid or medical
expertise, follow all their instructions, even if you do not understand
why. An emergency situation is not the time for a discussion or
debate – that can happen later. You may be needed to help to move
a casualty, to fetch water, blankets or dressings, or to reassure and
comfort the casualty during treatment.
Make the area safe
An accident or injury may have occurred in an unsafe area – and that
was probably precisely why the accident occurred there! Sometimes,
it may be that the accident has made the area unsafe for others. For
example, if someone has tripped over an electric flex, there may be
exposed wires or a damaged electric socket. Alternatively, a fall
against a window or glass door may have left shards of broken glass
in the area, or there may be blood or other body fluids on the floor.
You may need to make the area safe by turning off the power,
clearing broken glass or dealing with a spillage.
It may be necessary to redirect people away from the area of the
accident in order to avoid further casualties.
Maintain the privacy of the casualty
You may need to act to provide some privacy for the casualty by
asking onlookers to move away or stand back. If you can erect a
temporary screen with coats or blankets, this may help to offer some
privacy. It may not matter to the casualty at the time, but they have a
right to privacy and dignity if possible.
Make accurate reports
You may be responsible for making a report on an emergency
situation you have witnessed, or for filling in records later.
Concentrate on the most important aspects of the incident and
record the actions of yourself and others in an accurate, legible and
complete manner.
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Case study
Dealing with a health emergency

On the way to lunch one Tuesday, Miss Shaw, who on her hip. The first staff member on the scene was
sometimes experiences incontinence, had a little Maria.
accident in the main hallway. Another resident coming
1. List the actions that Maria should take, in order.
along behind called out, ‘Oh look! She’s done a
2. Could this accident have been prevented? If so,
puddle!’ and stopped to stare. Miss Shaw, feeling
how?
embarrassed and distressed, turned quickly to go back
3. What follow-up actions or discussions would you
to her room and slipped on the wet floor, falling heavily
recommend to the management?
How to deal with witnesses’ distress – and your own

People who have witnessed accidents can often be very distressed by
what they have seen. The distress may be as a result of the nature of
the injury, or perhaps the blood loss. It could be because the casualty
is a friend or relative, or simply because seeing accidents or injuries is
traumatic. Some people can become upset because they feel helpless
and do not know how to assist, or they may have been afraid and
then feel guilty later.
You will need to reassure people about the casualty and the fact that
they are being cared for appropriately. However, do not give false
reassurance about things you may not be sure of.
You may need to allow people to talk about what they saw. One of
the most common effects of witnessing a trauma is that people need
to repeat over and over again what they saw.
What about you?
You may feel very distressed by the experience you have gone
through. You may find that you need to talk about what has
happened, and that you need to look again at the role you played.
You may feel that you could have done more, or you may feel angry
with yourself for not having a greater knowledge about what to do.
If you have followed the basic guidelines in this element, you will
have done as much as could be expected of anyone at the scene of
an emergency who is not a trained first aider.
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4. Be able to reduce the spread of

infection
4.1 The recommended method for
hand-washing
The very nature of work in a social care setting means that great care
must be taken to control the spread of infection. You will come into
contact with a number of people during your working day – an ideal
opportunity for infection to spread. Infection which spreads from one
person to another is called ‘cross-infection’. If you work in the
community, cross-infection is difficult to control. However, if you
work in a residential or hospital setting, infection control is essential.
There are various steps which you can take in terms of the way you
carry out your work (wherever you work), which can help to prevent
the spread of infection.
You do not know what viruses or bacteria may be present in any
person, so it is important that you take precautions when dealing with
everyone. The precautions are called ‘universal precautions’ precisely
because you need to take them with everyone you deal with.
Table 1: Wear gloves.
When Why How
Any occasion when you will have Because gloves act Check gloves before putting them on. Never use
contact with body fluids (including as a protective gloves with holes or tears. Check that they are
body waste, blood, mucus, barrier against not cracked or faded. Pull gloves on, making
sputum, sweat or vomit), or when infection. sure that they fit properly. If you are wearing a
you have any contact with anyone gown, pull them over the cuffs. Take them off by
with a rash, pressure sore, wound, pulling from the cuff – this turns the glove inside
bleeding or any broken skin. You out. Pull off the second glove while still holding
must also wear gloves when you the first so that the two gloves are folded
clear up spills of blood or body together inside out. Dispose of them in the
fluids, or have to deal with soiled correct waste disposal container and wash your
linen or dressings. hands.
Do you follow the correct procedure for putting on and taking off gloves?
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Table 2: Wash your hands.
When Why How
Before and after carrying out any Because hands are a In running water, in a basin deep enough to
procedure which has involved contact major route to hold the splashes and with either foot pedals or
with a person, or with any body spreading infection. elbow bars rather than taps, because you can
fluids, soiled linen or clinical waste. When tests have re-infect your hands from still water in a basin,
You must wash your hands even been carried out on or from touching taps with your hands once
though you have worn gloves. You people’s hands, an they have been washed. Use the soaps and
must also wash your hands before enormous number of disinfectants supplied. Make sure that you wash
you start and after you finish your bacteria have been thoroughly, including between your fingers.
shift, before and after eating, after found.
using the toilet and after coughing,
sneezing or blowing your nose.
1. Wet your hands thoroughly under warm running 2. Rub your hands together to make a lather.
water and squirt liquid soap onto the palm of
one hand.
3. Rub the palm of one hand along the back of the 4. Rinse off the soap with clean water.
other and along the fingers. Then repeat with the
other hand.
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5. Rub in between each of your fingers on both 6. Dry hands thoroughly on a disposable towel.
hands and round your thumbs.
Table 3: Wear protective clothing.
When Why How
You should always wear a gown Because it will reduce the spread The plastic apron should be
or plastic apron for any of infection by preventing disposable and thrown away at
procedure which involves bodily infection getting on your clothes the end of each procedure. You
contact or is likely to deal with and spreading to the next person should use a new apron for each
body waste or fluids. An apron is you come into contact with. person you come into contact
preferable, unless it is likely to be with.
very messy, as gowns can be a
little frightening.
Have you worn these items of protective clothing before?
Table 4: Tie up hair.
Why
Because if it hangs over your face, it is more likely to come into contact
with the person you are working with and could spread infection. It
could also become entangled in equipment and cause a serious injury.
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Table 5: Clean equipment.
Why How
Because infection can spread from one By washing large items like trolleys with antiseptic solution. Small
person to another on instruments, linen instruments must be sterilised. Do not shake soiled linen or dump it
and equipment just as easily as on hands on the floor. Keep it held away from you. Place linen in proper bags
or hair. or hampers for laundering.
Table 6: Deal with waste.
Why How
Because it can then be processed By placing it in the proper bags. Make sure that you know the
correctly, and the risk to others working system in your workplace. It is usually:
further along the line in the disposal •• clinical waste – yellow
process is reduced as far as possible. •• soiled linen – red
•• recyclable instruments and equipment – blue.
Table 7: Take special precautions.
When How
There may be occasions when you have to deal Your workplace will have special procedures to follow.
with someone who has a particular type of They may include such measures as gowning, double
infection that requires special handling. This can gloving or wearing masks. Follow the procedures strictly.
involve things like hepatitis, some types of food They are there for your benefit and for the benefit of the
poisoning or highly infectious diseases. other people you support.
Reflect
Can you think of three ways that
you can improve your own practice
to reduce the spread of infection?
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4.2 Ways to ensure that your health and

hygiene do not pose a risk to others
What you wear
You may not think that what you wear has much bearing on health
and safety, but it is important. Even if your employer supplies, or
insists on you wearing, a uniform, there are still other aspects to the
safety of your work outfit.
There may be restrictions on wearing jewellery or carrying things in
your pocket which could cause injury. This can also pose a risk to you
– you could be accidentally stabbed in the chest by a pair of scissors
or a ballpoint pen!
Many workplaces do not allow the wearing of rings with stones. Not
only is this a possible source of infection, but also they can scratch
people or tear protective gloves.
High-heeled or poorly supporting shoes are a risk to you in terms of
foot injuries and very sore feet. They also present a risk to people you
are helping, because if you overbalance or stumble, so will they.
How many risks can you see? Keeping food safe

Maintaining the safety and hygiene of food provided for people you
support is an essential part of a safe and healthy environment. If you
are preparing areas or equipment for people who are about to eat or
drink, it is important that you follow basic hygiene procedures. This
will also involve you knowing how to store and prepare food safely in
order that people are able to eat it safely. Ensuring that food is not
contaminated by bacteria is a matter which raises many questions, for
instance:
Q What personal precautions do I need to make to ensure that I am
hygienic?
A You must make sure that if you have long hair, it is tied back or
covered. You should ensure that your nails are short and clean,
and that you are not wearing any jewellery in which food could
become trapped, such as rings with stones. You must ensure that
you wash your hands thoroughly at each stage of food
preparation and between handling raw food and cooked food,
or raw meat and food which will not be cooked. You must
always wash your hands after going to the toilet. Do not touch
your nose during food handling or preparation.
Q What should I do if I have a cut or sore on my hands?
A You must wear a special blue adhesive plaster dressing. This is
because no food is blue, and if the plaster should come off
during food preparation it will be easy to locate.
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Q How does food become contaminated?

A Food is contaminated by bacteria which infect food directly, that
is, food which is not heated or chilled properly, or by cross-
contamination, which is where bacteria are spread by somebody
preparing food with unclean hands or equipment.
Q What are the main bacteria that cause contamination of food?
A Salmonella, campylobacter and e-coli are types of bacteria that
can cause serious food poisoning in people who are old, ill or in
young children.
Q How can infection and cross-contamination be avoided?
A Raw meat is a source of bacteria and you should be sure to use
separate utensils and chopping boards or areas for raw food and
for cooked food. For example, do not chop the raw chicken
breasts and then chop the lettuce for the accompanying salad on
the same chopping board or with the same knife. This is sure to
give everybody who eats your salad a nasty dose of salmonella.
You should keep separate chopping boards for meat and
vegetables, and ensure that you use different knives. Remember
to change knives and wash your hands between preparing
different types of food.
Q Does it matter whether food is to be cooked or not?
A It is possible to kill bacteria by cooking food. But be careful with
foods which are not cooked, such as salads or mayonnaise, that
you are not using contaminated utensils to prepare them.
Q How hot does food have to be to kill bacteria?
A A core temperature of 75°C will kill bacteria. Hot food should be
heated or reheated to at least this temperature.
Q How cold does food have to be to kill bacteria?
A By law, food should be stored at below 8°C. However, good
practice dictates that food is stored below 5°C to be free from
any risk of contamination with bacteria. A fridge with the door
left open rapidly warms up to above 5°C or 8°C, and food can
deteriorate quite quickly and become dangerous. Food in a fridge
where the door has been left open or where the power has been
cut off should be discarded.
Q What other safety steps should I take with the fridge?
A When you arrange food in a fridge, you should be sure that you
put any raw meat on the bottom shelf to stop any moisture or
blood dripping from the meat on to any of the foods stored
below – moisture or blood from uncooked meat could be infected
with bacteria. Fridges should be kept scrupulously clean and
should be washed out regularly with an antibacterial solution. Do
not allow particles of food to build up on the inside of the fridge.
It is also important that the fridge does not become ‘iced up’, as
217
this will make the motor work harder in order to keep it cold and
could result in a warming of the fridge.
Q What about ‘best before’ dates?
A These are provided by the manufacturers to ensure that food is
not kept by retailers beyond a date when it is safe to eat. Many
manufacturers now include instructions about how soon the
food should be consumed after purchase. These should be
followed carefully. As a general rule, unless the manufacturer
indicates otherwise, you should consume food by its ‘best before’
date in order to ensure that it has not begun to deteriorate.
5. Be able to move and handle

equipment and other objects
safely
5.1 Legislation that relates to moving and
handling
Lifting and handling people is the single largest cause of injuries at
work in health and care settings. One in four workers takes time off
because of a back injury sustained at work.
The Manual Handling Operations Regulations 1992 require employers
to avoid all manual handling where there is a risk of injury ‘so far as it
is reasonably practical’. Where manual handling cannot be avoided,
then a risk assessment must be undertaken and all appropriate steps
must be taken to reduce risks. Everyone from the European
Commission to the Royal College of Nursing has issued policies and
directives about avoiding hazardous lifting.
Provision and Use of Work Equipment Regulations

1998 (PUWER)
These Regulations require employers to ensure that all equipment
used in the workplace is:
•• suitable for the intended use and for conditions in which it is used
•• safe for use, maintained in a safe condition and, in certain
circumstances, inspected so that it continues to be safe
•• used only by people who have received adequate information,
instruction and training
•• accompanied by suitable safety measures – for example,
protective devices, markings, warnings.
The regulations also mean that where the risk assessment has shown
that there is a risk to the workers from using the equipment,
employers must ensure that equipment is inspected by suitably
qualified people at regular intervals.
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Lifting Operations and Lifting Equipment

Regulations 1992 (LOLER)
These regulations came into effect on 5 December 1998 and apply to
all workplaces. An employee does not have any responsibilities under
LOLER, but under the Management of Health and Safety at Work
Regulations, employees have a duty to ensure that they take
reasonable care of themselves and others who may be affected by
the actions that they undertake.
Employers do have duties under LOLER. They must ensure that all
equipment provided for use at work is:
•• sufficiently strong and stable for the particular use and marked to
indicate safe working loads
•• positioned and installed to minimise any risks
•• used safely – that is, the work is planned, organised and
performed by competent people
•• subject to ongoing thorough examination and, where
appropriate, inspection by competent people.
In addition, employers must ensure:
•• lifting operations are planned, supervised and carried out in a safe
Doing it well way by competent people
•• equipment for lifting people is safe
Manual handling •• lifting equipment and accessories are thoroughly examined
•• Manual handling is a joint •• a report is submitted by a competent person following a thorough
activity between you and the examination or inspection.
person being moved. Lifting equipment designed for lifting and moving loads must be
•• Always use lifting and handling inspected at least annually, but any equipment that is designed for
aids wherever possible. lifting and handling people must be inspected at least every six
•• There is no such thing as a safe months. If employees provide their own lifting equipment, this is
lift, so always be alert to risks. covered by the regulations.
5.2 and 5.3 Principles for moving and

handling equipment and other objects
safely
On the rare occasions when it is still absolutely necessary for manual
lifting to be done, there has to be a risk assessment and procedures
put in place to reduce the risk of injury to the employee. This could
involve ensuring that sufficient staff are available to lift or handle
someone safely, which can often mean that four people are needed,
or it may require the provision of specific equipment in order that the
move can take place safely for all concerned.
The Health and Safety Executive is clear that this should be carried out
jointly with the person concerned wherever possible and that there
must be a balance between safety and the rights of the person. While
you and your employer need to make sure that you and other staff
are not put at risk by moving or lifting, it is also important that the
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person you are supporting is not caused pain, distress or humiliation.

Reflect Groups representing people with disabilities have pointed out that
Are you confident that your own blanket policies excluding any lifting may infringe the human rights of
moving and handling skills are up to someone needing mobility assistance. For example, people may in
date? If not, what steps are you effect be confined to bed unnecessarily and against their will by a lack
taking to improve them? of lifting assistance. A High Court judgement (A & B versus East
Sussex County Council, 2003) found in favour of two women with
disabilities who had been denied access to lifting because the local
authority had a ‘blanket ban’ on lifting, regardless of circumstances.
Such a ban was deemed unlawful under the Disability Discrimination
Act 1995. It is likely that similar cases will be brought under the
Human Rights Act 1998, which gives people protection against
humiliating or degrading treatment.
Doing it well
Moving someone
•• Decisions about the best way to move someone must be taken
jointly with the person concerned wherever possible.
•• Encourage and support people to do as much as possible for
themselves; only provide the minimum manual handling required.
•• Make maximum use of aids to support people to move themselves.
•• Your employer has a statutory duty to provide lifting and handling
equipment, but it is your responsibility to use the equipment that is
provided.
•• You have a right to work safely, but people have rights to be moved
with dignity and as safely as possible.
Using the right equipment reduces the
risk of harm for everyone.
Case study
Using safe lifting procedures

Jo is a new care assistant at a day centre for adults with of them said, ‘Oh, you don’t want to bother with that
disabilities. She was trained to use a hoist as part of a thing. Liz isn’t very heavy – it’s much easier just to lift
moving and handling course in her previous job. her yourself. Anyway, I don’t think the hoist works any
Although there is a mobile hoist at the day centre, Jo more.’
has noticed that none of the staff use it. On several
1. What should Jo do next?
occasions she has seen people being manually lifted
2. If the hoist does not work, what should Jo do?
from their wheelchairs by the staff, working in pairs.
3. What could be the consequences of lifting
One morning Liz, a regular user of the centre, asked Jo incorrectly to the staff and to Liz?
to accompany her to the toilet. Jo knew that Liz would 4. What training and safety procedures would you
need to be helped from her chair on to the toilet, so she recommend for this day centre?
went to get the hoist. As she passed the other staff one
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6. Know how to handle hazardous

substances and materials
6.1 Hazardous substances and materials
that may be found in the work setting
Control of Substances Hazardous to Health (COSHH)
What are hazardous substances? There are many substances
hazardous to health – nicotine, many drugs, even too much alcohol!
The Control of Substances Hazardous to Health Regulations (or
COSHH) apply to substances that have been identified as toxic,
corrosive or irritant. This includes cleaning materials, pesticides, acids,
disinfectants and bleaches, and naturally occurring substances such as
blood, bacteria and other bodily fluids. Workplaces may have other
hazardous substances that are particular to the nature of the work
carried out.
The Health and Safety Executive states that employers must take the
following steps to protect employees from hazardous substances.
Step 1: Find out what hazardous substances are used in the
workplace and the risks these substances pose to people’s health.
Step 2: Decide what precautions are needed before any work starts
with hazardous substances.
Step 3: Prevent people being exposed to hazardous substances, but
where this is not reasonably practicable, control the exposure.
Step 4: Make sure control measures are used and maintained
properly, and that safety procedures are followed.
Step 5: If required, monitor exposure of employees to hazardous
substances.
Step 6: Carry out health surveillance where assessment has shown
that this is necessary or COSHH makes specific requirements.
Step 7: If required, prepare plans and procedures to deal with
accidents, incidents and emergencies.
Reflect Step 8: Make sure employees are properly informed, trained and
Hazardous substances are not just supervised.
things like poisons and radioactive Every workplace must have a COSHH file, which should be easily
material – they are also substances accessible to all staff. This file lists all the hazardous substances used
such as cleaning fluids and bleach. in the workplace. It should detail:
•• where they are kept
•• how they are labelled
•• their effects
•• the maximum amount of time it is safe to be exposed to them
•• how to deal with an emergency involving one of them.
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6.2 Safe practices for storing, using and

disposing of hazardous substances and
materials
Since April 2005, employers are required to focus on the following
eight principles of good practice in the control of substances
hazardous to health.
1. Design and operate processes and activities to minimise emission,
release and spread of substances hazardous to health.
2. Take into account all relevant routes of exposure – inhalation, skin
absorption and ingestion – when developing control measures.
3. Control exposure by measures that are proportionate to the
health risk.
4. Choose the most effective and reliable control options which
minimise the escape and spread of substances hazardous to
health.
Activity 3 5. Where adequate control of exposure cannot be achieved by other
means, provide, in combination with other control measures,
COSHH suitable Personal Protective Equipment (PPE).
You must ensure that you and all 6. Check and review regularly all elements of control measures for
staff know the location of the their continuing effectiveness.
COSHH file in your workplace. 7. Inform and train all employees on the hazards and risks from the
Read the contents of the file, substances with which they work and the use of control measures
especially information about the developed to minimise the risks.
substances you use or come into 8. Ensure that the introduction of control measures does not
contact with, and what the increase the overall risk to health and safety.
maximum exposure limits are. You If you have to work with hazardous substances, make sure that you
do not have to know the detail of take the precautions detailed in the COSHH file. This may be wearing
each substance but the information gloves or protective goggles, or it may involve limiting the time you are
you need should be contained in exposed to the substance or only using it in certain circumstances.
the COSHH file, which must be
kept up to date. The COSHH file should also give you information about how to store
hazardous substances. This will involve using the correct containers as
supplied by the manufacturers. All containers must have safety lids
and caps, and must be correctly labelled.
Never use the container of one substance for storing another, and
never change the labels.
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Symbol Abbreviation Hazard Description
E explosive Chemicals that explode
F highly flammable Chemicals that may catch fire in contact with air, only
need brief contact with an ignition source, have a very
low flash point or evolve highly flammable gases in
contact with water
T (also Carc or toxic (also Chemicals that at low levels cause damage to health
Muta) carcinogenic or and may cause cancer or induce heritable genetic
mutagenic) defects or increase the incidence of these
Xh or Xi harmful or irritant Chemicals that may cause damage to health, especially

inflammation to the skin or other mucous membranes
C corrosive Chemicals that may destroy living tissue on contact
N dangerous for the Chemicals that may present an immediate or delayed

environment danger to one or more components of the
environment
Table 8: Identifying hazardous substances.
The symbols above indicate hazardous substances. They are there for
your safety and for the safety of those you care for and work with.
Before you use any substance, whether it is liquid, powder, spray,
cream or aerosol, take the following simple steps.
•• Check the container for the hazard symbol.
•• If there is a hazard symbol, go to the COSHH file.
•• Look up the precautions you need to take with the substance.
•• Make sure you follow the procedures, which are intended to
protect you.
If you are concerned about a substance being used in your workplace
that is not in the COSHH file, or if you notice incorrect containers or
labels being used, report this to your supervisor or manager. They
then have a responsibility to deal with the issue.
Dealing with hazardous waste

As part of providing a safe working environment, employers have to
put procedures in place to deal with waste materials and spillages.
There are various types of waste, which must be dealt with in
particular ways. The types of hazardous waste you are most likely to
come across are shown in Table 9 (next page), alongside a list of the
ways in which each is usually dealt with. Waste can be a source of
infection, so it is very important that you follow the procedures your
employer has put in place to deal with it safely, in order to reduce the
risks to you and to the people you support.
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Type of waste Method of disposal
Clinical waste – used Yellow bags, clearly labelled with contents

dressings and location. This waste is incinerated.
Needles, syringes, Yellow sharps box. Never put sharps into

cannulas (‘sharps’) anything other than a hard plastic box. This
is sealed and incinerated.
Bodily fluids and Cleared and flushed down sluice drain.

waste – urine, vomit, Area to be cleaned and disinfected.
blood, sputum, faeces
Reflect
Soiled linen Red bags, direct into laundry; bags
Other people will have to deal with disintegrate in wash. If handled, gloves
the waste after you have placed it in must be worn.
the bags or containers, so make sure
Recyclable Blue bags, to be returned to the Central
it is properly labelled and in the
instruments and Sterilisation Services Department (CSSD) for
correct containers.
equipment recycling and sterilising.
Table 9: Types of waste and their disposal.
7. Understand how to promote

fire safety in the work setting
7.1 Practices that prevent fires from
starting and spreading
Your workplace will have procedures that must be followed in the
case of an emergency. All workplaces must display information about
what action to take in case of fire. The fire procedure is likely to be
similar to the one shown below.
Fire Safety Procedure

1. Raise the alarm.
2. Inform the telephonist or dial 999.
3. Ensure that everyone is safe and out of the danger area.
4. If it is safe to do so, attack the fire with the correct
extinguisher.
5. Go to the fire assembly point (this will be stated on the
fire procedure notice).
6. Do not return to the building for any reason.
Important: Make sure that you know where the fire
extinguishers or fire blankets are in your workplace, and
also where the fire exits are.
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Your employer will have installed fire doors to comply with

regulations – never prop them open.
Your employer must provide fire lectures each year. All staff must
Reflect attend and make sure that they are up to date with the procedures to
Do not be a hero! Never attempt to be followed.
tackle a fire unless you are confident The Regulatory Reform (Fire Safety) Order 2005 requires that all
that you can do so safely, for businesses must have a person responsible for fire safety and for
example: carrying out a risk assessment. The government recommends a
•• you have already raised the five-step approach to a fire risk assessment.
alarm 1. Identify hazards: anything that could start a fire, anything that
•• you have a clear, unobstructed could burn.
route away from the fire in case 2. Identify who could be at risk and who could be especially at risk.
it grows larger 3. Evaluate the risks and take action to reduce them.
•• you are confident of your ability 4. Record what has been found out about hazards and the actions
to operate the extinguisher taken. Develop a clear plan of how to prevent fire and how to
•• you have the correct type of keep people safe if there is a fire. Train staff so they know what to
extinguisher. do in the case of fire.
5. Keep the assessment under regular review and make changes if
necessary.
Which extinguisher?
There are specific fire extinguishers for fighting different types of fire.
It is important that you know this. You do not have to memorise
them, as each one has clear instructions on it, but you do need to be
aware that there are different types and make sure that you read the
instructions before use.
All new fire extinguishers are red. Each one has its purpose written on
it. Each one also has a patch of the colour previously used for that
type of extinguisher.
Do you know what each fire extinguisher is for and where fire exits are in
your place of work?
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Type and Use for Danger points How to use

patch colour
Water Wood, cloth, paper, plastics, coal, Do not use on burning fat or oil, or Point the jet at the base of the
Red etc. Fires involving solids. on electrical appliances. flames and keep it moving across
the area of the fire. Ensure that all
areas of the fire are out.
Multi-purpose Wood, cloth, paper, plastics, coal, Safe on live electrical equipment, Point the jet or discharge horn at
dry powder etc. Fires involving solids. although the fire may re-ignite the base of the flames and, with a
Blue Liquids such as grease, fats, oil, because this type of extinguisher rapid sweeping motion, drive the
paint, petrol, etc. but not on chip does not cool the fire very well. fire towards the far edge until all
or fat pan fires. Do not use on chip or fat pan fires. the flames are out.
Standard dry Liquids such as grease, fats, oil, Safe on live electrical equipment, Point the jet or discharge horn at
powder paint, petrol etc. but not on chip although does not penetrate the the base of the flames and, with a
Blue or fat pan fires. spaces in equipment easily and the rapid sweeping motion, drive the
fire may re-ignite. fire towards the far edge until all
This type of extinguisher does not the flames are out.
cool the fire very well.
Do not use on chip or fat pan fires.
AFFF (Aqueous Wood, cloth, paper, plastics, coal, Do not use on chip or fat pan fires. For fires involving solids, point the
film-forming etc. Fires involving solids. jet at the base of the flames and
foam) (multi- Liquids such as grease, fats, oil, keep it moving across the area of
purpose) paint, petrol, etc. but not on chip the fire. Ensure that all areas of the
Cream or fat pan fires. fire are out.
For fires involving liquids, do not
aim the jet straight into the liquid.
Where the liquid on fire is in a
container, point the jet at the
inside edge of the container or on
a nearby surface above the
burning liquid. Allow the foam to
build up and flow across the liquid.
Foam Limited number of liquid fires. Do not use on chip or fat pan fires. Do not aim jet straight into the
Cream Check manufacturer’s instructions liquid. Where the liquid on fire is in
for suitability of use on other fires a container, point the jet at the
involving liquids. inside edge of the container or on
a nearby surface above the
burning liquid. Allow the foam to
build up and flow across the liquid.
Carbon dioxide Liquids such as grease, fats, oil, Do not use on chip or fat pan fires. Direct the discharge horn at the
CO2 paint, petrol, etc. but not on chip This type of extinguisher does not base of the flames and keep the
Black or fat pan fires. cool the fire very well. jet moving across the area of the
fire.
Fumes from CO2 extinguishers can
be harmful if used in confined
spaces: ventilate the area as soon
as the fire has been controlled.
Fire blanket Fires involving both solids and If the blanket does not completely Place carefully over the fire. Keep
liquids. Particularly good for small cover the fire, it will not be your hands shielded from the fire.
fires in clothing and for chip and extinguished. Take care not to waft the fire
fat pan fires, provided the blanket towards you.
completely covers the fire.
Table 10: Fire extinguishers.
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7.2 Emergency procedures in the event of

a fire in the work setting
and
7.3 The importance of maintaining clear
evacuation routes at all times
In an extreme case it may be necessary to help evacuate buildings if
there is a fire, or for other security reasons, such as:
•• a bomb scare
•• the building has become structurally unsafe
•• an explosion
•• a leak of dangerous chemicals or fumes.
The evacuation procedure you need to follow will be laid down by
your workplace. The information will be the same whatever the
emergency is: the same exits will be used and the same assembly
point. It is likely to be along the following lines.
•• Stay calm, do not shout or run.
•• Do not allow others to run.
•• Organise people quickly and firmly without panic.
•• Direct those who can move themselves and assist those who
Functional skills cannot.
•• Use wheelchairs to move people quickly.
•• Move a bed with a person in, if necessary.
listening
Use the questions on emergency Activity 4
situations as a basis for a discussion
with your team at work. Ensure that Emergency situations
everyone in the group has a chance 1. Where are the main evacuation points in your workplace?
to contribute to the discussion. 2. Which people use each one?
Present your answers clearly and ask 3. Do any people need assistance to reach evacuation points? If so, of
others to clarify any concerns that what kind?
you may have. Show your listening 4. Who is responsible for checking your workplace is cleared in an
skills by picking up on points made emergency?
by others. 5. What are your personal responsibilities in an emergency situation?
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8. Be able to implement security

measures in the work setting
8.1 Agreed ways of working for checking
the identity of anyone
and
8.2 Measures to protect security in the
work setting
Most workplaces where care is provided are not under lock and key.
This is an inevitable part of ensuring that people have choice and that
their rights are respected. However, they also have a right to be
secure. Security in a care environment is about:
•• security against intruders
•• security in respect of people’s privacy and decisions about
unwanted visitors
•• security against being abused
•• security of property.
If you work for a large organisation, such as an NHS trust, it may be
that all employees are easily identifiable by identity badges with
photographs. Some of these even contain a microchip which allows
the card to be ‘swiped’ to gain access to secure parts of the building.
This makes it easier to identify people who do not have a right to be
on the premises.
In a smaller workplace, there may be a system of issuing visitors’
badges to visitors who have reasons to be there, or it may simply rely
on the vigilance of the staff.
Some workplaces operate electronic security systems, like those in the
NHS where cards are swiped to open doors. Less sophisticated
systems in small workplaces may use a keypad with a code number
known only to staff and those who are legitimately on the premises.
It is often difficult to maintain security with such systems, as codes are
forgotten or become widely known. In order to maintain security, it is
necessary to change the codes regularly, and to make sure everyone
is aware.
Some workplaces still operate with keys, although the days of staff
walking about with large bunches of keys attached to a belt are fast
disappearing. If mechanical keys are used, there will be a list of
named keyholders and there is likely to be a system of handover of
keys at shift change. However, each workplace has its own system
and you need to be sure that you understand which security system
operates in your workplace.
The more dependent people are, the greater the risk. If you work
with high-dependency or unconscious patients, people with a severe
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learning disability or multiple disabilities, or people who are very

confused, you will have to be extremely vigilant in protecting them
from criminals.
Doing it well
Protecting against intruders
•• Be aware of everyone you come across. Get into the habit of
noticing people and thinking, ‘Do I know that person?’
•• Challenge anyone you do not recognise.
•• The challenge should be polite. ‘Can I help you?’ is usually enough
to find out if a visitor has a reason to be on the premises.
•• If a person says that they are there to see someone, do not give
directions – escort them. If the person is a genuine visitor, they will
be grateful. If not, they will disappear pretty quickly!
•• If you find an intruder on the premises, do not tackle them – raise
the alarm.
Protect the security of yourself and others

Workplaces where most or all people are in individual rooms can also
be difficult to make secure, as it is not always possible to check every
room if people choose to close the door. A routine check can be very
time consuming, and can affect people’s rights to privacy and dignity.
Communal areas are easier to check, but can present their own
problems; it can be difficult to be sure who is a legitimate visitor and
who should not be there. Some establishments provide all visitors
with badges, but while this may be acceptable in a large institution or
an office block, it is not compatible with creating a comfortable and
relaxed atmosphere in a residential setting. Extra care must be taken
to check that you know all the people in a communal area. If you are
not sure, ask. It is better to risk offending someone by asking, ‘Can I
help you?’ or ‘Are you waiting for someone?’ than to leave an
intruder unchallenged.
Case study
Checking visitors
Fitzroy works in a secure residential unit for older identify himself. The man says he is Mrs Gregory’s
people with dementia. All the entry and exit doors to nephew and has come to take her out for a drive in his
the unit are operated by a swipe card, and all staff and car. It is a cold day but Mrs Gregory is not wearing a
visitors are required to wear their identity pass visibly at coat.
all times. The visitor passes cannot open the doors.
1. Was Fitzroy right to challenge the man?
One day Fitzroy sees Mrs Gregory, a resident, standing 2. What should Fitzroy do next?
at the exit door with a man he does not recognise. The 3. What might have happened if Fitzroy had not
man has a swipe card and is about to open the door. challenged the man?
Fitzroy quickly approaches and politely asks the man to 4. What are the management issues in this case study?
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Protecting people
If very dependent people are living in their own homes, the risks are
far greater. You must try to impress on them the importance of
finding out who people are before letting them in. If they are able to
use it, the ‘password’ scheme from the utilities (water, gas and
electricity) companies is helpful. There are many security schemes
operated by the police in partnership with local authority services and
charities such as Age Concern and Help the Aged, such as ‘Safe as
Houses’ and ‘Safer Homes’. These provide security advice and items
such as smoke alarms and door chains to older people.
Every time you visit, you may have to explain again what the person
should do when someone knocks on the door. Give them a card with
simple instructions. Obtain agreement to speak to the local
‘homewatch’ scheme and ask that a special eye is kept on visitors.
Contact your local crime prevention officers and make them aware
that a vulnerable person is living alone in the house.
Restricting access
People have a right to choose who they see. This can often be a
difficult area to deal with. If there are relatives or friends who wish to
visit and the person does not want to see them, you may have to
make this clear. It is difficult to do, but you can only be effective if
you are clear and assertive. You should not make excuses or invent
reasons why visitors cannot see the person concerned. You could say
something like: ‘I’m sorry, Mr Price has told us that he does not want
to see you. I understand that this may be upsetting, but it is his
choice. If he does change his mind we will contact you. Would you
like to leave your phone number?’
Have you ever been asked to make an intervention that is outside your role?
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Do not allow yourself to be drawn into passing on messages or

attempting to persuade – that is not your role. Your job is to respect
the wishes of the person you are caring for. If you are asked to
intervene or to pass on a message, you must refuse politely but
firmly.
There may also be occasions when access is restricted for other
reasons, possibly because someone is seriously ill and there are
medical reasons for limiting access, or because of a legal restriction
such as a court order. In either case, it should be clearly written on
the person’s record and your supervisor will advise you about the
restrictions. If you are working in a supervisory capacity, it will be part
of your role to ensure that junior staff are aware of these restrictions.
Activity 5
Restricting access
Ask a colleague or friend to try this role play with you. One of you
should be the person who has come to visit and the other the care
worker who has to say that a friend or relative will not see them. Try
using different scenarios – angry, upset, aggressive and so on. Try at
least three different scenarios each. By the time you have practised a
few, you may feel better equipped to deal with the situation if it
happens in reality.
If you cannot find anyone to work with you, it is possible to do a

similar exercise by imagining three or four different scenarios and then
writing down the words you would say in each of the situations.
Security of property
Property and valuables belonging to people in care settings should be
safeguarded. It is likely that your employer will have a property book
in which records of all valuables and personal possessions are
entered.
There may be particular policies within your organisation, but as a
general rule you are likely to need to:
•• make a record of all possessions on admission
•• record valuable items separately
•• describe items of jewellery by their colour, for example, ‘yellow
metal’ not ‘gold’
•• ensure that people sign for any valuables they are keeping, and
that they understand they are liable for their loss
•• inform your manager if someone is keeping valuables or a
significant amount of money.
It is always difficult when items go missing in a care setting,
particularly if they are valuable. It is important that you check all
possibilities before calling the police.
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Inform your manager
Search the area where the item was last seen
Search the person’s room/locker
Check laundry
Check with relatives in case they have the item
Speak to other staff
Discreetly check any confused people
Look for possible break-in
Notify police
Action stages for when property goes missing.
8.3 The importance of ensuring that

others are aware of your whereabouts
There is always an element of risk in working with people. There is
little doubt that there is an increase in the level of personal abuse
suffered by workers in the health and care services. There is also the
element of personal risk encountered by workers who visit people in
the community, and have to deal with homes in poor states of repair
and an assortment of domestic animals! However, there are some
steps that you can take to contribute to your own safety.
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Doing it well
Steps to personal safety
•• If you work alone in the community, always leave details of where
you are going and what time you expect to return. This is important
in case of accidents or other emergencies, so that you can be found
and that someone will raise concerns if you are late returning.
•• Carry a personal alarm, and use it if necessary.
•• Ask your employer to provide training in techniques to combat
aggression and violence. It is foolish and potentially dangerous to go
into risky situations without any training.
•• Try to defuse potentially aggressive situations by being as calm as
possible and by talking quietly and reasonably. But if this is not
effective, leave.
•• If you work in a residential or hospital setting, raise the alarm if you
find you are in a threatening situation.
•• Do not tackle aggressors, whoever they are – raise the alarm.
•• Use an alarm or panic button if you have it; otherwise yell – very
loudly.
•• Your employer should have a written ‘lone-working’ policy that
identifies steps to be taken to protect staff working alone. Make
sure that you have read and understood the policy.
Case study
Risk in the community

Karinda was a home-care assistant on her first visit to cellar below. Mr West’s dog was in the hallway
Mr West. She had been warned that his house was in a growling and barking, and Mr West was at the top of
poor condition and that he had a large dog. She also the stairs shouting, ‘Who are you? You won’t get me
knew that he had a history of psychiatric illness and out of here – I’ll kill you first!’
had, in the past, been admitted to hospital compulsorily
1. What should Karinda do?
under the Mental Health Act.
2. When should she go back?
When Karinda arrived on her first morning, the outside 3. What sort of risks need to be assessed?
of the house was in a very poor state – the garden was 4. If Mr West refuses to allow a risk assessment, or his
overgrown, and it was full of rubbish and old furniture. house to be repaired, should Karinda go back in
The front door was half open and she could see that anyway?
half the floorboards in the hallway appeared to be 5. Who should carry out the risk assessment?
missing – there were simply joists and a drop into the
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9. Know how to manage own

stress
9.1 Common signs and indicators of stress
All of us know somebody who appears to manage a workload and
demands on their time that most of us would simply be unable to
cope with; however, they appear to manage and in many cases to
thrive very happily with what is apparently an extremely stressful
situation. While the responses to stress are individual, so are (to a
large extent) the effects. Stress can show itself in a number of ways.
Emotionally, stress can cause people to:
•• feel tense, uptight, angry
•• feel depressed, anxious, tearful, worthless
•• be unable to cope, concentrate or make decisions
•• feel tired and stretched to the limit
•• be uninterested in everything, including sex
•• contract respiratory disorders such as asthma and have chest
pains.
Stress can cause:
•• disturbance of sleep patterns
•• disturbance of change in normal appetite
•• feelings of anxiety
•• loss of concentration
•• quick temper or irritability
•• low tolerance of disruption, noise or other disturbance.
Physically, stress can cause:
•• tensing of the muscles
•• headaches, migraines
•• circulatory disorders such as high blood pressure, heart attacks,
strokes
•• digestive disorders such as ulcers
•• menstrual problems
•• increases in infections, such as cold sores or colds.
9.2 Circumstances that tend to trigger

own stress
Stress means different things to different people. The sorts of things
that can cause stress include:
•• work pressures
•• being in debt
•• having relationship problems
•• interrupted sleep.
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Stress is believed to be one of the major causes of time off work and
Activity 6 of staff turnover. Stress at work can be caused by:
Experiencing stress •• poor working relationships
Think of an occasion when you felt
•• the type of work that has to be done, especially in social care
very stressed. Make a list of the
•• the hours spent at work, especially for shift workers
feelings/emotions and physical
•• a lack of career progression opportunities
symptoms you had at the time.
•• a fear of redundancy or retirement.
9.3 Ways to manage your stress

Stress is dealt with in a range of ways, depending on the underlying
causes. It can be dealt with by physical means – that is, an immediate
removal from the cause of the stress such as taking a break from
work or respite from caring for a difficult, very ill or demanding
relative, or by medical means such as taking drugs to reduce the
physical effects of stress on the body and alter mood and responses.
Another way would be to undertake a programme of relaxation
exercises or meditation techniques in order to physically relax the
body.
Everyone has their own way of coping with stress but sometimes
coping mechanisms can make a situation worse! Things to avoid are:
•• drinking alcohol
•• smoking
•• compulsive eating.
Behaviours like these might make matters feel better at the time, but
in the long run can be very damaging to health.
Positive ways to deal with stress include:
•• physical activity, for example, going for a walk, doing some
gardening, punching a pillow – physical activity uses up the extra
energy bodies produce when stressed
•• talking things over, for example, with a friend or your supervisor
– chatting about a problem often helps to identify what the real
issues are and how to deal with them
•• doing something to take your mind off the problem, for example,
going to the cinema, reading a magazine, pampering yourself –
escaping from a problem enables you to come back to it with a
clear head and be more able to tackle things
•• learning relaxation techniques – activities in which you learn to
control your breathing can help to release the muscular tension
that goes hand-in-hand with stress
•• organising your time – do not take on more than you can handle
and do things in order of their importance
•• learning to shrug things off – raising your shoulders and lowering
them uses up energy, leaving you feeling more relaxed; it also
helps you get things into perspective – how important is what is
causing the stress anyway?
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Accessing support, advice and guidance

Anyone suffering from symptoms of stress which persist and who can
see no way forward, should seek help.
Family and friends are usually the first people to look to for support.
They have either ‘got the T-shirt’ or know someone who has been in
your position, and can offer support and help.
If your stress is associated with work, talk things through with your
supervisor. Some organisations employ people whose role includes
talking people through their problems and guiding them in finding
solutions. Often, stressful situations at work can be improved by some
training to learn how to manage time more effectively, or in how to
be more assertive so that it is easier to refuse to take on additional
work that will cause stress or to deal with situations in which people
feel that they have no control.
If the symptoms of your stress are seriously affecting your life, or if
they have gone on for a long time, you should see your GP, who
could treat your physical symptoms and perhaps refer you on to a
suitably qualified therapist or counsellor.
Alternative therapies such as reflexology and aromatherapy can also
be very valuable in helping to relieve stress.

This is essentially a very practical unit and most of the are familiar with the actions to take in emergencies and
assessment will be through your assessor observing your accidents.
practice. Some areas such as fire safety, dealing with
Your skills in working safely will be observed by your
accidents and dealing with emergencies cannot be
assessor. They will be looking to make sure that you are
observed, as they are unlikely to occur just when your
taking all the steps to prevent the spread of infection,
assessor is there! You will have to show your assessor
so how you dress, how you wash your hands, how you
that you know how to deal with each of these situations
clean areas and how you use personal protective
– this could be through a question and answer session
equipment will all be important areas to think about
or through the completion of an assignment. You will
when you are being assessed.
need to be sure that you understand the main pieces of
legislation that govern health and safety, and that you
236
Legislation
•• Control of Asbestos at Work Regulations 2002
•• Control of Lead at Work Regulations 2002
(COSHH)
•• Disability Discrimination Act 1995
•• Health and Safety at Work Act 1974 (HASAWA)
•• Health and Safety (Display Screen Equipment) Regulations 1992
(amended 2002)
•• Human Rights Act 1998
•• Mental Health Act
•• Noise at Work Regulations 1989
•• Provision and Use of Work Equipment Regulations 1998 (PUWER)

Workplace health, safety and security is an important and complex issue.
This section has dealt with the key factors and below are details of
opportunities to find out more.
•• www.dh.gov.uk (Department of Health – health and safety,

emergency planning)
•• www.hse.gov.uk (Health and Safety Executive (HSE), tel: 0845 345
0055)
•• www.healthandsafetytips.co.uk (Health and safety tips, tel: 01506
200109)
•• www.neli.org.uk (National Electronic Library of Infection)
•• www.nice.org.uk ((National Institute for Health and Clinical
Excellence)
•• www.nric.org.uk (National Resource for Infection Control)
•• Bowmen R. C., Emmett R. C. (1998) A Dictionary of Food Hygiene,
CIEH
•• Hartropp, H. (2006) Hygiene in Health and Social Care, CIEH
•• Horner J. M. (1993) Workplace Environment, Health and Safety
Management; A Practical Guide, CIEH
237
Unit HSC 028
Handle
information in
health and social
care settings
Increasing amounts of information are being recorded about

people, so recording accurately, keeping information secure
and being very clear about how it can be shared is very
important.
In social care, we record very sensitive and personal information
about people. We need to handle it in a way that protects
people’s privacy but also allows them to have the best possible
support provided to meet their needs.
This unit will help you to understand how to deal with the
different kinds of information that you will come across in
your work.

1. the need for secure handling of information in health
and social care settings
2. how to access support for handling information
3. how to handle information in accordance with agreed
ways of working.
239
1. Understand the need for

secure handling of information in
health and social care settings
1.1 Legislation about recording, storage
and sharing of information
Key term All information, however it is stored, is subject to the Data
Data Protection Act 1998 – a law Protection Act 1998, which covers medical records, social service
to ensure the safety of data held records, credit information, local authority information and so on.
Anything relating to a person, whether fact or opinion, is personal
data. Data is the same thing as information in relation to the Act.
Anyone processing personal data must comply with the eight
enforceable principles of good practice laid down in the Data
Protection Act 1998. These say that data must be:
•• fairly and lawfully processed
•• processed for limited purposes
•• adequate, relevant and not excessive
•• accurate
•• not kept for longer than necessary
•• processed in accordance with the data subject’s rights
•• kept secure
•• not transferred to countries without adequate protection.
‘Processing’ personal data means handling it in any way; gathering,
recording, storing or sharing it. In practice, the Act means that you
can only gather as much information as you need, you can only use it
for the purpose you collected it, you must store it securely, and you
cannot keep it after you have finished using it.
The Data Protection Act 1998 also gives people a right to see the
information recorded about them. This means that people can see
their medical records or social services files. Since January 2005, the
Freedom of Information Act 2000 has provided people with a right to
access general information held by public authorities, including local
authorities and the National Health Service. This means that people
are entitled to see their social care files, so remember this when you
are entering information in people’s notes. Personal information
about other people cannot be accessed and is protected by the Data
Protection Act.
The handling of information in the UK is monitored by the
Information Commissioner’s Office (ICO). This is an independent
authority with responsibility for upholding information rights in the
public interest. The ICO also has responsibility for promoting
openness by public bodies and data privacy for people.
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Handle information Unit HSC 028
The Information Commissioner’s Office is the authority responsible for all

aspects of information.
1.2 Secure systems for recording and

storing information
Once something is written down or entered on a computer, it
becomes a permanent record. For this reason, you must be very
careful what you do with any files, charts, notes or other written
records. They must always be stored somewhere locked and safe.
You should never take people’s personal files outside your work
premises if you work in a residential or hospital setting. There are
many stories about files being stolen from cars or left on buses!
However, if you are working in people’s homes, it is likely that records
may be kept there and completed by support staff who visit. You will
need to take great care that the information is kept safe and not left
lying around where casual visitors can see it.
241
Records kept on computers must also be kept safe and protected.

Your workplace will have policies relating to records on computers,
which will include access being restricted by a password, and the
computer system being protected by a firewall against the possibility
of people hacking into it. You are likely to find that there are security
practices in place such as having to change your password regularly,
and you may not be allowed to download any information from the
Internet.
The information that you will be handling about the people you
support will be very personal. It may contain details of medical history,
details of family background and financial information. People need
to feel confident that if they give these personal details, they will not
be shared with everyone.
Computer record systems are secure and protected by a firewall.
Manual recording systems

Not all systems are electronic, although most are. Many large
organisations will also keep paper-based files as a back-up to
electronic records. Keeping information safe and confidential in a
manual system is just as important as passwords and firewalls.
Files are usually kept alphabetically, but in some places, such as
hospitals, they may be allocated an index number. Systems for
keeping paper files safe will vary, but they are usually kept in locked
cabinets and may be in secure rooms.
Personal assistants
The kind of notes that you may keep if you are working as a personal
assistant will be the information that your employer has decided
needs to be recorded. This may include information for ensuring a
clear handover to the next shift, or measurements that must be
recorded for medical reasons. You may also need to keep records for
the Direct Payments system, so that expenditure can be verified.
242
2. Know how to access support

for handling information
2.1 How to access guidance, advice and
information
There will be times when you are unsure about what to do with
information. You may be uncertain about how to process or record
something, or someone may have asked you for information and you
are unsure about whether or not you should provide it.
The first place you should look for guidance is your supervisor or
senior colleagues. They are the ideal people to ask for advice with
regard to information in your workplace.
If you are looking for more general information or want advice
about the legislation, then the Information Commissioner’s Office
(www.ico.gov.uk) is the place to contact. There are offices in all four
countries of the UK. You will be able to find detailed information
about how to ensure that you are complying with the law in the way
that you are handling information.
Activity 1
Different types of
information
Consider the three following types
of information:
•• a person’s social care file

•• a letter from someone’s GP
•• the minutes of a meeting of
the Social Services Committee
from your local council.
Go to the Information
Commissioner’s Office website
(www.ico.gov.uk) and find out
who is able to see each of these
types of information.
Ask your manager about how to handle information if you are unsure.
243
2.2 Concerns over recording, storing or

sharing information
If you are concerned that there are issues with how records are stored
or how information is shared, then you must take action. Reporting
concerns about something in the organisation you work for is never
easy, but the place to start is with your line manager.
Your concerns may be straightforward and easily dealt with, or they
may be more difficult, as these two examples show.
Example 1
You may be concerned that people’s records are in an unlocked office.
You raise it with your manager who explains that after everyone has
gone home, the room is locked by the senior manager on duty.
✓ CONCERN DEALT WITH
Example 2
You may be concerned that night staff are not making notes of any
incidents that happen. Your manager explains that very little happens
during the night, so the night staff do not bother to record in the
notes because they would have to unlock all the records and this
would disturb people.
✗ CONCERN NOT DEALT WITH
Your next step would be to take this to a more senior manager or to
the person within the organisation who holds responsibility for
information. Ultimately, you have to take this concern to the director
or chief executive of your organisation if you are unable to get the
matter resolved in any other way.
Taking it further
When you do have concerns, and you are taking them to senior
management, you should:
•• put your concerns in writing
•• be clear about dates, times and the exact nature of your concerns
•• identify what steps you have already taken and the responses you
have had
•• involve your trade union or professional organisation in order to
support you. (This would be a very unlikely step, as the vast
majority of concerns can be dealt with through discussion with
your management.)
If this still does not produce a satisfactory response, you can take the
matter to the inspectorate for the country in which you work. Taking
such action against your employer is very difficult and you should try
all possible ways of addressing your concerns within the organisation
in the first instance. People who do report their employer for any type
of breach of the law or professional practice are protected against
244
any unfair treatment by the Public Interest Disclosure Act 1998.

However, you must involve your trade union or professional
organisation if you do have to take this action.
Can you see how you can move through steps to resolve your concerns?
Case study
Dealing with concerns

Maria works in a supported living house for people with Should Maria:
a learning disability. One of the people who used to live
1. carry out her manager’s request
there and who has since moved on has asked for his
2. refuse to change the file, but keep quiet about it
personal files. Maria’s manager asked her to change
3. refuse to change the file and report it to the
some of the entries she had made in the files and said,
Information Commissioner’s Office?
‘Well, he wouldn’t really understand about some of the
ways we work here. If you could just remove these Give reasons for your answer.
pages and replace them without mentioning the use of
restraint, that would make it much easier all round.’
245
3. Be able to handle information

in accordance with agreed ways
of working
‘Agreed ways of working’ means the policies and procedures that
your employer has put in place to around handling information.
3.1 Keeping records that are up to date,

complete, accurate and legible
Since the Access to Personal Files Act 1987, and subsequently the
Data Protection Act 1998, people can see their personal files. This
means that people can see their medical records or social services files
from the date of the Act. People are only entitled to see information
about themselves, and they cannot see any part of their record which
relates to someone else.
Doing it well The information that you write in files should be clear and useful. Do
not include irrelevant information, and write only about the person
ACES concerned. Anything you write should be true and able to be
Always think about what you write, justified. In general you should stick to the facts and not your opinion,
and make sure it is ACES: as the two examples below show.
•• Accurate The purpose of a file is to reflect an accurate and up-to-date picture

•• Clear of somebody’s situation, and to provide a historical record that can be
•• Easy to read referred to at some point in the future. Some of it may be required to
•• Shareable. be disclosed to other agencies. Any records must be signed and
dated.
Name: A. Potter Name: J. Soane
Mr P settling back well after discharge Joe visited new flat today. Very positive
from hosp. Fairly quiet and withdrawn and looking forward to move. No access
today. Son to visit in am. Report from problems; delighted with purpose-built
hosp included in file – prognosis not kitchen and bathroom. Further visit from
good. Not able to get him to talk OT needed to check on any aids required.
today; for further time tomorrow. Confirmed with housing assoc. that Joe
wants tenancy. Will send tenancy
agreement – should start on 1st.
Need to check: housing benefit, OT visit,

notify change of address to Benefits
Agency, PACT team, etc., shopping trip
with Joe for any household items.
Information should be clear and factual.
246
All information, however it is stored, is subject to the Data Protection

Act 1998, which covers medical records, social service records, credit
information, local authority information – in fact, anything which is
personal data (facts and opinions about a person). The principles of
data protection apply to all the records you keep.
The same principles apply whether you have handwritten notes
in a case record or if you use an electronic system. Written
Reflect communication may not be something you do very frequently. You
Think about the sort of information may not write many formal letters, but as a support worker you will
you would need to know. What have to write information in records that could prove to be of vital
things are important when handing importance.
over? The golden rule of good communication is to consider its purpose.
If you are completing a support plan or record for someone, then that
information needs to be there in order to inform the next support
worker who takes over.
You need to record accurately any distress or worries you have tried
to deal with, and any physical signs of illness or accidents. You may
need to record fluid balances or calorie intake charts. It may be
important to record visitors or any medical interventions.
Written records are no use unless they are legible. There is no point in
scribbling something illegible in someone’s notes. It is actually worse
than not writing anything, because colleagues waste time trying to
decipher what is there, and have to deal with the concerns raised by
the fact that there was clearly something worth recording, but they
have no idea what it was.
You also need to convey the message in a clear and concise way.
People do not want to spend time reading a lengthy report when the
main points could have been expressed in a paragraph. Equally, you
need to make sure that the relevant points are there. Often bullet
points can be useful in recording information clearly and concisely.
3.2 Agreed ways of working for recording,

storing and sharing information
Choosing the best way to pass on information
Sometimes the method of communication is dictated by the
circumstances. If the situation requires an immediate response, or
you need to find essential information urgently, then you are unlikely
to sit and write a long letter, walk down to the post office, put it in
the post and wait until next week to get a reply! You are far more
likely to pick up the telephone and see if you can contact the person
you need to speak to, or send a quick email. Or you may choose to
fax your request, or fax information in response to a telephone
request from someone else. These methods are fast (almost instant)
and relatively reliable for getting information accurately from one
place to another.
247
When choosing a method of communication, you have to take into

account:
•• who the information is for
•• whether it is urgent
•• whether it is confidential
•• what type of information it is
•• what the purpose of the information is
•• whether there needs to be a written record
•• who is sending the information
•• whether there needs to be a record of the information having
been sent.
There may be other occasions when, on the grounds of
confidentiality, something is sent through the post marked ‘Strictly
confidential’ and only to be opened by the person whose name is on
the envelope. This method may be entirely appropriate for
information that is too confidential to be sent by fax and would be
inappropriate in a telephone conversation or an email.
Types of information
The types of information you wish to convey can vary from the
simplest day-to-day information to the most complicated and detailed
information on somebody’s social and medical history, background,
diagnosis and prognosis, support plan and finances.
Simple information
You may simply wish to communicate to a colleague that someone
you are working with is probably not well enough to go out for a
walk today. However, you have agreed with the colleague that you
will go in with a cup of tea and see how she is feeling. You do not
wish to shout the information in public, thus making the person the
object of general interest, and you have agreed with your colleague
that you will check the situation and give her a nod or a shake of the
head to let her know. This is a very simple example of the way that
information can be sent from one person to another by physical
signals, without the need for words.
Two-way exchange
The information that you have to share may be the kind that requires
a conversation with a colleague, or relative or the person concerned.
The advantage of a verbal exchange of information is that it can be
two-way, and you can receive information at the same time as you
are sharing what you know.
Written information
Other information is of a nature that requires it to be written down.
This could include detailed records about someone, or information
that may need to be shared with more than one person and may be
for inclusion in a person’s health or care records. In this case you
would probably choose to write the information and send it by fax,
post or email.
248
Case study
Passing on information in different ways

Mr Shah had been receiving support in his own home Letter to GP:
for the past two years. His health and mobility had been
deteriorating and he had found it increasingly hard to
Dear Dr Sida
manage even with support. A review had been held at
his home where Mr Shah, his social worker, the Re: Mr W. S., 27 Miranda Street
occupational therapist and the community nurse had all
decided that his needs would best be met by a move Please find attached a copy of the review
into residential accommodation. His home carer had not notes for records of the above gentleman
been able to attend the review, and neither had his who is a patient of yours. The plan is to
niece, who was a regular visitor. Following the review, arrange his admission to residential care
Mr Shah’s social worker passed on the following as a matter of urgency. I will advise you
information:
of the date for admission.
Telephone call to Mr Shah’s niece:
Please do not hesitate to contact me if I
‘Hello, Mrs Patel, this is Maria, your uncle’s social can provide any further information.
worker. I promised your uncle I would call to let you
know how the review went. Your uncle decided, and Yours sincerely
we all agreed, that he would be better to move into
Maria Perez
residential accommodation. He would quite like to go
to Maidstone House, but if you and he decide you want Social worker
to look at any others, I’ll be happy to arrange it if you
like. Of course, we will send you a copy of the review
1. Can you see the different styles of information
notes, but I wanted to let you know as soon as
giving and work out why each one was
possible.’
appropriate?
Telephone call to home carer: 2. Would any of these styles have worked if they had
‘Hi Sue – Maria. Mr S went for residential, as you been used with a different recipient?
hoped. He wants Maidstone House – I’ll have to check 3. Do you think that you have always used the most
vacancies, it’s always really popular. I think he’d like you appropriate means of communication? Will this help
to carry on working with him until he goes in – he’s you to think more carefully in future?
very fond of you. I’ll keep you up to date with progress.’
Email to Maidstone House:
Hi Jo
How are you – not caught up since that last

training day – hope things are going well.
What’s your vacancy position? Can you let me
know ASAP, I’ve got quite an urgent male
admission if there’s any hope??
Speak soon
Maria
249
Making a decision between these three means of communicating

Activity 2 written information may be based on:
Recording types of •• availability of fax or email
information •• the nature and level of confidentiality of the information.
Keep a record for a week of the
Doing it well
types of information that come
into and go out of your workplace. Considering the person receiving the information
Note the methods used for
One of the factors you must consider when choosing the best method
different types of information.
of passing on information is the person who is going to receive it.
Ask people why they have chosen
to pass on information in a •• Make sure that the method is appropriate for the person who will
particular way. receive it.
•• Do not send a letter to a person who is visually impaired unless you
know they have a method of having it read.
Functional skills •• Do not attempt to pass on information by telephone to someone
with hearing loss unless you are using an adapted telephone system.
English: Writing; •• Use language that is at the right level for the person receiving it.
Reading
When writing information, it is Sharing information
important that you use the correct
Personal information on people you support should only be shared on
structures. You will need to learn
a ‘need to know’ basis.
how to take notes effectively, and to
write letters, reports and case It can be difficult when people claim to have a right or an interest in
studies. Ensure that spellings, seeing a person’s records. Of course, there are always some people
punctuation and grammar are who do need to know, either because they are directly involved in
accurate, and that the language is supporting the person or because they are involved in some other
suitable. All your information should role. However, not everyone needs to know everything, so it is
be written clearly and coherently. important that information is given on a ‘need to know’ basis. In
other words, people are told what they need to know in order to
carry out their role.
Relatives will often claim that they have a ‘right to know’. The most
famous example of this was Victoria Gillick, who went to court in
order to try to gain access to her daughter’s medical records. She
claimed that she had the right to know if her daughter had been
given the contraceptive pill. Her GP had refused to tell her and she
took the case all the way to the House of Lords, but the ruling was
not changed and she was not given access to her daughter’s records.
The rules remain the same. Even for close relatives, the information is
not available unless the person agrees.
It is difficult, however, if you are faced with angry or distressed
relatives who believe that you have information they are entitled to.
One situation you could encounter is where someone believes that
they have the right to be told about medical information in respect of
their parent. Another example is where someone is trying to find out
a person’s whereabouts. The best response is to be clear and
assertive, but to demonstrate that you understand that it is difficult
for them. Do not try to pass the buck and give people the idea that
250
they can find out from someone else. There is nothing more
frustrating than being passed from one person to another without
anyone being prepared to tell you anything. It is important to be clear
and say something like, ‘I’m sorry. I know you must be worried, but I
can’t discuss any information unless your mother agrees’, or ‘I’m
sorry, I can’t give out any information about where J is living now. But
if you would like to leave me a name and contact details, I will pass
on the message and she can contact you.’
Have you had to deal with relatives demanding information they should not
have access to?
Proof of identity
You should always check that people are who they claim to be. It is
not unknown for newspaper reporters, unwanted visitors or even a
nosey neighbour to claim that they are relatives or professionals from
another agency. If basic precautions are not taken to confirm their
identity, then they may be able to find out a great deal of confidential
information.
251
Doing it well
Sharing information
•• Generally you should only give the information with consent.
•• Only give people the information they need to know to do their job.
•• Information should be relevant to the purpose for which it is
required.
•• Check the identity of the person to whom you give information.
•• Make sure that you do not give information carelessly.
Checklist
rson who is
u do not know the pe
In pers on : if yo formation, you
ha ve a ri gh t to be given in
claiming to
should:
to any of your
t w he th er th ey are known
•• find ou
colleagues to be from
f of id en ti ty – if they claim
•• ask for proo iding care, they
cy involved in prov
an ot he r ag en rd), otherwise
an of fic ia l ID (identity ca
will ha ve and so on.
dr iv in g lic en ce, bank cards,
ask for
ise the voice of
te le ph on e: un less you recogn
On the
u should:
the person, yo ck
ber and call ba
ta ke th e telephone num
•• offe r to
checked
after you have the family or fr
iends are
be rs of
•• if variou s m em ar person,
te le ph on in g about a particul
likely to be d’.
nge a ‘passwor
you could arra
Case study
Sharing information with relatives of people you support

Mr Richardson is 59 years old. He is a resident in a paternal grandfather died ‘insane’ and he has now
nursing home, and he is now very ill. He has heard about his father being in a nursing home. He is
Huntington’s disease, which is a disease causing terrified that his father has a hereditary disease and that
dementia, loss of mobility and loss of speech. It is he also may have it. He also has young children and is
incurable and untreatable, and it is hereditary. desperate to know if they are at risk.
Mr Richardson was divorced many years ago when his
1. What can you tell Mr Richardson’s son?
children were very young and he has had no contact
2. Does he have a right to know?
with his family for over 30 years. A young man who
3. What do you think should happen?
says he is his son comes to the nursing home in great
4. Whose rights are your concern?
distress. He is aware, through his mother, that his
252
Who can see confidential records?

Every social care organisation will have a policy on confidentiality and
the disclosure of information. You must be sure that you know what
both policies are in your workplace.
The basic rule is that all information somebody gives, or that is given
disclosed to anyone without the consent of the person.
Sharing information with consent

There are, however, circumstances in which it may be necessary to
pass on information.
In many cases, passing information around is routine and related to
the person’s support. For example, medical information may be
passed to a hospital, to a residential home or to a private care agency.
It must be made clear to the person that this information will be
passed on in order to ensure that they receive the best possible
support.
The key factor to remember is that only information that is required
for the purpose is passed on. For example, it is not necessary to tell
the hearing aid clinic that Mr Smith’s son is currently serving a prison
sentence. However, if Mr Smith became seriously ill and the hospital
wanted to contact his next of kin, that information would need to be
passed on.
Each organisation should have a policy that states clearly the
circumstances in which information can be disclosed. According to
government guidelines (Confidentiality of Personal Information 1988)
the policy should state:
•• who the members of senior management designated to deal with
decisions about disclosing information are
•• what to do when urgent action is required
•• what safeguards are in place to make sure that the information
will be used only for the purpose for which it is required
•• arrangements for obtaining manual records and computer records
•• arrangements for reviewing the procedure.
Sharing information without consent
Sharing information without someone’s agreement is always a
difficult decision. You should always seek guidance from your
manager in this situation and they will decide if it is necessary to pass
on information.
There are several reasons why decisions about disclosing information
without consent may need to be made, and the person involved
should be informed at the earliest possible opportunity about what
has been disclosed.
253
The person may be at risk; for example, you may have discovered that
they have attempted to harm themselves and require urgent medical
treatment.
Information may be required by a tribunal, a court or by the
ombudsman. Ideally this should be done with the person’s consent,
but it will have to be provided regardless of whether the consent is
given.
You may have to consider the protection of the community, if there is
a matter of public health at stake. You may be aware that someone
has an infectious illness, or is a carrier of such an illness and is putting
people at risk. For example, if someone was infected with salmonella,
but still insisted on going to work in a restaurant kitchen, you would
have a duty to inform the appropriate authorities.
Court or tribunal Partner agencies

orders providing support
Best interests Ombudsman
Reasons to
share personal
information
Risk to health Protection of others
Police request Public interest
Reasons why it may be necessary to disclose information without consent.
There are other situations where you may need to give information to
the police. If a serious crime is being investigated, the police can ask
for information to be given, but information can only be requested in
respect of a serious offence and it has to be asked for by a senior-
ranking officer of at least the rank of superintendent. This means that
if the local constable asks if you know whether Mr Jones has a history
of mental health problems, this is not information you are free to
discuss.
There may also be times when it is helpful to give information to the
media. For example, an older, confused man, who wanders regularly,
may have gone missing for much longer than usual. A description
given out on the local radio and in the local paper may help to locate
him before he comes to any serious harm.
254
Doing it well
Disclosure without consent
Disclosure without consent can be made:
•• when it is necessary because of any legal requirement that has been

placed on your employer
•• when it is necessary to protect the best interests of the person
concerned
•• for social services purposes such as passing information to those
undertaking the support of a person or to other departments/
agencies
•• for other purposes such as when required by police, courts or
statutory tribunals
•• when it is necessary to protect the public.

You will need to be able to show your assessor that you have policies and procedures around handling
understand the reasons for careful handling of information, and you must be able to show your
information. This may be through completing an assessor that you understand and work within these
assignment about how information is handled in your policies. Just producing your employer’s policies on
workplace. You will need to know how the legislation confidentiality and recording information is not enough;
affects what you can and cannot do and how the your assessor will want to know how you include these
Information Commissioner works. Your employer will policies in your day-to-day practice.
Legislation
•• Access to Personal Files Act 1987
•• Confidentiality of Personal Information 1988
•• Freedom of Information Act 2000
•• Public Interest Disclosure Act 1998

•• www.ico.gov.uk (the Information Commissioner’s Office)
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Unit IC 01
The principles
of infection prevention
and control
Infection, even so-called minor infections, can be a major source of patient suffering
leading to more serious infections, costly drug therapies and treatments, and possibly
death. It is the responsibility of every care worker to understand their role in the
prevention and control of infection, and to put standard precautions in place to reduce
the risk of a person acquiring an infection.
This unit will focus on the principles of infection prevention and control, investigate laws
and policies which relate to infection control, and explain the employer’s and employee’s
responsibilities. You will consider your responsibilities in relation to the prevention and
control of infection, and be able to demonstrate an effective hand-washing technique and
the correct use of personal protective equipment (PPE).

1. roles and responsibilities in the prevention and control of infections
2. legislation and policies relating to prevention and control of infections
3. systems and procedures relating to the prevention and control of infections
4. the importance of risk assessment in relation to the prevention and control of
infections
5. the importance of using Personal Protective Equipment (PPE) in the prevention
and control of infection
6. the importance of good personal hygiene in the prevention and control of
infection.
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1. Understand roles and

responsibilities in the prevention
and control of infections
1.1 Employees’ roles and responsibilities
in relation to the prevention and control
of infection
Key term Over the past few years, there has been a dramatic increase in the
Healthcare-associated infection number of patients developing healthcare-associated infections
– an infection that has been (HCAIs). As a care worker, you have a responsibility to take care of
acquired as a result of treatment in your own health and safety and that of others who may be affected
any care setting by your actions such as the people you support, their family, friends
and your work colleagues. The Health and Safety at Work Act 1974
requires workers to:
•• take reasonable care for their own safety and that of others
•• cooperate with the employer in respect of health and safety
matters
•• not intentionally damage any health and safety equipment or
materials provided by the employer
•• attend training provided by the employer
•• use protective equipment provided by the employer.
When considering your responsibilities relating to infection within
your work setting, you need to:
•• think prevention
•• think control.
Prevention of infection
You may have heard the term ‘prevention is better than cure’; this is
also true when it comes to infection. Preventing a person from
acquiring an HCAI can save them from unnecessary discomfort,
anxiety and exposure to high levels of antibiotic therapy, all of which
could have serious consequences for people and their families. In
2000, the government identified that about 5,000 people die each
year as a direct result of HCAIs. Your action could save lives.
The effects of infections are not just health-related; there is also a
cost. The government identified that HCAIs may be costing the NHS a
staggering £1 billion a year. This money could be better spent on
developing cancer treatments, employing more staff or saving the
taxpayer money.
One of the most important responsibilities care workers have in the
prevention of infection is to adopt the practice of using standard
precautions for all people. The principle of standard precautions is
that all people are considered ‘high risk’; that is, they are considered a
high infection risk. This includes you!
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Principles of infection prevention and control Unit IC 01
You can help prevent infection by doing the following.
Disposing of waste
correctly
Maintaining personal Washing hands when

hygiene appropriate
Preventing
infection
Wearing clean PPE Keeping equipment
for each person clean
Attending infection control Remaining vigilant and

training and keeping updated reporting potential hazards
Preventing infection.
Activity 1 Control of infection

What are your If a person acquires an infection, your responsibilities will focus on
controlling and limiting the spread of the infection. The steps taken to
responsibilities?
help prevent infections will be maintained; you will already be
What are your responsibilities for treating all people as high risk, but with a confirmed infection
the prevention and control of outbreak, you will need to be more vigilant and record and report any
infection? Write a brief account changes in a person’s condition.
and explain:
•• why each responsibility is

1.2 Employers’ responsibilities in relation
important to the prevention and control infection
•• how it contributes to the
There is a general duty of care placed on all employers under health
prevention and control of
and safety legislation, which gives employers the responsibility to
infection.
protect employees from danger and harm, as far as is reasonably
possible. For example, employers must:
Functional skills •• provide a safe workplace
English: Writing •• carry out risk assessments to assess the dangers of certain work
activities
Write about your responsibilities for •• provide training for staff
the prevention and control of •• provide personal protective equipment
infection at your place of work. Use •• ensure regular health and safety checks are undertaken.
a suitable format to present your
information, and ensure that all your These responsibilities extend to employers protecting employees from
work is clear to read and provides the risks posed by biological hazards such as blood, body fluids and
sufficient facts to cover the task. associated infections. Within your workplace, your employer will have
Proofread your writing to ensure put infection prevention and control policies and procedures in place
accuracy and that each sentence for staff to adhere to. Your manager will have a good understanding
makes sense.
259
of the general care of the people within the setting and will be able
to respond appropriately in the event of a possible infection outbreak,
such as moving them to a single room and arranging for swabs and
specimens to be taken.
Care managers have a responsibility to the people within the care of
the organisation and should undertake regular checks on the
cleanliness of the setting, monitor hand-washing practice, know
whom to contact in the event of an infection outbreak and report
infections to the correct authority such as the Public Health
Activity 2 Department.
Can you smell gas?

Read the COSHH policy for your 2. Understand legislation and
workplace and find out what it
says about how to deal with a policies relating to prevention
urine spillage. You will probably
notice that the policy asks you to
clean the spill with a detergent
before using a bleach, or sodium 2.1 Current legislation and regulatory
hypochlorite, solution. body standards which are relevant to the
1. Why is this? prevention and control of infection
2. Would you use bleach, or
We have already discussed the Health and Safety at Work Act 1974
sodium hypochlorite, directly
(HASAWA) in relation to the responsibilities of employers and
on the spillage and why?
employees and their roles in protecting the health and safety of
people within the workplace such as workers, patients and visitors,
but, within the HASAWA there are regulations that have a relevance
Key term
to the prevention and control of infection. These include the Control
Sodium hypochlorite – the of Substances Hazardous to Health Regulations 2002 (COSHH) and
chemical name for bleach the Reporting of Injuries, Diseases and Dangerous Occurrences
Regulations 1995 (RIDDOR) .
Control of Substances Hazardous to Health
Functional skills Regulations 2002 (COSHH)
English: Reading The COSHH Regulations focus on hazardous materials used within
the workplace these include cleaning chemicals, disinfectants and, in
In your place of work, you will need care settings, body fluids such as urine and blood. The regulations
to read many policies. By doing this, explain how hazardous materials should be used in the workplace,
you will have the opportunity to read how they should be stored, how they should be labelled and how to
a range of formal documentation. deal safely with a spillage. For care settings, this would include what
For many of the written tasks you to do in the event of a urine or blood spillage.
have been set by your assessor, you
will need to understand the texts Reporting of Injuries, Diseases and Dangerous
and be able to extract and use Occurrences Regulations 1995 (RIDDOR)
information. The RIDDOR Regulations provides employers with a legal requirement
to record and report all accidents which occur in the workplace. These
records must be kept for three years and need to be available for
inspection by the Health and Safety Executive (HSE) if required. Needle
stick injuries would also be reported under these regulations.
260
There are some incidents which must be reported directly to the HSE;
these are:
•• death or major injury •• skin conditions such as
•• injury resulting in an dermatitis and skin cancer
employee being off work for •• lung disease such as those
more than three days linked to asbestos and
•• poisoning occupational asthma
•• musculo-skeletal disorders •• occupational cancers.
including fractures
In 2007, the Department of Health launched the Saving Lives initiative

to implement best practice, national guidance and the latest infection
prevention and control policies to help reduce HCAIs throughout the
NHS. The Department of Health also introduced the Health and Social
Care Act 2008. This Act created the Care Quality Commission (CQC),
which replaced the Healthcare Commission, the Commission for
Social Care Inspection (CSCI) and the Mental Health Commission; it
was designed to support improvements in the care given to patients.
From 2009, certain NHS organisations were required to register with
the CQC and made it a legal requirement to protect patients, workers
and others from HCAIs.
A code of practice for the prevention and control of HCAI was
produced under the Health and Social Care Act, which sets out how
the NHS will attempt to prevent HCAIs. These include the 10 key
criteria identified below.
1. Systems to manage and monitor the prevention and control of infection.

These systems use risk assessments. They consider how susceptible service
users are and any risks that their environment and other users may pose to
them.
2. Provide and maintain a clean and appropriate environment in managed
premises that facilitates the prevention and control of infections.
3. Provide suitable accurate information on infections to service users and their
visitors.
4. Provide suitable accurate information on infections to any person concerned
with providing further support or nursing/medical care in a timely fashion.
5. Ensure that people who have or develop an infection are identified promptly
and receive the appropriate treatment and care to reduce the risk of passing
on the infection to other people.
6. Ensure that all staff and those employed to provide care in all settings are
fully involved in the process of preventing and controlling infection.
7. Provide or secure adequate isolation facilities.
8. Secure adequate access to laboratory support as appropriate.
9. Have and adhere to policies, designed for the person’s care and provider
organisations, that will help to prevent and control infections.
10. Ensure, so far as is reasonably practicable, that care workers are free of and
are protected from exposure to infections that can be caught at work and
that all staff are suitably educated in the prevention and control of infection
associated with the provision of health and social care.
(Source: Code of practice for the NHS on the prevention and control of healthcare
associated infections and related guidance, Department of Health, April 2010.)
261
If a healthcare organisation fails to comply with the code of practice,

it could result in enforcement action by the CQC. From 2010/11 a
revised version of the code of practice covering independent
healthcare and social care will be prepared.
The Public Health (Control of Diseases) Act 1984 and the Public
Health (Infectious Diseases) Regulations 1988 provide information on
notifiable diseases such as cholera, dysentery, diphtheria and food
poisoning, to name a few, and explains how outbreaks of these
infections need to be dealt with, recorded and reported. The laws
give GPs and healthcare managers the responsibilities to inform the
local environmental health officer of any outbreak of a notifiable
disease and for healthcare managers to ensure that they fully
investigate the cause of any infectious outbreak.
Further legislation relating to the prevention and control of infection
which you may find useful includes:
•• the NICE Guidelines 2 2003
•• the Hazardous Waste Regulations 2005
•• the Food Safety Act 1990
•• the Health Protection Agency Act 2004.
2.2 Local and organisational policies

relevant to the prevention and control of
infection
Every health or social care setting should have clear policies and
procedures for the prevention and control of infection. These policies
will be tailored to meet the requirements of each care setting and
may include some of the following information:
•• roles and responsibilities of key members of staff in the
organisation such as infection control team members
•• how to achieve best hand hygiene
•• personal hygiene requirements
•• how to apply standard precautions
•• when and how to use personal protective equipment
•• safe handling and disposal of sharps
Activity 3 •• safe handling and disposal of clinical waste
What does your policy •• safe disposal of personal protective equipment
say? •• managing blood and bodily fluid products and spills
•• decontaminating equipment
Read the infection prevention and •• maintaining a clean clinical environment
control policy for your organisation. •• appropriate use and care of indwelling devices such as
Identify your responsibilities under catheter care
the policy. Can you think of how •• cleaning routines and requirements
you would put your policy into •• how to record and report accidents and incidents.
practice? For example, how and
where do you dispose of gloves It may be difficult to apply all of these suggestions in each setting. For
once you have finished with them? example, if you work in the community and have to work in a
person’s own home, you will be restricted on how clean you can keep
262
the environment you are working in. However, your workplace policy
should reflect what standards should be expected for the area where
you are required to work.
It is important for you to be familiar with the information in your
organisations infection prevention and control policy. You will
probably find that your organisation’s policy contains information
similar to the areas discussed above, but remember, it is your
responsibility to read and follow your organisation’s policy.
Case study
Refusing entry to visit people with infectious illnesses

Dusana is a care worker and works in the nursing unit During the evening shift, an angry relative demands to
of Rosenburg Hall nursing and care home. Over the last see their mother who is a patient on the unit and who
few days some patients and staff have been suffering has been confirmed as having the norovirus. The relative
from diarrhoea and vomiting. Results from specimens refuses to listen to Dusana and says that she does not
sent to the microbiology lab have come back and have the right to prevent them from seeing their
confirm an outbreak of the highly contagious norovirus, mother.
also known as the winter vomiting virus.
1. Is the relative right to say that Dusana does not
The infection control team have informed the charge have the right to refuse them entry to the nursing
nurse that the nursing unit has to be closed to all unit? Why?
visitors, because this virus is very contagious. They also 2. How can the risk of the infection spreading be
tell the charge nurse that all staff must follow the reduced?
standard precautions policy when providing patients 3. What aspects of an infection control policy are
care and that effective hand-washing skills are very important to consider in this situation?
important.
3. Understand systems and

procedures relating to the
infections
3.1 Procedures and systems relevant to
the prevention and control of infection
When looking at the prevention and control of infection, it can help
you identify specific procedures and systems if you split the focus of
the prevention and control measures into two areas, which are:
•• the environment and equipment
•• the people involved.
We will look at the procedures and systems relating to people later in
the unit, but first we need to consider the environment and
equipment in relation to the prevention and control of infection.
263
Care environments, and the equipment used within the care

environment, will differ depending on the setting where you work.
Environments within care settings can also differ depending on the
activity being undertaken within that specific location. For example, in
a hospital you will have wards, nursing stations, sluice and dirty utility
areas, operating theatres, outpatient departments, storage areas and
so on – these areas and the equipment used within them will need to
be kept clean to reduce the risk of infection.
The level of cleanliness required will depend on the type of activities
being undertaking. It is generally accepted that there are three levels
of cleaning:
•• general cleaning and decontamination
•• disinfection
•• sterilisation.
General cleaning and decontamination
General cleaning and decontamination is when dirt, dust and some
micro-organisms are removed by using warm water, detergent and
the physical action of cleaning. The purpose of cleaning is to change
the environment, so bacteria cannot breed. This is achieved by
removing physical debris such as body tissue and blood, where
bacteria can breed and by drying the area or item. Drying is very
important as bacteria cannot breed in a dry environment.
General cleaning is very important and its role in the fight against infection
should not be underestimated.
Disinfection
Key term
Disinfection is a process taken after general cleaning which aims to
Pathogenic – micro-organisms further reduce the number of pathogenic organisms present on a
that have the potential to cause surface. For example, once a work surface has been cleaned, a bleach
disease or infection or alcohol solution may be used to disinfect the surface. Unless there
is a specific reason such as after a urine spill, there is no need to
264
routinely disinfect ceilings, floors and walls. The process of

disinfection will kill most micro-organisms, but will not destroy their
resistant spores. This can only be achieved by sterilisation. Removing
physical debris needs to be achieved before further disinfection and
sterilisation can be effective.
Sterilisation
Sterilisation is the process of killing all micro-organisms and their
resistant spores. All surgical equipment used during operations will go
through the process of sterilisation to reduce the risk of infection, but
even these items will have gone through the process of cleaning to
remove physical debris such as blood and tissue before sterilisation.
Many single-use items used within the care sector such as catheters
and feeding tubes will also have been sterilised.
There are three main methods of sterilisation used for medical
purposes.
•• Autoclaving is one of the most common forms of sterilisation
and is frequently used in hospital sterilising departments.
Autoclaving is when steam (under pressure) is heated to between
134°C and 137°C to kill pathogenic organisms and their resistant
spores.
•• Chemicals can be used to sterilise equipment such as ethylene
oxide gas, but this type of sterilisation has to be undertaken at
specialist sterilisation centres. A more common form of chemical
sterilisation used on a smaller scale involves the use of sodium
dichloroisocyanurate solutions such as ‘Milton’, which is often
used in maternity departments to sterilise feeding bottles and
teats.
•• Gamma radiation is a common form of sterilisation for single use
items and for items that cannot withstand high temperatures.
Within your workplace, you will probably not be required to become
actively involved in the sterilisation process, but the chances are you
will be required to help clean the environment and disinfect
equipment. You may have a cleaning rota which identifies daily,
weekly and monthly cleaning activities, but you will need to follow
your organisation’s policies and procedures for cleaning and
disinfecting. Some specific times when cleaning activities may have to
be undertaken could include:
•• between clinical activities, such as operations and clinical
examinations
•• between personal hygiene activities, such as cleaning the bath or
disinfecting the toilet or commode
•• at the end of the day, such as washing floors
•• once a person has been discharged, such as cleaning the bed
frame and mattress.
265
Activity 4 After use Daily Weekly Monthly
Toilet ✓
Your organisation’s
cleaning policy Commode ✓
What is your organisation’s policy Bath ✓
for cleaning? Find out what action ✓
Shower
you should take if you discover a
piece of equipment that requires Floors ✓
cleaning. What other systems are Walls ✓
in place within your setting to
prevent and control the spread of
Ceiling ✓
infection? Bed frame
✓ or once
discharged
Cupboards ✓
Fridge ✓
Dining table ✓
Cleaning rotas can be useful, but everybody has a responsibility to keep the
environment and equipment clean.
Many organisations now employ domestic staff who have specific

responsible for undertaking general cleaning activities; however, you
will still be required to undertake certain cleaning or disinfection
tasks. For example, if you remove faulty equipment from service,
which has been involved in patient contact, it is your responsibility to
ensure the equipment is appropriately decontaminated before
sending it for repair. Any equipment that has been decontaminated
will need to be recorded according to your organisation’s policy.
What does your organisation state should be worn when cleaning equipment?
266
3.2 The potential impact of an outbreak of

infection on the individual and the
organisation
The outbreak of an infection within a care setting can have serious
consequences for both people and the care organisation. People who
acquire HCAIs will require medical treatment to deal with the
infection such as antibiotic therapy, but antibiotics can have side
effects such as allergic reactions, diarrhoea and nausea. Some
Key term pathogenic organisms have become resistant to antibiotics causing
MRSA – Methicillin-resistant the so-called superbug MRSA, which needs stronger antibiotics to
Staphylococcus aureas, an organism fight it.
which has mutated over the years to Unfortunately, the use of some antibiotics can also make people
become resistant to some antibiotics more susceptible to another increasingly common condition called
Clostridium difficile (C. diff). C. diff can live harmlessly in the bowel
alongside other naturally occurring bacteria; however, when a person
takes antibiotics for an infection, the antibiotics will destroy the
bacteria causing the infection and the naturally occurring good
bacteria in the bowel, but the C. diff bacteria is very resistant and is
not destroyed. This upsets the natural balance of bacteria in the
Key term bowel and enables the C. diff bacteria to increase in number and
Toxin – a poison produced by produce toxins that cause the symptoms of C. diff. These symptoms
micro-organisms such as bacteria include diarrhoea, abdominal pains, nausea and, in severe cases,
inflammation of the bowel.
The effects of a person acquiring MRSA or C. diff can at best be
uncomfortable and at worst devastating and fatal. The effects of
infections are not only physical; they can also have a mental impact
because people who acquire infections often think they are ‘dirty’,
which can lower their self-esteem. Some infections may require the
Reflect patient to be isolated from others to help prevent and control the
spread of infection. A person who has to be isolated from others may
Placing people who have certain
feel depressed because of the lack of social interaction. It is
types of infections into isolation can
important, therefore, that care workers perform regular checks on
leave them feeling lonely and
isolated people to help reduce the risk of them becoming depressed.
vulnerable, especially if they are
seriously ill. Is it right to put people For the organisation, an infection outbreak can prove to be an
in isolation, especially if standard expensive affair with the cost of treatment and a prolonged stay in
precautions are being used by care hospital; what’s more it can ruin the organisation’s reputation. If an
staff? investigation, conducted following the infection outbreak, identifies
poor practice or negligence, the HSE has the right to prosecute
What are the possible positive and
people, which could result in a fine and/or imprisonment.
negatives of isolation nursing
compared with the positive and Every care worker has a duty of care to ensure that they minimise the
negatives of not undertaking risks of a person from acquiring an HCAI. The main way this can be
isolation nursing? Place yourself in achieved is by having an awareness of their responsibilities under the
the position of the person with an organisation’s infection prevention and control policy, adopting safe
infection. practice including the use of standard precautions, effective hand-
washing and attending regular training.
267

English: Speaking and Your experience of infections in the care setting
listening Infections can have a massive impact on the person who has acquired
Use the three questions from Activity the infection and the workplace.
5 as the basis for a discussion with 1. What infections are commonly seen within the care setting where
your team about your experience of you work?
infection in the workplace. Make 2. What systems are put in place to prevent infection?
sure that all the participants have an 3. What procedures are put in place to control the infection?
opportunity to contribute to the
discussion and that you are able to
pick up on points made by others to
move the discussion forward. Present
your information clearly using
appropriate language. Read
risk assessment in relation to the
procedures and policies in your
organisation to familiarise yourself
with the subject matter. infections
4.1 The definition of risk
Within the care setting, there are a number of hazards that have the
potential to cause harm. Hazards that come from living organisms,
such as humans, are called biological hazards or biohazards and
include the organisms found in body fluids such as the HIV virus.
Once the biohazards within the workplace have been identified, the
next step is to identify the risks that the biohazard could present. For
example, if a patient had an MRSA infection, what is the risk of this
infection spreading? The level of risk is rated as low, medium or high,
depending on the severity of the hazard.
Biohazard 4.2 Potential risks of infection within the

workplace
This is the international
symbol for biohazards. There is always a potential risk of infection wherever you work or
wherever you go. For example, you expose yourself to the risk of food
poisoning when you eat out, but this is normally a very low risk
because there are stringent laws in place surrounding food hygiene
and safety. However, the risk of acquiring an infection increases
within the health and social care sectors because these sectors deal
with many people who are more susceptible to the risk of infection
due to their conditions. When considering the potential risks of
infection, you will need to think about:
•• the person being supported
•• relatives, friends and visitors
•• you the care worker
•• the environment
•• equipment.
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The person receiving care

The person who is receiving care is likely to be at a high risk of
acquiring an infection because of the following.
•• Age: The very young and the very old often have a weaker
immune system, and can therefore acquire infections more easily.
•• Immune status: People who have a low immune status, such as
people who have been receiving chemotherapy, have an increased
risk of acquiring an infection, because their low immunity makes it
more difficult to fight off infections.
•• Nutritional status: People who are malnourished often have a
weaker immune system, so are more susceptible to infection.
•• Skin integrity: Patients who have been admitted to hospital
following an accident, where they have open wounds as a result
of trauma, or patients who have undergone surgery, have an
increased risk of infection because the body’s natural defence
barrier against infectious agents, the skin, has been breached,
allowing harmful pathogenic organisms to gain entry.
•• Invasive therapy: The skin may also be breached because of
invasive therapies, such as when a cannula is inserted into a
patient’s arm so intravenous fluids can be administered, or when
catheters are inserted into a person’s urethra, so urine can drain
from the bladder. These invasive therapies give micro-organisms a
direct route into the body.
•• Drug therapy: People taking antibiotics can be at increased risk
of acquiring an infection because the antibiotic can alter the level
of normal bacteria living within the body – for example, C. diff.
Chemotherapy drugs can lower the body’s immune system and
therefore expose the patient to a higher risk of acquiring an
infection.
While people receiving care are clearly at a higher risk of acquiring an
infection, they are also a high risk of spreading infections. People
receiving care could have highly contagious blood-borne diseases
such as Hepatitis B or HIV, or they could have MRSA, so it is
important to remember to treat all people as high risk and use
standard precautions when providing care to people.
Relatives, friends and visitors

Friends and relatives can be exposed to the risk of infection when
Key term visiting their loved ones in a care setting. For example, if there is an
Aerosol – a cloud of solid or outbreak of the norovirus in the care setting, small aerosols
liquid particles in a gas containing the virus can enter the air when someone vomits and can
be passed to another person. However, friends and relatives can also
be risk factors and can bring infections into the care environment
such as the common cold. While the cold is often harmless to fit
healthy people, it can be fatal for people who have a weaker immune
system.
269
You, the care worker

Like friends and relatives, care workers can be exposed to a number
of potential infections within the workplace. These include the
common infections such as:
•• colds
•• flu
•• diarrhoea
•• vomiting.
However, care workers often come into contact with patients’ blood
and body fluids, which can pose greater infection risks and may
include the risk of acquiring hepatitis and HIV. Care workers may also
be at an increased risk of acquiring scabies, which can be spread by
touch.
Care workers may be exposed to infections spread through the air,
such as tuberculosis and swine flu, although these are quite rare.
Other airborne infections such as streptococcal infections are more
common and can lead to sore throats and raised temperature.
As a care worker, you are a potential source of infection to the
people you provide care for; because these people are at an increased
risk of acquiring an infection, you will need to ensure you take
precautions to minimise the risk of cross-infection. In particular, you
must ensure that you take appropriate action if you become ill,
because it may not be appropriate to go to work even if you just have
a cold. You must check your organisation’s sickness policy and inform
your manager if you are sick. If you have suffered from diarrhoea, you
should not return to work until you have been clear of symptoms for
48 hours. Even though you may feel you are letting your colleagues
down, your actions could be saving someone’s life.
The environment
The environment where people are being cared for and where you
work must be kept as clean as possible. Bacteria and pathogenic
organisms can live and breed in damp environments, and the resistant
spores can remain dormant for a long time, such as those which
cause C. diff. Some viruses such as HIV do not live outside the body
for very long, but the hepatitis virus can survive for months, if
conditions are right. Because some harmful pathogenic organisms are
so resistant, effective cleaning is important. Particular attention should
be paid to the bathroom, toilet, door handles and work surfaces,
including those where food is served or prepared. Bed frames and
mattresses need to be cleaned on a regular basis and bed linen
changed frequently. Floors in clinical areas should be hard, so that
they can be washed, and any spills can be cleaned quickly and
efficiently.
270
Equipment
Activity 6
Equipment that comes in contact with people may also come in
Potential sources of contact with blood or body fluid, so may harbour potential infectious
infection agents. Equipment that does come in contact with patients should be
There are a number of potential
disposed of in the appropriate manner. For example, ‘sharps’ such as
sources of infection within the
needles and scalpel blades need to be disposed of in a sharps bin;
workplace. These sources depend
catheters should be disposed of in yellow clinical waste bags.
on many things, including the type
Equipment that is non-disposable, such as surgical instruments,
of workplace where you work.
pumps, commodes and so on must be cleaned and disinfected after
use and, if appropriate, sterilised.
1. Make a list of all the potential
sources of infection which you 4.3 The process of carrying out a risk
come across during a routine
day.
assessment
2. Share your list with a colleague An infection control risk assessment, like other risk assessments, will
and see if they agree with you identify the potential biohazards within the workplace, the risks these
or if they can add any more. biohazards pose, who may be at risk and how the biohazard can be
removed or reduced.
Now you know some of the
potential risks for infection, you The HSE gives a five-step guide to risk assessment.
can start to think about what you
do to reduce these. 1. Identify the hazard – This step involves looking for and
identifying the biohazards by inspecting the workplace, talking
with employees looking at the types of activities taking place
within the setting. For example, staff working in an operating
theatre will be at a higher risk from biohazards than those
working in a residential care home who will have a lower risk.
2. Decide who might be harmed and how – This will
involve consideration of everyone in the workplace such as
patients and visitors, not just care workers.
3. Evaluate the risks and decide on precautions – The risks
arising from the identified biohazards need to be evaluated
and a decision taken on the precautions required to
minimise or remove the risk. This could include the use of
standard precautions, PPE and cleaning schedules. If
measures are already in place then the effectiveness of the
measures need to be considered as to whether the existing
precautions are adequate or if more are required.
4. Record the findings and implement them – The findings
from the risk assessment need to be recorded and an
explanation given on how the risks can be controlled to prevent
harm. Care workers must be informed about the outcome of the
risk assessment because they will need to implement the actions.
5. Review the assessment and update if necessary – The risk
assessment must be reviewed from time to time and revised if
necessary. For example, if new PPE becomes available, new
infections are identified or work activities/processes change.
(source: Health and Safety Executive.)
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4.4 The importance of carrying out a risk

assessment
Under the Health and Safety at Work Act 1974, employers have a
legal responsibility to protect the health and safety of their employees
and anyone else using the workplace; in care settings this would
include patients, friends and family. A risk assessment is one of the
most important assessments an employer can undertake to protect
these people as well as their organisation’s reputation. The
assessment identifies the risks in the workplace and the measures put
in place to reduce the potential harm from these risks. In most cases
straightforward measures can be put in place to control the risks – for
example, ensuring adequate PPE is available for staff to use.
Health and safety legislation does not require employers to eliminate
all risk, but does require them to protect people as far as is
‘reasonably practicable’. Failure to undertake a risk assessment is not
only illegal, but it also risks the health and safety of all people within
the workplace, especially the most vulnerable people, the people you
are providing care for.

using Personal Protective
Equipment (PPE) in the prevention
5.1 Correct use of PPE
There are many different types of personal protective equipment (PPE)
that can be used to protect people from harm. PPE is defined in the
Personal Protective Equipment at Work Regulations as: ‘All equipment
(including clothing affording protection against the weather) which is
intended to be worn or held by a person at work which protects
them against one or more risks to their health and safety.’
Below is a list of the equipment used by care workers to protect
themselves from the risk of acquiring an infection from a patient and
to protect patients from acquiring an infection from the care worker.
•• Uniforms
•• Gloves
•• Aprons
•• Masks
•• Visors
•• Goggles
•• Hats
•• Shoes
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Uniforms
Uniforms should be fresh every day; they should be loose-fitting to
enable free movement. This is vey important in clinical areas such as
emergency departments and operating theatres, where care staff are
required to wear ‘scrubs’ (protective surgical clothing). This is because
the friction caused by the action of the clothing rubbing on the skin
can cause skin scales to be shed, and skin scales can carry bacteria
which have the potential to spread infection. Any type of uniform
should be worn fresh every day and should have short sleeves to
prevent them from trailing in blood or body fluids. If travelling to and
from work in a uniform, you should ensure the uniform is covered
with another item of clothing, such as a coat or jacket.
Some care settings require special uniforms to help reduce the risk of infection.
Gloves
Gloves should be worn only when having direct contact with a person
or when dealing with blood, body fluids or items that could be
contaminated by these. Wearing gloves when you do not need to can
increase the risk of developing a latex allergy, as well as being an
additional expense to the employer.
Aprons
Aprons should be placed over the uniform before undertaking
activities involving blood, body fluids or liquids. Blue aprons should be
used for food use only and white aprons should be used for all other
activities. Once placed over the head, the apron should be secured by
tying the waist ties behind the back. Aprons must be changed
between patient contact.
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Masks
If you need to use a mask, you should ensure that you do not touch
the front of the mask during the donning process (the process of
putting it on) as this may damage the mask’s integrity. The mask
should be used where there is a risk to the care worker of blood or
body fluid aerosol. Most masks provide patients with some protection
from airborne infections from the care worker reaching the patient,
and this is why facemasks must never be worn round the neck, as the
mask could harbour a large colony of bacteria from the care worker’s
respiratory tract. If the mask is worn round the neck between uses,
there is the potential for the bacteria to spread.
Visors
Most non-disposable visors have an adjustable head strap so that the
visor can be adjusted to ensure a comfortable fit for the wearer.
Visors can also come attached to facemasks to provide full face
protection from the risks of blood and body fluid aerosol.
Goggles
Goggles, like face visors, can protect the eyes from blood or body
fluid splashes. Some goggles can be worn like glasses and have arms
that fit around the ears; however, some people find this type of
goggle uncomfortable as they can become loose and slide down the
nose. Another type of goggle has an elasticated head strap which
holds the goggles securely in place.
Hats
If hats/caps need to be worn, they should be securely fastened to the
head by fastening the cap ties so that the hat fits tightly to the head.
Shoes
If special footwear is required, such as the type worn in ultraclean
environments like operating theatres, then this should be provided by
the employer and worn as required. These types of footwear also
conform to antistatic regulations, which is extremely important when
working in oxygen-rich environments.
5.2 Different types of PPE

Uniforms
In many care establishments, it is a requirement for staff to wear
uniforms. Uniforms must be clean at the start of every shift and
should be changed if they become soiled during the shift.
Gloves
There are many different types of gloves available on the market for
care workers to use such as standard latex, nitrile and vinyl. Latex
gloves are the most common gloves used within healthcare
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organisations, but as more people are becoming sensitive to latex and

developing latex allergies, other gloves are becoming more popular.
These include nitrile gloves, which come in a variety of colours and
vinyl gloves.
Most gloves come in sterile and non-sterile packaging, depending on
why they need to be used, and are available in small, medium and
large sizes.
Gloves come in different sizes and are made from different materials.
Aprons
Plastic aprons can be placed over the uniform to help prevent the
uniform from becoming soiled when performing activities such as
personal care, toileting and wound care, and because plastic aprons
are waterproof, they also provide protection when assisting people to
have a bath or when handling body fluids.
Masks
These are disposable and come in three different types.
•• The first is the most common type used and is made from paper.
The mask forms a shield that may be pleated and has two ties for
around the head and a flexible nose bridge.
•• The second type of mask is similar to the first type but has ear
loops instead of ties.
•• The third type of mask has a moulded cup shape held in place by
an elastic cord around the head.
Visors
Like facemasks, visors are not commonly used outside the clinical
environment where they can be used to help protect the care worker
from the risk of splashing from blood or body fluids.
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Goggles
These can provide care workers with eye protection when dealing
with blood or body fluids.
Hats/caps
Surgical hats can be either disposable or reusable. Disposable hats
come in a range of colours and different sizes which can be adjusted
to fit different size heads by securely fastening the ties at the back of
the hat. Reusable hats are made from cotton material which can be
laundered at high temperatures.
Shoes
Most care workers are required to wear sensible shoes that are not
open-toed and do not have high heels. Within some clinical areas,
special footwear may be required such as theatre shoes, clogs or
boots; however, these types of footwear are only worn in specialist
areas and you should follow your organisation’s policy on footwear.
5.3 The reasons for use of PPE

Personal protective equipment is used to protect both care workers
and the people receiving care. It is important to ensure that when
using PPE, it is used correctly and for the purpose it was designed.
Uniforms are worn to reduce the risk of pathogenic organisms being
transferred from the outside environment on the care worker’s
clothing to the patient, and to prevent any pathogenic organisms
from the patient being transferred outside the care environment. This
is why it is important not to go shopping in your work clothes.
Gloves form a physical barrier between the care worker’s skin and all
other surfaces including the patient’s skin, blood and body fluids.
Because gloves form a physical barrier, pathogenic organisms can not
pass from one side to the other, so gloves provide protection for both
the care worker and the person receiving care.
Like gloves, an apron also provides a physical barrier between the
care worker and other surfaces, and provides similar protection. Blue
aprons should only be used when undertaking activities involving
food. White aprons should be used for all other activities; however,
some organisations use red aprons for staff when working with
patients who have highly infectious conditions.
Masks also form a barrier to protect healthcare workers from
patients’ blood or body fluid aerosols during surgical procedures, and
in settings where bacteria or viruses may be present. The mask
provides the patient with some limited protection, but to remain
effective masks need to be changed regularly and must never be
reused. The effectiveness of facemasks to prevent patients from
acquiring infections is questionable, but they do provide some
protection to staff.
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Full face visors are another type of barrier protection and can be
used when there is a risk to the care worker of blood or body fluid
spray to their face and eyes.
The purpose of wearing goggles is to try to prevent blood or body
fluids accidently getting splashed into the eyes.
Hats/caps are not commonly worn outside the operating theatre
because research has shown that provided care workers keep their
hair clean and tidy, the risk of infection is small.
It is important for shoes not to be open-toed, because this will reduce
the risk of infection if blood or body fluids are spilt. It also provides
the feet with some protection if an item is dropped on to them. In
specific clinical areas it is important that the footwear is not worn
outside that specific area, otherwise there is an increased risk of
pathogenic organisms being carried back into the ultraclean
environment on the soles of the shoes.
5.4 Current relevant regulations and

legislation relating to PPE
There are legal duties and obligations in relation to PPE placed on
employers. Under the Health and Safety at Work Act 1974, it is made
clear that if items of PPE are required, then they must be provided
free of charge by the employer; employees cannot be charged or be
expected to contribute to the provision or maintenance of PPE
required for them to carry out their work.
Under the Health and Safety at Work Act 1974, there are specific
regulations which specifically address PPE. These regulations are:
•• the Personal Protective Equipment at Work Regulations 2002
•• the Management of Health and Safety at Work Regulations 1999
•• the Control of Substances Hazardous to Health Regulations 2002
(COSHH)
These regulations ensure that where risks cannot be controlled by
other means, then PPE is correctly selected and used. The Personal
Protective Equipment at Work Regulations also place duties on
employees to take reasonable steps to ensure that the PPE which is
provided is used correctly and appropriately.
The Management of Heath and Safety at Work Regulations 1999
also relate to this area and require employers to identify and assess
the risks to health and safety in the workplace. All risks must be
minimised as far as reasonably possible. Where an activity involves a
risk this could be minimised in a number of ways – one way is to
wear PPE.
According to the Personal Protective Equipment at Work Regulations,
PPE should be used as the ‘last resort’ to protect against risks to
health and safety, and other control measures such as safe systems of
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work should be considered first. For example, after completing a risk

assessment, employers should investigate if it is possible to do the job
using methods that will reduce the risk of infection and will not
require the use of PPE.
There are also regulations regarding the quality of PPE equipment
and, since 1 July 1995, it has been a legal requirement that all new
PPE must be CE marked. The CE mark certifies that the PPE has met
the European Union (EU) consumer basic/minimum safety
requirements.
5.5 Employees’ responsibilities regarding

the use of PPE
Section 7 of the Health and Safety at Work Act 1974 places a
responsibility on employees to take reasonable care for their own
health and safety and that of others who may be affected by their
acts or omissions at work. This responsibility extends to PPE, which
employees must wear to protect themselves and others, including
patients. If an employee fails to wear PPE provided by the employer,
they could be disciplined, unless it is proven that the PPE risks the
health and safety of the employee, such as ill-fitting equipment.
Employees’ specific responsibilities include:
•• attending training provided by the employer relating to how to
use PPE
•• using PPE in accordance with the training
•• taking reasonable care of all PPE provided by the employer
•• returning PPE to the correct storage accommodation provided for
it after use
•• reporting to the employer any loss or obvious defect as soon as
possible.
5.6 Employers’ responsibilities regarding

the use of PPE
Under the Health and Safety at Work Act 1974, employers have a
general duty to ensure, as far as reasonably possible, the heath, safety
and welfare at work of all employees. Employers also have a duty of
care under the Personal Protective Equipment at Work Regulations
2002. These include the following requirements.
•• Properly assessing the need for PPE and assessing PPE before it is
used to ensure it is suitable. This will involve identifying the hazard
and the types of PPE that could be used. For example, blood and
body fluids splashes are hazards because there is a risk that these
substances could get into the care worker’s eye. The PPE options
available are safety spectacles, goggles, visors or face-shields.
•• Providing free PPE to employees. Employers cannot ask employees
to pay for PPE; however, if an employee leaves and does not
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return an item of PPE to the employer, the employer can deduct

the cost of replacing the equipment from any wages owed,
providing this information has been made clear in the contract of
employment.
•• Ensuring PPE is maintained and stored properly. Make sure
equipment is well looked after and stored correctly. Maintenance
may include: cleaning, examination, replacement, repair and
testing. The wearer may be able to carry out simple maintenance
(for example, cleaning), but more detailed repairs must be carried
out by a competent person. All maintenance, repair and
replacement cost are the responsibility of the employer.
•• Providing employees with adequate information, instruction and/
or training on its use. Training will include making sure that
anyone using PPE is aware of why it is required, when it is to be
used, repaired or replaced and its limitations. Employees must be
trained to use the PPE properly and understand how to perform
basic checks.
•• Ensuring employees follow the training provide and that they use
the PPE provided and fully investigate non-compliance.
(Source: Health and Safety Executive.)
5.7 The correct practice in the application

and removal of PPE
To ensure the risk of infection and cross-infection are fully minimised,
it is important that PPE is put on and removed correctly. Failing to
remove contaminated PPE can result in infections spreading and
defeats the purpose of using the equipment in the first place.
Uniforms
Uniforms should be fresh everyday and should be applied just before
starting the shift, as this will help reduce the risk of pathogenic
organisms from the outside environment being taken into the care
setting. However, if you need to travel to work in your uniform, you
should ensure that you keep your uniform covered with another item
of clothing such as a coat, jacket or cardigan. Before putting on the
uniform, you should ensure that you wash your hands and dry them
thoroughly.
Uniforms should be removed at the end of the shift or after becoming
contaminated with blood or body fluids. When removing a uniform,
you should try to avoid touching the front of the uniform as much as
possible, as this will reduce the risk of transferring pathogenic
organisms from the uniform onto your skin. Once removed, the
uniform should be placed in an appropriate place such as a laundry
sack, until it can be taken away for laundering. Soiled uniforms
should never be placed on the floor, as pathogenic organisms can be
transferred from the uniform to the floor.
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If you are required to launder your own uniform, you should be given
instructions on the washing requirements which will normally involve
washing at a temperature of at least 60°C and separately from your
everyday clothes.
Remember to wash your hands after removing your uniform!
Gloves
Gloves should be applied to clean, dry hands. The gloves should be
inspected before they are put on to straighten out folds and ensure
there are no holes or tears. You should not blow into gloves before
putting them on, because the moisture in your breath will help to
provide a damp, warm environment for bacteria to breed. When
putting on gloves, it is important to ensure that they are the correct
size and that they fit properly. If you work in an environment where
you need to wear a surgical gown, you may be taught the ‘closed
gloving technique’, which will enable you to put sterile gloves on
without touching the outside of the glove and pull the cuff of the
glove over the cuff of the gown, so that the gown cuff ends up inside
the cuff of the glove.
1. Check gloves before putting them 2. Pull gloves on, making sure that 3. Take them off by pulling from the
on. Never use gloves with holes or they fit properly. If you are cuff – this turns the glove inside
tears. Check that they are not wearing a gown, pull them over out.
cracked or faded. the cuffs.
4. Pull off the second glove while still 5. Dispose of them in the correct
holding the first, so that the two waste disposal container and wash
gloves are folded together inside out. your hands.
When removing gloves, it is important to follow these important steps

to reduce the risk of cross-infection.
•• Grab the cuff of one glove with the opposite hand and pull down
over the hand. This turns the glove inside out, so that the
contaminated surface is away from you. Hold this glove in the
hand which is still gloved.
•• While still holding the removed glove, pull off the second glove by
holding the cuff and pulling down over hand. While you do this,
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you will wrap the first glove in the second glove and both gloves
will be folded together with their contaminated surfaces facing
inwards.
•• Dispose of the gloves.
•• Wash your hands.
Aprons
When putting on an apron, you should ensure you have washed and
dried your hands before selecting the apron. The neck strap of the
apron should then be placed over the head and the waist ties should
be fastened behind the back. Once the apron has been secured, you
can then put on your gloves and undertake the activity.
When removing an apron, it is important to reduce the risk of
cross-infection by not touching the front of the apron. To remove the
apron, you should pull at the neck strap and the waist strap until they
snap, making sure that you keep hold of the apron so that it does not
fall to the floor. The apron can then be scrunched up into a ball in
your gloved hands. Once the apron is in a ball, it can be placed in one
hand and the gloves can then be removed, as described on the
previous page. The apron will end up securely enclosed in the gloves,
which can then be disposed of.
Masks
Make sure your hands have been washed and thoroughly dried
before selecting the mask. Once you have selected the mask, you can
gently pull the mask open by pulling on the top and bottom of the
mask from the middle, but remember not to touch the front of the
mask. Place the mask over your face and gently squeeze the nose
band area of the mask where it will sit on your nose. This will allow
the mask to fit your nose better and will help to hold the mask in
place while you tie it. You can tie the mask by grasping the top ties in
your hands and pulling them behind your head. Then, gently but
firmly, fasten the top ties behind your head, making sure they are
tight enough to hold the mask in place. Fasten the bottom ties
behind the back of your neck and make sure the mask feels secure.
Finally, ensure the nose band is pressed firmly over the nose and
make sure it feels comfortable before starting the activity.
When removing the mask, it is important not to touch the front of
the mask and only handle the mask by the ties. The mask should be
removed by untying the bottom tie then the top tie, and moving it
away from your face by holding the ties. You can then dispose of the
mask.
Visors
You should check the visor to ensure it is clean before placing it on
your face. Once the visor has been placed on the head, you may be
able to adjust the headband to ensure a more comfortable fit. If you
are using a facemask with a fitted visor, you should fit the mask as
described above.
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When removing the visor, you should slide the visor up and away
from your face. Once the visor has been removed, it should be
cleaned and decontaminated as appropriate and then dried. Once the
visor is thoroughly dried, it should be returned to the approved
accommodation. If the visor is part of a disposable facemask, the
mask should be removed and disposed of as described earlier.
Goggles
Like visors, goggles should be checked to ensure they are clean
before they are placed on the face. Some goggles fit like spectacles,
while others have a headband which can be adjusted to fit the head
and around the eyes. The goggles should be adjusted so there is a
firm seal around the eyes, but not too tight to be uncomfortable.
Once the goggles have been removed, they must be cleaned and
decontaminated as appropriate, and dried thoroughly. Once dried,
Activity 7 the goggles should be returned to the approved accommodation.
Personal protective
Hats
equipment
According to most sources, theatre hats should be the first piece of
Different job roles and work clothing worn when preparing to enter the operating theatre
environments will expose you to department. Before selecting the correct size hat, hands should be
different infection risks. Your washed and dried. The hat should be placed on the head, ensuring all
manager will have provided PPE to the hair is covered. The hat can be secured into position by tying the
minimise some of these risks. hat at the back. Once the hat is ready to be removed, it can be pulled
1. What PPE is available for you to off the head by using the ties and disposed of.
wear in your workplace?
Shoes
2. When should you wear this
and how should it be used? These should be the last item of clothing to put on because of the risk
3. What are your responsibilities of cross-infection. Once shoes have been put on, hands should be
regarding using PPE? washed and dried. Once removed, shoes should also be cleaned and
decontaminated as required, not just left lying around!
5.8 The correct procedure for disposal of

used PPE
Some PPE items such as uniforms, visors, goggles and footwear are
non-disposable and should be cleaned, decontaminated, dried and
stored in the appropriate accommodation ready for their next use.
You will need to make sure that you are familiar with your
organisation’s policy for dealing with such items.
Masks, hats, gloves and aprons are all classed as clinical waste and
are regarded as high-risk items; they should therefore be disposed of
carefully to reduce the risk of cross-infection. This is regardless of
whether the item has visible contamination or not. If clinical waste is
generated in a person’s own home, it still needs to be treated as
clinical waste and must not be placed in domestic waste bags for
household landfill sites.
The Hazardous Waste Regulations 2005 make it a legal requirement for
organisations disposing of hazardous waste to be registered with the
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Environment Agency. In 2006 the Department of Health Environment

Agency introduced the Safe Management of Healthcare Waste, which
incorporated a new European colour coding system for waste.
Colour Waste
Activity 8 Orange Infectious waste for alternative technology
Your organisation’s Yellow Infectious waste for incineration

waste policy Purple Cytotoxic for incineration
Read the disposal of waste policy
Yellow/black Offensive waste for suitably licensed facility
for your workplace.
Black As above for yellow/black
Where should you dispose of
gloves, aprons and masks? Table 1: It is your responsibility to find out what your workplace policy is for
waste disposal and to follow the policy.
Case study
Understanding the potential risk

Josh works as a care assistant at the Larks Residential He summoned help and Mrs King was assisted back to
Care Home for older people. Josh enjoys playing bed. The incident was written in the incident book.
football and while playing a match last Sunday, he was
A few weeks later, Josh became unwell, developed a
involved in a nasty tackle and sustained a few cuts and
fever, had diarrhoea and vomiting, and generally felt he
grazes to his hands. One day, while on duty, Josh was
had flu-like symptoms. These lasted for a few days so
asked to assist Mrs King to prepare for bed. She has
he sought medical advice from his GP. Blood tests
poor mobility but manages with a walking frame. While
revealed that he had contracted Hepatitis recently. On
Josh was assisting Mrs King into bed, she let go of her
investigation, it was discovered that he had contracted
walking frame and misjudged the distance to the bed.
Hepatitis from Mrs King. He received a verbal warning
She stumbled and fell to the floor, hitting her head as
for failing to comply with company policy.
she did so.
1. How should have Josh dealt with this situation?
Josh went to her assistance and noticed blood coming
2. Was it right for Josh to be punished for being ‘a
from her head; he put his hands into his pockets for his
good samaritan’?
gloves and discovered that he has used them all. He
3. Has Josh broken any laws?
decided Mrs King was of low risk, so grabbed a clean
4. Should Josh have known Mrs King was high risk
cloth and held it to her head. As he did this, a small
and would this have made a difference?
amount of blood entered one of the cuts in his hands.
Doing it well
Removing potentially infected PPE
•• Avoid touching the contaminated surface.
•• Remove the items before moving to the next patient.
•• Place the items in the correct waste containers ready for collection.
•• Decontaminate reusable equipment such as goggles and visors.
•• Return decontaminated items to their correct storage
accommodation.
•• Inform your manager if any PPE is damaged or stock levels are low.
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good personal hygiene in the
infections
6.1 Key principles of good personal
hygiene
As a care worker, you are a role model and need to set a good
example because you have a vital role to play in the prevention and
control of infection; this starts with your own personal hygiene. You
should ensure that you wash, shower or bathe and wear a clean
uniform for work every day. Fingernails need particular attention
because they can harbour bacteria, and you should ensure that they
are kept short, clean and free from nail polish or false extensions.
Hair does not normally pose an infection risk if it is kept clean and
should be washed on a regular basis. If you have long hair, it should
be tied back away from your face and products such as hairspray
should be avoided.
Jewellery should not be worn for work because items such as rings
and watches can harbour bacteria and could scratch the patient.
However, for some people it is unacceptable for them to remove their
wedding ring, so most policies permit a single plain band ring. This
should be the only exception and no other rings should be worn.
Bracelets, necklaces, dangling earrings and facial piercings should also
be removed to prevent the risk of cross-infection and to help prevent
you from scratching the patient; it also makes you look professional!
You should take every opportunity to promote and encourage good
personal hygiene for the people you provide care for. You should
encourage people to wash their hands after toileting activities, and to
wash every day. You should offer people the opportunity to bathe or
shower, if it is appropriate to their condition.
Doing it well
Preparing for work
•• Wash and ensure your face and hands are clean.
•• Do not apply make-up too heavily, if you wear it.
•• Ensure your uniform is clean.
•• Check your nails are well trimmed, clean and free from polish.
•• Keep your hair clean and, if it is long, tie it back.
•• Remove jewellery, except for stud earrings and a plain-band
wedding ring.
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6.2 Good hand-washing technique

Hand-washing is the single most important aspect of the prevention
and control of infection, yet it is still the most neglected practice
undertaken by care workers. Poor and ineffective hand-washing can
result in pathogenic organisms being transferred from one patient to
another or from part of the patient to another, such as from an
infected wound to a catheter site.
To reduce the risk of cross-infection, a good hand-washing technique
is required because it is well known that effective hand-washing can
significantly reduce the presence of pathogenic organisms on the
hands.
It is easy to develop an effective hand-washing technique and
dramatically reduce the spread of infection within the healthcare
setting.
An effective hand-washing technique aims to remove dirt, organic
material and pathogenic organisms such as those found in blood,
faeces and respiratory secretions such as phlegm. The duration of
the washing is extremely important because effective hand-washing
involves both the physical action of rubbing the hands together
and the chemical actions of the anti-microbial agent in the hand
wash solution; hand-washing should not just be a quick rinse
under the tap!
Once the hands have been washed, it is important that they are dried
thoroughly with absorbent disposable paper towels, as the friction
generated when drying is beneficial for removing any remaining
bacteria on the hands. Hot air blowers and communal hand towels
should be avoided as both these increase the risk of transferring
pathogenic organisms back on to the hands.
6.3 The correct sequence for hand-

washing
When washing your hands, it is important to have a sequenced,
step-by-step approach to help reduce the risk of missing an area of
skin. Before starting the hand-washing sequence, you must ensure
you are fully prepared and have everything you need. Once you are
ready to start, you should follow these steps.
1. Remove watches and rings.
2. Select the correct water temperature, as it needs to be
comfortable enough for you to place your hands underneath
without having to withdraw them because it is too hot or too
cold.
3. Wet both hands.
4. Apply a full measure of hand wash solution, but not too much,
and rub the palms of the hands together.
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5. Rub one hand over the back of the other, remembering to rub in
the spaces between the fingers.
6. Rub the finger tips together to clean the tips, the back and the
front of the fingers.
7. Rub the finger tips in a circular motion against the palm of the
opposite hand and then swap. If a wedding ring is being worn,
pay attention to this area and ensure you wash under the ring.
8. Interlock the thumbs ensuring that the thumbs and the wrists
have contact with the hand wash solution.
9. Once all the surface of the hands have been washed, ensure the
hands are thoroughly rinsed to remove any soap residue, as this
can make the skin sore and dry.
10. Depending on the type of hand-wash activity being undertaken,
steps 4–9 may need to be repeated.
11. Turn taps off using the elbows or foot pedal; some modern taps
turn on and off automatically when movement is detected by a
motion sensor.
12. Thoroughly dry the hands on absorbent disposable paper towel.
See pages 213–214 for more on hand-washing.
6.4 When and why hand-washing should

be carried out
Hand-washing activities must be performed regularly to help prevent
and control the spread of infection, but there are certain times when
it is recommended that care workers wash their hands. These are:
Key term
•• before putting on a clean uniform or PPE
Aseptic – without sepsis or being •• before any aseptic procedure
free from disease-causing micro- •• after patient contact
organisms •• after removing PPE
•• after going to the toilet
•• before handling food
•• after finishing work.
Before washing your hands, you will need to consider the hand-
washing method required for what you have just done or for what
you are about to do. There are three types of hand-wash methods
used within healthcare settings:
•• routine hand-washing using soap
•• disinfectant hand-washing using an anti-microbial agent
•• aseptic hand-washing using a surgical scrub solution such as
Hydrex or Betadine.
For example, if you have just assisted someone to the toilet and have
removed your gloves, you will need to perform a routine hand-wash,
but if you are going to assist during an invasive procedure such as
cannulation, you will need to perform a disinfectant hand-wash.
286
Care workers who work in the community may not have access to
soap and water to perform hand-washing activities. In situations such
has these, you should use hygienic wipes to remove any physical
debris from the hands and then apply an alcohol-based gel. Care
workers working in the community should ensure that alcohol-based
gel is applied prior to putting on and after removal of gloves. This
should be done in front of the person being assisted, to help promote
trust in the care profession.
6.5 Types of products that should be used

for hand-washing
There are many different types of hand-wash solutions on the market
and your employer will purchase the one which they believe best
meets their requirements, but some general points to consider are
discussed below.
General hand-washing soap

This type of soap is used for routine hand-washing and should be in a
dispenser unit not a bar, because bars of soap harbour bacteria and
can lead to the spread of infection. This type of soap has a minimal
ability to destroy micro-organisms and is only useful for removing dirt,
grease and loosely adhered micro-organisms.
Disinfectant hand-wash
Hand-wash solutions for disinfectant hand-washing procedures such
as 2 per cent Chlorhexidine gluconate soap solution is commonly
used in clinical areas for clinical purposes. It provides a significant
residual activity and can be used for general and disinfectant hand-
washing activities.
Surgical scrub solutions

Activity 9 Scrub solutions such as Povidone Iodine (Betadine) and 4 per cent
Chlorhexidine gluconate (Hydrex) have a high residual activity and
Hand-wash products should only be used for aseptic procedures, as these solutions can
There are a number of hand-wash lead to dry skin and irritations.
products on the market for you
to use.
Alcohol gel
1. What hand-wash products are
Hand gel containing 60–70 per cent alcohol kills 99.9 per cent of all
available within your workplace
bacteria and most gels contain moisturisers, emollients and skin
and are these available for you
protectors to help prevent the skin from drying out. These products
to use?
are not a substitute for hand-washing, but can be used in the
2. What are the benefits of each
community where sinks and soap are unavailable immediately after
of the products available?
direct patient contact. These gels are also effective in care
environments and can be applied after routine hand-washing.
287
6.6 Correct procedures that relate to

skincare
Maintaining healthy skin is an important step in the prevention and
control of infection. However, constant washing and the wearing of
gloves can cause the skin to dry out. To help prevent this, moisturising
cream should be applied to the hands following routine hand-
washing procedures. Gloves should not be worn when they are not
required – for example, when completing paperwork. General skin
Key term care should also include ensuring any cuts or grazes are covered with
Occlusive – something that closes, an occlusive dressing prior to patient contact.
such as a bandage or dressing that
If you notice that your skin has started to become sore, you should
closes a wound and protects it from
report this to your manager, but you should not stop practising good
the air
hand hygiene practice. If the condition continues to worsen, you
should contact your GP, who may refer you to a dermatologist for
patch testing. Latex gloves are known to cause reactions, so close
observation and reporting of any adverse reaction is extremely
important. Any reaction to hand-wash solution, gel or after wearing
gloves should also be recorded in an incident book or in accordance
with workplace policy.
Case study
Allergies to hand-wash products

Suzy works in a day procedure department at the local Chlorhexidine, an anti-microbial agent used in some
hospital. Her standards of care are very good and she hand-wash products.
always washes her hands between any patient contact.
When Suzy returns to work, she explains what has
However, Suzy has recently noticed that the areas in
happened to her manager, who asks her why she had
between her fingers are becoming sore after wearing
not reported the symptoms sooner. Suzy’s manager
latex gloves, so she decides to stop wearing the gloves
explains that there are alternative products available for
but continues to wash her hands between patient
Suzy to use and that these could have been used earlier
contact.
if she had informed the trust sooner.
The sores on Suzy’s hands do not improve and actually
1. At what point should Suzy have informed her
start to get worse. The skin between her fingers
manager?
becomes itchy, has started to crack and weep fluid.
2. Was she right to stop using the latex gloves?
Suzy decides to go and see her GP, who tells her that
3. What risks do her hands pose to others?
they think she has developed a contact dermatitis and
4. Will Suzy be able to work in this acute setting
refers her to a dermatologist. The dermatologist does a
and why?
patch test and discovers that Suzy has an allergy to
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LO1 term ‘risk’ means. They will want you to demonstrate
This outcome requires you to demonstrate your an awareness of potential risks of infection within the
knowledge of the responsibilities of employers and workplace. You could do this my completing an
employees in relation to the prevention and control infection audit, where you identify potential infection
of infection to your assessor. You could demonstrate risks within your work area. The audit could be taken
your knowledge by making a list of the employer’s one step further by describing the steps carried out
responsibilities and the employee’s responsibilities. during a risk assessment. Finally, you could write a small
report which explains why performing a thorough risk
LO2 assessment is important.
For this outcome, your assessor will need to be satisfied
LO5
that you know current legislation and policies relating
to the prevention and control of infections. To This outcome will require your assessor observing you
demonstrate your knowledge, you could make a list correctly selecting, putting on, removing and disposing
of some key legislation and write a short account of personal protective equipment (PPE). Your manager
explaining how the legislation impacts on infection or a senior care worker may write a witness testimony
control. You could also read your workplace infection to support the assessor’s observation. You will also
prevention and control policy and list the key points. need to explain to the assessor why PPE needs to be
There is no need to put a photocopy of the policy in worn and the responsibilities, relating to it. To do this
your portfolio. you could list the PPE you are expected to use and
explain the reasons for this. To describe responsibilities
LO3 surrounding PPE, you could list your responsibilities and
Your assessor will need you to demonstrate your your manager’s responsibilities or you could produce a
knowledge of systems and procedures within your poster or a spider diagram to show these
workplace that relate to the prevention and control responsibilities.
of infection. This could include cleaning policies
LO6
and procedures. To provide your assessor with this
information, you could explain the cleaning regime This outcome will require your assessor observing you
adopted within your workplace and the role which you washing your hands using an effective hand-washing
play. You also need to explain the potential impact an technique. While you are washing your hands, you
outbreak of infection could have on the person or the could explain to the assessor when you should perform
organisation. To help you to do this, you could look at hand-washing and describe each step of the procedure.
newspaper articles about people who have suffered You may also want to produce a hand-washing guide
from MRSA or other infections; you may also find for a new member of staff. The guide could start by
information on the Internet and discuss how the describing why personal hygiene is important for both
infection has changed their life. You could try to look staff and patient, and then list the times when hands
at government papers to find out the potential cost to should be washed, the products available to do this and
healthcare organisations when there are outbreaks of the correct sequence for hand-washing. The guide
infections. good finish with some ‘top tips’ on hand health, where
you can describe correct procedures for skincare,
LO4 including any skincare products that could be applied to
This outcome focuses on risk assessments and your the hands.
assessor will want you to tell them what you think the
289
Legislation
•• Control of Substances Hazardous to Health Regulations (COSHH)
2002
•• Food Safety Act 1990
•• Hazardous Waste Regulations 2005
•• Health and Safety at Work Act 1974
•• Health and Social Care Act 2008
•• Health Protection Agency Act 2004
•• NICE Guidelines 2 2003
•• Public Health (Control of Diseases) Act 1984
•• Public Health (Infectious Diseases) Regulations 1988
•• Reporting of Injuries, Diseases and Dangerous Occurrences
Regulations (RIDDOR) 1995

•• www.hse.gov.uk (Health and Safety Executive)
•• Serginson, E. and Torrance, C. (2004) Surgical Nursing, Bailliere
Tindall
•• Ayling, P. (2007) Infection Prevention and Control, Pearson
Education
290
Unit HSC 2002
Provide support
for mobility
Keeping mobile is extremely important for a person’s health

and for giving them a feeling of well-being. Keeping mobile
through activities such as exercise has both physical and
emotional benefits and can help to reduce the risks to health
caused by immobility. You will need to know about how to
maintain people’s mobility, despite their age or infirmity, or the
level of disability or difficulties they may experience. It is
important that you are able to offer them encouragement and
to help them to exercise to their maximum potential.
Mobility appliances help with walking and getting around, and
can make a major difference to someone’s life. Being able to
stay mobile allows people to maintain their independence and
avoid relying on human assistance. There is a world of
difference between being able to go where you want, when
you want to, even if you go there very slowly, and having to
wait while someone else makes special arrangements.

1. the importance of mobility
2. how to prepare for mobility activities
3. how to support individuals to keep mobile
4. how to observe, record and report on activities to support
mobility.
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Activity 1
mobility
Considering mobility 1.1 The definition of mobility
Mobility can mean different thing The term ‘mobility’ means different things to different people. For
to different people. Take a few some people, mobility is being able to go out when they want to and
moments to consider what mobility where they want to. For others, mobility is being able to get from one
means to you, then ask your place to another by any means to maintain their independence – for
friends and colleagues what example, getting from the living room to the kitchen to make a cup
mobility means to them. Finally, of tea or going to the toilet on their own. Maintaining mobility is vital
ask somebody whom you support as people grow older. It can make the difference between an active
what mobility means to them. Are old age and one spent sitting in a chair or shuffling around. Whatever
all your definitions the same? How mobility means to you, it is important that you check with people
would you define mobility? what mobility means for them.
1.2 How different health conditions may

affect and be affected by mobility
There are many conditions that can affect a person’s mobility as they
become older and the joints of the body become worn. Not all
mobility problems are caused by age; some people are born with
health conditions that can affect their mobility. Mobility may also be
affected following an accident or illness. Some people develop
conditions that affect the muscles and ligaments connecting to
bones, so they cannot move around easily. Some people may not be
able to control their movements well, or the muscles may be too
weak to support their weight.
Fractured bones
Throughout life, the bones in the body constantly change; this is
because they are living structures that become damaged through
Depending on age and health, broken everyday wear and tear. Most people’s bones will repair themselves
bones may take longer to heal.
by growing new bone if they are damaged. If a bone is broken, it will
probably need to be held in place, so that it mends in the right
position, which might mean wearing an awkward plaster cast. It may
take a while, but eventually the person will be back to normal, doing
Key term everything they did before. However, many older people, especially
Osteoporosis – condition women, may suffer from osteoporosis, which can cause bones to
associated with ageing in both men break very easily and which may take longer to mend.
and women where there is a loss of
bone density caused by excessive
Arthritis
absorption of calcium and Arthritis is a painful condition where one or two joints become
phosphorus inflamed and swollen, become tender, warm to touch and painful on
movement. There are two main types of arthritis:
•• osteoarthritis
•• rheumatoid arthritis.
292
Provide support for mobility Unit HSC 2002
Osteoarthritis is a degenerative condition where the cartilage covering

the ends of the bone surfaces becomes worn and damaged. This may
result in pain on movement because the bone surfaces may rub on
each other. Joints commonly affected by osteoarthritis are the hip,
knee and shoulder joints.
Rheumatoid arthritis commonly affects many smaller joints before
affecting the larger joints, and results in varying degrees of deformity.
The condition is also associated with muscle wasting at the joints. This
condition does not only affect the joints, though, and many doctors
now prefer to call it ‘rheumatoid disease’.
Severe arthritis of the hands can make it harder for a person to grip a walking
stick or hold on to grab rails.
Cerebral palsy
Cerebral palsy is a condition that typically occurs at or shortly after
birth, resulting in a range of mobility conditions ranging from
clumsiness to severe muscle rigidity.
Muscular dystrophy
Muscular dystrophy presents in early childhood and is a muscle-
wasting condition that results in loss of strength, increasing disability
and deformity.
Stroke
A stroke is when the blood supply to part of the brain is cut off as a
result of either a bleed or a clot leading to damage and/or death of
brain tissue. As the brain controls everything the body does, damage
to the brain will affect the body’s functions. For example, if a stroke
damages the part of the brain that controls how limbs move, mobility
will be affected.
293
Multiple sclerosis
Multiple sclerosis (MS) is a progressive disease of the central nervous
system where the protective sheath around the nerves, myelin,
becomes damaged and interferes with the messages sent from the
brain to the rest of the body. MS most commonly affects young
adults. As the condition progresses people may experience mobility
problems such as dizziness, muscle spasms and tremors.
Parkinson’s disease
Parkinson’s disease is an incurable disease which affects certain nerve
cells in the brain. Damage of these cells can affect a person’s mobility
by causing tremors, slow movement and rigidity of the limbs.
Not all mobility problems are caused by age.
Amputation
Amputation of a limb can occur at any age for reasons such as
disease or trauma from an accident. Amputation of a leg can make
walking difficult, even with an artificial limb.
Operations
Operations can have a large impact on a person’s mobility because of
pain or because the patient may feel too frightened to move in case
their stitches burst.
294
1.3 The effects that reduced mobility may

have on an individual’s well-being
People may have difficulty in moving around because of their age or
health. Some people may not want to mobilise because it causes
them pain or discomfort. However, sometimes a person’s lack of
mobility can cause other problems.
Effects of reduced mobility

Reduced mobility can lead to minor problems such as stiff, painful
joints, weak muscles and weight gain from not being able to exercise.
The effects of reduced mobility can create a vicious circle where it
gets even harder to keep mobile and may lead to a person becoming
Key term immobile. Immobility can have serious implications and may cause
Deep vein thrombosis (DVT) – a other serious conditions such as deep vein thrombosis (DVT) or
clot that forms in the deep veins of chest infections which can both be life-threatening.
the body, usually the leg veins. If the
clot moves it could get stuck in a
Discomf
blood vessel going to the lungs. If obile ort
Imm o nm
the clot is large enough, the patient se ov
could die or i ng
w
ts
ge
M
h
ov
alt
el
He
ess
ess mobile
Joints and musc

ingly l
eas
les
n c r
a
ei
ch
e
m
co
Be
M
ov
r ee
ke ve
wea n le
e ss
Muscles becom
The more discomfort a person experiences, the less they want to move
around. How might this create a vicious circle?
Whether you are employed in the health or social care sector, you will
be required to work as part of the multidisciplinary team to help
prevent people who have reduced or limited mobility from acquiring
more serious conditions associated with immobility.
295
A mobility support plan should be completed for all patients with

Activity 2 restricted mobility and any risks to the person should be identified.
Effects of reduced For example, risks from reduced mobility could include:
mobility •• chest infections
There are a number of effects that •• urine infection
reduced mobility can have on •• swollen feet and ankles
people. Some of these are common •• loss of independence
effects; some are more common in •• wound infections
health settings than social care •• pulmonary embolism
settings and vice versa. Think about •• deep vein thrombosis
the setting where you work and •• depression
identify the effects that reduced •• constipation
mobility can have on a person’s •• pressure sores.
well-being. The person’s mobility support plan should be followed and regular
mobility activities completed to reduce the risks. These activities may
include:
Functional skills •• getting out of bed and sitting in a chair
English: Speaking and •• regular turning of a patient who is unable to turn themselves
listening •• use of specialised equipment such as triple wave pressure-relieving
mattresses, surgical stockings and electronic or pneumatic calf
Have a discussion with some of your stimulators
team about how reduced mobility •• gentle breathing exercises
can affect a person’s well-being. •• encouragement.
Ensure that you take an active role in
the discussion and that you speak 1.4 The benefits of maintaining and
clearly to get your points and
opinions across. Pick up on points
improving mobility
raised by others to show that you Properly designed mobility activities can have a range of benefits for
have listened to what they are people, both physically and psychologically. For example, if people are
saying. encouraged to undertake everyday activities such as getting up from
a chair, walking across a room, washing, dressing, and going up and
down stairs, they are more likely to keep their joints supple and less
likely to become dependent on others. This is why it is important to
encourage people to be as mobile as possible within the limits of their
physical condition. People who have undergone surgical procedures
also need to be encouraged to become mobile as quickly as possible
following surgery, to reduce the risk of acquiring infections and to
regain their independence.
Maintaining mobility does not have to mean a specially designed
exercise programme; just remaining active will help. Moving around
the house, preparing a meal or taking a walk are all valid forms of
exercise which, as a care worker, you must encourage people to try
to maintain. Maintaining their mobility can also help people to
maintain their independence.
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Improved social life

A person who is in pain may not want to talk very much. This can
stop them from making friends and they may become lonely.
Encouraging people to take part in fun mobility activities will help
them to enjoy themselves. Working as a group may help people to
talk with each other, and to develop friendships.
Disability does not have to mean no mobility. If a person feels healthy
and is not in pain, then gentle exercise can help them to feel good
about themselves. They may want to do more for themselves which
will give them more independence. Being as independent as possible
makes people feel good, as they will not feel a burden to others.
Some mobility activities such as exercise can be part of a formal
programme which has been assessed by a physiotherapist, or it could
be a specific form of exercise designed to increase mobility or to
improve strength, stamina or suppleness. But more importantly,
mobility activities should include the simple day-to-day activities that
everyone carries out which involve some form of physical movement.
At its simplest, exercise is the contraction and relaxation of muscles in
order to produce movement. These muscle movements use energy
and raise the heart rate and breathing rate. These increased heart and
breathing rates strengthen the cardiovascular system, while the
movement itself tones and strengthens the muscles.
Case study
A healthy lifestyle
Strawberry Mill is a hostel for people with mental health taking the hostel dog for a walk, instead of leaving it to
problems. The effects of medication and the previous the officer in charge! Some residents also decided they
lifestyles of several residents have contributed to the would try to stop smoking and stop eating so many
fact that most of the residents (and staff) are unfit. At a sweets and chocolates.
house meeting, it was decided to start a fitness
1. What would you expect to be the results of this
programme. The residents decided to call it ‘Best Foot
programme?
Forward’. It was decided to hold an exercise class every
2. What other activities could the group try?
other evening, with a basic exercise video for everyone
3. How can they keep motivated to carry on?
to follow. They also decided that everyone would walk
4. What other benefits may come from this
to the shops instead of getting a lift or using the bus for
programme?
just two stops, and that there would be a rota for
Maintaining and improving mobility can have many benefits, both

physically and psychologically, including:
•• more flexible joints •• improved social life

•• better breathing •• independence
•• reduced risk of infection •• more confidence
•• improved cardiovascular •• improved self-esteem
system •• less pain
•• stronger muscles •• reduced embarrassment.
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2. Be able to prepare for mobility

activities
2.1 Agreeing mobility activities with the
individual and others
When agreeing mobility activities with people, it is important to
remember that they may already have a programme which has been
devised by a physiotherapist, or another specialist such as an
occupational therapist or even a doctor, to meet a specific outcome.
If this is the case, the activity must be carried out exactly as it has
been planned.
You must ensure that:
•• the mobility activity is detailed in the plan of support and that it is
followed accurately
•• the person is given encouragement and support to follow the
programme
•• progress is carefully recorded, and achievement is recognised and
celebrated
•• any problems are immediately reported to your manager and to
the professional who designed the programme.
If you are assisting a person to follow a programme designed by a
physiotherapist, your role may be quite clearly defined. There may be
times when you need to lend physical assistance or you may be
required to assist in the case of exercise aids which are used as part of
the programme. For example, someone who has had a stroke may be
squeezing a rubber ball in their hand in order to strengthen the arm
and hand muscles on one side of the body. Your job may be to count
the number of repetitions of an exercise.
However, if you are simply trying to persuade someone to be more
active by encouraging them to move from one room to another, or to
start to mobilise following surgery, you will need to work with them
to identify and agree the best ways they can keep mobile. You should
encourage them to communicate their preferences about keeping
mobile with other family members, friends and care professionals
such as your line manager, fellow care workers and physiotherapists.
You should also record this information on the support plan.
2.2 Removing or minimising hazards in the

environment before a mobility activity
Before starting a mobility activity, you must ensure that a person can
undertake the activity in a safe environment, and that a risk assessment
has been carried out in relation to the activity and the person.
298
Doing it well
Risk assessments for activities
This will include checking: If the activity is being carried out by someone in bed,
check that:
•• that the floor surfaces are safe and dry to reduce the
risk of falls •• it is stable and steady
•• that there is nothing that can be tripped over or that •• the bed brakes are firmly on.
could cause injury
If the activity is being carried out by someone following
•• what support, if any, a person will need
surgery, check that:
•• how many professional carers need to be involved
with the activity •• catheter bags and drains are off the floor and out of
•• the actions to be taken in an emergency. the way of the patient’s feet
•• drip stands are stable, steady and free moving.
If the activity is being carried out by a person sitting in a
wheelchair, check that: If the activity is being carried out by a person using a
walking aid, check that:
•• the wheelchair is absolutely stable and steady
•• the brakes are firmly on. •• the aid is being used properly
•• the aid has been measured correctly to make sure it
is the correct size.
2.3 The suitability of an individual’s

clothing and footwear for safety and
mobility
The clothes that a person wears must be appropriate for the activity
they are about to undertake. It is no coincidence that the tracksuits
and trainers worn by athletes for many years have now been adopted
as regular wear by people relaxing or taking part in leisure exercise, as
Reflect they are so comfortable and easy to wear.
Think about how you make your This type of clothing may be suitable for all kinds of people
work environment safe before undertaking mobility activities. You will need to make sure that shoes
undertaking mobility activities with are firm, comfortable and offer support, and that any exercise which
the people you help to support. involves standing or moving the feet is not carried out in loose or
What do you do if you notice ill-fitting shoes or slippers, but in firm, well-fitting, well-supporting
something is wrong or unsafe? shoes with safe, non-slip soles. The correct clothing also helps to
maintain people’s dignity, as they need not fear that the exercise will
involve them in exposing parts of themselves which they would rather
keep covered!
2.4 The safety and cleanliness of mobility

equipment and appliances
There are particular ways of using the various mobility appliances in
order to get the maximum benefit from them. It is important that you
ensure that people are using them in the correct way, because
otherwise they are likely to cause injury or discomfort.
299
It is also important to explain to people how different floor surfaces

and floor coverings affect the use and safety of appliances. Make sure
that you check the risk assessment which will have been carried out in
relation to the person and the use of the appliance. This will have
been recorded in their support plan, and you should always make
sure that the person is using the appliance in accordance with the risk
assessment.
It is also very important to remember that each appliance should be
cleansed with the appropriate cleansing agent to minimise the
chances of cross-infection between use.
Walking sticks
Measuring a walking stick
To measure a stick correctly, you need to ask the person to hold it in
the hand which is opposite to their ‘bad side’, if they have one. If the
weakness or pain is not located in a particular side of the body but is
more general, for instance spinal problems, the person should use the
stick on the side of the body which they would normally use most –
the right-hand side for right-handers, the left-hand for left-handed
people.
You should ensure that the person’s hand is at the same height as
the top of their thigh when it is resting on the stick handle. The
elbow should be slightly bent, but make sure that the shoulders are
level and that one side is not pushed higher.
Do you check the safety and cleanliness

With an adjustable metal stick, you will be able to measure fairly
of mobility equipment and appliances on easily by sliding the inner part of the stick up and down until the
a regular basis? correct height is reached. The metal button will then snap into place
in the guide holes.
With a wooden walking stick, you will need to measure the correct
Key term height and then the person responsible should saw the stick to the
Ferrule – rubber foot on the proper length, making sure that the rubber ferrule is firmly attached
bottom of a walking frame or to the bottom of the stick. It is important that you check that the
stick ferrule is in good condition because if it becomes worn or the
suction ridges have become smooth, the stick is likely to slip when
leaned on.
Quadrupeds or tripods
A quadruped should only be used for a person who has considerable
difficulty in walking on one particular leg, either because of hip or
knee degeneration or a stroke. It is not an appropriate aid for
somebody who is generally unsteady.
Measuring a quadruped or tripod is exactly the same procedure as
measuring a walking stick. Quadrupeds are made from metal and are
adjustable. You should check that the three or four small ferrules,
which are on the suction feet, are safe and not worn.
300
Walking frames
A person should be provided with a walking frame when they need
considerable support from one or two care workers and are no longer
steady on a walking stick or quadruped.
Functional skills Measuring a walking frame
Maths: Analysing and Walking frames are measured in the same way as walking sticks. They
interpreting are usually adjustable in height between 28 and 36 inches (71 and 91
Measure the height of a person you cm), although they do come in different sizes with a range of 3–4
support and calculate the height inches (8–10 cm) alteration within each frame.
needed for their walking frame. To reach the correct height, the person should stand against the
Carry out this activity for a number frame, holding it and leaning slightly forward. The feet should be
of people and document your level with the back legs of the frame and the arms only slightly bent.
findings in an organised way. Use a
If a walking frame is too small, you will see the person hunched
minimum of five sets of calculations
forward at the frame. If the elbows are very bent and the shoulders
to work out the mean and range of
are hunched up, the frame is too tall.
the frames required for people in
your workplace. You will also need to check that the ferrules are in good condition on
each leg.
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3. Be able to support individuals

to keep mobile
3.1 Promoting active participation during
a mobility activity
Active participation is a way of working that recognises a person as
Activity 3 an active partner in their own care or support, rather than just a
Putting yourself in passive recipient of care. It puts the person at the centre of their care
someone else’s shoes and involves them in decisions taken about them. Before active
participation, many users of care services felt that they were not
Imagine you are a recipient of care. being listened to and that paperwork was more important than the
For example, you might be in person.
hospital with a broken leg. Imagine
the care team do everything for An important aspect of active participation is to listen to what users
you: they wash you, place you on a of a service want and responding to their needs. People who use care
bedpan when you want to go to services should not have their needs come second place to the needs
the toilet, choose your meals, tell of the service provider.
you what time to turn the light off As a care worker, it is important to promote active participation
and what time to go to sleep. throughout everything you do, including mobility activities. This can
1. How would you feel about not be achieved by offering people choice about the type of mobility
being offered any choice? activity they would like to be involved in, where they want to do the
2. How would you want to be activity and at what time.
treated?
3.2 Assisting an individual to use mobility
appliances correctly and safely
Mobility appliances will be recommended by an appropriate
professional, either a physiotherapist or occupational therapist. This
professional will have explained to the person how the appliances are
to be used, and there will have been an opportunity to try them
under supervision. However, you will need to reinforce the advice and
continue to support people until they are confident and are using
appliances correctly.
Using a walking stick

Depending on how much support a person needs, there are two
generally recommended ways of using a walking stick. The method
for a person who needs a considerable degree of support is as
follows.
1. Move the stick forward, slightly to one side.
2. Take a step with the opposite foot, going no further forward than
the level of the stick.
3. Take a step with the foot on the same side as the stick. This
should go past the position of the stick. Then move the stick again
so that it is in front of you, and repeat the sequence.
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For a person who needs less support – for example, if they are just
using a stick because of lack of confidence or are just generally a little
unsteady – move the stick and the opposite leg forward at the same
time. Then move the leg on the stick side forward past the stick.
Repeat the sequence.
For a person who needs considerable support, walking with a walking
stick may require some practice. You may find that there is a natural
progression in people who are improving their mobility and that, as
they get better, they will automatically begin to move their leg and
the stick at the same time. They should be encouraged to do so.
If you need to provide physical support for somebody who is walking
with a stick, you should give it from behind and you should support
with one hand on each side of the pelvis, just below the person’s
waist.
If you find that you need to offer this kind of help on a regular basis,
you should consider suggesting an increase in the degree of walking
support the person is offered. It is far better for them to have a more
supportive walking aid than to rely on help from a care worker.
Using a quadruped
The quadruped should be held in the opposite hand to the person’s
‘bad side’.
Move the quadruped forward, and then take a step with the opposite
foot. Then take a step with the foot on the same side as the
quadruped so that it is either at the same level or slightly in front of
the quadruped, and then repeat.
If you find that someone’s condition is improving and they have
started to put the quadruped and the opposite leg forward together,
rather than after each other, then they should be moved on to a
walking stick, as the support offered by a quadruped is no longer
needed.
Using a walking frame

It is important that a person follows the proper pattern of walking in
order to get the maximum benefit from a walking frame. If there are
difficulties, or if the person uses a frame in the wrong way, it can be
quite dangerous and may cause a fall or other injuries.
Put the frame forward so that the person can lean on it with arms
almost at full stretch. They should then take a step forward – if they
have a ‘bad side’, step first with that leg; if not, then either leg.
The next step should be taken with the other leg walking past the
first leg. Repeat the sequence.
It is essential that you ensure that the frame has all four feet on the
ground at any point when the person is taking a step.
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Offer additional assistance if it is needed. It should be offered from

behind the person, as giving assistance under one arm is not possible
when a person is using a walking frame.
A walking frame with wheels is also available in various styles. This
means that the walking pattern is not interrupted in the way it is with
an ordinary walking frame. This is very useful for people who are too
confused to be able to cope with learning the walking pattern for an
ordinary walking frame. It is also useful for people who have
particular arm or shoulder problems, which mean they cannot lift a
frame. The assessment of the suitable height for a frame with
wheels is carried out in exactly the same way as for an ordinary
walking frame.
Wheelchairs
Where an assessment has been made that a person requires a
wheelchair, they are entitled to have a wheelchair of their own which
will be correctly measured and assessed by a physiotherapist.
Wheelchairs come in a range of sizes and styles. They include chairs
which have to be pushed, chairs which people can propel themselves
and electric wheelchairs. Many younger people with disabilities have
very clear views about the types of wheelchair they will use, the
amount of equipment and additions that they have on their
wheelchair, the colours they are decorated in and the speed at which
they travel around in them! Regardless of age, a person’s choice of
wheelchair style must be respected.
A person’s choice of wheelchair style must always be respected!
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Mobility scooters
Many people who want to be able to get out and about, but have
mobility problems when outdoors, can use powered scooters to get
around. Most large shopping centres have a ‘shopmobility’ centre
where powered scooters can be borrowed or rented to make
shopping easier. Similarly, many theme parks and large public
attractions offer scooter facilities. Scooters can be very useful in
supporting people in maintaining their independence and their ability
to make local journeys without assistance.
The use of wheelchairs should not be seen as negative. Many people
with disabilities have described how getting a wheelchair has
increased their mobility to such a great extent that their lives have
been significantly improved. They progressed from slow, painful
movements with walking sticks, where everything was a tremendous
effort, to suddenly being able to move themselves around at will.
The biggest problems experienced by wheelchair users are the result
of other people’s attitudes to them and the limited access available to
most buildings. However, the Disability Discrimination Act 1995 does
make it a requirement of all public buildings to be accessible to
anyone who wants to use them, and this includes people with any
type of disability. The Act adds the phrase ‘where it is reasonable to
do so’, and so this will not be universal. But a large number of
buildings have become more accessible than they have been, and all
new buildings have to be accessible to all.
Activity 4
Wheelchair users
Wheelchair users can often find it difficult to access all the buildings
they would like to. Look around the local area where you live.
1. How accessible are the buildings for users of wheelchairs?

2. Would making reasonable adjustments to these building improve
accessibility?
3. Can you suggest how these buildings could be improved?
You could discuss your findings with wheelchair uses to see if they
have experienced problems accessing the buildings you have identified.
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3.3 Feedback and encouragement to the

individual during mobility activities
One of the most significant factors which affects how well people
carry out mobility activities is whether they feel confident. Supportive
feedback and encouragement can play a major part in helping to
build people’s confidence.
Feedback to people undertaking mobility activities should be given
during and after the activity. The feedback should be constructive and
should identify how the person could improve the activity. For
example, if a person is not using their walking stick correctly, then
you need to provide feedback to them explaining how to improve the
activity next time. However, you must ensure that you do not alter
any aspect of the person’s mobility plan. Giving constructive feedback
and encouragement can promote people’s confidence, and their
dignity.
It may not be necessary for you to assist a person physically in order
to give them support; it may be sufficient for you simply to be there
offering verbal support and encouragement as they carry out the
mobility activity. Your support and encouragement could range from
going along to the local gym to support a person from your setting
who plays in a wheelchair basketball team, to giving words of
encouragement to someone following a stroke who is lying in bed
trying to raise an arm by 2 or 3 inches.
If someone is having problems following the exercises they have been
set because they are too difficult, too strenuous or are causing
discomfort, you must report this immediately to the physiotherapist or
to your supervisor.
Never advise anyone to do an exercise in a different way, even
though it may seem to you that, if they simply moved a little to the
left or to the right, or did it a little bit differently, it would be easier
and less painful. You should never make such a suggestion, as you
could cause injury, or further discomfort or pain to the person. Any
difficulties should be reported to the professional who prepared the
programme.
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4. Be able to observe, record and

report on activities to support
mobility
4.1 Monitoring changes and responses
during a mobility activity
It is essential that you regularly check the progress of anyone who is
using any type of mobility aid or following an activity plan. You
should never assume that any condition will remain static – just
because somebody was walking well with a frame or a stick when it
was given to them does not mean that it is still the most appropriate
mobility aid for the person to use.
Whether a person is following a mobility plan or just attempting to
improve their mobility, it is important to observe them and monitor
for any changes in their mobility. The mobility support plan should
state how progress will be monitored and it should identify the
person’s mobility goal. For example, if someone has begun to regain
confidence or had a mobility aid as a temporary measure while
recovering from an illness or injury, you should encourage them to
Reflect move away from dependence on the aid as soon as possible.
Information contained in people’s If someone has been using a wheelchair temporarily following illness,
records needs to be accurate and you should encourage them with daily exercises to increase their
kept as up to date as possible. Think mobility and stop the use of a wheelchair as soon as possible. If the
about people that you complete use of the wheelchair is permanent, you should still record and
mobility records for. What records monitor the progress of its use to ensure that there are no problems
do you complete and what and the user is coping with adjusting to using the wheelchair.
information do you include?
4.2 Recording observations of mobility
activity
Recording a person’s progress on a mobility activity is important. The
Functional skills
physiotherapist or other care professionals will want to regularly
English: Writing review the progress that is being made so that they can change and
update the programme as necessary. Observations of mobility
Information in records needs to be
activities need to be detailed and kept up to date. You should take
presented in a logical sequence,
careful notes about how many times an activity or exercise has been
using language that is fit for
repeated and whether there is any evidence that flexibility, suppleness
purpose. You need to write your
or strength is improving as a result. If the aim is for the person to
report in a concise and factual way,
become generally more active, you should regularly note in their
and proofread it.
records the differences that a more active approach is making to their
general level of fitness, alertness and mobility.
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4.3 Progress and/or problems relating to

the mobility activity including choice of
activities, equipment, appliances and the
support provided
Once a person’s progress on mobility activities has been monitored
and recorded, it is important to report any progress or problems to an
appropriate person. This person may be your line manager or a care
professional.
Doing it well
Reporting progress on people’s mobility
•• Ensure the report is factual based on what you have seen and what
the person has told you.
•• Include information about how well the person is doing with the
planned activities and any improvement in their mobility or ability to
cope with the activities.
•• Be aware of any particular difficulty a person is having in using a
mobility aid, and you should report any of those problems
immediately. It could be that a reassessment will be needed and a
different type or size of aid will need to be provided.
•• Report any problems like shortness of breath, dizziness or pain
following mobility activities without delay.
You may be required to report your findings in the person’s mobility

support plan; however, if there has been a problem with a piece of
equipment or a mobility appliance, you may need to complete an
incident form, especially if the person suffered from a fall as a result
of faulty equipment. This is a legal requirement under the Reporting
of Injuries, Diseases and Dangerous Occurrences Regulations 1995,
which is part of the Health and Safety at Work Act 1974. If you notice
any signs of damage or wear, you must immediately stop the person
from using the aid. Report the fault at once and make arrangements
for a replacement or repair.
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LO1 LO3
Maintaining and improving mobility have a number of There is a variety of ways that you can use to support
benefits to people. To show your assessor that you people during mobility activities. Your assessor will
understand the benefits of mobility, you could draw a want to see that you are able to support people to keep
spider diagram to identify the possible benefits for mobile. To help prepare for this, you could produce a
people from the setting where you work. You could workplace guide on how to support people to keep
then write an account that describes the benefits you mobile. You could also ask your line manager or a
have identified in the spider diagram. Remember to senior member of staff to write a testimony to support
maintain confidentiality. your knowledge.
LO2 LO4
For this learning outcome, you need to demonstrate to This outcome requires you to be able to observe, record
your assessor that you are able to prepare for mobility and report on activities to support mobility. You will
activities. To help you prepare for this assessment, think need to show your assessor how you monitor, record
about the people you support. What mobility activities and report your findings on mobility activities
do you help them prepare for? How do you agree the undertaken by people. You can prepare for assessment
mobility activity and how much support will you give? by identifying the records and reports that you
How do you ensure that the environment and mobility complete for people so you can show your assessor.
equipment and appliances are safe? You could reflect You do not need to photocopy these documents, as the
on the last time you prepared for a mobility activity and assessor will be able to see them, although they should
write an account for your assessor. You could also ask not read the confidential information contained within
your line manager or other health professional, such as the report. You could write an account about how
a physiotherapist, to write a witness testimony to information contained within is used by the care team
support your account. to review a person’s care.
Legislation
•• Reporting of Injuries, Diseases and Dangerous Occurrences
Regulations 1995

•• www.mssociety.org.uk (Multiple Sclerosis Society)
•• www.parkinsons.org.uk (Parkinson’s UK)
•• www.scope.org.uk (Scope)
•• www.stroke.org.uk (The Stroke Association)
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Unit HSC 2003
Provide support
to manage pain
and discomfort
In this unit you will learn about why people who you support
may experience pain and discomfort. There are many reasons
for this – every person is different in what they feel and how
they would prefer to manage pain. You will learn how to
support a person using an individualised and holistic approach
to help to reduce their pain and discomfort.
The person’s pain can change, so it is important that you know
how to keep an eye on this.

1. approaches to managing pain and discomfort
2. how to assist in minimising individuals’ pain or
discomfort
3. how to monitor, record and report on the
management of individuals’ pain or discomfort.
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1. Understand approaches to
managing pain and discomfort
1.1 The importance of a holistic approach
to managing pain and discomfort
Pain is basically whatever the person who is suffering it feels it to be.
Physical pain can be experienced as a result of disease or injury, or
some other form of bodily distress. Childbirth, for example, is not
associated with injury or disease, but can nevertheless be an extremely
painful experience that is different for everyone who gives birth. But
pain is not only physical; it can also be social, emotional and spiritual. It
Key term is therefore important that we consider areas other than physical pain
Holistic – looking at the ‘whole and have a holistic approach.
person’, considering all of their Pain is caused by the transmission of the sensation of pain from the
needs site of the injury, disease or stress along a pain pathway. It is
transmitted through sensory nerve endings along nerve fibres to the
top of the spinal cord and into the brain. There are thought to be
different routes for pain pathways for acute pain, caused by an
immediate injury, disease, inflammation or illness, and for chronic
pain, which is long-standing and continuous.
The feelings linked with these types of pain are often described very
differently. Acute pain may be described as a stabbing or pricking
sensation, whereas chronic pain is more likely to be described as a
burning sensation and is perhaps quite difficult to locate in one
particular spot. Acute pain serves an essential purpose – it is the
body’s warning system that something is wrong or that there is an
Reflect injury. But there is often no obvious purpose to chronic pain. It
Think about times in your life when frequently cannot be cured; it can only be treated so that its effects
you have experienced pain or are reduced as much as possible.
discomfort – for example, Emotions play a huge part in the experience of pain. If someone is
toothache, period pain, headaches, afraid or tense, or has no knowledge of what is wrong, they are likely
burns or following an accident or to experience more pain than someone who is relaxed and knows
injury. Did you know the reasons for exactly what the cause of their pain is. Sometimes the fear of pain
the pain? Can you describe how can make it worse; it can cause additional pain through anticipation.
different the pains were? This is commonly seen in a person who has an illness or injury in
which movement is extremely painful, and they react in anticipation
of being moved. Social pain may also be evident – for example, if the
person who is ill worries about paying bills and supporting their
family, especially if their illness is long term. Spiritually, the person
may feel guilt, regret and anger; this can be particularly difficult for
the care worker to help to support a person suffering such emotions.
Chaplains and other specialists can help spiritually, but care workers
can also give vital support by using their effective communication
skills and by just being there. It may be useful for care workers to
have training in supporting people emotionally and spiritually.
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Provide support to manage pain and discomfort Unit HSC 2003
Case study
Supporting a person with different types of pain

Ferdik is Czechoslovakian. He works for a small local was incontinent of urine and the sheets needed to be
builder to support his wife and three children. Ferdik changed; this was very uncomfortable for him.
does not get paid from his employer if he does not
Because of the physical nature of Ferdik’s job, it was
work; he gets a reduced amount of money from the
clear that he would not be able to go back to work for
government for sick pay. He finds it difficult sometimes
some time. At times he appeared very quiet and
to express what he means, because his English speaking
frightened.
skills are limited.
1. How could the care workers support Ferdik when
Ferdik began to have abdominal pains and he was told
changing his sheets to minimise the physical pain?
he had appendicitis; he was admitted to hospital and
2. What other pain do you think that Ferdik was
had an emergency appendectomy. He was extremely
experiencing?
frightened because things happened very quickly and at
3. How can care workers support the holistic needs of
times he was not sure what was going on. After the
people who suffer pain and discomfort?
operation, Ferdik experienced a lot of physical pain, he
Key terms Doing it well

Appendicitis – inflammation of Supporting people with emotional and social
the appendix
pain
Appendectomy – surgical removal
•• Remember that people do not just experience physical pain; they
of the appendix
may be suffering emotional and social pain as well. For example,
Palliative care – care that relieves they may worry about loved ones and how they will support them
symptoms, but does not cure while they are unwell.
•• Support people holistically by using effective communication skills,
verbal and non-verbal, including active listening to help to support
the person.
•• Appropriate use of touch especially if a person is unable to
communicate verbally can be very reassuring for them.
Having a personalised and holistic approach to a person’s pain and

discomfort needs good teamwork. For example, nurses and care
workers may be able to help to support the person with physical pain,
but support from the palliative care team or chaplain may
contribute to the spiritual and emotional aspects. It must be
remembered that the person themselves should be central to the
assessment, choices, treatment and review.
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English: Speaking and Supporting different people

listening Consider the following – how would you help to support each person?
Choose one of the topics in Activity 1. Eric has broken his leg and is in the accident and emergency
1 to discuss with members of your department.
team. Give your opinions as to how 2. Jeremy has a long-standing back condition and has constant pain;
you would support the people and he has been told that he will probably be off work for about 12
listen to points raised by others; weeks.
show that you are listening by 3. Jennifer has been diagnosed with the final stages of cancer; she
responding with additional has abdominal pain.
comments or suggestions. Present
your ideas clearly using appropriate
language. 1.2 Different approaches to alleviate pain
and minimise discomfort
Activity 2 Before you use any equipment to alleviate pain, or undertake any
moving or changing of positions, it is essential that you take note of
Different drugs used
the risk assessment your employer will have carried out in relation to
Find out the range of drugs used at use of any equipment. You must also carry out a risk assessment for
work and the procedure for their the particular person before any movements or the use of any
administration. equipment. Even simple methods of alleviating discomfort, such as
hot-water bottles, are not without risk, so it is vital that you protect
the person and yourself by following the correct procedures and
Functional skills taking all necessary precautions.
English: Writing The types of approaches to pain which are known to be effective are:
List the range of drugs used at your •• drugs
place of work. Devise a chart with •• physical methods
columns to show the name of the •• self-help methods
drug and the procedures for their •• alternative therapies.
administration. Lay out your findings
using a suitable format. Write your Drugs
information in a clear and concise Drugs used for pain relief are classified as:
way. Proofread your work to check
that spellings, punctuation and •• analgesics (for example, aspirin, paracetamol)
grammar are accurate. •• opiates (for example, morphine, heroin)
•• anti-inflammatories (for example, ibuprofen)
•• anaesthetic blocks (for example, epidural).
Key term Drugs which are supplied on medical prescription for the relief of pain
Analgesic – a medicine used to are likely to be analgesics or, in more extreme cases of severe or
reduce pain prolonged pain, may be opiates.
If additional pain relief is requested, you must refer this to your
supervisor and through them to a medical practitioner who is able to
prescribe additional drugs if necessary.
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Physical methods
Physical methods of pain relief include:
•• massage (superficial or pressure)
•• vibration
•• ice application (with massage)
•• superficial heat or cold
•• transcutaneous electrical nerve stimulation (TENS)
•• transcutaneous spinal electroanalgesia (TSE)
•• repositioning.
Self-help methods
Self-help methods of pain relief that have been found to be effective
include:
•• moving or walking about, if this is possible
•• imagining oneself in a pleasant place and in comfort
•• taking a warm bath
•• taking some recommended exercise
•• finding a task to distract from the pain
•• having a conversation.
Alternative therapies
Often people get relief from having a massage or from using
aromatherapy oils. The practice of reflexology can be a useful way of
relieving pain, and many agencies and care settings have experts who
visit on a regular basis to offer services like this.
Alternative therapies are increasingly being accepted by practitioners
of mainstream Western medicine as having a valuable role to play in
the reduction of pain and the improvement of general well-being.
Alternative therapies include:
•• aromatherapy – the use of natural oils
•• homeopathic medicine, which works by treating the illness or
disease with minute quantities of naturally occurring substances
which would cause the illness if taken in larger amounts – these
may not be used in some care settings
•• reflexology – specialised foot massage to stimulate particular
areas of the feet which are said to be linked to parts of the body
•• acupuncture – like the other treatments, this must be
administered by an expert; it uses ancient Chinese medical
knowledge about specific points in the body which respond to
being stimulated by very fine needles, and is now being
increasingly recognised by Western medicine and becoming
available from the National Health Service in many places
•• yoga and meditation – these work essentially on the emotional
component of pain. Meditation works by dealing with the mental
response to pain, whereas yoga combines both mind and body in
an exercise and relaxation programme. Relaxation can often be a
315
key to relieving discomfort and to helping people cope. Pain is

increased by muscles which are tense, so when people are able to
find a relaxation technique that they can use when necessary, this
can be extremely beneficial.
Alternative therapies should be used only where care professionals
are in agreement that they may be used with a particular person.
Some people may prefer to use home remedies which have been
used in their family for many years. This could be something like a hot
drink or soup which is made in a particular way. Others may prefer to
use alcohol or other drugs, such as cannabis, which is known to
provide relief in some conditions and can be prescribed in specific
circumstances. Requests for these forms of pain relief should be
referred to your supervisor in the first instance.
Most methods of pain relief are not curative – they are not treatments
or cures for any particular illness, disease or injury. They are palliative
– they provide relief from the symptoms without curing the illness or
disease itself. These palliative treatments may be offered alongside
drugs which are designed to cure a particular condition.
For example, an infected wound may be treated with antibiotics to
clear the infection and with painkillers to deal with the pain caused by
the infection. In other conditions such as arthritis, terminal cancer,
osteoporosis or other long-standing chronic conditions, the cause of
Do you know anyone who has found
the pain may not be curable, but the pain can certainly be relieved
reflexology, aromatherapy or massage a
useful relaxing technique? and strategies can be developed to help people to cope with it.
Case study
Working with a person who uses cannabis

Gabriel is 37 and has multiple sclerosis. He is currently He finds that this is effective in relieving pain and
living in a specialised unit as he is no longer able to care discomfort, and says he intends to continue to use it.
for himself. He hopes to be in the unit for a short time
The staff hold a review with Gabriel and his key worker
only until his medication and treatment regime is stable,
to discuss the situation and how to respond.
then he plans to employ personal assistants using the
direct payment scheme and live in an adapted 1. What would you do in this situation?
bungalow. 2. Is Gabriel right to relieve his pain by any means
necessary?
In the meantime he is causing concern among the staff
3. Can the unit support him in this?
of the unit because he is a regular smoker of cannabis.
316
Activity 3 1.3 Agreed ways of working that relate to

Methods of relieving
managing pain and discomfort
pain Information about the best ways to manage pain or enable someone
to rest and sleep should be entered in the plan of care. You should
Ask your friends and colleagues
always check the plan before starting to work with people to support
about their experiences of pain and
them and make them comfortable, and make sure that you enter any
discomfort, and what they do to
new information so that colleagues can take appropriate action.
relieve it.
Do not forget that any information you enter into a plan of care is
Note the different types of pain,
covered by the Data Protection Act 1998 (see Unit HSC 028) and you
and different ways that each of
must take all necessary steps to keep information confidential.
them use to relieve the discomfort.
How much do they vary? Doing it well
Supporting people to manage pain and discomfort
Functional skills •• Be very clear about how a person’s pain and discomfort should be
managed and only use agreed and approved methods.
English: Speaking and •• Remember that team communication and a consistent approach
listening are vital.
Have a discussion with friends and •• If you are not sure, then read the support plan or ask your supervisor.
colleagues about their experiences of •• If the person asks for something different from what is on the
pain and what they do to relieve it. support plan – if they ask you to buy them some alcohol, for
Ensure that you make relevant and example – always check with your supervisor first. It may be
full contributions to the discussion absolutely fine for them to have some alcohol, but sometimes
and allow others in the group to alcohol can affect how prescribed drugs work.
respond to your points. Present your •• If you have any concerns at all about how a person wants to relieve
information clearly using appropriate their pain, discuss this with your supervisor immediately.
language.
2. Be able to assist in minimising

individuals’ pain or discomfort
2.1 How pain and discomfort may affect
well-being and communication
We saw earlier in the unit how pain and discomfort can affect a
person physically, socially, emotionally and spiritually. Pain can also
have a huge effect on a person’s ability to sleep and rest. There are
several theories around the need for these two things. Some theories
suggest that sleep is for the repair and renewal of the body, while
other theories say it is for allowing our brains to organise and file all
the things which have happened during the day and get the
information into some kind of order. Some say that it is about
escaping from the world and a chance to recharge our batteries.
Whatever the reason for sleep and rest, pain and discomfort can
certainly affect the amount and quality of sleep that we have.
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Researchers have managed to keep volunteers awake for between

100 and 200 hours at a stretch, but after that time they tend to fall
asleep anyway, regardless of what steps are taken to keep them
awake. So it is clear that sleep is very necessary and that ultimately
the body will ensure that it does sleep.
The physical effects of sleep deprivation are quite slight:
•• slight changes in temperature
•• insignificant changes in heart and breathing rate.
Most people deprived of sleep are still able to carry out physical tasks
without any serious change in their ability to do so.
Emotional changes are more noticeable. People tend to become:
•• irritable or anti-social
•• very depressed
•• suspicious almost to the point of paranoia
•• very poor at carrying out mental tasks.
Memory can also be affected by lack of sleep. People’s ability to recall
things they learned before being deprived of sleep seem to be quite
seriously affected.
2.2 Encouraging an individual to express

feelings of discomfort or pain
Measuring pain
One of the important factors that you need to establish when
somebody is experiencing pain is how much pain they are feeling.
This is difficult because everyone experiences pain at a different level
and it is not possible to have an objective measure of pain.
You need to be very clear that pain is about what a particular person
experiences and cannot be measured against pain you suffer or
anyone else may suffer. You cannot measure one person’s suffering
against another’s, because each is a unique experience.
Reflect
Several methods have been developed to try to measure pain, but
Try to remember an occasion when one of the most effective is to ask the person to describe it to you on
you have experienced pain and rate it a scale of 1 to 10, with 1 being mild discomfort and 10 being the
on a scale of 1 to 10. Note it on the most excruciating pain they have ever felt. This will at least give you
scale you have drawn. How has this some idea of the level of discomfort the person is feeling and the sort
affected your behaviour and of assistance they are likely to need.
communication?
Remember that this is not about comparing like with like. If two
people have arthritis and one only puts their pain at 3 while the other
puts it at 7, you cannot say that the person who rated their pain at 7
is a ‘moaning Minnie’ and that the one who put it at 3 is a
‘wonderful, brave soul’. It is about individual experience and you need
to react to the level at which that person describes their pain.
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0 1 2 3 4 5 6 7 8 9 10
An example of a pain scale.
Because of people’s beliefs, values and culture, they may not find it
easy to say that they are in pain. This can result from a feeling that
they do not want to make a fuss, be a nuisance or bother anyone.
Many think it is somehow ‘wet’ or ‘babyish’ to ask for pain relief and
that they should accept pain without complaining.
It is important that you create as many opportunities as possible for
people to express their pain and that you contribute towards creating
an atmosphere where people know it is acceptable to say that they
are in pain and they want something done about it. You can help by:
•• noticing when someone seems tense or drawn
•• noticing facial expressions, especially if someone is wincing or
looking distressed
•• observing if someone is fidgeting or trying to move around to get
more comfortable
•• noticing when someone seems quiet or distracted
•• checking when someone is flushed or sweating, or seems to be
breathing rapidly.
All of these signals should prompt you to ask a person whether they
are in pain and if any help or relief is needed. Even in the absence of
any obvious signals, it is important to check regularly and ask if any of
the people you work with are in pain or discomfort, or need any
assistance.
You will need to be particularly aware of possible pain when you are
providing care for people who are not able to communicate directly
with you, including people who:
•• do not speak English as a first language
•• have speech or hearing difficulties
•• have a severe learning disability or multiple disabilities
•• are extremely confused.
You will need to be especially vigilant if you provide care for anyone
who comes into these categories. In all of these cases, you may need
to look for indications of distress and be able to react to those rather
than waiting for the people to communicate directly in some way. If a
person who is very confused is in pain, this can be difficult to detect
because they may not be able to find appropriate words to
communicate with you.
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2.3 Encouraging an individual to use

self-help methods of pain control
Sometimes even the simplest of methods can be effective in
responding to and dealing with pain. It may be sufficient just to alter
someone’s position, or to provide them with a hot-water bottle or an
ice pack. Sometimes a distraction, like getting them involved in an
activity or talking to them, can help.
Many people who have long-term problems will have developed their
Reflect own strategies for dealing with pain. You should make sure that you
Think about a time when you have know what these are and what part you can play in making them
had pain (you may think back to the effective. Self-management is always the most effective method of
examples that you gave on page dealing with pain and discomfort, because it gives the person the
318). Did you use any self-help maximum amount of control. People who feel out of control, and
methods and were they effective? who do not have any information, experience a greater degree of
pain than people who feel that they are in control and have a strategy
that works for them to minimise their pain.
You should note down in the support plan each person’s preferred
way of dealing with discomfort and ensure you are able to offer them
the assistance needed. Sometimes it can be a case of simply
positioning a limb or feet on a pillow, raising the feet a little or
helping the person to get up and move around, and this can make all
the difference.
2.4 Assisting an individual to be

positioned safely and comfortably
Pain will obviously be a hindrance to personal comfort, so it is
important that you establish that the person is positioned as
comfortably as possible and has had any treatments – for example,
self-help or medication. If the person needs to be turned during the
night, ensure that this is done as comfortably and quickly as possible,
with minimum disturbance.
Positions for resting

While for many people the most comfortable position for resting and
sleeping is to lie down in bed with their head supported by a pillow,
this may not be the case for others. Everyone has their preferred
position for sleeping. Some medical conditions may mean that people
have to rest propped up or sitting in a chair. You will need to check
with the person and their support plan if there are any reasons for
ensuring that someone maintains a particular position; for example, a
breathing problem, a stoma, a musculo-skeletal condition or a
prosthesis may mean that someone cannot rest in a particular
position. Above all, you will need to check with people themselves
about positions in which they are comfortable, and positions which
are not possible for them.
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2.5 Carrying out agreed measures to

alleviate pain and discomfort
Key term
Clearly the most natural response you will have to anyone in pain is
Empathy – putting yourself in empathy. This may seem obvious, but it is always worth restating
someone else’s shoes; showing that one of the most supportive responses to anyone in pain is to be
understanding and kindness empathetic and offer some TLC – tender loving care.
A person’s support plan will include a strategy for dealing with any
pain that they experience. This strategy will have been carefully
planned by the whole team if the person you are caring for suffers
from a condition known to involve pain.
Activity 4
Alternatively, someone may be suffering pain as a result of an
Guidelines for accident or injury which is a sudden occurrence, and you may need to
responding to people’s respond before a support plan has been drawn up. If this is the case,
pain it is important that you offer sympathy and support, and immediately
refer the person to your team manager or supervisor, who can
Find out the guidelines in your arrange for a medical assessment to take place and appropriate pain
workplace for responding to relief to be prescribed.
people’s pain; check the procedure
that needs to be followed. Responses to pain are almost as varied as the people involved.
Background, culture and beliefs have a great deal of influence on
Find out the forms of pain relief how we respond both to our own pain and to others who are
which can be provided, and those experiencing pain. If you have been brought up with the view that
which have to be referred for a you should ‘get on with it’ or ‘not make a fuss’, then you may find it
medical opinion. difficult not to become exasperated with someone who constantly
complains about the level of pain that they are experiencing. There
may be a temptation to remind the person that ‘there are plenty
Functional skills worse off than you’ or that ‘if you take your mind off it and think
about something else, you will feel a lot better’. That type of response
English: Reading
is largely unhelpful to someone who is suffering pain and does not
Read the guidelines in your place of know how to manage it. These are not acceptable responses from a
work for how to respond to people’s care worker.
pain. Then check any written
Being empathetic does not mean that you cannot offer suggestions
documentation on procedures that
and be constructive in advising a person about steps they can take
need to be followed before
personally to minimise pain. Empathy is about more than just patting
administering pain relief. By doing
someone’s hand and agreeing that it must be awful; it includes
this, you will be skimming
offering practical help and ideas to improve things.
documents to pick out relevant
information. Use the information you It is also important that you ask the person what help and support
have found to ensure that you have they would like you to give. It may be that they know from previous
sufficient knowledge to help people experience that a hot-water bottle, a change of position, a cushion or
manage their pain. Make notes of a walk around the garden will help to minimise the pain. Make sure
the key points you have found out. that you ask the person what they would like to do before offering
any of your own suggestions.
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3. Be able to monitor, record and

report on the management of
individuals’ pain or discomfort
3.1 Carrying out required monitoring
activities relating to management of pain
or discomfort
The person’s pain and discomfort levels should be regularly monitored
in accordance with their support plan. This will show if there are any
changes and it will also give an idea if the pain-relieving methods are
effective or not.
Measurements should be taken at times stated in the person’s
support plan. In some situations, pain scoring can help a nurse judge
how much analgesic to give, so it is important to get it right. Always
use the agreed pain measurement tool throughout, and follow the
instructions and guidance accurately. If the person has difficulty using
the numerical scales, then a visual ‘face rating’ scale may be
suggested.
Sometimes it is necessary to measure pain when the person is at rest
and then in movement. Knowing how painful it is for a person to
move is very helpful, especially if they are undergoing activities such
as physiotherapy or moving after they have had an operation.
A behaviour rating pain assessment tool may be used if it is not
possible for the person to give a self-assessment score of pain
themselves – for example, due to communication difficulties or lack
of understanding.
If you have any difficulty assessing a person’s pain, then it is
important that you let your supervisor know; if you have difficulties,
then others might too. Never be tempted to guess, because you may
get it wrong.
3.2 Completing records in required ways

Records about a person’s comfort, sleep and rest should be accurate
and contain enough information so that other care workers can
continue to support them. Statements like ‘had a good night’,
‘comfortable night’ or ‘slept well’ do not give enough information
and they do not provide enough accurate information. How do you
know that Mr Jones had a comfortable night – did he tell you or did
he not use his buzzer at all? He may have been lying in bed awake,
not wanting to be a nuisance and call you.
Never make assumptions about someone’s comfort and sleep levels.
You could ask the person or observe them and reflect this in your care
records. For example, ‘Mr Smith said that he had a good long sleep
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last night; he said that he woke once to use the toilet but he was soon
back to sleep; he thinks that he had his usual 7 hours and feels
refreshed this morning.’
If a person cannot tell you – for example, if they have communication
difficulties – your care record could say, ‘Mrs Khan appeared to have
had a restful night and enough sleep; on observation for each check
she appeared asleep. At 6.30 she called for help to use the
commode.’ This statement makes it clear that you can only assume by
observation that Mrs Khan had a good night’s sleep; you are not
claiming that she definitely did.
Getting it right is important because it might affect the support and
care that is given following periods of rest. For example, if you
recorded that a person ‘slept well’ and he did not, then he may be
encouraged to get up and dressed when he could do with more time
Activity 5 resting. He may even have a fall as a result of being tired – therefore
Record keeping accurate and factual record keeping is vital.
Good record-keeping skills are vital Records should be written in a way that they are easy to understand
in care work, so refer back to Unit by everyone, so avoid jargon and abbreviations. Remember that care
HSC 028 to find out how you need records are legal documents and need to be treated as such.
to record information properly. Not completing records is as serious as completing them incorrectly.
For example, if no care entry is made, it would be assumed that no
care was given; this could be seen as neglect.
What negative consequences could this situation have?
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Records support continuity of care. If a decision has been made to

respond to a situation or to care for a person in a particular way – for
example, if a person likes to have a hot malt drink or listen to music
before going to bed – then other care staff are aware of this, thus
Key term
ensuring continuity of care. Good clear records will also detect
Trend – a tendency or a problems or difficulties early; this can be done by looking at trends.
development – for example, a If a person’s pain score is becoming higher, then there may be an
person’s pain score is getting higher underlying problem that needs to be taken further.
or lower
3.3 Reporting findings and concerns as
required
We have discussed the importance of effective and accurate record
keeping in relation to a person’s physical comfort and rest, but it is
important to know what to do with this information. It would not be
helpful to just leave this information in the person’s care notes. It is
essential that you know what to do with the information and whom
to share it with. It is also important that you know what information
needs to be shared urgently with others.
Concerns that you will need to report and record

If a person is in pain, it is important to report this quickly, especially if
it is a different type of pain. For example, if a person says that she has
period pain (dysmenorrhoea) which she says is a dull nagging pain in
her pelvic area, but then starts to complain of a ‘stabbing’ pain in her
right side, this might be related to something completely different.
This is why it is very important to get a good description of the pain.
It is not just worsening of pain that you need to report on; you may
find that a person’s pain gets better, and you must report this too.
For example, if a person is using a Patient Controlled Analgesia pump
but is feeling much better, it may be that it is time for their pain relief
medication to be changed. Some people are worried about taking
painkillers in case they become addicted to them. If this is the case,
this needs to be reported so that the nurse or doctor can talk this
through with the person.
People may not rest and not only because of physical pain; they may
have things on their minds that are stopping them from relaxing,
resting and sleep.
For example, Mr Chan may not be sleeping well at the moment
because he is worried about his hospital appointment at the end of
the week. People may worry when awaiting test results. Worry about
money can also affect sleep and rest. It is important, if you discover
that someone has something on their mind that could affect them
resting and sleeping, to ask them if you can pass this information to
your supervisor, because they may be able either to help or to find
someone else who can.
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Why does this sort of worry affect someone’s relaxation, rest and sleep?
If you discover a change in a person’s condition that might affect their

Reflect sleep and rest, you must report it to your supervisor. They may then
Think about what has stopped you need to pass this information on to others – for example, the GP.
from sleeping and how you have felt
the next day. You may be more able Doing it well
to tell someone this, whereas the
people you are supporting may rely Identifying changes in people’s conditions
on you to pass this information for •• Get to know people well so that you can quickly recognise when
them. things are not right.
•• Use effective communication skills – for example, observation and
active listening skills.
•• Report changes to people’s conditions (for example, pain and
discomfort) quickly to your supervisor or manager.
•• Tell the person that you have reported their pain and discomfort;
that way they will know that it is being taken seriously.
•• Keep the team informed.
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LO1 LO3
This learning outcome requires you to be able to Your assessor will want to see that you complete
demonstrate your knowledge and understanding of records properly relating to people’s pain and
agreed and approved ways of working in relation to discomfort. You do not need to photocopy their records
managing people’s pain and discomfort. You may be because you must respect confidentiality. Show your
asked to write some case studies on different assessor the records that you have completed relating
approaches to managing pain and discomfort. Use to a person’s pain and discomfort. Records could be
examples from your work setting if possible, but you using pain-scoring tools, daily care records, support
could also give examples of different approaches that plans or other records specific to your workplace. You
have been used from other work settings if you can. could also get a witness testimony from your supervisor
to confirm that you do keep records properly relating to
Assessors will be looking to see that you can understand
pain and discomfort. If you do not complete many
the different approaches to manage pain and
records, then you could provide an example of a record
discomfort, but also to see that you can apply the
that you could write in order to support the records
knowledge that you have and that you support people
that your assessor sees.
as individuals.
You also need to demonstrate your understanding of
LO2
reporting findings and concerns. You may be asked to
You will need to demonstrate to your assessor that you write a reflective account of a situation when you were
can help to position a person safely and comfortably. concerned about somebody’s pain; you may have
Check with the person and their support plan to see observed that they were in pain even though you knew
how they would like or need to be positioned, and have they had had painkillers (analgesia) or they were
pillows, cushions, blankets and so on ready. Remember experiencing a different type of pain. Your assessor will
that people’s needs and preferences change, so your need to see that you know whom to report concerns
assessor will want to see that you take this into account. to, what to report and when.
A witness testimony or reflective account supporting
another person may be useful as well, to show that you
can support people as individuals and respect their
differences.
Legislation

•• http://bnf.org/bnf/index.htm (British National Formulary (BNF))
•• www.nhs.uk/CarersDirect/guide/bereavement/Pages/
Accessingpalliativecare.aspx (NHS Choices)
•• http://therapiesguide.co.uk (information on alternative and
complementary therapies)
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Unit HSC 2014
Support
individuals to
eat and drink
In this unit you will learn how to support a person to eat and drink.
Eating and drinking is not only vital for life, it is also a social activity.
We all have our preferences relating to food and drink. Diet choices
can also be influenced by our religion, our moral beliefs or maybe a
medical condition. You will need to know about basic food hygiene
and the processes involved in handling food hygienically – it is likely
that you will participate in a food hygiene course and obtain a basic
certificate in food hygiene.
You may work in a care team that includes dieticians and occupational
therapists, so you may need to know about special equipment as well
as how to support a person to consume food if they are unable to so
themselves. Records of intake of food and drink sometimes need to be
kept, so you will learn how to do this as well.

1. how to support individuals to make choices about food and
drink
2. how to prepare to provide support for eating and drinking
3. how to provide support for eating and drinking
4. how to clear away after food and drink
5. how to monitor eating and drinking and the support
provided.
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to make choices about food
and drink
1.1 Establishing with an individual the
food and drink they wish to consume
It is important to give people some choice in the food they eat. This
will make mealtimes more enjoyable. Just imagine being unable to
prepare meals for yourself and having to sit down day after day to eat
boring, unappetising or badly cooked food!
Choice should be offered in the type of food, the way it is cooked
and the quantity of food that is provided. It may also be helpful, if
possible, to vary the times at which food is provided, so that people
can choose the time at which they wish to eat rather than having to
fit in with the arrangements of their care setting. Of course, this is not
easy as there are always considerations about staffing and running
any care facility.
Knowing the types of food and drink a person likes will help to build
a trusting relationship. Some people choose not to eat meat because
of their concern for animals. Some people have foods that they just
Key terms
do not like.
Halal – meat from animals that have
been slaughtered according to Some people choose not to eat certain foods because of religious
Muslim Law reasons. People from some groups will only eat food that has been
prepared in certain ways depending on their religious laws. For
Jhatka – meat from animals that example, meat from animals that have been slaughtered according to
have been killed with one stroke Muslim Law is halal. Meat for Sikhs must be Jhatka, while some
Kosher – meat from animals that Jewish people eat only kosher food.
have been humanely slaughtered It is likely that people’s preferences will vary according to their life
according to Jewish Law stage. For example, young children are likely to have quite different
tastes from those of adults or older people. A meal of burger, chips
and ice cream may be very attractive to a 10-year-old, and to a
Functional skills considerable number of adolescents, but may not be welcomed by an
older person.
listening
Reflect
Have a discussion with your
colleagues and people you support Think about how your food tastes have changed. Reflect back on the
about your food and drink food choices that you made when you were a child and the choices that
preferences. Ensure that you make you make now. Have your tastes and preferences changed?
relevant comments and allow others Compare your food and drink preferences to those of people that you
in the group to contribute. Present support and your colleagues.
your choices clearly and respond to
points made by others.
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Support individuals to eat and drink Unit HSC 2014
Hindu Muslim
Very strict vegetarians No pork or pig products
Will not eat food stored near meat No alcohol
Check ingredients for animal-based Meat and dairy products must be halal
additives such as gelatine
Sikh
Vegan Often choose vegetarian food
No dairy foods, eggs or
Some common
No beef (the cow is sacred)
animal-related products food preferences Other meat only if Jhatka
No alcohol
Jewish Christian
Food must be kosher, including chicken If Catholic, may prefer fish to meat on
and eggs Wednesdays or Fridays
Meat only from animals with split hooves Others may also give up luxuries such
and that chew the cud (sheep, cows) as chocolate during lent
Fish only with fins and scales, such as cod
Always respect people’s needs and preferences.
Doing it well
Respecting people’s food preferences
•• Ensure that you discuss people’s religious preferences with them
and support them in choosing suitable food and drink.
•• Make sure these preferences are recorded in their support plans and
are observed by everybody who is providing care for them.
•• Discuss the personal likes and dislikes of each person with them and
record these.
•• Ensure that it is clear to any new member of the care team if there
are particular types of food which a person does not eat or does
not like.
1.2 Encouraging the individual to select

suitable options for food and drink
It is important to know what a healthy and balanced diet is.
Encouraging people to make suitable choices about what they eat is a
Key term very important part of supporting them. Some people may need to
Diabetes – a condition that affects have a special diet for medical reasons, such as diabetes. Check
the level of sugar in the blood people’s support plans to find out about what their dietary needs are.
A healthy balanced diet gives people all the nutrients in the right
amounts for their age and gender. The amount of food taken in by a
person needs to balance with the energy they use. If these are not
balanced, the person will lose or gain weight. For example, an
energetic teenager eats more than an older person who is not very
active, because the teenager uses more energy.
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Do you eat the right amounts of food from the nutrition pyramid?
Everyone should eat a variety of foods, so that our bodies get all the
nutrients that we need. This is especially important if people are
recovering from an accident or an operation. The nutrition pyramid
above typically shows the amount needed from each food group
every day. If dietary choice permits, try to choose low-fat dairy foods
and lean meat. Eat two portions of fish each week.
Alcohol should be kept within the recommended limits or, better still,
to occasional use only. The long-term effects of too much alcohol
include conditions that can cause serious damage to the liver, or the
stomach. It can also lead to dementia.
It is important to encourage people to drink on a regular basis. For
example, you could offer water, fruit squash, fruit juice and other
drinks. However, too many sugary drinks, such as fizzy drinks, and
drinks that contain high levels of caffeine should be avoided.
A lot of research has been carried out about what we eat. It has
shown that too much salt is bad for you because it can lead to high
blood pressure and heart disease. Research has also shown that
eating enough fruit and vegetables can help to prevent some cancers.
A person who eats too much and does not exercise enough may
become obese. This puts a huge strain on the body, and can lead to
many other problems. Obesity has been linked to heart attacks,
varicose veins and diabetes. It can also lead to low self-esteem, which
means that the person does not feel good about themselves. Eating
too much junk food can make the person feel sluggish because it can
be filling, but does not contain many nutrients.
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Recommended daily allowances

The government has suggested a recommended daily allowance
(RDA) of many nutrients, such as salt, fat, protein, and so on. The
RDA is the amount that an average man or woman needs every day
of each nutrient in order to stay healthy. Some people may not need
as much if they are not very active. But it is still very important that
what they do eat is nutritious. If a person has a very small appetite, it
is even more important that the little they do eat is very nourishing,
and gives them what they need to stay well.
Make sure that you know what a healthy diet is so that you can
support people to make healthy choices. If you help people to
develop independent skills by supporting them to do their own
shopping, point out the healthy options and alternatives. Healthy
food can also be made appealing by presenting it nicely on the plate.
What can food manufacturers do?

Manufacturers must show the nutritional value of food items on the
packaging. Food manufacturers and supermarkets use labels that
show nutritional information in many different ways. Some are
colour-coded, while others show the amount of each ingredient as a
percentage. These can be the recommended daily allowance (RDA) or
the guideline daily amount (GDA).
The Food Standards Agency’s ‘traffic light’ system of food labelling is
another system in use, and is becoming more popular. Colour-coded
panels clearly show the levels of total fats, saturated fats, sugar and
salt in foods such as ready meals. This can help people to make
healthier choices at a glance.
•• Red means eat this once in a while.
•• Amber means this is fine to eat most of the time.
•• Green means that this is a good choice at any time.
1.3 Ways to resolve any difficulties or

dilemmas about the choice of food and
drink
There can be many reasons why a person does not choose a healthy,
balanced diet. They may not know what a healthy diet is. Diet can
also be linked to social class because poorer people may not be able
to afford good-quality food; however, with some thought it is
possible to eat a healthy diet on a budget.
Busy lifestyles mean that some people eat a lot of processed or
convenience foods, which usually contain a lot of salt and fat. Other
people just do not want to follow the advice to eat well, because they
feel that the unhealthy option tastes better!
331
Make sure that you know what a healthy diet is so that you can help
people to make healthy choices. If you help them to develop
independent skills by supporting them to do their own shopping,
point out the healthy options and alternatives. You also need to know
what the consequences of a poor diet choice might be. For example,
obesity can lead to heart disease, varicose veins, diabetes and arthritis.
High cholesterol and diets high in salt can lead to heart attacks and
strokes. If you are aware of the consequences, this means that you
can offer sound advice.
Long-term eating habits may take some time to change. You may
therefore wish to suggest making small changes at a time, such as
introducing more vegetables. Explain the benefits of making healthy
choices, such as more energy and raised self-esteem. Effective
communication skills with a positive outlook from you can be
encouraging, and remember to be a good role model yourself.
Case study
Improving Kelly’s food choices

Kelly lives in a flat with her three children. She does not work and has
very little money to spend on food. Kelly tends to buy a lot of cheap,
processed foods such as pies, sausages and beef burgers which fill the
children up. She usually buys the children some sweets at the end of a
shopping trip. She does not buy fresh fruit very often, because it is too
expensive.
1. What are the potential health problems with Kelly’s shopping list?
2. How could you support Kelly to help her to provide more healthy
foods for her family?
1.4 How and when to seek additional

guidance about an individual’s choice of
food and drink
People may be reluctant, or may even refuse, to eat certain types of
food which have been noted in their support plan as a requirement
for their condition – such as a diabetic diet, a weight-reduction diet or
a gluten-free diet. This can cause difficulties in terms of being able to
offer freedom of choice. You may feel that this places you, and other
care staff, in a very difficult position.
If someone is determined to ignore medical advice and to follow a
different diet, this should be reported and discussed among the care
team and the medical staff responsible for the person’s care.
Ultimately you have little control over a diabetic who buys and eats
chocolate bars and sweets. However, you do have a responsibility to
provide full information and explanations, and to repeat the
explanations regularly to the person, making every effort to persuade
332
them to comply with the dietary requirements. If a person chooses, in

full knowledge of the consequences, to ignore medical advice, then
that is their choice.
The situation is different, however, for children, people who are
compulsorily detained under the Mental Health Act 1983 or subject
to guardianship, and older people who are very confused or severely
demented. All of these situations require a high degree of tact, skill
and understanding. It is important that you report immediately to
your supervisor any difficulties involving a person’s consumption of
food and drink.
2. Be able to prepare to provide

support for eating and drinking
2.1 The level and type of support an
individual requires when eating and
drinking
Most people can feed themselves, but some will need you to help
them. They may have a physical problem such as a broken arm, or
there may be another reason such as confusion or dementia. The
level of support may be different even if two people have the same
condition – for example, one person who has had a stroke might be
able to feed themselves because they have some movement in their
arm, while another may have no movement or strength at all and will
need more support.
Your Code of Practice says that you must ‘treat each person as a
person and promote independence’. Always check to find out how
much help each person needs. Giving too much help can take away a
person’s right to independence, and not giving enough help may lead
to them not having enough to eat and drink.
If a person can tell you, then ask them how you can support them to
eat and drink. It may be that just cutting food up into manageable
chunks is enough to enable a person to eat their meal independently.
It can be degrading to feed a person if they are able to feed
themselves with a little support. Always check the person’s support
plan because this includes all of the care needs; helping to eat and
drink will be one part of this. Remember, though, that needs
sometimes change; the person’s condition may improve and they may
be able to do more for themselves, or their condition might have
deteriorated and they will need more support. The support plan must
accurately reflect changes.
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Had a stroke and lost Arthritis in fingers, so Broken or injured

the use of one arm cannot grip cutlery an arm/hand
Problems with Dementia – person is

swallowing confused and suffers
Why people memory loss
need help
with eating
and drinking
Not able to tip their A tremor, e.g.
head back Parkinson’s disease
Badly fitting dentures Sight loss An eating disorder
Some reasons why people may need help with eating and drinking.
Professionals such as speech and language therapists and

occupational therapists can give guidance about how much support a
person may need when eating and drinking. If they are involved in
the care of the person, then their advice should be easily accessible in
the person’s support plan.
2.2 Effective hand-washing and use of

protective clothing when handling food
and drink
All establishments where food is prepared and served are governed
by the Food Safety (General Food Hygiene) Regulations 1995. These
regulations set out the basic hygiene principles that must be followed
in relation to staff, premises and food handling.
Under the regulations, all establishments must have effective food
safety management measures (or ‘controls’) in place, to ensure that
food is produced safely and that the health of people is not put at
risk.
Handling food safely

Infection control is important when helping people to eat and drink.
You will need to show that you can handle food hygienically. Food
poisoning can spread very easily and quickly. Some people may be at
risk of catching infections because they may already be unwell, and
have a weak immune system. Older people can be more at risk too.
Food poisoning can kill, so you must protect people.
If it is part of your job to prepare and handle food, then you need to
follow some basic hygiene rules and have a Food Hygiene Certificate.
This will show that you have had training in safe food handling.
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Food poisoning is extremely unpleasant for the person who gets it.
They can become very ill, and even die. Signs of food poisoning can
include vomiting, diarrhoea and flu-like symptoms. Food poisoning
occurs when there are dangerous bacteria on food when it is eaten.
Effective hand-washing can dramatically reduce the risk of spread of
infection and food poisoning.
Hand-washing
If hands are not clean, they can spread food-poisoning bacteria. A
quick rinse will not make sure they are really clean, so it is important
for all staff to know how to wash hands properly. Basic rules of
hygiene must be followed to avoid the risk of contaminating food
and drink. See pages 213 and 214 for the correct hand-washing
procedure.
Have you used ultraviolet light to check how well you have washed your
hands?
Doing it well
Handling or preparing food
•• If you have long hair, tie it back.
•• Wear a protective hat if working in a kitchen.
•• Wear a protective apron.
•• Wash knives and utensils well after using them on raw meat.
•• Keep nails short and do not wear jewellery where germs can lodge
underneath.
•• Wash your hands thoroughly between each stage of food
preparation.
•• Wash your hands thoroughly after going to the toilet.
•• Do not touch your nose during food handling or preparation.
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2.3 Supporting the individual to prepare

to eat and drink, in a way that meets their
personal needs and preferences
Although the basic rules of hygiene must be followed to avoid the
risk of contaminating food and drink, all of us have our own ideas
about what is acceptable and hygienic practice in relation to food
preparation and eating. For example, some people always wash their
hands before starting a meal, whereas others never do. Others will
wash in specific ways for religious or cultural reasons. It is important
that you are aware of your own values and beliefs about hygienic
arrangements for eating and drinking, and recognise that they are
your own values and not necessarily those of others. You must never
attempt to impose your own values on other people, but at the same
time you do need to be aware of any situation where the values of
others place people at risk of contamination, and be able to point this
out in a tactful and positive way.
You will need to make sure that people are given the opportunity to
wash their hands and go to the toilet before a meal. This can be time
consuming if you are working with a group of people who need
assistance, so make sure you start in plenty of time so that people are
not rushed.
It is also important that people have the opportunity to complete any
religious activities which may be important to them at mealtimes,
such as saying a prayer, giving thanks or washing themselves.
People who need to have protective napkins should be provided with
them before the start of the meal. You must take care that you do
not patronise people or treat older people as if they were children by
tucking bibs around their necks. Sometimes it is necessary to protect
clothing, and for comfort and cleanliness to protect a person’s neck
and chest if they do have some difficulties in eating. It is far better to
offer some kind of protection and allow people the dignity and
independence of eating by themselves than to assist them to eat
simply because they make a mess.
2.4 Suitable utensils to assist the person

to eat and drink
The most important thing you need to do is to establish with the
person whether they require your assistance. You should never
impose help on a person – it is far better to encourage independence,
if necessary through the use of specially adapted utensils, rather than
to offer to provide assistance to eat or drink. Occupational therapists
are trained to give advice on how people can remain independent. If
necessary they can recommend equipment that might help. Some
people would be perfectly capable of eating by themselves if they
were given a minimal amount of assistance.
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There are also special ways of helping people who have particular
needs. For example, a visually impaired person is often able to
manage to eat for themselves if you can help to prepare the plate of
food in advance. If you arrange the food in separate portions around
the plate and then tell the person, using a clock face as a comparison,
that pie is at 12 o’clock, lettuce at 3 o’clock, tomatoes at 6 o’clock
and so on, then this is often enough to allow the person to work out
what they are eating and to enjoy the meal.
If you do need, because of additional requirements, to provide direct
assistance to a person who has a visual impairment, you should try to
avoid giving instructions like ‘open’, which could be patronising, to
indicate that you are ready with the next mouthful of food. Perhaps a
signal like a tap on the hand or saying ‘OK’ would be appropriate.
You can agree with the person in advance what signal they would
like you to use.
Arranging food in a clock face pattern can help people with visual impairment.
Activity 1
Understanding eating with a visual impairment
Sit down and practise being fed by a colleague. You could have a
blindfold on or keep your eyes closed, to see what it is like to be
visually impaired. Swap places and be the care worker feeding the
other person. Think about the following.
•• How did it feel to be fed?

•• Was the speed right?
•• Was the food given to you in the right combination?
•• Was it the right temperature?
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3. Be able to provide support for

eating and drinking
3.1 Factors that help promote an
individual’s dignity, comfort and
enjoyment while eating and drinking
As well as storing and preparing food, and making sure that people
are being given a balanced and healthy diet, you also need to ensure
that the environment is safe, hygienic and pleasant for people to eat
food. The place where food is consumed in your work setting should
be clean and attractive.
Doing it well
Providing a pleasant environment for eating
•• Make sure that there are no unpleasant smells where people
are eating.
•• Turn the television off to avoid distractions or interruptions, and, if
possible, have some quiet background music on.
•• Ensure that the room is warm but not too hot. Remember that
when people are sitting still they are more likely to feel the cold, so
avoid draughts.
•• Mealtimes should be a social event, so try to make sure that each
person sits next to other people that they get on with.
•• Keep the environment scrupulously clean and ensure that it can be
used by everyone with or without assistance.
•• Some people may not be able, or wish, to eat in the dining room. If
they have their meal in their room, make sure that the food is still
hot when it gets to them.
Some workplaces encourage care workers to sit down and eat with
people; this can help to create a good homely feeling for all
concerned.
There is no reason why people receiving meals in a care setting
should not have exactly the same consideration about the
presentation, the flavour, content and attractiveness of their food as
in top restaurants where great trouble is taken with presentation. It is
amazing what some careful presentation can achieve with the
simplest meal in terms of making it more appetising, more attractive
and more likely to be eaten and enjoyed.
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3.2 Supporting the individual to consume

manageable amounts of food and drink
at their own pace
Mealtimes should be enjoyable and not rushed. If people need active
support with feeding, make sure that you allow plenty of time. If food
is offered and eaten too quickly, the food or drink may spill, or the
person may develop indigestion or even choke. Rushing people can
make them feel as if they are a nuisance and undervalued. We all eat
at different paces. Do not be tempted to rush the person to finish
their meal, nor be so slow that the person is waiting for the next
mouthful.
Reflect Doing it well

Think of a time when you have felt Helping a person to eat
rushed when eating. You may have
been in a restaurant and the staff
•• Sit down beside the person, slightly to one side and in front of
them.
were eager to clear the table ready
for the next customers. Or you may
•• Make sure that you leave enough time for them to chew or swallow
each mouthful properly.
have felt rushed on your lunch break
because you needed to get back to
•• Bear in mind that if someone is ill, they may take longer to eat.
Make sure that you do not rush and find yourself hovering with the
work. How did being rushed make
next spoonful before they have finished the last one.
you feel as a person, as well as
physically?
•• Offer the person regular drinks before, during and after the meal.
•• Chat and keep an interesting conversation going but beware of
asking a question just after you have placed some food in their
mouth!
3.3 Providing encouragement to the

individual to eat and drink
If someone is reluctant to eat or drink, you will need to talk with
them and try to find out the reason for the problem. You will need to
establish whether it is a physical reason. One of the most common
causes of eating problems, particularly for older people, is badly
fitting dentures. This can often be a source of difficulty for people
eating, partly because it is physically difficult to eat and also because
they could be embarrassed by the fact that their dentures do not fit
properly and could fall out or become clogged with food. This is a
problem that can be resolved very simply by making arrangements for
the dentures to be properly fitted, perhaps by the use of denture
adhesive.
If people have dental problems, a sore mouth or difficulty swallowing,
you may need to provide food which has been liquidised or puréed to
make it easier to eat.
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Reluctance to eat may be due to an emotional problem to do with

being unhappy, frightened or worried. In this case, you should use
your communication and listening skills to try to find out the nature
of the concerns and if there is anything you can do to assist. With
reassurance or some greater involvement in settling in to a new care
setting, or with some empathy and understanding, it may be possible
gradually to improve the person’s interest and appetite.
Case study
Identifying Mrs Maxwell’s difficulties with eating

Mrs Maxwell is a resident at Sunnymead Residential weight. Sasha spoke to her and it became clear what
Home for older people. She has worn dentures for the problem was.
many years. She enjoyed her food and had a good
Sasha reported the problem to her supervisor who then
appetite. One day her upper dentures broke and the
made another appointment for Mrs Maxwell to see her
care staff made an appointment for her to see her
dentist. Meanwhile, she agreed to have her food
dentist. Mrs Maxwell had a new set of dentures made,
liquidised or puréed to make it easier to eat.
but she found them difficult to get used to. They made
her mouth very sore, and gave her mouth ulcers. 1. What might give you a clue that someone has a
sore mouth when eating?
Sasha noticed that Mrs Maxwell was eating very little at
2. What effect could this have had on Mrs Maxwell if
lunchtime and looked as if she was in pain while eating.
Sasha had not reported this to her supervisor?
She also noticed that Mrs Maxwell was starting to lose
Functional skills 3.4 Supporting the individual to clean

English: Writing; Reading themselves if food or drink is spilt
Sometimes people can spill food or drink despite being given support
When answering questions relating
or equipment to be independent. If food is spilt the person may feel
to a text, you are practising both
embarrassed, especially if there are other people nearby; they may
reading and writing skills, as you
consider themselves a nuisance. They may already feel childlike
have to extract relevant information
because they may need extra support with feeding. How you react to
to answer the questions and write
the situation is vital. Do not draw attention to the situation. Instead,
coherently and clearly with
discreetly offer the person a napkin and let them clean themselves if
appropriate detail to show that you
they are able; if they are not able to clean themselves then you should
have understood the meaning. You
do it for them tactfully. Such situations can affect how a person feels
will need to lay out your information
about themselves. For example, if the care worker deals with the
in a logical way and use suitable
situation negatively and makes the person feel a nuisance, their
language to answer points.
self-esteem may be reduced, or they may be nervous about eating or
Proofread your work to ensure that
drinking in the future. Professional care workers show empathy and
it is accurate in spelling, punctuation
sensitivity in such situations.
and grammar.
3.5 Adapting support in response to an

individual’s feedback or observed
reactions while eating and drinking
Sometimes it is necessary to adapt the support that you give to help a
person to eat and drink. For example, a person who is usually able to
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eat independently with minimal assistance may feel unwell and weak.
Your observation skills at mealtimes will help you to notice if they
need extra support. On the other hand, you may find that a person
who usually needs a lot of support is more able to eat and drink with
just minimal assistance. Remember to ask them if they feel that the
level of support is right for them. How people feel can change on a
daily basis, so you need to use your observation and effective
communication skills, and adapt the support that you give when
necessary.
Occasionally, you may find that a person has an allergic reaction to a
particular food. Signs and symptoms of a serious allergic reaction
include:
•• redness of skin, nettle rash (hives)
•• swelling of throat and mouth, difficulty in swallowing or speaking
•• feeling sick, stomach pain, vomiting
Key term •• wheezing, severe asthma
Anaphylaxis – a severe allergic
•• collapse and unconsciousness.
reaction Anaphylaxis is very serious and needs treatment straight away,
because it could lead to death. Immediate medical help should be
called.
As a care worker, if you know that one of the people has such an
allergy, make sure they have their medication with them at all times.
Check expiry dates on their medication, too. Make sure that the
allergy and what to do in the event of a reaction are written in the
support plan.
Choking in adults
This is often caused by something stuck in the back of the throat
(usually a piece of food). It is very frightening for the person who is
choking. As with any other emergency, try to keep the person calm.
Reassure them, so that they do not become more anxious.
Signs and symptoms of choking are:
•• a red face at first, later turning grey
•• coughing and distress (panicking)
•• finding it difficult to speak and breathe
•• holding the throat or neck.
Your aims are to:
•• remove the item
•• get medical help as soon as possible if it cannot be removed.
It is common for people to choke, especially if a person’s swallowing
reflex is impaired – for example, if they have had a stroke. It is
possible for a person to die if emergency aid is not given when a
person is choking. Emergency aid techniques cannot be learned from
a book – try to attend a course on this.
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1. If the person is breathing, lean forward and encourage them to

cough. Remove the item if it is coughed up.
2. If they are unable to cough, stand beside them, support their chest
and give up to five firm back slaps between the shoulder blades. Stop
if the obstruction comes out.
3. If this does not work, try abdominal thrusts, starting by standing

behind the person. Lean the person forward. Bring your hands
around the front of the person, just below the breastbone. Make a
fist with one hand, and grasp this fist with your other hand. Sharply
pull your joined hands in an inwards and upwards movement. The
force should get rid of the obstruction.
4. If it does not clear, try steps 2 and 3 up to three times.
5. If it still does not clear, then call for an ambulance straight away.
What to do if someone chokes.
This advice is not a substitute for a first aid course. Unless you have
been on a first aid course, you need to be careful about what you do
because doing the wrong thing could cause harm.
4. Be able to clear away after

food and drink
4.1 Why it is important to be sure that an
individual has chosen to finish eating and
drinking before clearing away
The way in which you clear up is just as important as the way you
present and serve food to people. Most of us have had the experience
of being in a café or restaurant and having plates cleared away before
you are ready to leave, or, even worse, having crumbs swept into
your lap and the table wiped with a soggy cloth! It is important to be
sure that people have chosen to finish their meal before you start
clearing away. Clearing away when a person has not finished their
meal does not demonstrate respect and it reflects negatively on the
overall service, just as it would in a restaurant. Sometimes people will
put their cutlery down and have a rest during a meal, and it may look
like they have finished, but they may wish to continue eating after
having a rest and digesting some of their food. Some hospitals have
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protected mealtimes, which means that nurses and care staff can
concentrate on helping people to eat and drink. Non-emergency
procedures do not take place during this time.
4.2 Confirming that the individual has

finished eating and drinking
People may take their time for all sorts of reasons, and, although it can
be frustrating if you are busy and need to get on with the next job, you
should make sure that people can finish their meal at their own pace.
Doing it well
Allowing people to finish eating when they
choose to
•• Always check with people that they have finished eating and drinking.
•• Ask the person if they have finished or whether they would like
some more time to finish.
•• Let the person know that it is all right if they wish to continue eating
and drinking.
Key terms •• Do not clear away until you are absolutely sure that they have finished.
Dehydrated – not enough fluid in
the body If the person is unable to tell you verbally, then you will need to use
other methods of communication. If you take the food away before
Constipation – difficulty in passing
the person has finished, they may fall short of the valuable nutrients
faeces
that they need and if they do not have enough to drink they may
Concentrated – strong become dehydrated, which can lead to all sorts of problems such as
headaches, infections and constipation.
Case study
Respecting people’s eating habits

Suki is 32 years old and is a patient on an orthopaedic collecting the trays afterwards. She likes to make sure
ward in the local general hospital. She had a car that the ward is neat and tidy and free of clutter. Suki’s
accident last week which she is slowly recovering from. tray is often taken away before she has had a chance to
Suki has limited use at the moment in both of her arms. finish. Sometimes even full cups of drink are taken away
She does not sleep well at night and tends to have naps before she has a chance to finish them. The ward has
during the day. She can manage to feed herself but she been very hot recently and Suki is getting headaches.
needs to use her left hand because her right arm was Staff wonder if she is drinking enough because her
badly fractured (she is usually right handed). It takes urine is very concentrated.
Suki a long time to finish her meal but she is
1. What should Karen do if Suki is having a nap while
determined to be independent and do it herself. She
she is clearing up the trays?
often has a rest during her meal between courses,
2. Why is it important for Suki to say that she has
because her arm aches so much if she uses it a lot. Suki
finished her meal?
likes to save her dessert until later in the evening, when
3. What might happen if Suki’s food and drinks
she feels hungry again.
continue to be taken away before she has finished?
The ward is very busy and there is a new member of
staff, Karen, giving out the meals and drinks, and
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4.3 Clearing away used crockery and

utensils in a way that promotes active
participation
Crockery, cutlery and other items from the table should be cleared
and removed to the kitchen or designated area. Depending on the
setting in which you work, this may be a trolley rather than an area
for cleaning utensils. The cleaning may take place elsewhere and your
role may be only to stack utensils in the proper sections of the trolley
for removal.
Encouraging people to assist

Some people may want to clear away for themselves, or want to help
you do this. If it is feasible and safe, you should encourage this as far
as possible.
Whether people can help with the washing and putting away of
dishes and utensils will depend on the setting. If you are working on a
hospital ward, clearly it is not possible for people to do much about
washing up and putting dishes away, but in a supported living
environment, this is something that should be a normal part of
everyday living.
Disposing of waste
Your workplace will have policies about the disposal of food waste.
As with all waste disposal, you must comply with the set procedures
as they are based on safe and hygienic practices to protect both you
and the people you work with. Policies are likely to include:
•• wearing an apron or other protective clothing
•• following correct hand-washing procedures both before and after
clearing away
•• placing all leftover food in a marked bin for collection
•• never reusing leftover food.
There may be policies about recycling, which will involve separating
green waste from cooked food and meat, to be collected separately.
Much will depend on the waste collection arrangements in your local
area.
4.4 Supporting the individual to make

themselves clean and tidy after eating
or drinking
Just as you prepared the area for the person to eat, so you must
support people to feel clean and tidy after they have eaten. This
might be as simple as providing them with hand-washing facilities
afterwards. Clothes might have become ruffled if a napkin has been
tucked in. People may wish to have a toothpick, especially if they
have had meat or food that can easily get stuck between their teeth.
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Give them the opportunity to clean their teeth if they wish,

remembering that some people may not wish to do so; do not
impose your own values on others.
Support the person to feel as tidy as they did before they had their
meal. They may wish to return to their room to freshen up and have a
look in the mirror, maybe apply some lipstick and comb their hair.
Support people to feel and clean and tidy, as they did before their meal.
5. Be able to monitor eating and

drinking and the support provided
5.1 The importance of monitoring the
food and drink an individual consumes
and any difficulties they encounter
Reporting and recording
It may be necessary for you to pass on information about how much
people are eating and drinking, or if they are having problems. It is
important not to ignore problems. Accurate record keeping is vital.
Some people may need to have their food intake recorded, especially
if they are at risk of malnutrition. People may be assessed to judge
their risk of malnutrition. People who may be at risk could include
those who:
•• have difficulties with chewing and swallowing
•• are unable to feed themselves
•• are depressed
•• may lose appetite because of tablets or medication they are
taking.
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If a person is at risk of malnutrition, then their dietary intake will be

monitored and recorded. This will show problems early on and action
can then be taken to prevent the situation getting worse.
It may be necessary to monitor fluid intake; usually urine output is
recorded as well. Recording fluid intake and output can give a good
indication about how well the heart and kidneys are working.
Difficulties eating and drinking need to be reported and recorded
also, because if a person has difficulties eating and drinking (for
example, swallowing), it may mean that their food needs to be
prepared in such a way that they can consume it.
Doing it well 5.2 Carrying out and recording agreed

Filling in records
monitoring processes
•• Always fill in records properly, Reporting and recording
making sure that they are
accurate and give enough
It may be necessary for you to pass on information about how much
information.
people are eating and drinking, or if they are having problems. It is
•• Make sure that they are clear
important not to ignore problems. Accurate record keeping is vital. If
and easily understood.
records are not accurate, it can have an effect on the care that a
•• If you have problems filling
person receives. For example, if fluid intake was not recorded when it
records in, then ask your
should have been, or the quantity was not correct, then it might
supervisor or a colleague to
appear that there is something wrong when there is not, and the
help you.
person may end up being treated for a problem that they do
not have.
English: Writing Record keeping

When recording information on a Good record keeping skills are crucial if accurate information is to be
person you support, it is important passed on about a person’s consumption of food and drink. Accurate
that you follow the format used in records should ensure that people receive the correct care and
your place of work. All the treatment.
information recorded should have
Read the section in Unit HSC 028 (pages 246–255) to remind you how
the appropriate amount of detail.
to record, store and share information properly.
Check your records for accuracy, use
suitable language at all times and
present the information using a You may need to add up and record at the end of the day the total
logical sequence. intake. If you are unsure, ask a colleague to check. If you have made
a mistake or forgotten to record something, always tell your
supervisor – it is much safer to be honest.
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Food and Drink Record Chart

Davina Jones
Name: ........................................................... Women’s Centre 1
Ward: ...........................................................
12 February 2011
Date: ............................................................. Is patient receiving a special diet? Yes / No
Please record all food and drink consumed, giving details of type and quantity eaten.
Small Yes / No Women’s Centre 1
Breakfast Details 1/4 1/2 3/4 All Energy Protein
Cereal + Milk + Sugar (tsp)
Egg
Bread/Toast (slices)
Butter/Margerine/Jam/Marmalade
Tea/Coffee + Milk + Sugar (tsp)
Other (e.g. supplement)
Lunch
Soup
Cheese/Egg/Fish/Meat/Pulses
Vegetables
Potato/Rice/Pasta/Bread
Dessert
Drink
Supper
Soup
Cheese/Egg/Fish/Meat/Pulses
Vegetables
Potato/Rice/Pasta/Bread
Dessert
Drink
Before bed
Drinks
Cake/Biscuit
Total
A completed diet and fluid chart is one way to ensure that people are eating and drinking the right amounts.
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5.3 Reporting on the support provided for

eating and drinking in accordance with
agreed ways of working
We discussed earlier why it is sometimes necessary to monitor and
how to record people’s eating and drinking intake, and difficulties
they may be having. It is also necessary to pass on information about
the type and level of support that has been provided for people when
they are eating and drinking – for example, if you were assisting a
person to eat their meal and you cut up the food for them and they
ate independently, then you need to pass this information on. Equally
if a person managed to eat completely independently, this should be
reported too. Passing on information is necessary because any
changes which might mean a problem or an improvement can then
be clearly seen.
It may be necessary for you to complete people’s care records with
this information, but in some workplaces it is enough for you to pass
on the relevant information to your supervisor and they will record it.
You will need to find out the correct procedure for your workplace.
Legislation
•• Food Safety (General Food Hygiene) Regulations 1995
•• Mental Health Act 1983

•• www.dlf.org.uk (Disabled Living Foundation)
•• www.food.gov.uk (Food Standards Agency)
•• www.nutrition.org.uk (British Nutrition Foundation)
•• www.nutritionsociety.org (Nutrition Society)
•• www.rcn.org.uk (Royal College of Nursing)
•• Lear, M. (2006) Fox and Cameron’s Food Science, Nutrition and
Health, Hodder Arnold
•• Tull, A. (1997) Food and Nutrition (Home Economics), Oxford
University Press
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LO1 need to provide evidence that you are able to adapt to
such changes; your assessor may suggest that you
You will need to provide evidence that you can describe
obtain a witness testimony or complete a self-reflective
different ways to resolve conflict about the food and
account.
drink that people choose. It could be that you are
supporting a person who has diabetes and they insist on LO4
eating an unhealthy diet, or a person chooses to eat
It is important for the area to be cleared away properly
very little and you know that it is not enough for them
after mealtimes. That means making sure that crockery
to be healthy. You will need to give examples of
and utensils are dealt with in the correct way. The
different ways that the situation could be overcome.
procedure may differ depending on the area that you
Ideally evidence should come from real workplace
work in. Your assessor will want to see that you follow
situations, in which case you could obtain a witness
the correct procedure and involve people that you
testimony from your supervisor. If this is difficult
support as much as possible; again, the level of
because you are not experiencing conflict with food
participation will depend on the area in which you
choice, you could write a fictional account and give
work. Correct disposal of waste food from dishes will
examples of what could be done.
also need to be disposed of properly. Let your assessor
LO2 know when you feel ready to be assessed.
Effective hand-washing is vital to reduce the risk of food LO5

poisoning. Your assessor will want to see that you are
This learning outcome is about the importance of
able to wash your hands properly when handling and
monitoring the food and drink a person consumes and
preparing food. Practise washing your hands using the
any difficulties they may have. You will need to explain
hand-washing guide on pages 213 and 214, and let
to your assessor and give real examples if you can from
your assessor know when you feel ready for assessment.
the workplace. You can prepare for assessment by
Remember to wear protective clothing and equipment
finding out if any people in your workplace have their
such as aprons and gloves when appropriate. If you
food and drink intake monitored and if you are not sure
have a basic Food Hygiene Certificate, this can be used
why, then you could ask your supervisor. Your assessor
to support your evidence for this outcome.
may suggest that you write an account of your
LO3 examples or they may ask you oral questions and then
write down your answers.
Eating and drinking should be a pleasurable experience,
and it is important to be able to provide the appropriate You do not need to photocopy records that you have
support. You will need to describe to your assessor completed because you need to maintain
factors that can help to promote the person’s dignity, confidentiality. Your assessor will, however, want to see
comfort and enjoyment while they are eating and records relating to monitoring eating and drinking
drinking. You will need to demonstrate that you are activities; they may suggest that you obtain a witness
able to offer practical support while people are eating testimony from your supervisor confirming that you
and drinking, and afterwards. Sometimes it is necessary can competently monitor and record eating and
to adapt the support that you give as a result of your drinking activities.
observations and feedback from the person. You will
349
Unit HSC 2015
Support
individuals to meet
personal care needs
In this unit you will learn how to support people to meet their care needs.
Supporting personal care is more than just helping people to wash, bathe and
use toilet facilities; it is about understanding why hygiene is important and
how to be sensitive while respecting people’s personal preferences and beliefs
with regards to personal care. You will learn why people may need support
with personal care and how to find out the level of support that they need.
Looking good can make you feel good too; you will explore how to support
people to manage their personal appearance in ways that respect dignity,
promote active participation and retain their individuality.
When you are helping people with hygiene, it is easy to spread germs. You
will find out how to prevent this from happening, thus ensuring that you
protect yourself and others from the spread of infection.

1. how to work with individuals to identify their needs and
preferences in relation to personal care
2. how to provide support for personal care safely
3. how to support individuals to use the toilet
4. how to support individuals to maintain personal hygiene
5. how to support individuals to manage their personal appearance
6. how to monitor and report on support for personal care.
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1. Be able to work with

individuals to identify their needs
and preferences in relation to
personal care
1.1 Encouraging an individual to
communicate their needs, preferences
and personal beliefs affecting their
personal care
It is important to consider people’s preferences; what they prefer may
be very different to what you would like. There may be cultural
considerations that you might need to think about too. If the person
is unable to communicate their needs, preferences and personal
beliefs very easily, you may need to give them more time or use other
methods of communication to find out. Refer back to Unit SHC 21 to
read about how to promote effective communication. You could ask
family, friends or previous care providers for advice. Some people
prefer a bath to a shower. You may feel that it is more practical to
have a shower than a bath, but this may not be what they would like.
Never impose your own views on others. Some people may wish to
bathe or shower weekly and just have a daily wash; you need to
respect their choices and views even if they conflict with what you
believe.
As well as personal preferences, some people have religious or
cultural needs regarding personal care. It is important that you find
out about these and respect them, otherwise you could easily offend
the person and their family without intending to do so.

English: Speaking and Different opinions
listening
Answer the following questions, then ask a friend or colleague to
Have a discussion with a group of answer them as well. Compare your answers.
friends or colleagues about the
1. Do you prefer to shower or bathe?
topics listed in Activity 1. Ensure that
2. Do you use bubble bath, soap or shower gel?
you take an active part in the
3. Do you have a preferred variety?
discussion by picking up on points
4. (If female) Do you shave, wax, sugar or use hair remover cream?
made by others and by making your
5. Do you use a particular shampoo and conditioner? If so, what
own contributions clearly and using
variety?
appropriate language.
6. Do you wear make-up?
7. Do you have a preferred brand of make-up, creams and so on? If
so, what?
352
Support individuals to meet personal care needs Unit HSC 2015
People from some cultures who need help with their personal care
may prefer or insist on a care worker of the same gender. That means
males for men and females for women. Where possible, you must
respect their wishes to avoid causing offence and embarrassment. For
example, a Jewish woman would accept help from a male care
worker if necessary, but a Muslim or Hindu man would be very
offended to be helped by a female care worker.
Here are some examples of cultural and religious preferences.
Remember to ask the person how they would like you to help them.
•• Many people prefer to wash in running water. If showers are not
available, you should provide a basin and fresh water.
•• Muslims and people of some other faiths perform special washing
rituals before prayers.
•• Some people prefer to wash themselves rather than using toilet
paper. If bidets are not available, provide a jug of water.
1.2 Establishing the level and type of

support and individual needs for personal
care
The amount of help that people need with personal hygiene will
differ. You must promote the person’s independence so they can
actively participate; that way they will feel that they still have some
control over their own life. For example, a person with arthritis in their
hands may find turning on the taps very difficult – you could consider
simple changes to the taps or filling the basin for them. This small
action could help the person to manage unaided. If the person can
wash themselves all over, apart from their back, you could just help
with what they are unable to do. Never be tempted to do more to
save time. Remember to ask the person how much help they need.
There are many ways of helping people to manage their own hygiene
and independence. An occupational therapist can help; they are
specialists who can advise on changes and sometimes equipment to
help people to be independent. The occupational therapist will assess
the person’s needs fully and make suggestions about what will really
help them to manage with daily living tasks on their own. This may
not necessarily mean the use of equipment; sometimes changes in
the way people do things can be enough. It is advisable that people
seek advice from professionals such as occupational therapists before
Activity 2 purchasing any equipment, because it can be very expensive and may
not even be suitable.
Levels and types of People should be encouraged to do as much for themselves as they
support can, but never forced to do things. Some people are nervous about
Explore the different levels and getting in and out of the bath even with special equipment. They may
type of support that is needed for be scared in case they slip and have a fall, or they may worry that
the people you support. Have you powered equipment will not work properly. You will need to help to
used any of these before? build the person’s confidence and let them know that you will be
there to help if needed.
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1.3 Agreeing with the individual how

privacy will be maintained during
personal care
Ideally people should be able to manage their personal care
independently and in private; however, this is not always the case and
they may need some degree of assistance. It should be agreed
between the person and the care team how much the person can do
unaided and unsupervised, and this should be clearly documented in
the plan of care. The person should be fully involved in the decision.
Sometimes it can be risky for the person to manage personal care for
themselves unsupervised – for example, if they have had a stroke or
at risk of slips or falls for other reasons. The person may wish to bathe
completely in private and wish to take the risk of any resulting
consequences; in such circumstances this must be clearly agreed
between the person and then documented.
If support is needed and agreed, then the care worker must exercise
great sensitivity. Try to empathise with the person’s situation. Simple
actions can maximise privacy and make all the difference – for
example, knocking on the door before entering the room. It can be
more difficult in a hospital setting where there may only be a curtain
to maintain privacy, but you can make sure that there are no gaps
A range of equipment such as non-slip
mats and handles is available to support and alert the patient by calling their name and asking permission to
people with personal care. enter before opening the curtains, in order to avoid entering when
they may be exposed.
If a person is being supported with personal care at home and they
are unable to use their bathroom (for example, it may be upstairs and
Reflect they have limited mobility), ensure that privacy is maintained, by
preventing people outside from seeing the activity by closing curtains
Imagine that you are a patient in a
or blinds.
hospital and you share a bay with
five other people. There are people Modesty is greatly valued by some religions and cultural groups, such
of the opposite sex on the ward in as Muslims. In order to avoid offence, talk to the person to establish
other bays. You have had an the level of privacy they wish to have when personal care is being
operation and are unable to manage undertaken.
your own personal care, so you need If a person requires full support by the care worker for personal care,
a care worker to help you. then maximum privacy can still be maintained. If the care worker
How you would feel and how would needs to help with an assisted wash or a blanket bath, ensure that
you like the care worker to support the person remains covered as much as possible by not exposing
you? them unnecessarily. You will need to ensure that you have extra
towels or a warm sheet for this purpose.
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Would you like an audience if you were having a bath?

personal care safely
2.1 Supporting the individual to
understand the reasons for hygiene and
safety precautions
When we are babies and small children, our personal care is
supported by our parents or guardians. This can influence our habits
and values. For example, some people bathe or shower daily while for
others it may be weekly. Attitudes to the care of teeth, hair, shaving
and nails can also differ. Those who have very little contact with other
people may become less motivated to pay attention to personal
hygiene – for example, a person with limited mobility living alone.
While we must respect people’s differences and attitudes to hygiene
and not impose our own standards, health and social care workers
have a responsibility to promote healthy and safe practice in relation
to hygiene.
Skin is the largest organ of the body; it provides a protective covering.
Any breaks to the skin leads to a risk of infection entering the body.
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The outer layer (the epidermis) is constantly being renewed; cells are
Key term shed and replaced with new cells. The skin contains glands that
Epidermis – the outer layer of produce sweat and sebaceous glands that produce an oily substance
the skin called sebum that maintains the waterproofing of the skin.
If skin is not washed and kept clean, dried sweat, dead skin cells and
oily sebum build up; this creates a breeding area for a range of
bacteria and also leads to body odour.
Care of the teeth is as important as care of the skin. It is
recommended that teeth should be cleaned at least twice a day in
order to remove particles of food which could decompose and lead to
mouth infections, tooth decay and gum disease.
Hair can become greasy if not washed; however, as we get older our
hair generally becomes drier and more brittle and it is particularly
important to use a mild shampoo in this case. Hair must be
thoroughly rinsed to remove shampoo and conditioner residues,
which can lead to a dry, irritated scalp.
Be vigilant for head lice which can be easily spread between people
who have close head-to-head contact. Head lice can be easily treated
using preparations from the chemist or GP. Electronic nit combs are
also available to kill head lice, thus avoiding the use of chemicals.
Reinfection can be prevented by applying conditioner and combing
through using a fine toothcomb. Well-conditioned hair makes it more
difficult for the egg to latch on to the hair. Special head lice repellent
sprays are also available.
Personal hygiene is not only about preventing the spread of infection,
it improves the way we feel about ourselves. We usually feel better
when we have had a shower or bath, washed our hair and cleaned
our teeth. Care workers need to promote and demonstrate good
hygiene practices, and be positive role models. Some people that you
support may need to be sensitively reminded and educated about
hygiene.
Case study
Supporting a person with poor personal hygiene

Keith is 30 and lives in a small residential home for Keith’s family are upset when they visit, especially when
people with learning disabilities. He refuses to wash; he they see other people are ignoring him.
sweats a lot and sometimes wets himself. Keith does
1. Why do you think that Keith does not want to
not like to clean his teeth either; he has bad breath and
wash?
tooth decay. Some of the other residents are unkind
2. Why is it important to maintain good hygiene?
and refuse to sit near Keith because they say that he
3. If you were supporting Keith, what would you do?
smells. He likes the company of other people and wants
to join in with activities, but gets upset and does not
understand why the other people will not talk to nor be
near him.
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2.2 Protective equipment, protective

clothing and hygiene techniques to
minimise the risk of infection
Germs can spread very easily from one person to another, especially if
they get onto your uniform; therefore, you must limit the spread of
infection. You must use the correct precautions to stop infections
from spreading.
Washing your hands and using personal protective equipment (PPE)
such as gloves and aprons when supporting people with personal
care can greatly reduce the spread of infection. Inform people you
support that these universal precautions are in place to protect
everyone from the spread of infection. Your organisation may provide
hand gel for you to use after you have washed your hands; if they do,
then you must use it. Hand gel should be applied to clean hands.
Remember to cleanse your hands when you remove gloves and put
them into the correct bin.
Never put dirty laundry such as soiled bedding or clothes on to the
Use hand gel on clean hands if your floor, because this unhygienic practice can spread infection. Instead,
employer provides it. have the correct laundry bag at hand to use.
Always use people’s own toiletries when helping them with personal
Doing it well care and never share personal items with others. Germs can harbour
in creams, make-up, combs and so on; they can easily spread from
Personal presentation
person to person if shared. Sharing toiletries and equipment also
and hygiene at work
compromises a person’s individuality.
•• Tie your hair back if it is long
Your own hygiene should be of a high standard. Wear a clean
enough.
uniform each day which has been laundered in a hot wash and wash
•• Make sure that your fingernails
uniforms separately from other household laundry. It is a good idea to
are clean and not too long.
have a separate uniform available to wear in case of spills or
•• Keep jewellery to a minimum
contamination. Never wear uniforms in public places such as
(check your workplace policy to
supermarkets, because not only does it portray a negative
find out what is allowed);
professional image, but it also puts other people at risk of infection.
jewellery can harbour and
Use changing areas if they are provided by your employer, otherwise
transmit germs.
go straight home to change.
•• Do not wear strong perfumes
and keep make-up to a
minimum.
•• Remember that if you smoke,
the smell of stale smoke may be
offensive to others, especially if
they are feeling unwell.
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Activity 3 2.3 How to report concerns about the

Organisational policies
safety and hygiene of equipment or
and procedures facilities used for personal care
Refer back to Unit HSC 027 to Facilities and equipment used for personal care should be in good
remind yourself of your working order, safe and clean. We all have a responsibility under
responsibilities about following health and safety law to ensure the safety of all people using the
organisational policies and premises; be observant by not putting anyone at risk of danger or
procedures, including using PPE. harm. Equipment should be checked regularly, and all electrical
equipment needs to be tested and confirmed to be safe. You should
become familiar with the correct working of equipment. That way
you will recognise when things are not right.
You should check equipment before every use and not use anything
Activity 4
that might cause harm; take the item out of use and report and
Reporting faulty or record as per your local policy. Dripping taps can be a hazard. If hot
unsafe equipment water drips from a tap while a person is bathing, the person could
suffer serious burns. Sharp edges on bath seats, for example, can
Find out how you should report cause skin tears.
faulty or unsafe equipment or
facilities that are used for personal Items such as dirty or unhygienic bath mats, commodes and bath
care. hoists can easily spread infection. Unclean items should be reported
to the appropriate person and cleansed thoroughly before use.
2.4 Ways to ensure the individual can

summon help when alone during
personal care
If people are alone during personal care, they must have the means
of calling for assistance if needed. If a call system is available, make
sure that it works and that the person knows how to use it. Never
leave a person until you are absolutely sure that they are able to call
for help if needed. People being supported in their own home
without an electronic call system can be given a hand bell or simply
call you, in which case you will need to be fully aware and listen
carefully for their call and not be distracted by other things such as a
radio or TV. Always be alert when a person is alone during personal
care and check from time to time if you are concerned about them.
You could agree a time at which you will return to see if they need
further assistance. Always respond to calls quickly because many
accidents occur in bathrooms; if a person is left without response to
their call, they may attempt to do more than they are able and suffer
a fall or other accident.
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How would you feel if a person fell because you could not hear them calling for you?
2.5 Safe disposal of waste materials

Offensive hygiene waste is natural products of the human and animal
population (not known to be infectious). Waste can include:
•• urine
•• faeces
•• incontinence pads
•• catheter and stoma bags
•• sanitary items
•• condoms
•• sputum
•• vomit
•• blood.
Such waste should not pose a risk if it is properly wrapped, free from
excess liquid and disposed of properly. If handled, however, there are
risks, such as contracting gastrointestinal infections resulting in
diarrhoea and vomiting. It is therefore vital that you know how to
safely dispose of waste. Remember that other people have to deal
with waste after you have put it into a bag or container. Organisations
have a legal obligation to dispose of waste properly; make sure that
you are fully aware of your workplace’s procedures regarding waste
disposal and do not overfill bags, as these can be a risk to moving and
handling as well as splitting open and contamination. Do not overfill
bins, as these can pose a risk to the environment and people by
encouraging vermin.
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It is important that waste is properly disposed of to keep people safe.

Table 1 details where waste should be disposed of.
Waste Disposal
Liquid waste such as urine, Normal sewage system

faeces, vomit, blood
Incontinence pads, sanitary Yellow bag

items, wound dressings, used
gloves
Soiled foul linen Red bag with inner dissolvable

liner
Linen White bag
Household waste Black bag
Sharps Yellow sharps box
Table 1: Correct methods of disposal for different types of waste.
When you handle any waste, remember to wear gloves and wash
your hands.

to use the toilet
3.1 Providing support for the individual to
use toilet facilities in ways that respect
dignity
It can be embarrassing to have someone else supporting you to use
toilet facilities. When going to the toilet, most of us would prefer to
use our own toilet and do so in private. Unfortunately, this is not
always possible. For example, a person may have had an operation
and need some help for a short time, while others may have a
long-term health problem that severely affects their mobility and they
need longer-term care. You may feel embarrassed supporting people
to use toilet facilities, but it will help the person if you treat all aspects
of going to the toilet in a straightforward, natural way – after all,
getting rid of body waste is a perfectly normal process and promoting
continence is an essential part of a care worker’s role.
Where possible the person should use the proper toilet facilities.
Adapted clothing can help a person to be independent when using
toilet facilities. Sometimes small changes can make all the difference,
such as clothes that are easy to remove; elasticated waistbands and
Velcro instead of buttons may help.
360
Doing it well
Supporting people to use toilet facilities
•• Make the activity as private as possible in order to maintain the
person’s dignity and self-respect.
•• Communicate with sensitivity, using appropriate language and
terms to demonstrate a professional approach.
•• Try to avoid other people hearing you when you discuss toilet issues.
•• Some people prefer to have a care worker of the same sex to help
them to use toilet facilities; although this is not always possible, ask
the person if they have any particular preferences and respect these
as much as possible.
Sometimes people may need to use portable toileting equipment

such as a commode, bed pan or urinal. Toilet aids can help a person
to be independent with toileting. Supporting people while using
equipment in bed or in an area away from the bathroom can
sometimes make it be more difficult to maintain dignity and privacy,
but you must take every effort to make it as private and
unembarrassing as possible. Make sure that doors or curtains are
closed properly and that the person is free from interruptions. You
may wish to provide an air freshener that can be used to eliminate
unpleasant odours that can be embarrassing for the person. This is
especially so if a person has a colostomy bag that is not a sealed unit
and emits strong odours. It is best if the person is able to use the
Key term odour eliminator themselves; that way they will feel that they are in
Empathise – have compassion for, control. Remember to empathise with their situation.
understand
If a person is embarrassed, then they may avoid going to the toilet.
This can lead to many problems such as not asking for support to
use the toilet, which may then lead to incontinence, urinary
Reflect infections or constipation. Remember to ensure that the person can
Imagine that you are a patient on a communicate their need to use the toilet, and exercise sensitivity at
busy hospital ward and you are all times.
unable to use the toilet. The care
worker supports you and helps you 3.2 Supporting individuals to make
to use a bed pan. The curtains are themselves clean and tidy after using
closed but you can hear everything
that is happening on the other side. toilet facilities
Support people to cleanse thoroughly after using the toilet to prevent
How do you think you would feel?
them from becoming sore. Traces of urine and faeces that have been
left can lead to soreness and infections. Make sure that there is
enough toilet tissue and always wipe in the correct way (from front to
back); this prevents traces of faeces being drawn towards the vagina
and urethra, which could cause infections.
People in some cultures may wish to have running water to cleanse
after using the toilet. If bidet facilities are not available, then a jug and
water may suffice. Some people like to use moist toilet wipes after
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using the toilet. Females who are menstruating may wish to

use feminine wipes that are gentle and non-irritant. Make sure that
underwear is comfortable and help to replace pads if necessary,
checking they are correctly positioned.
Hand-washing facilities should be available and people should be
encouraged to wash hands thoroughly, as should the care worker
who has assisted. Soap and water should be used and hands dried
thoroughly afterwards using paper towels.
Doing it well
Supporting people with toileting
•• Find out from the person how much support they need.
•• Wear gloves and an apron.
•• Wash the genital areas gently.
•• If using water, make sure that it is warm, not too hot nor too cold.
•• If using paper or wipes, make sure that the area is thoroughly clean
and free from urine, faeces (and blood if menstruating).
•• Wipe from front to back to prevent faeces entering the vagina or
urethra.
•• Dispose of waste properly and safely.
•• Encourage the person to wash their hands and wash your own hands.

to maintain personal hygiene
4.1 Ensuring room and water
temperatures meet individual needs and
preferences for washing, bathing and
mouth care
Areas where personal care is being undertaken should be warm and
free from draughts. Prepare and warm the room beforehand by
closing windows and ensure that heating is on. When a person is
wet, they will feel the cold more readily because heat is taken from
the body to evaporate the water. You can warm towels and clothes
to take the chill off, but make sure that they are not too hot.
Remember also that if you put towels on radiators, you will be
preventing the warm air flow from the radiator into the room.
When running baths, run the cold water first; hot water can cause
scalds, especially to vulnerable people. A number of serious scalds in
the health and social care sector have been reported to the Health
and Safety Executive, and guidelines about safe water temperatures
and those who may be at risk have been issued. Older and younger
people are more at risk of burns, as are people with circulation
362
problems and diabetes. Those who are confused may not be able to
judge or control the temperature of the water, and people with
limited mobility may not be able to get out of the bath quickly
enough if it is discovered that the water is too hot. Risk assessments
should be carried out to establish whether a person is at risk of scalds,
and measures then taken to reduce the risks.
Water should be at an appropriate temperature; the maximum set
hot water temperature is recommended to be:
•• 44°C for a bath
•• 41°C for a shower
•• 41°C for a washbasin
•• 38°C for a bidet.
Always use a thermometer to check the temperature of the water
and report water that is not within the recommended temperatures.
People may also need support to clean their teeth. Encourage people
not to leave the tap running, as we all have a responsibility not to
waste water.
Do you always use a thermometer to check the temperature of the water?
4.2 Ensuring toiletries, materials and

equipment are within reach of the
individual
Keeping toiletries, materials and equipment to hand makes personal
hygiene easier. If the person can reach things easily, it will help them
to manage to wash and groom independently. Consider a toiletry bag
that can hang in an easily accessible place. Make sure, though, that
the area is not cluttered with things that are not needed, because this
can be more of a hindrance, especially if things fall to the floor and
the person tries to pick them up – this could cause an accident.
Arrange things in an organised manner. Ensure that the person has
their glasses or hearing aid to hand if they wear them, as well as
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prostheses such as a false breast or limb. Explain where things are,

Key term then check that the person has everything they need before you leave
Prostheses – artificial parts of the them and that they know how to call you if necessary.
body, such as, eyes, limbs or breasts
4.3 Supporting personal hygiene activities
in ways that maintain comfort, respect
dignity and promote active participation
People should be encouraged and supported to manage their own
personal care so that they are as independent as possible. It is
important to find out how much they can do independently; this
should be in the support plan, but you still need to be observant
because a person’s condition and needs can change. People should
be encouraged to participate actively; you help by giving the right
level of support. Too little help may lead to the person feeling unable
to cope, yet too much help will take away their independence. Even if
the person can only do a little for themselves, then you must support
them to do so. Never be tempted take over because it is quicker; this
does not show respect or value for the person.
Offer the person the opportunity to use toilet facilities before they
wash, bathe or shower, and help to minimise any levels of pain as far
as possible. If a person is suffering pain, they are less likely to want to
move or even wash. Ensure that prescribed painkillers have been
given beforehand if appropriate.
Make sure that the person knows Ensure that equipment is

how to call for assistance safe and in good order
Make sure that the Find out which toiletries

area is private they like to use
How to show
Show respect and dignity sensitivity when Do not rush them
helping people with
personal care
Get everything ready Respect cultural and
beforehand religious beliefs
Offer choice by finding out whether Find out how much the person
they prefer a bath or shower can do for themselves
How to show sensitivity when helping people with personal care.
364
An occupational therapist can advise the person about how personal

care can be managed as independently and as safely as possible.
Sometimes the use of equipment or aids may be suggested. It is best
if the person can try the equipment out before they commit to buy
them, because it can be very expensive.
Activity 5
Equipment that allows independence
Ask an occupational therapist, research using the Internet or use
catalogues to find equipment that could support a person to be
independent with personal care.
If you have a Disability Resource Centre nearby, ask if you can visit to
find out about the services they provide.

to manage their personal
appearance
5.1 Supporting individual to manage their
personal appearance in ways that respect
dignity and promote active participation
Our individuality is very much expressed by our clothes, hairstyle,
make-up, jewellery and perfume. Help people that you support to
express their individuality. Find out what their preferences are. Do
they have favourite brands of hair product, for example? If they are
unable to tell you, ask their family and friends.
Respect and offer choice, even if the person cannot communicate
very well. It can be confusing for some people to be given too much
choice, so you could offer two options; this way, you are still
respecting their right to choose. Ensure that people have access to a
mirror to shave or apply make-up; a magnified mirror can help if a
person is sight-impaired. A full-length mirror will enable the person to
feel confident that their appearance is how they intend it to be.
Shaving
Check with men that you support to see if they prefer a traditional
wet shave or a dry shave using an electric razor. Many men are very
particular with how they like to shave.
Females may like to remove excess body hair; if so, you will need to
ask them how this should be done. For example, do they shave, use
hair removal creams, or visit a beauty therapist for wax or sugar
treatments?
365
Supporting people to do as much as they can for themselves will help them to
have control of their lives.
Nails
Remember to pay attention to fingernails and toenails. Care must be
Key term
taken with toenails; many organisations have a policy that cutting of
Chiropodist – a professional these must be carried out by a professional chiropodist. You can,
trained person who looks after feet however, care for nails by supporting the person to keep them clean
and dry. After washing, fingers and toes should be dried very carefully
using a soft towel. Do not pull toes apart or pass a flannel through
them, because this can split and damage the skin. Trimming
fingernails is easier after bathing because the warm water softens
them.
Some people like to use foot or hand cream after washing; if you help
to apply cream, it is best that you wear gloves.
Hair
The way we feel is sometimes reflected in our hair – for example, if
we are feeling unwell, our hair may be dull and lifeless. Hair that is
clean and styled can raise our self-esteem. People usually have
particular preferences regarding styles and hair products that are
used. Promote individuality and find out what the person likes; they
may have a particular hairdresser they like to use. If so, find out if a
visit can be arranged.
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Choices
Do not impose your views on others – for example, you may think the
clothes that a person has chosen to wear do not match. Remember, it
is their identity, not yours, and you must respect this. However, if the
person chooses to wear a thin summer dress on a winter day, you
have a duty of care to protect them from harm. You may need to use
gentle persuasion to encourage them to wear more suitable clothing.
As well as personal preferences, some people may have religious or
cultural needs regarding how they dress. It is important that you find
out about these and respect their wishes; if you do not, you may
offend the person and their family.
Case study
Respecting Ethel’s individuality

Ethel is 80 years old and lives in a residential home. She and sometimes laugh at her. The care workers are very
has always liked to be different and unique; her family worried and have tried to advise Ethel on what to wear.
describe her as eccentric. One care worker even hid a dress that she thought was
inappropriate. A few care workers think it is funny and
Ethel likes to choose what to wear, and loves bright
laugh at Ethel.
make-up. The colours of her skirts and jumpers often
clash, or she wears her tops on the wrong way round. 1. What are the care workers’ concerns?
Other times, she chooses clothes that are unsuitable for 2. Is it right for Ethel to choose what she likes to
the weather. For example, last week it was very cold, wear?
but Ethel wore a thin orange stripy blouse with bright 3. What would you do in this situation?
purple trousers to go into town. People often turn, look
Functional skills
5.2 Encouraging the individual to keep
their clothing and personal care items
English: Writing
clean, safe and secure
Use the case study to gather your
information to answer the set When living with other people, it is easy for clothes and other items
questions. Ensure that each question to get lost. You can help to avoid this by labelling clothing and
is answered fully and that your equipment clearly. Support people to put clean clothes away neatly
answers are laid out using an on hangers and in drawers. Combs and brushes should be kept clean
appropriate format. Answers should with any hair in them removed. Encourage people to discard make-up
be checked for accuracy of spelling, or creams that are old because these can harbour germs and cause
punctuation and grammar. infections. Make-up can create stains that are difficult to remove from
fabric; therefore, make sure that tissues are available and clothes are
protected from any mess.
Razors should be clean and in working order. Make sure that foils are
intact on electric razors and that safety razors used for wet shaves are
clean and not blunt. Blunt and dirty blades could result in damaged
skin, causing not only discomfort but a route for infection.
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6. Be able to monitor and report

on support for personal care
6.1 Feedback from the individual and
others on how well support for personal
care meets the individual’s needs and
preferences
Feedback from people is important when a service is provided. This
enables health and social care workers and organisations to know
what they are doing well and the areas that they could improve on. It
can be uncomfortable sometimes to ask for feedback from others
when you have carried out an activity, because you may be worried
about what they might say. You could ask, ‘What have I done well
and what could I have done better?’ Seeking informal feedback is a
good way of developing your own knowledge and practice (see Unit
SHC 22 for more on informal feedback).
Formal feedback is also sought from time to time. For example, when
a patient is discharged from hospital services they are often asked to
Activity 6 complete a questionnaire to measure their level of satisfaction.
Registered care providers who are inspected by the Care Quality
The support that you give when
Commission also seek feedback from those who use the service; this
helping a person with personal
aims to continually improve the quality of health and social care
care can influence what their
service provision.
perception is about the quality of
service overall that is being All people should have equal access to give feedback. Therefore, if a
provided. person is unable to give feedback themselves (for example, if they
have dementia), then it can be sought from their family, friends or
Seek informal feedback from
advocates. Questions should be asked in a straightforward manner,
people you support with personal
both verbally and written, because this will maximise the accuracy of
care and reflect on what you have
the responses.
done well and how you could
improve the support that you give.
6.2 Monitoring personal care functions
and activities in agreed ways
Having an idea of what is normal for the person, and what is not, will
help to prevent unnecessary discomfort or something more serious
from developing. Each person is unique, and what is normal for one
person may not be for another. You are more likely to be the one to
notice changes because you probably support the person on a
day-to-day basis, whereas your manager may not provide hands-on
support in the same way.
What is normal for urine?

Urine should be clear and straw-coloured. However, in the morning it
is usually stronger and may look more yellow or orange. There should
be no pain on passing urine. If the urine is cloudy and smells fishy, it
368
may mean that the person has an infection. Ask them if they have
noticed any change in their urine and tell them that you will need to
report this to your supervisor, who may ask you to collect a urine
sample to send off to be tested. (If you are not sure how to do this,
ask your supervisor.)
You may have urine testing kits that use dipsticks. These can give an
early clue as to whether there is an infection or not. These sticks can
also show other things that are in the urine, such as blood or glucose.
Doing it well
Testing urine
•• Always record the results clearly and accurately.
•• Inform your supervisor and record the results even if they are
normal; your supervisor may want to report your findings to the
doctor.
•• Remember to keep the person informed about what you are doing.
•• Always ask for their permission before taking samples and testing.
•• Remember it is their right to be involved in their care.
What is normal for faeces?

Key terms Faeces should be brown, soft and formed. People will differ as to
Faeces – waste matter remaining how often they pass a motion. As with urine, what is normal for one
after food has been digested, which person may not be for another, so it is important to find out what is
is discharged from the bowel right for the person.
Motion – an emptying of the bowel If faeces are hard, it may mean that the person is constipated. You
need to encourage people to drink enough fluid to prevent them
Constipated – finding it difficult to
becoming dehydrated and to have a diet with enough fibre to
pass faeces
prevent constipation (see Unit HSC 2014 for more about diet).
Bristol Stool Chart
Type 1 Separate hard Type 5 Soft blobs with

lumps, like nuts clear-cut edges
(hard to pass) (passed easily)
Type 2 Sausage-shaped Type 6 Flufy pieces with

but lumpy ragged edges, a
mushy stool
Type 3 Like a sausage Type 7 Watery, no solid

but with cracks pieces. Entirely
on its surface Liquid
Type 4 Like a sausage

or snake,
smooth and soft
The Bristol Stool Chart helps you to report accurately on the texture of faeces.
369
If you suspect that the person is constipated, report this to your

supervisor. The GP may prescribe laxatives. These are medicines that
can help people to open their bowels. You may need to record when
the person has passed faeces and note the consistency and texture.
You may have to record what they have eaten, when they ate and
how much. It can help with early detection of constipation or to
Key terms monitor diarrhoea. The dietician might need to recommend changes
to the person’s diet.
Diarrhoea – liquid faeces
Anorexia – an eating disorder Women and menstruation

where the person does not eat If you are looking after women of childbearing age, they may need
enough help when they are menstruating (having their periods). You should
Menopause – when a woman’s always report any changes. Missed periods could mean a woman is
periods stop pregnant, but there could also be other reasons such as stress or
anorexia. It may mean that the woman is going through the
Anaemic – not having enough iron
menopause. Heavy periods could lead to the person becoming
in the blood
anaemic. There could be other medical reasons that need
investigating for heavy periods. You must always report any bleeding
after the menopause, as this will need to be investigated.
6.3 Recording and reporting on an

individual’s personal care in agreed ways
You may be asked to record and report on a person’s personal care.
When you have supported a person with any aspect of personal care
(for example, with hygiene or toileting needs), it is important to
record and report accurately on the support that you have given, as
well as any changes you have noticed. Organisations have different
records and ways of reporting, so you will need to become familiar
with the procedures of your own workplace.
Accurate record keeping is vital and could have serious consequences
if not done properly. For example, sometimes a person’s urine output
needs to be measured and recorded because they may have a kidney
or heart condition – if the care worker did not record accurately, the
person might end up having some treatment or medication that they
do not need. If you forget to measure the amounts accurately or have
difficulty doing so, it is best to be honest and tell your supervisor.
370
Case study
Being honest about recording and reporting

Tom is a healthcare assistant working on a busy male output; he had just disposed of the urine without
ward. He usually remembers to check to see if patients’ measuring it. Tom did not get on very well with his
urine output is to be recorded before he takes away supervisor and was worried about telling her.
urinal bottles.
1. If you were Tom, what would you do?
Tom had been supporting Mr Jones with his personal 2. What might happen to Mr Jones because of Tom’s
care when, at the end of his shift, he realised that he carelessness?
should have measured and recorded Mr Jones’ urine
Functional skills Legislation
English: Reading •• Health and Safety at Work Act 1974
This unit provides you with a number

of opportunities to practise your
reading skills. Some examples of this
are researching new terminology, •• www.cqc.org.uk (Care Quality Commission)
reading case studies and reviewing •• www.dh.gov.uk (Department of Health)
information listed in the websites •• www.hse.gov.uk (Health and Safety Executive)
provided to broaden your •• www.nhs.uk (NHS)
knowledge. When reading for •• www.nhsfife.scot.nhs.uk (NHS Fife: hot water management risk
information as part of a unit, it is control measures for the prevention of scalds and burns)
important to identify the main points •• www.skillsforcare.org.uk (Skills for Care)
so that they can be used for your •• www.skillsforhealth.org.uk (Skills for Health)
coursework. It is important that you •• Benson, S. (1994) Handbook for Care Assistants, 5th edition,
understand what you are reading Hawker, London
and, if necessary, that you use a •• Burgess, C., Shaw, C. and Pritchatt, N. (2007) S/NVQ Level 2 Health
dictionary to clarify unknown words. and Social Care: Easy Steps, Pearson Education
When you are given a set text to
read for your place of work, ensure
that you understand how you need
to use it – for example, to extract
information for a set purpose or to
extend your knowledge on a topic.
371

LO1 shows privacy, dignity and respect. It may not be
appropriate for your assessor to observe you in such
It is important to consider people’s preferences when
sensitive situations, but nevertheless they will need
supporting them with personal care; it is therefore vital
evidence to prove that you are competent in these
to encourage people to communicate (in their preferred
activities. Your assessor may therefore suggest that you
way) their personal preferences, to provide the person
obtain witness testimonies from your supervisor or
with the right level and type of support, and to agree
manager.
how privacy will be maintained. Evidence must come
from a real work environment and activities. If it is not LO5
appropriate for assessor observation, it may be
For this outcome you need to support people to
suggested that you obtain expert witness testimonies to
manage their personal appearance. You will need to
provide evidence for this outcome.
demonstrate how you promote independence while
LO2 respecting people’s choice and dignity. You will also
need to show evidence of encouraging people to keep
Handling body waste and not disposing of it properly
their personal care items clean and safe. Assessor
can increase the risk of the spread of infection. You will
observation is preferable, but if this is not possible,
need to show your assessor that you can demonstrate
your assessor may suggest that you obtain witness
safe disposal of a range of waste products. You will also
testimonies from your line manager.
need to explain why you disposed of the waste the way
that you did. Your assessor may ask you to obtain a LO6
witness testimony of safe disposal of waste; this will
This outcome is about being able to monitor and report
provide evidence to your assessor of consistency of your
on support for personal care, which includes what is
performance.
normal for the person and what is not. You work
LO3 closely with the people that you support and you are
more likely to notice when situations have changed.
This outcome requires you to be able to support people
You will need to show your assessor that you notice
competently to use the toilet in a way that respects
changes in people and that you are able to record and
privacy, dignity and respect and to support them with
report them properly according to your workplace’s
cleansing afterwards. It may not be appropriate for your
procedures. Your assessor may not be with you when
assessor to observe you in such sensitive situations, but
you do notice changes with people’s personal care, so
nevertheless they will need evidence to prove that you
they may suggest that you collect a witness testimony
are competent in these activities. Your assessor may
from your supervisor. You could also show your
therefore suggest that you obtain witness testimonies
assessor records that you have completed relating to
from your supervisor or manager.
personal care, such as care records and input/output
LO4 charts.
This outcome requires you to be able to support people
competently to maintain personal hygiene in a way that
372
Glossary
Glossary
Accessible – able to be obtained, used or experienced without
difficulty
Accommodation – regarding eye sight, the process by which the eye
changes optical power to focus on an object as its distance changes
Acquired – in terms of sensory loss, anything that is not present at
birth but develops some time later
Acrylamide – a chemical found in starchy food that has been cooked
at high temperatures – for example, crisps, chips or crisp breads
Active participation – when a person participates in the activities
and relationships of everyday life as independently as possible; they
are an active partner in their own care or support, rather than a
passive recipient
Advocacy – acting and speaking on behalf of someone who is
unable to do so for themselves
Advocate – a person who is responsible for acting and speaking on
behalf of someone who is unable to do so for themselves
Aerosol – a cloud of solid or liquid particles in a gas
Anaemic – not having enough iron in the blood
Analgesic – a medicine used to reduce pain
Anaphylaxis – a severe allergic reaction
Anatomy – the physical structure of the body
Anorexia – an eating disorder where the person does not eat enough
Aphasia (or dysphasia) – a reduced ability to understand and to
express meaning through words
Appendectomy – surgical removal of the appendix
Appendicitis – inflammation of the appendix
Aseptic – without sepsis or being free from disease-causing
micro-organisms
Autistic spectrum – a spectrum of psychological conditions
characterised by widespread abnormalities of social interactions and
communication, as well as severely restricted interests and highly
repetitive behaviour
Bariatric – a term used for a person whose weight exceeds 25 stone
British Sign Language (BSL) – a way of communicating with people
who cannot hear, using hand signals instead of words
Chiropodist – a professionally trained person who looks after feet
Competence – demonstrating the skills and knowledge required by
National Occupational Standards
373
Concentrated – strong
Congenital – present at birth
Constipated – finding it difficult to pass faeces
Constipation – difficulty in passing faeces
Contract – in terms of muscle function, get shorter
Data Protection Act 1998 – a law to ensure the safety of data held
Deep vein thrombosis (DVT) – a clot that forms in the deep veins
of the body, usually the leg veins. If the clot moves it could get stuck
in a blood vessel going to the lungs. If the clot is large enough, the
patient could die
Dehydrated – not having enough fluid in the body
Dementia – a disease that affects the brain, especially the memory
Diabetes – a condition that affects the level of sugar in the blood
Diarrhoea – liquid faeces
Discrimination – treatment of one group or person in a less or more
favourable way than another on the basis of race, ethnicity, gender,
sexuality, age or other prejudice
Dosette box – a pill organiser; usually someone’s medication for the
day, part of the day, or for a whole week
Empathise – have compassion for, understand
Empathy – putting yourself in someone else’s shoes; showing
understanding and kindness
Epidermis – the outer layer of the skin
Faeces – waste matter remaining after food has been digested,
which is discharged from the bowel
Ferrule – rubber foot on the bottom of a walking frame or stick
Generic – basic or common
Halal – meat from animals that have been slaughtered according to
Muslim Law
Hazard – something that could possibly cause harm
Healthcare-associated infection – an infection that has been
acquired as a result of treatment in any care setting
Holistic – looking at the ‘whole person’, considering all of their needs
Induction – a formal briefing and familiarisation for someone starting
at an organisation
Jhatka – meat from animals that have been killed with one stroke
Kosher – meat from animals that have been humanely slaughtered
according to Jewish Law
374
Glossary
Learning style – how we learn – for example, by watching, doing,

reading or seeing, or a combination of these
Legislation – laws
Menopause – when a woman’s periods stop
Motion – an emptying of the bowel
MRSA – Methicillin-resistant Staphylococcus aureas, an organism
which has mutated over the years to become resistant to some
antibiotics
National Occupational Standards – UK standards of performance
that people are expected to achieve in their work, and the knowledge
and skills they need to perform effectively
Non-verbal communication – body language, the most important
way in which people communicate
Occlusive – something that closes, such as a bandage or dressing
that closes a wound and protects it from the air
Ombudsman – a public officer who investigates complaints about
poor service or unfair or improper actions from public services
Osteoporosis – condition associated with ageing in both men and
women where there is a loss of bone density caused by excessive
absorption of calcium and phosphorus
Outcomes – the results that come from the services provided to a
person for their visions of their life
Palliative care – care that relieves symptoms, but does not cure
Pathogenic – micro-organisms that have the potential to cause
disease or infection
Personal development – developing the personal qualities and skills
needed to live and work with others
Physiology – the normal functions of the body
Professional development – developing the qualities and skills
necessary for the workforce
Prostheses – artificial parts of the body – for example, eyes, limbs or
breasts
Risk – the likelihood of a hazard causing harm
Risk control measures – actions taken in order to reduce an
identified risk
Sacrum – the bony part of the back located at the base of the spine
Self-esteem – how people value themselves; how much self-respect
and confidence they have
Self-image/self-concept – how people see themselves
375
Sodium hypochlorite – the chemical name for bleach

Stereotyping – making negative or positive judgements about whole
groups of people based on prejudice and assumptions, rather than
facts or knowledge about a person as an individual
Toxin – a poison produced by micro-organisms such as bacteria
Trend – a tendency or a development – for example, a person’s pain
score is getting higher or lower
Vena cava – a large vein that returns blood to the right atrium of
the heart
376
Legislation referenced in this book
Legislation
This page lists all the legislation referenced in this book. For more
information on any item, please refer to the index.
Access to Personal Files Act 1987

Adult Support and Protection (Scotland) Act (ASPA) 2007
Care Home Regulations 2001

Care Quality Commission (Registration) Regulations 2009
Care Standards Act 2000
Carers (Equal Opportunities) Act 2004
Carers and Disabled Children Act 2000
Children Act 1989
Confidentiality of Personal Information 1988
Control of Asbestos at Work Regulations 2002
Control of Lead at Work Regulations 2002
Control of Substances Hazardous to Health Regulations 2002
(COSHH)
Criminal Justice Act 1998
Data Protection Act 1998

Disability Discrimination Act 1995
Disability Discrimination Act 2005
Employment Equality (Age) Regulations 2006

Employment Equality (Religion or Belief) and (Sexual Orientation)
Regulations 2003
Equal Pay Act 1970
Equality Act 2006
Equality Act 2010
Family Law Act 1996

Food Safety (General Food Hygiene) Regulations 1995
Food Safety Act 1990
Fraud Act 2006
Freedom of Information Act 2000
Hazardous Waste Regulations 2005

Health and Safety (Display Screen Equipment) Regulations 1992
(amended 2002)
Health and Safety at Work Act 1974
Health and Social Care Act 2008
377
Health and Social Care Act 2008 (Regulated Activities) Regulations

2010
Health Protection Agency Act 2004
Human Rights Act 1998
Lifting Operations and Lifting Equipment Regulations (LOLER)

Local Authority Social Services Act 1970
Management of Health and Safety at Work Regulations 1999

Manual Handling Operations Regulations 1992 (amended 2002)
Mental Capacity Act 2005
Mental Health Act 1983
National Assistance Act 1984 S47

National Minimum Standards for Care Homes for Adults (18–65)
National Minimum Standards for Care Homes for Older People (65+)
NICE Guidelines 2 2003
No Secrets (England) and In Safe Hands (Wales)
Noise at Work Regulations 1989
Offences Against the Person Act 1861

Office of the Public Guardian
Personal Protective Equipment at Work Regulations 1992

Police and Criminal Evidence Act 1984 S17
Protection from Harassment Act 1997
Protections of Vulnerable Groups Act 2007
Provision and Use of Work Equipment Regulations 1998 (PUWER)
Public Health (Control of Diseases) Act 1984
Public Health (Infectious Diseases) Regulations 1988
Public Interest Disclosure Act 1998
Race Relations Act 1976

Racial and Religious Hatred Act 2006
Reporting of Injuries, Diseases and Dangerous Occurrences
Regulations (RIDDOR) 1995
Safeguarding Vulnerable Groups Act 2006

Sex Discrimination Act 1975
Sexual Offences Act 2003
Special Educational Needs and Disability Act 2001
Theft Act 1968
Work and Families Act 2006
378
Unit numbers by awarding organisation
Unit no. in Unit accreditation Edexcel / C&G / CACHE /
Unit title Unit group
Heinemann book no. NCFE unit no. OCR unit no.
Introduction to communication in health, social care or children’s and Group M:
SHC 21 F/601/5465 1 SHC 21
young people’s settings Mandatory/Shared Core
Introduction to personal development in health, social care or children’s Group M:
SHC 22 L/601/5470 2 SHC 22
and young people’s settings Mandatory/Shared Core
Introduction to equality and inclusion in health, social care or children’s Group M:
SHC 23 R/601/5471 3 SHC 23
and young people’s settings Mandatory/Shared Core
Introduction to duty of care in health, social care or children’s and Group M:
SHC 24 H/601/5474 4 SHC 24
young people’s settings Mandatory/Shared Core
Group M:
HSC 024 Principles of safeguarding and protection in health and social care A/601/8574 5 HSC 024
Mandatory/Shared Core
Group M:
HSC 025 The role of the health and social care worker J/601/8576 6 HSC 025
Group M:
HSC 026 Implement person-centred approaches in health and social care A/601/8140 7 HSC 026
Group M:
HSC 027 Contribute to health and safety in health and social care R/601/8922 8 HSC 027
Group M:
HSC 028 Handle information in health and social care settings J/601/8142 9 HSC 028
HSC 2002 Provide support for mobility H/601/9024 46 HSC 2002 Group C: Competence
HSC 2003 Provide support to manage pain and discomfort K/601/9025 47 HSC 2003 Group C: Competence
HSC 2007 Support independence in the tasks of daily living T/601/8637 51 HSC 2007 Group C: Competence
HSC 2012 Support individuals who are distressed L/601/8143 55 HSC 2012 Group C: Competence
HSC 2013 Support care plan activities R/601/8015 56 HSC 2013 Group C: Competence
HSC 2014 Support individuals to eat and drink M/601/8054 57 HSC 2014 Group C: Competence
HSC 2015 Support individuals to meet personal care needs F/601/8060 58 HSC 2015 Group C: Competence
HSC 2028 Move and position individuals in accordance with their plan of care J/601/8027 68 HSC 2028 Group C: Competence
Group B:
IC 01 The principles of infection prevention and control L/501/6737 21 IC 01
Specialist Knowledge
Group B:
SS MU 2.1 Introductory awareness of sensory loss F/601/3442 34 SS MU 2.1
Specialist Knowledge
= Group M = Group C = Group B

Legislation
379
Index
Index
Key words are indicated by bold page numbers.
CD chapters are indicated after the page number by:
A (HSC 2007)
B (HSC 2012)
C (HSC 2013)
D (HSC 2028)
E (SS MU 2.1)
A accessible 19
abdominal thrusts 205 accidents and illnesses
abuse action to take 198–211
assessment requirements 129 bleeding 198–200
carers 114–16 burns and scalds 206–7
confidentiality and disclosure of 107–8 cardiac arrest 200–1
consent to action against 117–18 choking/difficulty breathing 204–5
danger, harm and 94–5 distress resulting from 211
defining behaviour as 126 electrical injuries 207–9
discriminatory 101–2 epileptic seizure 204
effects of 127–9 fractures 206
empowerment against 118–21 Heimlich manoeuvre 205
financial 99 loss of consciousness 201–3
functional skills 103, 105, 109 poisoning 207
further reading 130 recovery position 203
institutional 102–3, 125 reporting 196–7
legislation 121–3, 130 shock 201
long-term 103 tasks following 209–11
neglect 99–101 training for taking action 209
patterns and nature of 103 types of 198–211
physical 96–7 accommodation 5(E)
by professional carers 123–9 acquired sensory loss 22(E)
psychological 98–9 acronyms 17
recognising risks 94–5 acrylamide 13(A)
recognising signs of 105–6 action learning sets 47
responding to suspicions/allegations of 107–13 active participation 77
risk factors 103–5 clearing away after eating and drinking 344
self-harm 106 encouraging 166–9
serial 103 independence in daily living 2–4(A)
sexual 97–8 mobility activities 302
signs and symptoms of 95–103 moving and positioning people 26–7(D)
situational 103 personal care 364–5
situations of 95 support plans 11–12(C)
types of 95 advice and support
unacceptable behaviour from colleagues 126–7 communication 16, 23
vetting and barring schemes 123 confidentiality 31
whistleblowing 123–9 distress, supporting people in 6(B)
381
diversity, equality and inclusion 79 moving and positioning people 33(D)

duty of care 88 pain and discomfort 326
for handling information 243–5 personal care needs and preferences 371
health and safety 190 personal development 59
independence in daily living 10(A) person-centred approaches 182
managing own feelings 8–9(B) sensory loss 25(E)
moving and positioning people 30–1(D) support plans 21(C)
stress 236 workers, health and social care 149
team difficulties 147–8, 149 assistance, summoning 358
advocacy 103 assistive technology 3–4(A)
advocates 76–7 attitudes and beliefs 38–41
aerosols 269 autistic spectrum 11
agreed ways of working 143–4 autoclaving 265
information 246–55
moving and positioning people 4–6(D) B
pain and discomfort 317 badges 228
aids. See equipment bariatric 18(D)
alcohol gel 287 barring schemes 123
allergies 341 bathing. See personal care needs and preferences
alternative therapies for pain relief 315–16 beliefs and attitudes 38–41
amputation 294, 4(D) beliefs and preferences, respect for 73–6
anaemic 370 bleeding, action to take 198–200
analgesic 314 body language 5–7, 20–1
anaphylaxis 341 bones, broken 206
anatomy 2–3(D) breathing, difficulty with 204–5
anger as effect of abuse 128 British Sign Language 7(E)
anorexia 370 broken bones 206
anti-slip sheets 25(D) burns and scalds 206–7
aphasia 10
appearance, people’s 365–7 C
appendectomy 311 calmness 10–11(B)
appendicitis 311 capacity, mental 87–8, 163
appraisals 48–9 cardiac arrest 200–1
aprons 273, 275, 276, 281 care plans. See support plans
arthritis 292, 3(D) carers
aseptic 286 legislation 114–15
assertiveness 11(B) supporting 115
assessment requirements vulnerable 116
abuse 129 working with 114
communication 32 cataracts 20(E)
distress 21(B) cerebral palsy 293, 4(D)
diversity, equality and inclusion 80 chiropodists 366
duty of care 91 choices
eating and drinking 349 food and drink 328–9
health and safety 236 rights to 153
independence in daily living 24(A) risk assessment for health and safety 194–5
infection prevention and control 289 in support plans 6(C)
information 255 supporting 170–6
mobility 309 choking 204–5, 341–2
382
Index
cleaning 264–6, 19–20(A) confidence and active participation 166, 168–9

Clostridium difficile (C. diff) 267 confidentiality
clothing 214, 216, 299, 357, 367, 17(D) and communication 26–31
Codes of Practice 34, 35, 261–2 and disclosure of abuse 107–8
colleagues, working with 137–9 sharing of information and 250–5
See also teams confusion and communication 11, 19
communication congenital sensory loss 22(E)
advice and support about 16, 23 consciousness, loss of 201–3
assessment requirements 32 consent 162–5, 253–5, 20(D)
barriers 17–19 constipation 343, 369
body language 5–7, 20–1 contract 3(D)
confidentiality 26–31 Control of Substances Hazardous to Health
dementia/confusion 11, 19 (COSHH) 221–3, 260, 18(A)
with different people 4–5 culture
disorders 11 and communication 24–5
distress, impact of on 3–4(B) and person-centred approach 161
of empathy and reassurance 10(B)
equality and diversity 24–5 D
of feelings concerning pain 319 daily living. See independence in daily living
functional skills 4, 28, 32 danger, harm and abuse 94–5
further reading 32 Data Protection Act 1998 240, 246–7
good practice in 7 Deafblind Manual Alphabet 7(E)
hearing loss 10, 13–14, 19 deafblindness
identifying needs and preferences 8–11 and communication 15(E)
of information 247–8 impact of 3(E), 4(E), 5–6(E)
language differences 10, 12–13, 19 overcoming impact of 7–8(E)
learning disability 11, 15 signs of 24(E)
listening 20–3 deafness. See hearing loss
methods to meet needs 12–16 decision-making and partnership working 147
moving and positioning people 19–20 (D), decisions, challenging 174–6
21–2(D) decontamination 264–6
needs 10–11 deep vein thrombosis (DVT) 295
non-verbal 5–7, 20–1 dehydrated 343
obtaining consent 163–4 dementia 11, 19, 51
pain and discomfort, impact of on 318 development, personal. See personal development
partnership working 146 diabetes 329
physical disability 10–11, 14–15, 19 diabetic eye disease 18–19(E)
questions 22 diarrhoea 370
reactions to 5–7 dignity
reasons for 2–3 consent 162
recording needs and preferences 8–9 personal care 364
and sensory loss 10, 14, 19, 2–3(E), 13–16(E) right to 153
and technology 14 toileting 360–1
through actions 16 while eating and drinking 338
understanding, ensuring 19–23 disability
competence 38 and communication 10–11, 13–15
complaints 89–91 discrimination due to 64
concentrated 343 See also sensory loss
conductive hearing loss 21(E) Disability Discrimination Act 1995 305
383
disclosure of information 253–5 drugs for pain relief 314

discomfort. See pain and discomfort duties and responsibilities 34–5
discrimination 63 duty of care
abuse based on 101–2 advice and support 88
challenging 76–8 assessment requirements 91
defined 63–4, 70 complaints 89–91
generalisations 64–5 conflict with people’s rights 85–8
labelling 67 defined 82–3
legislation 71–3 functional skills 83, 84, 88
stereotypes 65–6, 68, 70 further reading 92
ways to reduce 68–71 impact on work role 83–4
disinfection 264–5 dysphasia 10
distress
alleviating 10–11(B) E
assertiveness 11(B) ear conditions 20–2(E)
assessment requirements 21(B) eating and drinking
calmness 10–11(B) active participation in clearing away 344
causes of 2(B) adapting support 340–1
communication, impact on 3–4(B) allergies 341
empathy and reassurance, communicating 10(B) assessment requirements 349
encouraging expression of 14(B) assistance with 336–7
functional skills 9(B), 13(B), 19(B) choking 341–2
further reading 21(B) clearing away after 342–4
impact on you of others’ 5(B) confirming people have finished 342–3
information and advice 6(B) dignity, comfort and enjoyment with 338
involving others in support 12–13(B) encouragement in 339–40
managing own feelings 8–9(B) environment for 338
recording 19(B) functional skills 328, 340, 346
reporting incidents 20(B) further reading 348
responding to reactions to support 12(B) hand-washing 335
resulting from accidents and illnesses 211 healthy choices, encouraging 331–2
reviewing ways of coping 17–18(B) labels 331
signs of 2(B) legislation 348
specialist interventions, need for and level and type of support required 333–4
accessing 6–8(B) monitoring 345–7
triggers, identifying/reducing 14–16(B) pace of 339
distress as effect of abuse 128–9 personal hygiene following 344–5
diversity preferences, establishing 328–9
advice and support 79 preparation for 336
assessment requirements 80 recommended daily allowances 331
challenging discrimination 76–8 reporting on support given 348
and communication 24–5 safe handling of food 334–5
further reading 80 seeking guidance about choices 332–3
legislation 80 spilt food and drink 340
meaning of 62–3 suitable options, selection of 329–30
respect for beliefs and preferences 73–6 education, past, of people
dosette boxes 3(A) and person-centred approach 160
drink, food and. See eating and drinking; food and and support plans 3(C)
drink electrical injuries 207–9
384
Index
emergencies. See accidents and illnesses; health and feedback

safety mobility activities 306
empathise 361 on personal care support 368
empathy 321, 10(B) on support given to independence in daily
employment, past, of people living 22(A)
and person-centred approach 159–60 on support plans 15–17(C)
and support plans 3(C) using for development 58–9
empowerment against abuse 118–21 financial abuse 99
English skills 4, 28, 32, 37, 41, 46, 71, 74, fire
75, 83, 84, 88, 103, 105, 109, 138, evacuation 227
143, 147, 169, 172, 176, 182, 197, extinguishers 225–5
227, 250, 259, 260, 268, 296, 307, procedures 224–5, 227
314, 317, 321, 328, 340, 346, 352, food and drink
367, 372, 3(A), 8(A), 11(A), 16(A), 9(B), 13(B), preparation 336, 15–16(A)
19(B), 4(C), 9(C), 9(D), 18(D), safety 216–18, 334–5
20(D), 21(D), 25(D), 6(E), 7(E) spilt 340
epidermis 356 storage 12–14(A)
epileptic seizure 204 See also eating and drinking
Equalities Act 2010 72–3 footwear 273, 276, 277, 282
equality for mobility for activities 299
advice and support 79 formal support networks 47
assessment requirements 80 fractures 206, 292
challenging discrimination 76–8 freezers 13(A)
and communication 24–5 fridges 13(A)
functional skills 71, 74, 75 friendships 132, 133–4
further reading 80 functional skills
legislation 71–3, 80 abuse 103, 105, 109
respect for beliefs and preferences 73–6 communication 4, 28, 32
ways to reduce discrimination 68–71 distress 9(B), 13(B), 19(B)
Equality and Human Rights Commission 79 duty of care 83, 84, 88
equipment eating and drinking 328, 340, 346
cleaning 215, 264–4 English 4, 28, 32, 37, 41, 46, 71, 74, 75, 83, 84,
infection prevention and control 271 88, 103, 105, 109, 138, 143, 147, 169, 172,
lifting and handling 218–19 176, 182, 197, 227, 250, 259, 260, 268, 296,
for mobility 299–300 307, 314, 317, 321, 328, 340, 346, 352, 367,
moving and positioning people 22–6(D) 372, 3(A), 8(A), 11(A), 16(A), 9(B), 13(B), 19(B),
for moving and positioning people 8(D) 4(C), 9(C), 9(D), 18(D), 20(D), 21(D), 25(D), 6(E),
evacuation routes 227 7(E)
extinguishers, fire 225–5 equality 71, 74, 75
eye conditions 17–20(E) health and safety 193, 197, 227
inclusion 71, 74, 75
F independence in daily living 3(A), 8(A), 11(A),
faeces 369–70 16(A), 17(A)
familiar layout and routines 4(E) infection prevention and control 259, 260, 268
families information 250
concerns over independence 169 Maths 193, 301, 17(A), 6(D), 8(D)
as information source 9(C) mobility 296, 301, 307
relationships in 132, 133 moving and positioning people 6(D), 8(D), 9(D),
structure of 134 18(D), 20(D), 21(D), 25(D)
385
pain and discomfort 314, 317, 321 equipment handling 218–19

personal care needs and preferences 352, 367, fire 224–7
372 food safety 216–18
personal development 37, 41, 46 functional skills 193, 197, 227
person-centred approaches 169, 172, 176, 182 further reading 237
sensory loss 6(E), 7(E) hazardous substances and materials 221–4
support plans 4(C), 9(C) infection, reducing 212–17
workers, health and social care 138, 143, 147 legislation 186, 191, 218–19, 237
further reading manual handling 189, 218, 219–20
abuse 130 mobility equipment 299–300
communication 32 moving and positioning people 7–18(D)
distress 21(B) personal safety 232–3
diversity, equality and inclusion 80 policies 189
duty of care 92 reporting risks 192–4
eating and drinking 348 responsibilities for 187–9
health and safety 237 risk assessment 191–2, 194–5
independence in daily living 25(A) security 228–33
information 255 storing items in the home 18(A)
mobility 309 stress 234–6
moving and positioning people 32(D) support and information 190
pain and discomfort 326 training for particular tasks 189
personal care needs and preferences 372 Health and Safety at Work Act 1974 258, 260, 277,
personal development 60 279
person-centred approaches 183 health and social care workers. See workers, health
sensory loss 25(E) and social care
support plans 22(C) health of people
workers, health and social care 149 and person-centred approach 159
and support plans 2–3(C)
G healthcare-associated infection 258
gender discrimination 64 hearing loss
generalisations 64–5 causes of 20–2(E)
generic 5(C) and communication 10, 13–14, 19, 14–15(E)
glaucoma 18(E) impact of 2–6(E)
gloves 212, 273, 274–5, 276, 280–1 overcoming impact of 7(E), 8–9(E)
goggles 273, 276, 277, 282 signs of 24(E)
Heimlich manoeuvre 205
H help, summoning 358
hair 284, 356, 366 hoists 23–4(D)
halal 328 holistic approach
handling belts 25(D) pain management 312–13
hand-washing 213–14, 285–7, 335 person-centred approach 159–61
harm, danger and abuse 94–5 support plans 2(C)
hats 273, 276, 277, 282 homes, people’s, risk control in 192
hazardous substances and materials 221–4 hygiene, personal 216
hazards 187
head lice 356 I
health and safety identity 177–8
accidents and illnesses 196–211 proof of 251–2
assessment requirements 236 identity badges 228
386
Index
implied consent 164 See also personal protective equipment (PPE)

inclusion informal support networks 47–8
advice and support 79 information
assessment requirements 80 access to and active participation 168
challenging discrimination 76–8 agreed ways of working 246–55
defined 71 assessment requirements 255
functional skills 71, 74, 75 communicating 247–8
further reading 80 on communication needs and preferences 8–9
legislation 71–3, 80 concerns over, dealing with 244–5
respect for beliefs and preferences 73–6 confidentiality 26–31
ways to reduce discrimination 68–71 distress, supporting people in 6(B)
independence in daily living functional skills 250
active participation 2–4(A) further reading 255
adapting support 23(A) health and safety 190
agreeing people’s participation 9–10(A) kept by personal assistants 242
assessment requirements 24(A) legislation 240, 255
benefits of 2(A) manual records systems 242
changes in circumstances, recording 22(A) on moving and positioning people 31–2(D)
cleaning of people’s homes 19–20(A) security of 240–2
culture and background, impact of 4–5(A) and sensory loss 3–4(E), 16(E)
feedback on support given 22(A) sharing of and confidentiality 250–5
food preparation 15–16(A) sources of for development 44–5
food storage 12–14(A) support for handling 243–5
functional skills 3(A), 8(A), 11(A), 16(A), 17(A) types of 248–50
further reading 25(A) informed consent 164
guidance in resolving difficulties 10(A) institutional abuse 102–3, 103, 125
learning/practising skills 5–6(A) Internet as information source 45
meals, planning 11(A) interpreters, use of 12
right to 153
roles and responsibilities for support 7(A) J
safe use of items 19(A) jewellery 216, 284
security in the home 20–1(A) Jhatka 328
shopping 16–18(A) job descriptions 140–3
storage of items 18(A)
support plans 8–9(A) K
individuals, treating people as 152–3 knowledge and skills, developing 44–5, 54–9
inequality 68–9 kosher 328
infection prevention and control 212–17
assessment requirements 289 L
food safety 216–17, 334–5 labelling 67
functional skills 259, 260, 268 language differences and communication 10, 12–13,
impact of outbreaks 267–8 19
legislation 258, 260–3, 289 learning. See personal development
moving and positioning people 17(D) learning disability and communication 11, 15, 19
personal hygiene 212–16, 284–8 learning styles 6(A)
policies 262–3 legislation 4(D)
procedures and systems 263–6 abuse 121–3, 130
risk assessments 268–72 carers 114–15
roles and responsibilities 258–60 confidentiality 26
387
eating and drinking 348 health conditions related to 292–4

hazardous substances and materials 221 impact of reduction in 295–6
health and safety 186, 191, 218–19, 237 legislation 301, 309
inclusion 71–3, 80 monitoring changes/responses during
infection prevention and control 258, 260–3, activities 307
289 recording observations 307
information 240, 255 reporting progress/problems 308
lifting and handling equipment 218–19 risk assessment before activities 298–9
mobility 305, 309 and sensory loss 5–6(E)
moving and positioning people 4–5(D), 22(D), support plans 252
32(D) mobility scooters 305
pain and discomfort 326 motions 369
personal care needs and preferences 372 moving and positioning people
personal protective equipment (PPE) 277–8 active participation 26–7(D)
Public Interest Disclosure Act 1998 124 advice and assistance with 30–1(D)
sensory loss 25(E) agreed ways of working 4–6(D)
support plans 22(C) aids and equipment 22–6(D)
whistleblowing 124 anatomy and physiology 2–3(D)
lifting handles 25(D) assessment requirements 33(D)
Lifting Operations and Lifting Equipment Regulations communication with colleagues 21–2(D)
1992 (LOLER) 219, 22(D) communication with the person 19–20(D)
listening skills 20–3 conflict with people’s wishes 14–15(D)
long-term abuse 103 consent for 20(D)
loss of consciousness 201–3 emergencies 30(D)
environment for 15–16(D)
M equipment 18(D), 31(D)
macular degeneration 17–18(E) functional skills 6(D), 8(D), 9(D), 18(D), 20(D),
manual handling 189, 218, 219–20 21(D), 25(D)
See also moving and positioning people further reading 32(D)
masks 273, 275, 276, 281 health and safety 7–18(D)
Maths skills 193, 301, 17(A), 6(D), 8(D) infection prevention and control 17(D)
meals, planning 11(A) information sources on 31–2(D)
meat storage 13(A) legislation 4–5(D), 22(D), 32(D)
menopause 370 maintenance of positions 25–6(D)
menstruation 370 monitoring people 27(D)
Mental Capacity Act 2005 87–8 preparation for 11–16(D), 19–20(D)
mistakes, use of 55–6 recording and reporting activities 28(D)
mobility refusal to cooperate 31(D)
active participation 302 risk assessment 9–13(D), 15(D), 17(D)
agreeing activities 298 risk minimisation 9–18(D)
assessment requirements 309 and specific conditions 3–4(D)
assisting with appliances 302–5 MRSA 267
benefits of maintaining/improving 296–7 multiple sclerosis 294
clothing and footwear for activities 299 muscular dystrophy 293
defined 292 muscular system 2–3(D)
equipment for 299–301
feedback and encouragement 306 N
functional skills 296, 301, 307 nails 366
further reading 309 National Minimum Standards 35–7
388
Index
National Occupational Standards 35 equipment 357, 358

neglect 99–101 feedback on support 368
networks, support 47–8 functional skills 352, 367, 372
non-verbal communication 5–7, 20–1 further reading 372
legislation 372
O level and type of support 353
occlusive 288 monitoring functions and activities 368–70
occupational therapists 353 privacy 354–5
ombudsman 29 reasons for personal hygiene 355–6
operations 294 recording and reporting 370
oppression 70 reporting concerns 358
organisational abuse 102–3, 125 security of personal items 367
osteoporosis 292 summoning assistance 358
outcomes 135 temperature of room and water 362–3
toileting 360–2
P toiletries/equipment within reach 363–4
pain and discomfort uniforms 357
agreed ways of working 317 waste disposal 359–60
alleviating/minimising, approaches to 314–21, personal development 56
321 appraisals 48–9
assessment requirements 326 assessment requirements 59
concerns and findings, reporting 324–5 attitudes and beliefs 38–41
emotions 312 competence 38
expressing feelings of 318–19 duties and responsibilities 34–5
functional skills 314, 317, 321 feedback 58–9
further reading 326 functional skills 37, 41, 46
holistic approach to managing 312–13 further reading 60
impact on well-being and communication knowledge and skills 44–5, 54–9
317–8 mistakes, use of 55–6
legislation 326 plans 51–3
measurement of 318–9, 322 recording progress 59
monitoring management of 322 reflective practice 42–4, 46
positions for resting 320 sources of support 46–50
records 322–4 standards 35–7
self-help control methods 320 supervision 48
palliative care 313 support networks 47–8
Parkinson’s disease 294, 3(D) training and development 49–50, 56–8
partnership working personal hygiene 216, 294–8, 357, 17(D)
with service users 153 See also personal care needs and preferences
in work teams 145–9 personal protective equipment (PPE) 357
pathogenic 264 application and removal of 279–82
personal assistants, records kept by 242 correct use of 272–4
personal care needs and preferences disposal of used 282–3
active participation 364–5 legislation and regulations 277–8
appearance 365–7 reasons for using 276–7
assessment requirements 371 responsibilities regarding 278–9
comfort, respect and dignity 364–5 types of 274–6
communication of 352–3 personal relationships 132–4
culture and religion 352–3 personal safety 232–3
389
person-centred approaches Provision and Use of Work Equipment Regulations

active participation 166–9 1998 (PUWER) 218
assessment requirements 182 psychological abuse 98–9
challenging decisions 174–6 Public Interest Disclosure Act 1998 124
choices, supporting 170–6
consent 162–5 Q
in day-to-day work 159–61 quadrupeds 300, 303
finding out what people want 157–9 questions 22
functional skills 169, 172, 176, 182
further reading 183 R
holistic approach 159–61 reassurance, communication of 10(B)
risk-taking as part of 154–5 recommended daily allowances 331
support plans, use of for 156 records
values 152–4 agreed ways of working with 246–55
well-being, promoting 177–82 changes in circumstances 22(A)
physical abuse 96–7 communication needs and preferences 8–9
physical access and active participation 168 concerning abuse 111–13
physical disability and communication 10–11, 14–15, concerns over, dealing with 244–5
19 confidentiality 109
See also sensory loss eating and drinking 345–7
physiology 2–3(D) kept by personal assistants 242
pillows 25(D) manual systems 242
poisoning 207 moving and positioning people 28(D)
policies pain and discomfort 322–4
as agreed ways of working 143–4 on people’s distress 19(B)
confidentiality 20 personal care 370
health and safety 189 personal development 59
infection prevention and control 262–3 security of 240–2
moving and positioning people 6(D) support plans 13–15(C)
positions for resting 320 recovery position 203
See also moving and positioning people reflective practice 42–4, 46
poverty 68–9 refusal of consent 165
preferences and beliefs, respect for 73–6 registration 34
prejudice, recognising own 73–4 relationships
privacy friendships 132, 133–4
personal care 354–5 personal 132–4
right to 153 sexual 132, 133
procedures working 132, 135–9
as agreed ways of working 143–4 religion and person-centred approach 161
complaints 89–90 Reporting of Injuries, Diseases and dangerous
infection prevention and control 263–6 Occurrences (RIDDOR) Regulations 1995 193–
moving and positioning people 6(D) 4, 260–1
professional development 56 respect for beliefs and preferences 73–6
professional relationships 135–7 consent 162
proof of identity 251–2 partnership working 146
property, security of 231–2, 367 right to 153
prostheses 364 resting positions 320
protection. See abuse rights of people
protective clothing 214 access to 153
390
Index
and duty of care 85–8 overcoming impact of 6–11(E)

legislation 71–3 percentage of population with 23(E)
and lifting 219–20 reporting concerns 24–5(E)
risk assessment for health and safety 194–5 signs of 23–4(E)
risk assessments 173–4 serial abuse 103
health and safety 191–2, 194–5 sexual abuse 97–8
infection prevention and control 268–72 sexual relationships 132, 133
before mobility activities 298–9 shaving 365
moving and positioning people 9–13(D), 15(D), shock 127–8, 201
17(D) shoes 216, 273, 276, 277, 282
risks 83, 187 shopping, support with 16–18(A)
control measures 191 sight loss
and duty of care 85–8 causes of 17–20(E)
minimising when moving and positioning communication 10, 14, 19, 13–14(E)
people 9–18(D) impact of 2–6(E)
recognising 94–5 overcoming impact of 6–7(E), 9–11(E)
reporting risks 192–4 signs of 23–4(E)
taking of as part of person-centred situational abuse 103
approaches 154–5 skeletal system 2(D)
skills and knowledge, updating 44–5
S skin 288, 355–6
safeguarding. See abuse slide sheets and boards 24(D)
Safeguarding Adults Boards 118, 125 social factors
scalds and burns 206–7 and person-centred approach 161
scope of the job 140–3 and support plans 3(C)
scrub solutions 287 sodium hypochloride 260
security standards 35–7
in the home 20–1(A) stereotypes 65–6, 68, 70
of information 240–2 sterilisation 265
of people’s personal items 231–2, 367 storage
risk assessment 194 of food 12–14(A)
in work settings 228–33 household and personal items 18(A)
self-esteem 26, 159, 166, 178–80 stress 234–6
self-harm 106 See also distress
self-image 177–8 stroke 293, 9(A), 4(D)
self-management of pain 320 supervision 48
self-neglect 99–100 support
sensorineural hearing loss 21–2(E) distress, supporting people in 6(B)
sensory loss for handling information 243–5
acquired 22(E) health and safety 190
assessment requirements 25(E) independence in daily living 10(A)
attitudes and beliefs 11–12(E) managing own feelings 8–9(B)
causes of 17–22(E) sources of for development 46–50
communication 13–16(E) stress 236
congenital 22(E) team difficulties 147–8
functional skills 6(E), 7(E) support plans
further reading 25(E) active participation of people 11–12(C)
impact of 2–6(E) adapting to suit preferences 12(C)
legislation 25(E) agreeing changes 20–1(C)
391
assessment requirements 21(C) V

choice, enabling 6(C) values
control of by people 7–8(C) as a health and social care worker 38–41
factors affecting people 2–4(C) in person-centred approaches 152–4
feedback on 15–17(C) preparing to eat and drink 336
functional skills 4(C), 9(C) respect for 73–6
further reading 22(C) vena cava 26(D)
holistic approach 2(C) verbal consent 165
importance of following 10–11(C) vetting and barring schemes 123
independence in daily living 8–9(A) visors 273, 275, 277, 281–2
information sources for 8–9(C) visual impairment. See sight loss
legislation 22(C)
monitoring 15–17(C) W
preferences of the person 4–5(C) walking frames 301, 303–4
records of 13–15(C) walking sticks 300, 302–3
reviewing 15–19(C) waste
revisions of 13–14(C) disposal of 215, 282–3, 344, 359–60
use of in person-centred approaches 156 hazardous 223–4
wedges 26(D)
T well-being, pain and discomfort, impact of on 317–8
teams well-being, promoting 177–82
partnership working 145–9 wheelchairs 304
resolving issues and difficulties 147–8 whistleblowing 123–9
working in 137–9 workers, health and social care
technology agreed ways of working 143–4
assistive 3–4(A) assessment requirements 149
and communication 14 functional skills 138, 143, 147
teeth 356 further reading 149
temperature of room and water 362–3 job descriptions 140–3
toenails 366 partnership working 145–9
toileting 360–2 personal relationships 132–4
toxins 267 resolving issues and difficulties 147–8
training 49–50, 56–8 responsibilities for health and safety 188–9
action concerning accidents and illnesses 209 scope of the job 140–3
health and safety 189 teams, working in 137–9
manual handling 189 working relationships 132, 145–9
See also personal development working relationships 132, 135–9, 145–9
trend 324 written consent 164
tripods 300
turn discs 25(D)
U
uniforms 357, 273, 274, 276, 279–80, 17(D)
urine 368–9
392
Unit HSC 2007
Support
independence in the
tasks of daily living
This unit will help you to learn how to support people in the tasks of
daily living. You will need to know why it is important to promote
independence as well as recognising what support people need,
taking into consideration people’s preferences and abilities. Being
independent gives us a sense of control over our life.
Eating and drinking is vital for life. You will learn how to support
people to plan and prepare nutritious meals while encouraging them
to participate actively. Being independent also means being able to
shop for personal and household items. You will learn how to
support people to buy items of their choice safely in a way that they
prefer. Some people may require help to know how to keep their
home safe and secure; you will learn how to support them to do so.
A person may become more independent or they may need more
support. You will learn to recognise when people’s needs do change
and know how to respond to these changes.

1. principles for supporting independence in the tasks of daily
living
2. how to establish what support is required for daily living
tasks
3. how to provide support for planning and preparing meals
4. how to provide support for buying and using household
and personal items
5. how to provide support for keeping the home clean and
secure
6. how to identify and respond to changes needed in support
for daily living tasks.
1
1. Understand principles for

supporting independence in the
1.1 How individuals can benefit from
being as independent as possible in the
Being independent gives someone a feeling of control over their life.
People feel more comfortable, safe and reassured when they can do
things for themselves and this also helps to uphold their self-esteem.
Independence can help people to achieve their life goals; we know
ourselves better than anyone else does and thus the direction in life
that we are heading. Holding on to independence about decisions
that are made regarding ourselves as well as where and how we live
can make us feel that we are positively contributing to society.
Being independent contributes positively to our physical health.
Keeping active is good for all of our body systems; for example, it
maintains a healthy heart and circulation.
Losing independence can have a negative impact on our mental
health and well-being. It can be very costly, for example, if a person is
unable to do their own shopping, personal care or domestic tasks. It
may be necessary to employ someone else to do this for them.
Physical and emotional health can soon decline when a person starts
to lose their independence.
Reflect
Imagine that you have broken both your leg and arm (you have a plaster
cast on each), and you live alone. Think about the following.
1. How will you manage the tasks of daily life such as maintaining your
personal care, shopping and housework?
2. How does it feel to have to ask other people to help you?
3. The plaster casts have now been removed and you can do things for
yourself. Compare how you feel now to when you were unable to
do things for yourself.
1.2 How active participation promotes

independence in the tasks of daily living
Active involvement in learning to develop life skills can help people to
become independent. Learning in a safe environment and knowing
that there is support at hand in case it is needed will give a person
2
Support independence in daily living Unit HSC 2007
confidence and reassurance. Many of us learn by doing – in fact, this

Activity 1 is how we learn as children. We sometimes make mistakes but this
Researching assistive can be positive as long as it is handled properly and the person is
given constructive feedback and appropriate advice and guidance.
devices
Some people who are being supported in the community will find care
Use the Internet to explore the
worker support and encouragement invaluable. For example, it is
range of assistive devices available
better for people to do shopping and manage at the till independently
that can enable a person to retain
(the care worker can stand back and intervene with support if
their independence.
necessary) – this will help to develop the person’s confidence and life
skills. A supportive relationship between the two parties is crucial.
Functional skills Being independent means that the person can have some control
over choices and outcomes – for example, active participation in their
English: Reading care package and services that they wish to use.
Using the Internet, search for and
Assistive technology has enabled many people to retain independence
read a range of documents about
where in the past they would have been dependent on others.
assistive devices available to enable
Assistive technology includes a range of equipment that supports
people to retain their independence.
active participation in promoting and maintaining independence – for
By doing this, you will be reviewing
example, reminder messages for people with dementia or medication
and using a variety of texts to find
aids such as dosette boxes. Assistive
out information for the set task for
your course.
Key term
Dosette box – a pill organiser;
usually someone’s medication for
the day, part of the day, or for a
week
How can you support people to use assistive devices?
3
technology can help a person stay in their own home rather than
have to consider residential care. Fingerprint entry systems, which can
make keys not necessary (eliminating the issue of lost keys), and
special mobile phones designed for easy use, which can be used to
call support centres, enable the person to participate actively in
retaining their own independence. Providing appropriate assistive
devices enables people to be less dependent on others and helps
them to retain a sense of control over their life.
1.3 How daily living tasks may be affected

by an individual’s culture or background
How we carry out our daily living tasks can be affected by our culture
and background. For example, if a person has been used to having
things done for them such as cooking and cleaning, then they may be
reluctant to do these tasks for themselves. On the other hand, if a
person has been used to doing things for themselves without the
help of others, then they may feel more inclined to want to continue
to do so. Maybe the person has struggled financially and had to be
very careful with money, leading to careful meal planning to reduce
waste, perhaps using leftovers to provide another meal. Repairing
worn clothing instead of throwing it away is a practice common to
some people who have had little money to spare to buy new items.
You may have differing opinions to others on domestic matters.
4
Some people have routines at home that they feel must continue. For
Reflect example, they may vacuum and dust daily, while others may do such
Our upbringing and culture duties only occasionally as the need appears to arise.
strongly influences how we carry out Gender perception and culture can influence daily living tasks. For
our daily living tasks. Reflect on your example, some might find it more acceptable for women to deliver
childhood and younger adult years. personal care and tend to household tasks because this is how they
What routines did you and your were brought up. Some people may feel that certain roles should be
parents/care givers have? How has male or female (for example, the belief may be that women shop and
this influenced how you do things cook dinner while the male is the financial provider).
today?
1.4 The importance of providing support
that respects the individual’s culture and
preferences
It is important that the support given fully respects the person’s
culture and preferences. It would be wrong to try to change a
person’s belief and culture just because it is not what we believe is
right. We must respect people for who they are and give people
equal opportunities of access in order to promote and retain
independence. Culture may affect the support that is given. For
example, a female who follows Muslim beliefs may be offended if she
is assisted with her personal care by a male care worker. Find out
about people’s preferences and beliefs; if you are not sure, then ask
them or their family, friend or advocate. Never assume that if a
Activity 2
person belongs to a certain group, they all hold the same preferences
Codes of Practice and beliefs, as this is not always the case. It is better to involve the
person actively and find out what their preferences are.
Check your Codes of Practice –
what do they say about respecting If personal preferences are not respected, then this could not only
people’s cultures and preferences? offend the person, but also they may avoid seeking support when
they need it. Sensitivity should be exercised at all times.
1.5 How to identify suitable opportunities

for an individual to learn or practise skills
for daily living
People can learn practical living skills on a day-to-day basis. It is
important therefore that care workers recognise opportunities and
give the appropriate support. If a person is living in a supported living
environment, the opportunities to learn life skills can be effectively
embedded on a regular basis. For example, while the support worker
is helping the person to do their shopping, use public transport or
access a service such as a cinema, there are opportunities to develop
communication, organisation and numeracy skills. When planning
activities the support worker, with the person, should recognise and
seize opportunities for that person to develop valuable learning and
life skills. Shopping trips can be a useful learning opportunity – for
example, when planning what is needed, writing lists, organising
5
where to go and keeping within budget. Learning to shop online can

also be a valuable learning experience for the development of
functional ICT skills. People with restricted mobility such as those with
Parkinson’s disease, following a stroke, or surgical operation may also
find Internet shopping useful in order to maintain independence, but
they may not have the ICT skills to be able to do this effectively.
Support workers and local training providers can help the person to
develop these skills.
In an increasingly technological world, however, people should be
made aware about how to keep safe while using the Internet and
mobile phones, as well as other electronic devices. Raising awareness
of e-safety is an important part of protecting vulnerable people from
the potential harm of identity theft.
Key term When identifying opportunities and supporting people to develop
Learning style – how we learn – skills, remember that people have different learning styles. Some
for example, by watching, doing, people prefer to learn by doing, while others may be visual learners.
reading or seeing or a combination Colleges and other training providers usually offer a comprehensive
of these range of formal training courses that incorporate the development of
personal and social development, confidence building, vocational and
functional English, maths and ICT skills courses. All of these can be of
benefit for the person to promote independence and employment
opportunities for the future.
Do you know who you are giving your personal information to when using the Internet?
6
1.6 Why it is important to establish roles

and responsibilities for providing support
Several people can be involved in supporting someone to be
independent – for example, the person themselves, the support
worker and other professionals such as occupational therapists and
social workers. It is important to establish each person’s role and
responsibilities at the beginning of the care support delivery so that
all parties are clear; that way unrealistic expectations and mistakes
can then be avoided. It will also enhance the standard and continuity
of care.
People using the service should be actively involved, and clear about
what their role and responsibilities are. This information must be
given in a way that is accessible and able to be understood.
The person using the service will have confidence in the organisations
involved if information is clear; the service will be more efficient
because each party will know what they need to do. Overall it will
portray a more positive professional image as well as satisfaction for
the person using the service.
When roles and responsibilities have been established, they should be
clearly documented so that they can be referred to. Changes in roles
and responsibilities should be communicated to the person and to
others involved in the support delivery.
If roles and responsibilities were not clearly established, an aspect of
care support might be missed which would impact negatively on the
person. It could even prove harmful – for example, the person might
miss an important health screening procedure if it was assumed that
someone else was responsible for organising it.
7
2. Be able to establish what

support is required for daily
living tasks
2.1 Information about support for daily
living tasks, using an individual’s care
plan and agreed ways of working
When a person’s needs have been assessed by health and social care
Functional skills professionals, a support plan will follow. The person will be actively
involved in the plan; relatives, advocates and other professionals may
English: Writing also contribute. A support plan is a detailed written or electronic
document that gives guidance on how to support a person with their
By completing the questions on the
needs. Before you can give a person support with any daily living task,
support plan, you will be practising
you must read and understand the support plan. If you do not fully
your writing skills as well as your
understand the support plan, you must speak to your supervisor, who
reading skills. You will need to
will go through it with you. You must do what the plan says and
answer the questions in a coherent
follow it carefully, sticking to the agreed and approved ways of
way, using full sentences that have
working that have been documented.
accurate spelling, punctuation and
grammar. Your work needs to be You will find information about the person’s abilities relating to daily
laid out using a suitable format and living tasks such as managing hygiene, toileting, mobility and diet.
the information should be presented The plan should promote active participation of the person to
in a logical order. promote independence. It is important that you are very clear about
what you need to do in order to support the person; that way, you
will not give too much or too little assistance.
Case study
Supporting people to maintain their independence

Mrs Vine is 66 years old and, up until last week when Mrs Vine with her daily living tasks. Rashid did not
she had a stroke, she was completely independent. follow the support plan – instead of supporting her to
Mrs Vine lived a very active life and after retiring from mobilise over to the bathroom (using the agreed
her teaching job, she continued to work part time in a mobility aids) to have a wash, he hoisted her into a
department store. She often looked after her wheelchair and took her over where he washed her,
grandchildren while their parents worked; she was also then wheeled her back and hoisted her into a chair. At
a very active member of the community where she lunch time he fed her, claiming that it would take too
organised many activities for her local church. long for her to feed herself and the food would get
cold.
The stroke that Mrs Vine suffered resulted in left-side
weakness. She was hospitalised, where her needs were 1. Why did Rashid not follow the support plan?
assessed by the multidisciplinary team and a support 2. What might happen to Mrs Vine if support workers
plan put in place. Clear guidance was given outlining do not follow the agreed support plan and
how to support her in her daily activities such as with approved ways of working?
mobility, hygiene and toileting. 3. Why is it important to follow the support plan?
4. What should Rashid have done when supporting
The ward was very busy and Rashid, a healthcare
Mrs Vine?
support worker, was responsible for supporting
8
The person may be following a rehabilitation programme, for

Key term example, after suffering a stroke or a fall. It is therefore vital that the
Stroke – a sudden illness which support plan is followed accurately in order for rehabilitation to be
may be caused by a clot or a bleed successful.
in the brain. It can cause weakness
Failure to work in the way that the support plan states could lead to
or loss of use of one side of the
delivery of a poor standard of care and inconsistencies between those
body and speech may be impaired.
who are supporting the person. You will also be in breach of your
It can also cause brain damage,
working contract and impact on their recovery.
resulting in communication
difficulties and problems 2.2 The requirements for supporting an
understanding things
individual’s independence in daily living
tasks
As well as following the person’s written or electronic support plan,
you must actively involve the person when supporting activities of
daily living tasks; that way there will be less likelihood of any
misunderstanding. Before you support the person, talk through and
agree each person’s participation – for example, the support plan
Confirm with the person beforehand the way that support will be given.
9
might state that the support worker may collect the person’s toiletries
and chosen clothes to wear and take them to the bathroom, then
help the person over to the bathroom where they may then manage
their personal care independently. The method of calling for
assistance will be agreed and stated, then the support worker may
assist the person back to their chair. If you are supporting a person
who has mobility difficulties to do their shopping, the plan of care
may state that they will use sticks to walk and you can open doors
and carry shopping. Always confirm details with the person
beforehand.
Clarifying and actively involving the person shows value and respect,
as well as giving them a sense of control over their life and choices. If
the person themselves is unable to contribute to the discussion, then
the agreed people who are acting on their behalf, such as relatives or
an advocate, should be involved.
If equipment has been indicated in the support plan to be used in
order to support independence, ensure that they know how to use it
properly through demonstration, encouragement and support.
2.3 How and when to access additional

guidance to resolve any difficulties or
concerns about support for daily living
tasks
It is important to refer to the support plan and clarify and agree the
support that people need before offering support with any activity.
However, you may notice that the person is having difficulties in
carrying out the tasks as outlined in their support plan; if this is the
case, then you must seek guidance from your supervisor. People’s
needs can change very quickly – for example, you may be supporting
a person who is undertaking a mobility rehabilitation programme
whose support plan indicates that they will use a frame to mobilise;
however, you are made aware that they have had a sleepless night
because they have developed flu and they are very unsteady on their
feet. It may be unsafe for them to mobilise independently using their
frame for a day or so, because they may be at a high risk of falls; their
needs have changed. Changes need to be reported to your
supervisor, who will then reassess the person’s needs and adjust the
support plan to meet their current needs.
If you find that you are unable to support the person according to
their support plan because you consider that the demands on your
time are so great and you simply do not have the time, then you must
inform your supervisor. This needs to be documented clearly and
reported to the manager.
10

planning and preparing meals
3.1 Supporting the individual to plan
Activity 3 meals that contribute to a healthy diet
Extending your
and reflect their culture and preferences
knowledge An adequate supply of essential nutrients in the diet is essential for
health. It is therefore important that you have a good understanding
Read the section in Unit HSC 2014
of the components of a healthy diet in order to be able to advise and
(pages 328–333) to find out about
support people when they are planning meals. Care workers are in an
the components of a healthy diet.
ideal position to promote healthy lifestyles which include diet and
nutrition. Many people have been found to be malnourished when
admitted to hospital when they are physically and mentally
Functional skills vulnerable.
English: Reading The components of a healthy diet are discussed in Unit HSC 2014;
however, nutritional and energy needs and demands change in
By doing this, you will be using
certain circumstances and throughout life stages (see Table 1). The
reading skills to extract information
body uses food and nutrients that it takes in to create energy.
from a text.
Factor How it influences energy needs
Age Older people have a slower metabolism; therefore their energy requirements
are lower.
Gender Men generally have a greater muscle mass and a higher metabolic rate; therefore
their energy requirements are higher than females’. On average, men require 2,500
calories while females need approximately 2,000 calories per day.
Height and build Larger bodies need more nutrients to maintain cells.
Physical activity The more physical activity is carried out, the more energy is needed.
Pregnancy The rapid growth of the foetus, especially in the second and third trimester, puts
demands on the mother’s nutrition, but only by about 200 extra calories. The
decreased maternal activity towards the end of pregnancy often compensates for
this.
Breast feeding A woman who breast feeds requires increased energy; her calorie intake should
increase by about 500–600 calories per day.
Injury and infection The body’s metabolic rate increases in reaction to injury and infection; therefore
more energy is needed.
Limited mobility Calorie intake needs to be reduced to avoid gaining weight; however, even a very
inactive person should not drop their calorie intake below 1,400 (for women) and
1,700 (for men).
Table 1: Factors that affect energy needs.
11
When supporting people to plan meals, you should consider their

energy requirements and the components of a healthy diet.
It is important also that people consume adequate amounts of fluids
each day; the recommended fluid intake is 2 litres. Non-alcoholic
drinks such as water, fruit juices and squash should be encouraged.
Coffee, tea and other caffeine-rich drinks should be consumed in
moderation.
As well as helping to support a person’s biological nutritional needs,
you need to consider their preferences and cultural needs when
helping them to plan a healthy diet. Have a look at dietary
preferences and cultural requirements in Unit HSC 2014.
When planning meals with people, it is useful to consider their
lifestyle and circumstances. For example, does the person sometimes
need to prepare meals quickly because of time constraints, or do
they live alone and not need to use a full pack of meat? Preparing
meals and freezing them to use another day can be useful in these
circumstances because it will save time, reduce waste and save
money.
3.2 Supporting the individual to store

food safely
Storing food properly promotes food hygiene and safety, and reduces
waste. Knowing about safe storage of foods will help you to support
the people to plan meals better; for example, knowing how to store
leftover food will help the person to use this for another meal,
therefore saving money.
The basic rules are:
•• store the food in the right place
•• store it at the correct temperature
•• use within the correct timescale.
People can become confused by the messages that shops and
manufacturers give about how long food can be kept and when it
should be used by. Table 2 explains the guidelines.
Guideline Description
Sell by This is a guideline for the customer; usually the food

is OK for a few days after the sell by date if stored
properly.
Use by This is the date that the food must be used by (this
often relates to refrigerated items).
Best before This is a guideline about when food will be ‘past its
best’, but may still be all right to eat.
Table 2: Guidelines on food labels.
12
The fridge
Food is kept in the fridge to stop bacteria from growing on it. Cooked
food, raw food, ready-to-eat food such as ready meals and desserts
should be kept refrigerated. The fridge must be cold enough; the
temperature should be between 0°C and 5°C. Use a thermometer if
you are unsure.
Food should be cooled before you put it in the fridge, otherwise it will
raise the temperature inside the fridge, which will put other food at
risk. If the fridge is full, you may need to turn it down to lower the
temperature. Keep the fridge door closed as much as possible.
Some jars and bottles need to be kept in the fridge once they have
been opened, so always read the label. Do not keep uncooked
Key term potatoes in the fridge because this can lead to an increase in a
Acrylamide – a chemical found in chemical called acrylamide when they are baked, roasted or fried at
starchy food that has been cooked high temperatures. Acrylamides have been found to cause cancer in
at high temperatures – for example, animals.
crisps, chips or crisp breads Storing meat
Bacteria can spread easily from meat on to other items. To prevent
this from happening, store meat in sealed containers on the bottom
shelf of the fridge. This will make sure that juices do not drip and that
the meat does not touch other food. Cooked meat should be cooled
quickly and then stored in the fridge, away from raw meat.
The freezer
Using a freezer is an excellent way of making sure that you always
have food in stock; it is also a very good way to store leftovers for
another day. Frozen food can last for a long time, sometimes years,
but always read the label for thawing and cooking instructions.
The quality and the texture of the food can deteriorate over time in a
freezer, so it may not taste as good after a long period of time.
Doing it well
Freezing food
•• Freeze before the use-by date.
•• Follow the food manufacturer’s thawing and cooking guidelines
(cook food until it is steaming hot).
•• Use the food within one or two days after thawing.
Store cupboard items

Many foods do not need to be kept in the refrigerator. Foods such
as rice, pasta, flour and biscuits can be stored safely in a store
cupboard. Items should, however, be well wrapped and stored away
from chemicals. Never use used food containers to store household
chemicals.
13
The cupboard should be dry and not too warm. Remember that some
foods need to be kept in the fridge once they have been opened;
always check the label.
Tin cans
Tinned food can last a long time, so keep tinned food items in a store
cupboard. If all of the contents of the tin are not used when it has
been opened, transfer the contents to a container and store in the
fridge. Never store food in the tin, because the tin from the can may
transfer on to the contents of the can and can be harmful when
eaten.
However, some foods are fine to remain in the can because the
contents do not react to the tin (foods such as treacle, cocoa and
mustard – tins for these are re-sealable).
Cling film
Cling film is useful to cover and protect items but must be used
correctly. Do not confuse cling film with wrapping film. Wrapping
film is much thinner and unsuitable to use for cooking; it is useful for
keeping items such as sandwiches fresh.
Doing it well
Using cling film
•• Do not use cling film if there is a possibility that it could melt on to
the food.
•• You can use cling film in the microwave but make sure that it does
not touch the food.
•• Only let cling film touch high fat food when the label says that it
is OK.
Kitchen foil
Kitchen foil is very useful for covering and wrapping items to keep
them fresh. Food containers containing aluminium and kitchen foil
should not be used to store highly acidic foods such as tomatoes,
rhubarb and some soft fruits, because the aluminium may react with
the acid in the food and it will affect its taste.
Using food items

Remember always to use the oldest item first. When you unpack
shopping, get into the habit of putting the newer items behind the
older ones – stock rotation will ensure that you use the items before
they go out of date.
14
Doing it well
3.3 Supporting the individual to prepare
Washing your hands
food in a way that promotes active
Always wash your hands:
participation and safety
When supporting people to prepare food, encourage them to
•• before you start to prepare food
participate actively and be as independent as possible. Both you and
•• after going to the toilet
the person will need to know about how to handle food safely in
•• after blowing your nose
order to prevent the spread of bacteria which could lead to the
•• after touching pets
possibility of becoming ill with, for example, food poisoning.
•• after touching the bin
•• after handling raw meat. There are some important things that you need to know.
Refer to Units HSC 027 and IC 01 to find out how to wash your
hands properly. Remember to dry your hands thoroughly after
washing them.
Doing it well
Cleaning preparation areas and worktops
•• Clean worktops with detergent thoroughly before you begin.
•• Thoroughly clean and dry any areas that have had raw meat, poultry
or eggs on them.
•• Clean up spills straight away.
•• Never put cooked or raw food on an area following handling of raw
meat, poultry or eggs.
Kitchen cloths
Kitchen cloths may look clean but they can harbour lots of germs.
Change dishcloths and tea towels regularly, and launder at a high
temperature. Paper kitchen towel is more hygienic than cloths to
clean and dry surfaces, but it can be expensive to use.
Knives and other utensils

Wash and dry knives and other utensils thoroughly after use; this is
especially important after using with raw meat. Dishwashers can be
very effective because they wash at high temperatures; however,
some people do not like putting knives in the dishwasher because it
can blunt blades.
If it is your role to handle food, then it is expected that you achieve a
Food Hygiene Certificate. Check with your local college or training
provider to see what courses are available. You can also complete
Food Hygiene training online.
15
Doing it well
Supporting people to prepare food
•• Allow plenty of time.
•• Refer to relevant risk assessments.
•• Check the person’s support plan to find out how much they can do.
•• Wash and dry hands properly.
•• Ensure surfaces, dishes and utensils are all clean.
•• Get everything ready beforehand.
•• Provide adapted cutlery and so on if required.
•• Ensure knives and boards are changed or thoroughly washed if
handling raw meat then other foods.
•• Clean the area thoroughly afterwards.
•• Dispose of waste properly (vegetables may go into a compost bin).
•• Record activity in appropriate records.

buying and using household and
Activity 4 personal items
Different methods of 4.1 Different ways of buying household
shopping
and personal items
Research your local area to find out
the different ways you can buy Nowadays, there are several ways of buying household and personal
household and personal items. items. For example, there is the standard supermarket that stocks
What are the benefits and probably all that is needed in terms of food, household cleaning
drawbacks of each method? items, pet food, hardware and clothes; some even have a pharmacy.
Supermarkets can be very busy and can feel overwhelming for some
people, especially if they have mobility or learning difficulties. Most
supermarkets are equipped with special trolleys that can support
Functional skills
people who have mobility problems; most have a designated wider
English: Speaking and checkout specifically for this purpose. Some supermarkets have
listening self-checkout tills that are automated; these can be useful if the
person has only a few items and little time.
Take part in a group discussion
about how you can buy household Some supermarkets will offer a home delivery service where the
and personal items in your local area. person can do their shopping in store and then have it delivered to
Make relevant and extended their home at an agreed time slot; this is particularly useful because it
contributions to the discussion that saves having to carry heavy items and shopping bags. Another benefit
allows for all the participants to take of this service is that the person can pay for the items in their
part. Present your points clearly and preferred way. The person may prefer to shop at a quieter time –
use suitable language at all times. several supermarkets are open 24 hours a day. However, the licensing
Show that you are listening to others law will restrict the times that it is legal to sell alcohol.
by picking up on points made by Internet shopping is becoming increasingly popular; the convenience
them. of shopping at home is becoming appealing to many people.
16
However, when shopping online, the person must have a debit or

credit card, so care and guidance may be needed to raise aware of
e-safety.
Small local convenience stores can be very useful. Sometimes these
are more expensive and stock less of a variety of items than the larger
supermarket stores, but the convenience of being able to pop out
and buy an item that you have run out of can be worth it.
Some towns still have markets, and people often wish to support
their local market which may have a large selection of stalls selling a
variety of items from food, vegetables, hardware, clothes and often
much more.
Functional skills 4.2 Identifying household and personal

Maths: Understanding items that are needed
routine problems It can be annoying when you have done your shopping and returned
home only to find that an essential item has been forgotten. Having a
Using your shopping list, compare
shopping list can help. Some people like to have a ‘live’ shopping list
the prices of goods on the Internet
in operation that they can then use when they shop. A notepad with
to the prices in local shops. Calculate
a pen in the kitchen, for example, can be useful; when it is discovered
the mean of the goods from both
that an item has run out or is getting low, writing it on the list will
places and document your findings,
ensure that the item will not be forgotten. It can be useful before
showing how you reached your
shopping to mentally or physically go through each cupboard and
answers.
area such as the kitchen and bathroom to generate the shopping list.
When using the Internet to shop, websites usually have categories of
items such as household, pets and toiletries; this can be good as a
reminder about what might be needed.
Remember that we all have different ways of working out what we
Shopping list need to buy, so it is important to respect the person’s methods of
working, especially if they work well. You can offer advice if their
Bread system does not work, but never force your way on to them.
Milk
Eggs 4.3 Supporting the individual to buy items
Cheese in their preferred way
Sausages Find out how the person wishes to buy items that they need – refer
Chicken to the support plan and risk assessments. Some people like to use a
Washing-up liquid combination of different methods. For example, they may wish to go
Laundry tablets to the supermarket to buy most of the food items but use the local
convenience store for fresh milk and bread. Some may prefer to use
Bleach
Internet shopping to buy heavy and bulky items so that they do not
Shampoo need to be carried from the shop.
Soap
Establish at the beginning of the activity what both of your roles and
Sieve
responsibilities are, and ensure that you both are clear and
Wooden spoons understand. Remember also to respect how the person wishes to pay
for the items – they may prefer to use cash, credit or debit cards. If
you are supporting someone in a store, it is important to promote
How do you make your shopping list?
17
active participation and ensure that shop assistants speak directly to

the person rather than you. Wheelchair users and care workers find
sometimes that people talk to the care worker and ignore the person
in the wheelchair!
People may wish to try a different way of shopping and you may
need to give them advice – for example, some are nervous of
shopping on the Internet because of the possibility of identity theft.
You can support the person to feel safe by telling them how they can
be safe online.
Support the person to buy wisely; if you notice a special offer, draw
the person’s attention to it.
4.4 Supporting the individual to store

items safely
Household and personal items must be stored properly both for
safety reasons and for the product to remain in a good, effective,
usable condition. Chemicals should be stored in a secure area well
away from food items and away from children. Children, people with
learning disabilities or others who may have an impaired mental
capacity such as a person with dementia could easily mistake a
container of chemicals for squash and this could result in fatal
poisoning.
Support and encourage people to read and understand the labels on
items and store them as advised. Care workers must be aware of the
Control of Substances Hazardous to Health Regulations 2002
(COSHH, revised in 2009). This requires employers to ensure that
hazardous substances are stored and labelled correctly, and every
workplace should have a COSHH file which lists all the hazardous
substances in that workplace. Revisit Unit HSC 027 to read more
about COSHH. You can also read about your and your employer’s
responsibilities under the COSHH Regulations in this unit.
You may be supporting people who are living in their own home and
Activity 5 it is your responsibility to support the person to store and use
chemicals safely. Some chemicals such as bleach, dishwasher and
Household safety and
laundry tablets are irritants to eyes and skin, so they need to be kept
children
securely stored. Aerosols such as furniture polish, fly spray and air
Imagine you have a young child fresheners should not be stored in areas exceeding 50°C and should
coming to stay in your home. Have be kept out of direct sunlight and areas of ignition, such as cookers,
a look around – are there any because there is a risk that they may explode.
household items or chemicals
Items such as knives, razors and electrical items need to be stored
about that might harm them?
safely as well, in order to prevent accidents.
18
4.5 Supporting the individual to use

items safely
Items should be used exactly as the manufacturer has intended them
to be used. Failure to do so could lead to serious harm or the item not
being as effective as it should be. Read the labels before you start the
activity and do not assume that because one product is similar to
another, it can be used in the same way. Care and attention must be
exercised when handling items. For example, some laundry and
dishwasher tablets are coated with a dissolvable film that
disintegrates during use. If these are handled with wet hands, the film
breaks down and the irritant contents will be emitted on to the
hands.
Kitchen items such as knives, blenders and microwaves are also
potentially dangerous and although you must encourage people to
be as independent as possible while using such items, you have a
responsibility to maintain a safe environment. Never leave people
unattended when using items that could potentially harm them.
People should be supported to exercise good kitchen safety – for
example, when using cookers to ensure that gas is not left on and
that saucepan handles are turned in when used in order to prevent
accidents such as scalds.

keeping the home clean and
secure
5.1 Supporting the individual to keep
their home clean, in a way that promotes
active participation and safety
A person’s home is a reflection on the person who lives there. People
will have different beliefs on what their house should look like and its
level of cleanliness. Some people like to spend a lot of time cleaning
their home while others consider it a burden and choose to do the
bare minimum. A lot of these differences stem from upbringing and
culture.
Whatever the personal choice on the level of cleanliness that the
home should be, it should be in a suitably clean state in order to
avoid contamination with vermin such as mice, rats and flies, which
can spread diseases if they are not controlled.
Most people prefer to live in a clean and tidy environment, and prefer
that their home is visually pleasing for visitors.
19
Support people to participate actively in the cleaning of their home;

that way they will feel that they have some control over their life. If a
person has limited ability mentally and physically, it may be beneficial
to do a little at a time; the person could be supported to draw up a
timetable of what needs to be done and when.
Some appliances such as vacuum cleaners can be very heavy – it
might be worth considering a change to a lighter model. Some
activities may be too strenuous or difficult, such as window cleaning
and heavy gardening work; the services of a window cleaner and
gardener may be needed – have a look in the local paper or see if a
friend or neighbour can recommend one.
Window cleaner wanted

Must be reliable and trustworthy.
References required.
Please ring 07890 123456 for more details.
A little bit of help with cleaning, ironing and garden maintenance, for
example, can make all the difference.
5.2 Different risks to home security that

may need to be addressed
People whom you support may be vulnerable and at risk of intruders.
We often hear of bogus people entering houses and stealing from
the trusting people who live there. Some people also are of the
generation that left their doors unlocked without fear of burglars or
intruders. Sadly, nowadays we need to be vigilant and prevent
unwanted visitors from entering premises. People who have been
burgled often suffer great mental anguish afterwards, feeling violated
and exposed. Open windows can entice unwanted intruders. People
who are vulnerable, such as elderly people or those with learning
difficulties, are often trusting and do not readily challenge and
scrutinise a visitor’s identity, therefore leaving the person at risk of
harm and abuse.
If the home is to be left for some time – for example, if the person is
going into hospital or residential care for a while – the home may be
prey to intruders.
Keys left on the inside of a door can be a risk because intruders can
break glass and then let themselves in. Cat flaps also create a
potential way in for unwanted visitors.
20
Case study
Identifying the risks

Esme is 86 years old and she has very limited which they take in the afternoon between 2pm and
independent mobility following a hip fracture two years 4pm, and they usually leave the bungalow and have a
ago. She has the support of a live-in carer to help her walk around the town. Esme insists that the front door
with daily living tasks. Esme’s bungalow has lots of is left on the latch when the carer has gone and will not
antique furniture and she has her mother’s jewellery, give the carer a key.
which is not only valuable but holds sentimental value
1. Why do you think that Esme does not want the
too. Ange, the carer, stays with Esme for two weeks,
door locked?
another care worker takes over for a week, and then
2. Why do you think she does not want to give the
Ange returns.
carers a key?
Esme has had several carers over the course of time. 3. What are the risks?
Each day the carers are entitled to a two-hour break,
5.3 Supporting the individual to use

agreed security measures
Specific security measures that need to be taken should be clearly
documented in the person’s care records. It may be that the person
lives alone and has an emergency alert device such as Telecare. The
person can raise an alarm using the pendant or wrist band that they
wear. You will need to check that they fully understand how to use
the device.
The plan of care should indicate what security measures you and the
person need to take; it may be closing and locking windows and
doors, and taking the key out of the inside of the door at night or
when the person goes out. Support the person to do as much as
possible for themselves. A relative or neighbour may have a spare key
and they may be happy to keep an eye on the property and report
anything untoward; this should be in agreement with the person that
you are supporting. Remember to document accurately in the care
records the level of support that you have given or any concerns or
worries that you have. The person may have agreed to have valuables
stored safely and securely in the bank, for example; you may need to
reinforce the benefit of this action.
If the person is living in a residential setting with other people, it
should be clearly established what each person’s responsibility is in
relation to maintaining security. The building may have a key pad or
fingerprint entry system; again you need to make sure that they are
familiar with how it works and know what to do if the system
breaks down.
21
6. Be able to identify and respond

to changes needed in support for
daily living tasks
6.1 Enabling the individual to express
views about the support provided to
increase independence in daily living
tasks
Feedback from people is important when a service is provided. This
enables health and social care workers and organisations to know
what they are doing well and the areas that they could improve
upon. It can be uncomfortable sometimes to ask for feedback from
others when you have carried out an activity, because you may be
worried about what they might say. You could ask, ‘What have I
done well and what could I have done better?’ Seeking informal
feedback is a good way of developing your own knowledge and
practice (see Unit SHC 22 for more on informal feedback).
Formal feedback is also sought from time to time; this helps service
providers and the inspectorate to judge the quality of service
provision. The person may be given a questionnaire in order to
measure their level of satisfaction. Registered care providers who are
inspected by the Care Quality Commission also seek feedback from
those that use the service; this aims to continually improve the quality
of health and social care service provision.
All people should have equal access to give feedback. Therefore, if a
person is unable to give feedback themselves (for example, if they
have dementia), then feedback can be sought from family, friends or
advocates. Questions should be asked in a straightforward manner,
verbally and written, because this will maximise the accuracy of the
responses.
6.2 Recording changes in the individual’s

circumstances that may affect the type or
Activity 6
level of support required
It is likely that you will be working more closely with the person than
Finding out more about anyone else. You will therefore be the one who notices any changes
record keeping that might affect the type and level of support that is needed. It is
Have a look back in Unit HSC 028 important that changes are reported to your supervisor and recorded
and read the section about record clearly and accurately in their support plan.
keeping. It may mean that the person requires another assessment of their
needs and the support plan will need to be reviewed and a new one
implemented.
22
6.3 Adapting support in agreed ways to

address concerns, changes or increased
independence
Concerns and changes should be clearly and fully documented in the
person’s support plan. Changes to the current level and type of
support will be agreed during support planning and review meetings
with the person, advocate and other professionals; a reviewed
documented support plan will follow. It is vital that the team
accurately follow the support plan and a consistent approach is taken;
that way the person is more likely to have confidence in the care
team. If you are unsure how to work according to the adapted
changes, speak to your supervisor, who will go through it with you.
Failure to follow the agreed ways to support the person may affect
their safety and well-being; for example, the person may take
unnecessary risks when managing their own hygiene when the
support plan states that they need support to get to and from the
bathroom using mobility aids. There is also a possibility of hindering
and prolonging the effective recovery or rehabilitation of the person if
too much support is given.
If you consider the support plan is not accurate or effective, you must
report this to your supervisor.
If you are unsure about how to support a person’s changing needs, ask your
supervisor to go through it with you.
23

LO1 place as well as supporting people to prepare food
For this outcome, you will need to show your assessor safely. Your assessor will want to see how you actively
that you understand the principles for supporting involve the person and promote independence. If you
independence in the tasks of daily living. To do this, you have a current Food Hygiene Certificate, give a copy to
could complete a case study on a person that you are your assessor, who may be able to use it for supporting
supporting to be independent (remember to maintain evidence.
confidentiality). In your case study, you could include LO4
some background information about the person, and
Supporting people to buy and use household items
cover the following questions.
safely is an important part of promoting independence.
•• What are the benefits to them of being Your assessor will need to assess you in real-life
independent? activities and with a range of different people whom
•• How does active participation help them to be you support. They will need to observe that you can
independent? identify different ways of buying household and
•• Do they have any preferences or cultural personal items, support people to identify the items
considerations that affect the support that is given? that they need and then support them in their
•• What opportunities are available to enhance their purchase. When the items have been purchased, your
independent living skills? assessor will need to see that you are able to support
•• Who is involved in the support of the person? What the people to store and use the items safely.
are their roles and responsibilities?
LO5
LO2
This outcome requires you to provide evidence about
People’s needs are all different, and all those whom you supporting people to keep their home clean and secure.
support will have a support plan that you need to refer Your assessor will want to observe you in real work
to and work with. You will need to show your assessor activities. The first part is about supporting people to
that you can use support plans to access information keep their home clean; your assessor can observe you
about how to support people with daily living tasks and doing this. The second part is about security and risks
work in accordance to the support plan. You will also – you need to describe the different risks to home
need to show that you actively involve the person and security that may need to be addressed. Your assessor
confirm the support requirements before supporting may suggest that you do this in the form of a written
them. Your assessor will need to observe you in real exercise. You will need to demonstrate using real
work activities to demonstrate competence. You will workplace activities how you support people to use
also need to demonstrate how you respond to agreed security measures.
difficulties or concerns, for example, if a person’s
LO6
condition deteriorates and the support plan is
inappropriate or unsafe. Your assessor may not be This outcome is about being able to identify and
around when this happens so they may suggest that respond to changes needed to support daily living tasks.
you obtain a witness testimony from your supervisor. Your assessor will want to observe you in real work
activities encouraging people to express their views
LO3
about the support that they have had to increase their
This outcome requires you to demonstrate that you can independence in daily living tasks. You will also need to
provide support for planning and preparing meals. Your show that you know how to record changes that may
assessor will want to observe you during real work affect the type and level of support they require. You
activities. They may plan to observe you with people could show your assessor records that you have
when you are planning meals. They will also need to see completed when someone’s support needs have
you supporting people to store food safely in the proper changed.
24
Legislation
(COSHH)

•• www.carelineuk.com/about_carelineuk (CarelineUK)
•• www.cqc.org.uk (CQC Care Quality Commission)
•• www.dh.gov.uk (Department of Health – Essence of Care (CQC))
•• www.eatwell.gov.uk/keepingfoodsafe/storing (Food Standards
Agency)
•• www.scie.org.uk (Social Care Institute for Excellence)
25
Index
A G
acrylamide 13 guidance in resolving difficulties 10
active participation 2–4
adapting support 23
advice and support 10
H
health and safety 18
agreeing people’s participation 9–10
assessment requirements 24
assistive technology 3–4 L
learning/practising skills 5–6
learning styles 6
B
benefits of independent living 2
M
Maths skills 17
C meals, planning 11
changes in circumstances, recording 22
meat storage 13
cleaning 19–20
Control of Substances Hazardous to Health (COSHH)
18 R
culture and background, impact of 4–5 recording changes in circumstances 22
roles and responsibilities for support 7
D
dosette boxes 3 S
safe use of items 19
security in the home 20–1
E shopping, support with 16–18
English skills 3, 8, 11, 16
storage
of food 12–14
F household and personal items 18
feedback 22 stroke 9
food and drink support 10
preparation 15–16 support plans 8–9
storage 12–14
freezers 13
fridges 13
T
technology, assistive 3–4
functional skills
English 3, 8, 11, 16
Maths 17
further reading 25
26
Unit HSC 2012
Support
individuals who
are distressed
In this unit you will learn about why people that you support
may experience distress. There are many reasons for this – every
person is different. How people react to stress can be very
different too. Whatever the reasons of their distress, it is
important that you are able to offer support and comfort, and
to reduce and relieve the distress wherever possible. You will
learn how to help to support a person who is distressed using
an individual and holistic approach to help to reduce and relieve
their distress.
The person’s condition can change, so it is also important that
you know how to keep an eye on this.

1. causes and effects of distress
2. how to prepare to support individuals who are
experiencing distress
3. how to support individuals through periods of distress
4. how to support individuals to reduce distress
5. how to record and report on an individual’s distress.
1
1. Understand causes and effects

of distress
1.1 Common causes of distress
The causes of distress are varied and differs form person to person.
A situation that reduces one person to tears may be shrugged off by
another. Be careful not to confuse the causes of the distress with the
reasons for it. The causes can be a range of external factors; however,
the reasons have a much deeper, psychological influence which
affects the way different people respond in different circumstances.
Most people most of the time behave within the accepted norms of
society. However, occasionally the emotions may become too
powerful or the control which people have over their emotional
feelings relaxes, resulting in a display of emotion which is recognised
as distress. People can become distressed because of a wide range of
causes and these can be the trigger for the underlying emotional
response.
People commonly become distressed when:
•• they are informed of the death or serious illness of someone close
to them
•• they receive other bad or worrying news
•• there are problems with a relationship which is important to them
•• there is an overload of work or family pressures
•• they have serious issues which worry them, such as money,
problems with work or their family
•• they are reacting to the behaviour of others towards them
•• they are responding to something that they have heard, seen or
read in the media
•• they are in an environment which they find frustrating or
restricting
•• they are in an environment which they find intensely irritating –
for example, a noisy one
Activity 1
•• they are deprived of information and are fearful
Triggers for distress •• they have full information about a situation and they remain
fearful of it
There can be many triggers that
•• they are anxious about a forthcoming event
can lead to a person becoming
•• they are unable to achieve the objectives which they have
distressed. Think about the people
set themselves.
that you support. Can you identify
any triggers that can lead to a These are some of the more common triggers for distress. Clearly
person becoming distressed? there are many others which you may come across depending on the
setting in which you work.
2
Support individuals who are distressed Unit HSC 2012
1.2 Signs that may indicate an individual

is distressed
When you have a close working knowledge of a person’s behaviour
over a period of time, it can be easy to see when they are becoming
distressed. You will find that you become tuned in to their behaviour
and can notice the small signs that mean a change in mood.
However, you will not always know people so well. Also, you may not
only be dealing with distress of people that you are supporting, you
may also have to deal with it in a carer or work colleague.
There are some general clues that may show that a person is
becoming distressed.
•• Their voice may be raised or at a higher pitch than usual.
•• Their facial expression may change – for example, scowling, crying
or snarling.
•• The pupils could be dilated and their eyes open wider.
•• Their body language would show agitation; they may become
aggressive, leaning forward with fists clenched.
•• Their face and neck are likely to be reddened.
•• They may sweat excessively.
•• There may be changes in breathing pattern – they may breathe
faster than normal.
Changes in behaviour
You are likely to notice a change in a person’s behaviour when
someone is distressed. For example, someone who is normally chatty
may become quiet and someone who is usually quiet may start to
shout and talk very quickly. A person who is usually lively may sit still
and not want to move, whereas someone who is usually relaxed may
pace about waving their arms.
You need to keep an eye on changes in behaviour, even if they are
less obvious than the examples given. Sometimes small changes can
mean that someone is becoming distressed; you are far more likely to
notice these small changes in people who you know well and have
worked with over a period of time.
1.3 How distress may affect the way an

individual communicates
There has always been much debate about whether our emotional
responses are inborn or learned from the environment. It is most likely
that they are a mixture of the two. Most psychologists agree that
there is an inborn response. Psychologists have identified the crying
response in young babies as the earliest human response. This
response is extremely useful because it is the means by which the
baby attracts its mother’s attention to have its needs met. Crying
therefore provides an effective appeal for help – and it is a response
many people continue into adulthood.
3
A baby cries to alert their mother to have their needs met.
Babies appear to demonstrate three different emotional responses:

fear, rage and love. Psychologists and psychiatrists dealing with
people suffering from mental health problems or disturbed emotional
behaviour are able to identity the three basic emotional responses of
rage, fear and love, plus a fourth category of depression.
A person who is distressed may become very quiet and withdrawn,
and not want to talk; they may turn away from you and not make
eye contact. Their self-esteem may be very low. Body language may
appear closed and even negative. Often, although they may need and
want support, they may feel like they are a burden and this can create
a real barrier to communication. You may find this difficult because
the communication is one-sided and you may be frustrated because
you feel that you are not getting anywhere, because you are not
getting feedback.
However, sometimes people who are distressed may appear angry;
they may do all the talking and control the conversation, and not be
prepared to listen. This can be equally difficult because you may feel
that you are not able to have your say and to help them.
A person may talk a different language which will make
communication even more difficult, or they may have a learning
disability.
4
1.4 How working with an individual

who is distressed may impact on your
well-being
It can be very upsetting to deal with someone who is distressed.
People’s experiences can be so moving and distressing that you may
feel very grateful or perhaps even guilty for your own happier
circumstances. On the other hand, if you are having difficulties
yourself, you could find these may be brought to the surface when
supporting a person who is distressed.
Feeling concerned, upset or even angry after a particularly emotional
experience with a person is normal. You may feel that you have not
done your job well and you could have done more. You may question
your actions and abilities. After a period of time, you hopefully will
have put the experience behind you, but occasionally this is not the
case and you may find it interfering with your work, either with the
person concerned or with others.
The distress of others, whether it is in the form of anger, sadness,
worry or anxiety, can be very distressing for the person who is
supporting the person. It can create worry and concern, and even
lead to the care worker having physical and emotional effects of
stress themselves. Stress upsets nearly every system in the body; it can
lead to, for example:
•• insomnia
•• headaches
•• lack of appetite
•• high blood pressure
•• infertility
•• skin problems
•• chest pain.
Feeling stressed yourself not only affects the quality of your work, it
Reflect can also affect relationships with others such as family and friends; it
People who we work and live with can even lead to relationship breakdown.
sometimes suffer distress for many Over a period of time, working with a person who is distressed may
reasons; perhaps the person has lost lead the care worker to feel negative about themselves. Their mental
their job or have had bad news. health may be affected, their own self-esteem may become low and
Have you been the person there to they may even show signs of depression.
offer support? How did the situation
make you feel? Did it affect you It is therefore vital that you recognise when another person’s distress
physically or emotionally in any way? is having an effect on you. There are many sources of support that
can help. The first person you should speak to is your supervisor.
5
2. Be able to prepare to support

individuals who are experiencing
distress
2.1 Accessing information and advice
about supporting an individual through a
time of distress
Remember to involve the person themselves – they may have
experienced these feelings before and know from experience what
helps. Friends and relatives may also be able to offer advice; they may
have helped the person through similar experiences in the past and
found effective ways to reduce distress. Remember confidentiality
though, and always ask permission from the person before you
discuss issues with others. Ideally the person themselves should be an
active part of the discussion.
The support plan may give guidance on how to support the person if
they are experiencing distressing situations. If the person has
transferred from another service – for example, from a residential
setting into nursing or a hospital environment – then previous care
Activity 2 staff may be able to give some valuable guidance.
Local services offering Specialist professionals such as cancer care nurses or palliative care
support teams can offer advice and guidance on supporting people when
they or a member of their family or friend have been diagnosed with
There are many different
a terminal illness. Also, other support groups can offer information
organisations that can offer advice
and advice – for example, the British Heart Foundation. The person’s
about supporting a person who is
general practitioner (GP) can give advice and may signpost to
distressed for many different
specialist services – for example, counselling – as can nurse
reasons (for example, cancer care
practitioners. Local support services and national helplines can be a
nurses). Find out what services are
source of support, offering information and advice to help the person
available in your area; make a note
through the difficult time of distress.
of the support that they can offer
and their contact details. This may Work colleagues may be able to give advice about how they have
be a useful resource that could be supported the person through times of distress; they may have
used at work. found strategies that have helped. Working closely with the
multidisciplinary team will enable you to take a holistic approach.
2.2 Signs of distress that would indicate

the need for specialist intervention
The level of help and support that you should offer is always best
decided along with the person themselves. Wherever possible, this
should be done through a process of discussion. Questions should be
open, clear and designed to find out the level of support that is
needed, such as, ‘I can see that you are very upset; would it help to
talk to me about it?’ or ‘I can see that you are very upset; would you
like me to find you someone to talk to?’
6
If the person becomes very withdrawn, you may be fearful that they are
suicidal and will attempt to take their own life.
There may be times, though, in which it is not possible to discuss the

level of support that the person needs. This can be because they are
extremely agitated, angry or in a very distressed state and unable to
hold a calm conversation, or it may be because they are threatening
to harm themselves, you or others. They may be so distressed that
they are damaging property, whether their own or that of others.
On the other hand, the person may become very withdrawn, not
wanting to communicate or may behave in a way that is out of
character.
In these situations, you will need to judge how best to act. It is
possible that specialist intervention is needed. Getting to know the
person well will help you to identify the situations that you can deal
with and those that you need specialist support for. The person’s
support plan and daily care notes may give you an idea of their mood
and behaviour. This will give an indication of possible trends, both
improvement and deterioration.
2.3 How to access specialist intervention

The types of support and intervention will differ depending on the
situation; one thing that is likely, though, is that you may need
immediate help from your supervisor or a senior colleague. Check the
procedure at work to find out how you call for emergency assistance.
Some workplaces will have call systems in rooms and other areas
7
around the building. Other places of work may have radios or other
call devices that you can use to summon immediate help. Make sure
that you fully understand how the equipment works before you are
placed in the situation. It may be that you are supporting a person in
their own home, and you need to use a mobile phone to alert your
supervisor or colleague that the person needs support and you need
assistance to deal with the situation. You may not be in a position to
judge what assistance is needed unless, for example, it is clearly an
emergency situation – perhaps the person is violent and you or others
are in danger. In this case you might need to summon the police
services.
If a person’s mental or emotional health gets worse quickly, this is
known as a mental health crisis and it is important to get help quickly.
There may be details on the person’s support plan about what to do
in an emergency and whom to call.
The person may need an emergency appointment with their GP or
out-of-hours doctor, so it is useful to make sure that you are familiar
with the contact details. They may visit the person and advise on the
best action to take.
Activity 3
You could also contact your local Mental Health Crisis team (most
Researching your local areas have one). The mental health crisis team is made up of
services psychiatric nurses, social workers and support workers. These teams
Research your local area for are a part of social services and their number can be found via your
services that are available to local council.
support distressed people. Make a NHS Direct can also signpost you to support services; its number can
note of what support they offer be found in your local directory or via its website. Other specialist
and their contact details. services such as bereavement counselling are available – for example,
You could make this into a booklet Cruse. This, as with many other organisations, is mostly run by trained
or poster. Show it to your volunteers and is contactable by telephone or email; however, it does
supervisor; it could be useful as a not offer immediate emergency support.
reference guide at work.
2.4 Sources of support to manage your
feelings when working with an individual
who is distressed
It can be very upsetting when you are dealing with somebody who is
distressed and displaying strong emotions. Some people’s situations
and experiences can be so moving that they can affect you. You may
feel grateful that the situation has not happened to you, or you may
worry in case a similar thing happens to you in the future and you
may wonder how you would cope. Feeling concerned, angry and
worried are normal and you may have these feelings for some time.
You might find that your self-esteem and confidence have
been affected.
8
Talking through your experiences and feelings with a trusted

colleague or supervisor can help. If we can understand some of the
reasons why things have happened the way they did, then it can be
easier to come to terms with. Make use of supervision opportunities
at work where you can reflect on the situation. If you do not feel
comfortable talking to your supervisor, speak to your manager if you
can and they will find a member of the team who is trained to
support you during supervision.
Occasionally, professional counselling is needed to help come to
terms with something and accept what has happened. It may be that
you do not wish to talk to someone in the work setting about your
feelings and would prefer to talk to someone outside from the
situation. You could talk to your GP, who can offer support or
signpost you to someone who could. Also, there are several advice
lines that you could access. For example, if the situation was related
to somebody’s alcohol misuse, then organisations such as Al-Anon
Functional skills
could help.
listening Activity 4
Talk through your feelings about Talking through your feelings
distressing situations at work with
chosen members of your team We can be faced with many distressing circumstances at work that can
whom you have confidence with. affect us even when the situation is over. We can be left with feelings
This will be an opportunity to have ourselves that need to be addressed.
an informal discussion. Present your Whom would you be comfortable talking to about the situation
information clearly and allow others (remembering about confidentiality)? What are the arrangements at
to give feedback. Respond to others’ work for supervision? Find out the procedure at work for helping to
points with relevant comments. deal with your own feelings following such events.
9

through periods of distress
3.1 Communicating empathy and
reassurance in ways that respect an
individual’s dignity, culture and beliefs
It is important to acknowledge the feelings that distressed people
may be experiencing. If people are being taken seriously and are
Doing it well
being listened to, this may have a calming effect. Reflective listening
Using effective non- skills and the ability to keep the conversation going will be very
verbal communication important. A professional would make sure that the conversation is
skills warm and sincere while also seeking to build an understanding of the
situation. Thanking the person for clarifying issues may be one way in
•• Convey empathy by using which you can reduce the frustration the person may feel. If you can
appropriate eye contact. communicate understanding of the person’s point of view, this may
•• Show warmth and concern. go a long way towards calming a situation.
•• Maintain an open body posture.
•• Make appropriate use of touch. If communicating verbally, think about the tone of your voice; is it
showing sincerity and warmth?
Always bear in mind, however, that people will react in different ways
to support that is being given. Some people may find it reassuring
and comforting and would prefer to have you with them for some
time, while others may find the situation overbearing and prefer you
to offer reassurance and empathy, then go, so that they can think
things through in private. You also need to consider issues of culture,
gender and age. For example, an elderly male may prefer to be
emotionally supported by a more mature support worker and a
female Muslim may prefer to be supported by a female support
worker. However, you must never make assumptions about a
person’s preference. Getting to know the person is vital if you are to
provide effective support.
3.2 Ways to alleviate immediate distress

If a person is becoming distressed, it is important to deal with the
situation quickly and calmly. You need to be in control of your own
feelings and act in a professional manner. If you know the reasons for
the distress, then it may be easier to support the person and you may
have supported them or others in a similar situation that you can
reflect on. Appear relaxed and calm; you may not feel calm inside,
but this can be a skill that you can learn. If you appear calm, then this
can have a calming effect on others.
10
Relaxed forehead
Varied eye contact
Doing it well Head at slight angle
Varied gaze (not face to face)
Demonstrating calmness Relaxed face
Relaxed shoulders
•• The volume of speech should be Closed mouth
normal, not raised nor too quiet.
•• Talk in a normal tone and at a
normal volume to show that you Relaxed posture
do not feel threatened, angry or
shocked. Arms by side
•• Demonstrate active listening and
empathetic skills will show that
you are interested and want to
understand the person’s
viewpoint and circumstances.
This will show respect for the
person and show that you care.
Open hands
Low muscle tension
Doing it well
Alleviating a person’s Person creates interpersonal space
distress
Non-verbal signs of being calm.
Acting quickly when a person is
distressed can prevent the situation Be assertive, this will help you to cope with difficult and challenging
from becoming much worse. How situations.
you react can make all the The assertive person can:
difference.
•• understand the situation that the person is in – including the facts
•• Stay calm. and other people’s perceptions
•• Be assertive. •• control personal emotions and stay calm
•• Use active listening skills. •• use the right body language
•• Create the right emotions and •• use the right words and statements.
atmosphere.
•• Be aware of your own body If you actively listen and show the person respect, then it will create
language. the right emotions and a supportive atmosphere and environment.
•• Use supportive verbal The person is more likely to feel calm, in control and supported. They
communication. are also more likely have confidence in you and the care team in
•• Call for assistance if you are being able to support them through their difficult time. Always be
concerned about the person or aware, however, that you may need to call for assistance if you are
your ability to offer support. worried about the person in any way or about your ability to offer
support.
11
3.3 Adapting support in response to an

individual’s reactions
Depending on how the person responds to your immediate support
when they are distressed will depend on the support that you need to
offer. It may be enough for you just to be there and continue with
your effective communication and empathetic skills. Alternatively, the
person may feel much better and prefer to be left alone. They may
feel that they want to be distracted from the situation and have a
Reflect drink, do an activity or watch the television. You could ask a
Think about an occasion when you colleague to make a drink for the person while you are still there with
have supported a person who was them. Always be aware of potential dangers; for example, if leaving
distressed. Following the immediate the person with a hot drink, they could become upset, spill it and
support that you gave, how did you burn themselves. It may be better for you to sit with them while they
adapt the support afterwards? are drinking.
Was it enough to continue with If you do leave them alone, make sure that you go back to check how
empathetic communication support? they are on a regular basis in case they become distressed again, or
Did they want to be left alone or did ask a colleague to do so if you are not there.
you need to summon assistance?
It is possible, though, that the situation may not get better, but
Reflect on your observation skills. become more worrying, and the person may not be comforted by
How did you know what was your empathetic support. They may start to become more upset,
needed? angry or even aggressive, in which case you will need to use your
assertiveness skills and you may need to summon assistance from
a senior colleague, professional or even the emergency services,
depending on the area in which you work and the situation.
Getting to know the person well will help you to know what to do
next. Be aware of what is in the plan of care, because this may give
guidance on how you can support the people in different situations
and reactions.
You will need to use your observation skills in order to adapt the
support that you give in line with how the interaction is going,
bearing in mind that the situation and mood can change, in which
case you will need to be ready to act quickly and efficiently.
3.4 How to involve others in supporting

an individual who is distressed
When offering support to a person who is distressed, it may become
evident that someone else needs to be involved in order to support
the person. It may be that they are worried about something or
someone and they need to make contact with that person. Your
support in this situation may be as simple as making a telephone call.
For example, if a person was in hospital and they were worried about
the security of their home, it would not be practical for you to go and
check, but a call to their neighbour may provide reassurance.
12
You may need to arrange transport or escort the person to meet an

appropriate professional – for example, providing a taxi so that the
person can meet their solicitor or other legal adviser.
Functional skills Check the support plan – there may be guidance on who needs to be
contacted if the person becomes distressed – for example, the mental
English: Writing health team or social worker. Contact details should be given with
details of out-of-hours arrangements. The GP can also offer support
Use the case study below to give you
and can signpost the person to a range of support services.
information to answer the set
questions for this unit. Present your A person who is distressed because of bereavement may value your
information in an organised way support in helping them to contact support networks via the Internet
with sufficient detail to cover the or email. You need to be aware, however, of how to support people
requirements of the task. Ensure that while they are using the Internet, ensuring that they remain safe
your answers have accurate spelling, online and do not fall victim to harm and abuse. People should never
punctuation and grammar by disclose personal information online. Distressed people can be
proofreading your work carefully. vulnerable and they will need your support to keep safe.
Use complete sentences for all
Information about the person’s distress and outcomes needs to be
answers.
clearly communicated between the care team, so that a consistent,
appropriate and professional approach can be taken.
Case study
Reducing Sadie’s distress

Sadie was admitted to hospital in an emergency with a since early that morning. She had left her mobile phone
suspected heart attack. She is 62 and she lives at home. at home.
When Sadie complained of chest pains to her doctor,
1. What were Sadie’s main worries?
she was quickly admitted to hospital because a heart
2. Can you think of anything else that she may have
attack was suspected. As time went on, Sadie became
been worried about?
more and more agitated and distressed. She was clearly
3. How could you try to reduce Sadie’s distress?
very worried about her home – she was not sure if the
4. Is there anyone else that could help to reduce her
back door had been left unlocked and she was very
distress?
concerned about her two cats which had not been fed
13

to reduce distress
4.1 Encouraging an individual to express
thoughts and feelings about troubling
aspects of their life
Encouraging people to communicate thoughts and feelings about
things that trouble them in their life can be very sensitive. You will
need to use good effective communication skills such as active
listening and show empathy. If you have undertaken any training in
counselling skills, you will find this very useful. You must remember
though that you are not a trained counsellor and you should not
attempt to offer counselling unless you have been adequately trained
and had the opportunity for supervised practice. However, do not
underestimate the support you will be able to provide by using good
communication skills and genuine empathy. You can encourage
someone to express how they feel about what is causing them worry,
anxiety or distress.
While it is good for people to talk about things that trouble them,
sometimes strong feelings can emerge that you may not be trained to
deal with.
Never probe a person to talk about more than they want to, because
this can cause extreme distress if the situation is not handled
properly.
What you could do, however, is encourage and support the person to
undertake counselling therapy. Ask the counsellor advice on how best
to support the person if they want to talk about sensitive issues.
4.2 Working with an individual and others

to identify triggers for distress
Knowing what is triggering a person’s distress can help to start the
process of accepting and dealing with it. It is much easier to cope
with something if you know what the problem is.
It may be quite obvious for you and the person to see what the
reason for the distress is – for example, they have been told of the
death or serious illness of someone close to them, or they hear other
bad or worrying news. However, other triggers may not be quite so
obvious. The person may have had problems with a relationship over
a long period of time and may be worried about money, or the
person may be stressed because of an overload of work or family
commitments and pressures. Sometimes the reasons for the distress
may not be absolutely clear to the person themselves; it can
sometimes appear to be a build-up of several things that they find
14
difficult to unpick that may even be masked or hidden by excessive

alcohol consumption or gambling.
It can sometimes take time for things to unfold and emerge, and the
process cannot be rushed. The person may benefit from professional
counselling sessions in order for them to get to the bottom of what is
causing the distress; then you can support them to deal with it.
Give the person the opportunity to talk and express themselves,
making sure that you are non-judgemental and supportive.
You will need to work closely with the person and use effective
communication and observation skills to help the person to find the
reasons and triggers for their distress. The care team as a whole, and
maybe others such as advocates, social workers and the mental
health team, will need to work together in order to support the
person. Good observation and communication between the team is
vital.
Sometimes your brain can feel messed up; unravelling your thoughts can help
you get to the bottom of the problem.
4.3 Working with an individual and others

to reduce triggers or alleviate causes of
distress
Working closely and getting to know people well can often help you
to discover the triggers that make people distressed. You may
manage to find ways in which you can contribute to reduce causes of
distress. For example, if the cause of the person’s distress is worrying
about paying the bills and losing their house because they cannot pay
their mortgage, you may signpost them to professional help such as
the National Debtline or the Citizens Advice Bureau. If the person is
distressed because what they can do is limited – for example, they
may have mental health problems with a physical disability and they
may feel that they cannot deal with complicated issues such as
organising care or feel that they cannot speak for themselves when
15
important decisions need to be made – then an advocate can support

them and ensure that their views are heard.
Depending on the underlying forces, distress can sometimes be dealt
with by physical means – that is, an immediate removal from the
cause such as taking a break from work or from caring for a difficult,
very ill, demanding relative.
Once the trigger or cause of distress is known, talk to the person and
ask them how they feel that distress can be reduced or prevented.
Involving the person will show that you respect and value them.
People are different and cope with things in different ways, so it is
vital to involve them in decision making. It might be as simple as
giving the person plenty of time to prepare themselves mentally
before an important meeting. The person may find that the support
of friends and relatives can help to reduce causes of distress,
sometimes just being there to offer support if needed.
You could suggest that the person keeps a diary of their feelings. This
could help to identify what the triggers and how the distress was
effectively managed or not. The diary could include:
•• what happened
•• what the cause was
•• how they reacted
•• what made it better.
The person may be willing to share this with you and other members
of the team, in order for you all to work together to try to find out
what causes the distress and effective ways of managing the related
feelings.
Case study
Identifying triggers of distress

Mrs Daley is 83 years old and lives in a residential home. time; she worries in case the care staff forget and that
She has had several appointments for various services the transport has not been booked or is late. Mrs Daley
– for example, the optician, dentist and more recently has an appointment at the local hospital in the morning
the local hospital where she is undergoing tests for to discuss the results of her bladder tests.
bladder problems.
Carrie passes on her observations and thoughts to the
Carrie is Mrs Daley’s key worker and has noticed that care team.
when she has an appointment, she becomes very
1. What do you think are Mrs Daley’s concerns about
agitated and worried beforehand. Mrs Daley has limited
this appointment?
mobility and relies on the care workers to help her to
2. How might she react?
wash and dress in the morning. It became evident that
3. Now that the care team know the triggers to
she becomes very worried in case she is not ready in
Mrs Daley’s distress, how can they reduce them?
16
Have you ever kept a diary of your feelings?
4.4 Encouraging an individual to review

their usual ways of coping with distress
Some distress cannot be removed, and we cannot expect the
impossible – for example, the feelings related to the loss of a loved
one, a serious illness or redundancies. We do not have the power to
change some things, and we need to live with some things on a
day-to-day basis. What we can do, however, is support people to try
to learn to accept things that they cannot change and help them to
live their life in a more positive way. Sometimes people can choose
unhealthy methods of controlling stress – for example, using alcohol
or cigarettes; this might make them feel better in the short term, but
in the long term these measures can be very harmful to their health.
Support the person to reflect on what they enjoy or used to enjoy. It
may be that they have lost sight about what they enjoy in life because
life has become so hectic or it has become clouded with what is
making them feel distressed.
17
Supporting someone to find the real person inside and finding out
what they would enjoy can help you both to find more positive
methods of dealing with their distress. Perhaps the person used to
like swimming or other sports when they were younger, perhaps they
could take it up again.
Not all stress-reducing activities cost money – going for a long walk
and being with nature can be very relaxing, as can having a long
bath.
It will be necessary to review the effectiveness of the new ways of
coping with distress; perhaps they are not working. Maybe the
swimming pool is busy and noisy and therefore they cannot have a
relaxing swim when they want to. You will then need to work
together to explore other stress-relieving activities. Having a range of
possible activities will help.
Everyone has different ways of dealing with stress.
18
5. Be able to record and report on

an individual’s distress
5.1 Records relating to an individual’s
distress and the support provided
All incidents of distress and the support that has been provided must
be reported to your supervisor or line manager and recorded. You
must make sure that you follow the correct procedure. You are not in
a position to make a decision on the next step to be taken or, if the
incident is serious enough, to be followed up. Write up the incident
as soon as possible, because although you might think that you will
be able to remember everything, details can easily become blurred
with time, especially if you go on to do something else after the
event. Your workplace will have a special form that you need to
complete. Your records should only contain the real facts and not
what you think you saw or heard. Your report should be clear, easy
to read and completed in black ink. No gaps should be left between
your statements. Make sure that you sign, date and enter the time of
the entry.
If there is any reason why writing a report is not possible, then you
should record your evidence on an audio tape. It is not acceptable just
to pass on information verbally, because there must be a record that
can be referred to. Your evidence may be looked at by other people
– for example, the mental health team or social workers.
If you do not feel confident writing a report, you could ask a
colleague to help you; tell them exactly what happened, then write it
in rough. They can read through it to see if it is clear and accurate.
You can then transfer it onto the required record. The record must be
stored in line with your workplace’s procedures. Record keeping and
communication is crucial in order to ensure that the person receives
the proper care and support; records can also show trends of
activities and can even prevent very serious situations from occurring
– for example, attempt of suicide.
Functional skills
English: Writing Activity 5
To write a report you must use a set
Good record keeping
format that records your information
in an organised and coherent way. Record keeping is vitally important in all aspects of care work and it
All writing must be accurate in must be done properly in line with legal and your workplace
grammar, spelling and punctuation, requirements. Your records may be looked at by other professionals and
as it is likely that the report will be important decisions may be made depending on records that are seen. It
used by multidisciplinary teams to is therefore extremely important that you complete them properly.
access information on somebody you Have a look back at Unit HSC 028 and remind yourself about how
support. records must be kept.
19
5.2 Reporting on periods of distress in line

with agreed ways of working
Incidents of distress must always be reported, no matter how trivial
that you may feel the situation is. All workplaces will have reporting
and recording procedures in place and it is vital that you are familiar
with the correct procedure. Even if you have worked for the
organisation for some time, it is possible that the procedure has been
updated and changed. It may be different depending on the people
that you are supporting. The person may be considered to be ‘high
risk’ – for example, their distress may be so severe that they may
self-harm or even attempt suicide. In this case, it is likely that their
behaviour needs to be monitored very regularly and closely, then
recorded and reported upon.
Remember that as well as completing records, you need to pass on
information verbally. You may have a specific handover time between
shifts where information is verbally passed on Alternatively, you may
be supporting a person in their own home by providing live-in
support where you spend a long period of time with the person, and
you will need to pass on accurate and detailed information to the
next care worker.
Wherever you work, make sure that you familiarise yourself with how
you should report on situations of people’s distress.
Activity 6
All workplaces may differ slightly on reporting procedures. Find out
what the procedure is where you work. If you cannot find it, have a
word with your supervisor or line manager.
Reflect
Reflect on your reporting skills. Do you report incidents in enough
detail in order for others supporting people after you to continue
the support that is required?
20

LO1 supervisor or line manager, outlining your ability to
There are many causes of distress and the person will demonstrate empathetic skills.
usually show some signs and symptoms of this. Your LO4
assessor will want you to be able to describe signs and
This learning outcome requires you to know how to,
symptoms that a person is becoming distressed. They
and to be able to support people to, reduce distress by
may ask you to show your knowledge and
reviewing with them their usual ways of coping. Your
understanding by writing an account. You could give
assessor will want to see you review their methods of
examples from the workplace, but remember to
distress relief. This learning outcome must be assessed
maintain confidentiality and not mention names.
in a real work environment. Ideally, your assessor will
observe you but if this is not possible (for example, if
LO2
the situation is sensitive), then they may ask you to
This outcome requires you to know about how to access
obtain a witness testimony from your supervisor or line
information and advice about supporting people who
manager. Your assessor may also ask you to write a
are distressed. Sometimes specialist intervention is
reflective account about another time when you have
necessary; you will need to show that you know when
reviewed with a person their usual ways of coping with
and how to access this specialist intervention. Your
distress. When you write your account, be sure to write
assessor may suggest that you complete a research
what you did and why; this will show your assessor that
project about services that are available in your local
you fully understand your own actions.
area. Working with distressed people can have an effect
on you; you will need to know where to access support LO5
for yourself the worker – you could include this in your This learning outcome is about the importance of
project. Your assessor may also suggest that you obtain recording and reporting people’s distress. Your assessor
witness testimonies from your supervisor or line will need to see that you are competent in reporting
manager as evidence that you have accessed and record-keeping activities relating to people’s
appropriate services for people who are distressed. distress and that you can clearly record the support that
has been given. They will also want to know that your
LO3 records are completed in a timely manner. Do not
Your assessor will want to know that you can photocopy records because they are confidential and
demonstrate effective communication skills, showing they should not be in your portfolio. If your assessor is
empathy and offering reassurance. You will also need to not around when you are completing records, you can
show that you take into consideration dignity and the show them the record when you next meet (if this is
person’s personal preferences, culture and beliefs. It appropriate). They may suggest that you obtain a
may not be possible or appropriate for your assessor to witness statement from a senior colleague or your line
observe you in such sensitive situations, so they may manager about your record keeping in relation to
suggest that you obtain a witness testimony from your people’s distress and the support that has been given.
21

•• www.al-anonuk.org.uk (Al-Anon UK)
•• www.direct.gov.uk/en/disabledpeople/healthandsupport/mentalhealth/dg_10023332
(DirectGov Mental Health Crisis Team)
•• http://helpguide.org/mental/stress_management_relief_coping.htm (advice on stress
management from Helpguide)
•• www.nas.org.uk (National Autistic Society)
•• www.nationaldebtline.co.uk (National Debtline)
•• www.rethink.org (Rethink)
•• www.scope.org.uk (Scope)
•• www.thecbf.org.uk (the Challenging Behaviour Foundation)
•• Age Concern (2005) Supporting People with Dementia, Dementia Voice
•• Woodward, P., Hardy, S., Joyce, T. (2007) Keeping it Together, a Guide for Support Staff
Working with People Whose Behaviour is Challenging, Pavilion Publishers
22
Index
A M
advice and support 6 managing own feelings 8–9
alleviating distress 10–11
assertiveness 11
R
reassurance, communication of 10
records 19
C reporting incidents 20
calmness 10–11 responding to reactions to support 12
causes of distress 2 reviewing ways of coping 17–18
communication
distress, impact of on 3–4
of empathy and reassurance 10
S
signs of distress 2
specialist interventions, need for and accessing 6–8
E supporting people in distress 6
empathy and reassurance, communicating 10
encouraging expression 14
English skills 9, 13, 19
T
triggers, identifying/reducing 14–16
F
functional skills 9, 13, 19
further reading 21
I
impact on you of others’ distress 5
information and advice 6
involving others in support 12–13
23
Unit HSC 2013
Support care
plan activities
Services are provided by a wide range of agencies in many

different ways. One of the most important aspects of the
provision of a service is to ensure that it is meeting the needs of
the person. These needs are not what an agency or care worker
believes to be needed; they are what people understand their
own needs to be. One of the most important roles of a care
worker is to find out from people about the type of service
needed and then to work alongside them and their family, and
any other carers, to ensure that the best and most effective
level of service is provided and that it meets the needs of all
those concerned.
It is also important that a worker understands the limitations of
the service provided by their agency. Sometimes it is necessary
to explain these limitations to a person, even though it may be
disappointing not to be able to provide exactly what had been
hoped for.

1. how to prepare to implement care plan activities
2. how to support care plan activities
3. how to maintain records of care plan activities
4. how to contribute to reviewing activities in the care
plan.
1
1. Be able to prepare to
implement care plan activities
1.1 Sources of information about the
individual and specific care plan activities
A holistic approach
One of the essential aspects of planning care services is to have a
holistic approach to planning and provision.
This means recognising that all parts of a person’s life will have an
impact on their care needs and ability or wish to take control of their
support, and that you need to look beyond what you see when you
meet them for the first time.
A wide range of factors will have an impact on the circumstances
which have brought a person to request social care services. All of the
following factors will directly affect a person and they must be taken
into account when discussing how people want you to provide
services and support.
Factors directly affecting a person.
Health
The state of people’s health has a massive effect on how they
develop and the kind of experiences they have during their lives.
Someone who has always been very fit, well and active may find it
very difficult and frustrating to find their movement suddenly
restricted as the result of an illness such as a stroke. This may lead to
changing behaviour and the expression of anger against those who
are delivering services. Alternatively, the person may become
2
Support care plan activities Unit HSC 2013
depressed. Someone who has not enjoyed good health over a long
period of time, however, may be able to adjust well to a more
limited physical level of ability, perhaps having compensated for poor
health by developing intellectual interests.
Employment
Health is also likely to have had an impact on a person’s employment
opportunities, either making employment impossible at times or
restricting the types of jobs they could do. Whether or not people are
able to work has a huge effect on their level of confidence and
self-esteem. Employment may also have an effect on the extent to
which people have mixed with others and formed social contacts.
This may be an important factor when considering the possible
benefits of residential care as opposed to care provided in a home
environment.
Income levels are obviously related to employment, and these will
have an effect on standards of living – the quality of housing, the
quality of diet and the lifestyle people are able to have. Someone in a
well-paid job is likely to have lived in a more pleasant environment
with lower levels of pollution, more opportunities for leisure, exercise
and relaxation, and a better standard of housing. It is easy to see how
all of this can affect a person’s health and well-being.
Education
A person’s level of education is likely to have affected their
employment history and their level of income. It can also have
an effect on the extent to which they are able to gain access to
information about health and lifestyle. It is important that the
educational level of a person is always considered so that explanations
and information are given in a way which is readily understandable.
For example, an explanation about an illness taken straight from a
textbook used by doctors would not mean much to most of us!
However, if the information is explained in everyday terms, we are
more likely to understand what is being said.
Some people may have a different level of literacy from you, so do
not assume that everyone will be able to make use of written notes.
Some people may prefer information to be given verbally or recorded
on tape.
Social factors
The social circumstances in which people have lived will have an
immense effect on their way of life and the type of care provision
they are likely to need. Traditionally, the social classification of society
is based on employment groups, but the social groups in which
people live include their family and friends, and people differ in the
extent to which they remain close to others. The social circumstances
of each person who is assessed for the provision of care services must
be taken into consideration, to ensure that the service provided will
be appropriate.
3
Religious and cultural factors

Functional skills Religious and cultural beliefs and values are an essential part of
everyone’s lives. The values and beliefs of the community people
English: Speaking and belong to and the religious practices which are part of their daily lives
listening are an essential aspect for consideration in the planning of services.
Take part in a discussion with your Any service provision which has not taken account of the religious
team about people you support. and cultural values of the person is doomed to fail.
Review the support plans as a basis
for discussion on the current needs Doing it well
of people. Ensure that you take an
active role in the discussion and that
Gathering information for a support plan
you listen to what others have to •• Remember that a wide range of factors will influence the person’s
say; extend the discussion by picking support plan and that the information can be established from a
up on points made by fellow range of sources.
members of the team. Speak clearly •• Actively involve the person.
at all times and use suitable •• With permission, ask other relevant people such as relatives, friends,
language. neighbours and previous care providers.
1.2 Establishing the individual’s

preferences about carrying out
care plan activities
The process of providing care is something which should be carefully
planned and designed to ensure that the service is exactly right for
the person it is meant to be helping. This is of key importance, not
just because it is a right to which all people are entitled in a civilised
society, but also because health and well-being responds to
emotional factors as much as physical. People will benefit if the
service they receive is centred around their own needs and the ways
in which they wish those needs to be met. Feeling valued and
recognised as a person is likely to improve the self-esteem and
confidence of people, and thus contribute to an overall improvement
in health and well-being.
When a person either requests or is referred for a service, the
assessment and planning cycle begins. Throughout the consultation
and planning which follows, the person and their needs and desired
outcomes should be at the centre of the process. You will need to
make sure that the person has every opportunity to state exactly how
they wish those needs to be met and to plan the outcomes they want
to achieve. Some people will be able to give this information
personally. Others will need an advocate who will support them in
expressing their views.
The principles of good communication, which were explored in Unit
SHC 21, are an important part of making sure that the person is fully
involved in making plans for the service they will receive.
4
All organisations must ensure that the way in which services are
provided allows people to plan exactly how they want to be
supported and what services they want, and that all those who will
play a part in planning and delivering services on a personal level are
able to use listening and communication skills in order to respond to
the person’s requirements. The consequences of not planning service
delivery around the needs of those who receive services can be
far-reaching. Table 1 shows some of them.
Need/wish of person Ways to meet need Possible effects of not taking

account of need
Food prepared according to Ensure that service is provided by Food not eaten, so health
religious or cultural beliefs people who have been trained to deteriorates
prepare food correctly
Other services refused
Food eaten out of necessity but in
extreme distress
To maintain social contacts while Provide transport to visit friends Person becomes isolated and
in residential care and for friends to visit depressed
To take control of own Discuss and support the planning Person loses self-esteem and
arrangements for personal care of direct payments and individual becomes disempowered
budgets
Table 1: Meeting people’s needs and wishes.
Maintaining the person’s wishes at the core of any plans for care
provision can have far-reaching benefits for the person and their
family.
Activity 1
Matching the support plan to the person
Spend some time talking and really getting to know a person that you
support. Find out what they like and what they used to like to do, as
well as what they really do not like. Perhaps they were keen on wildlife
Key term and gardening, but really did not like football or other sports.
Generic – basic or common Now read the support plan. Does it fully reflect the interests of the
person or is it more generic with little emphasis on their personality?
Is there anything else that you think could be different on the support
plan to fully reflect the person’s preferences?
5
1.3 Confirming with others your

understanding of the support required
for care plan activities
Giving people choices
You need to think carefully about the ways you influence people. It is
not only your own personal style of communication that influences
them, it is also the way you explain the possibilities of service
provision. You will need to beware of pushing people and their
families into a particular solution, simply because you happen to
believe it is the best one.
People will ask for your advice, and perhaps ask, ‘What would you
do?’ You will have to learn to avoid answering that question directly,
as it is not your role to give advice about a course of action, nor is it
for you to explain what you think you might do if you were in a
similar situation. This is not helpful.
What you can usefully do is provide information about services and
empower people to make their own decisions. You should simply
provide unbiased, accurate and clear information and then support
people to achieve the best outcome with the decision they have made.
Are you able to provide unbiased information?
6
Putting people in control

Throughout the process of obtaining information, you should make
sure you constantly check that people are fully aware of what is
happening and feel they are in control of the process. One of the
problems with the way services are provided, regardless of whether
they are services for health, for social care or for children and young
people, is that many people feel they play only a passive role.
It is easy to see how this can happen. Agencies and service providers
have well-organised systems which can often involve filling in a great
many forms, attending meetings and working through the
bureaucracy. If you work for such an organisation these things are a
day-to-day part of your life. They do not represent a threat to you. But
you need to remind yourself that many of the people you deal with
will not be familiar with the workings of your agency and may not feel
confident enough to question or challenge what is happening.
There are several steps you can take at each stage of the process to
ensure that people feel they are in charge of their service.
1. People should make clear who needs to be involved in the process
of thinking about and planning their service provision. You may
need to prompt them to think about the people they would like
to be involved. Sometimes it is helpful to make some suggestions.
For example, you could ask, ‘What about your neighbour, Mrs S,
the one who pops in with your dinner? Might it be a good idea to
ask her?’ or ‘Your niece Susan might have some ideas about the
sorts of services you could use.’
2. At each stage of the process, you should check with the person
that they are in agreement with the steps that have been taken so
far. You should do this using the means of communication which
the person prefers. For example, if your normal means of
communication is to talk, then you could have a regular chat to
ensure that the service provided is what the person wants and to
ask whether there are any specific ways in which they want tasks
to be carried out. Alternatively, if the person has any form of
hearing impairment, your means of communication to establish
the same information may be by writing or using signs.
3. The use of any additional sources of information – for example,
previous records from other agencies who may be involved with a
person – must be agreed in advance before you approach the
sources for the information. It is important you do not take this
agreement for granted and that you explain exactly what it is you
intend to do so it is clear what is being agreed.
4. Make sure that you record the person’s agreement to other people
being approached for information. Some agencies require written
confirmation of a person’s agreement before they provide
information about the person. If at any point during your initial
assessment and checking of information a person withdraws consent
for you to approach a particular agency or person, you must respect
that and not pursue that particular source of information.
7
Do you see how this puts the person you are supporting in control?
Obtaining information from other sources

Once you have ensured you have a person’s agreement to do so, you
may wish to consider accessing a range of other sources to complete
the picture of the person and the way in which they can most benefit
from the services your agency provides. Examples of sources are:
•• members of the family
•• friends
•• other agencies who are involved, such as a health visitor, GP,
probation officer or teacher.
Reflect
Bear in mind that information you gain, particularly from other
professional sources, may be restricted by:
•• the rules of confidentiality under which that professional operates

•• the legal restrictions as to how information may be passed on.
Which of these do you think will be typically most restrictive? Why?
Most professionals are bound by principles of confidentiality in

respect of their clients. You know that there are limits to the
information you can share with others about the people you support,
so you must expect that other professionals from whom you are
seeking information will be bound by similar rules. Information can be
protected under a range of different legislation, as Table 2 shows.
8
Type of information Relevant legislation
Medical information/hospital records Data Protection Act 1998
Information relating to children and young people Children Act 1989
Information relating to people with mental health problems Mental Health Act 1983
Information relating to people with a disability Disability Discrimination Act 1995
Any information stored on a computer or in manual records Data Protection Act 1998
Table 2: Information protected by legislation.
All of these Acts work on the basic principle that personal information
Functional skills given or received in what is understood to be a confidential situation
and for one particular purpose may not be used for a different
English: Reading purpose. They also state that information may not be passed to
Develop your reading skills by anyone else without the agreement of the person who provided the
reading a range of government information. The Data Protection Act ensures that people have access
Acts relating to people you support. to their own health or social services records but that these are not
Make written notes to aid your available to anyone else without the person’s permission. This applies
understanding of the information. even after death, where a person has expressly forbidden any
Use the information you have found information to be passed on to anyone else or to a specific person.
to extend your knowledge of how to
work with people you support. If you
Family and friends
have difficulties with terminology, Family and friends can be an invaluable source of information about
either use a dictionary or ask others a person and their needs. However, you must be sure before you
to clarify the meaning of unknown discuss anything with family or friends that this is being done with
words. the consent of the person concerned. It is easy to assume that
because someone is a relative or close friend, there will be no
objections over them giving information to you. Always confirm with
people that they have no objection to you discussing their case with
family or friends.
Other sources
Sometimes you may find that you have completed all your discussions
with people and their families, but are still unsure about how best to
provide the support that has been identified. You should discuss this
with your supervisor, who will be able to advise you about the
alternatives available and the best sources of further information. This
could include voluntary or private sector organisations, carers’ groups,
other carers or people already receiving a service.
9
2. Be able to support care plan

activities
2.1 Support for support plan activities in
accordance with the care plan and with
agreed ways of working
Following support plans
Every workplace has its own style of support plan and you should be
shown how to use the ones in your workplace correctly. But they all
follow the same broad principles. Following a support plan is
essential. This makes it possible to ensure that the person receives the
same level of care from all of those involved in providing it.
Professional carers do not work 24 hours a day (it just feels that way!)
and they do have days off and holidays, so it is important that care
services are provided by a team who all work in the same way. The
support plan is the document that makes sure this happens. If the
players in a football team all played to slightly different rules, there
would be chaos and a bad result! The same is true of care provision
– all the team members should be delivering care to the same
standard and in the same way.
Support plans are important documents that make it possible for people to
receive appropriate and consistent care.
10
Following the support plan is the way to make sure this happens.
Every person will have a plan for their support. This will have been
developed by the person, their carers and those responsible for the
care. The support plan will vary according to the work setting, but will
include the details listed below. The services you provide must be
carried out in accordance with the plan, but it is important that you
understand:
•• how to access information about the plan
•• how the plan has been developed
•• how the information is gathered
•• who has access to it
•• how the person and carers have organised the plan.
2.2 Active participation of an individual in

Active participation
Your role is to ensure that you are carrying out activities in line with
what the person needs and wants, always making sure that every
option for maintaining or increasing independence is explored.
Many different care workers undertake the role of obtaining
information about people and the services they need. Some could be
assessing people for domiciliary services while they remain in their
own homes; some could be assessing the needs which people may
have once they leave a hospital or a residential care setting; others
could be talking to a teenager or a young person about needs for
residential or other support services – the possibilities are very broad.
Whatever role you have as a worker and regardless of the kinds of
services your agency provides, there are some basic principles which
apply to the work you do.
One of these is that you must carefully explain to the person your role
in the whole process. Before you can clearly explain your role to
someone else, you must ensure that you understand it fully yourself.
Doing it well
Understanding your role
Your role is to ensure that:
•• the needs of the person and the outcomes they want to achieve are
met by providing the service
•• as much information as possible is obtained from the person
•• you provide the person and their carers and family with as much
information as you can about the options available.
11
You will also need to explain to a person exactly which services are
available and how a support plan can be put together. It can
sometimes be helpful to explain how your agency is funded and what
the limitations may be on the types of services that can be provided.
There are opportunities to use services in new ways so that people
can have the support they want.
2.3 Adapting actions to reflect the

individual’s needs or preferences during
The needs of the person must to be central to the support that is
planned. For example, the solution that you have to a problem may
be very different to the solution that someone else might suggest. It is
important to look at the holistic needs of the person in all aspects of
the support planning process and activities.
It is important to be flexible when planning support for people, and
the care team must be prepared to adapt and change as the needs of
the person changes. People are different and have a range of
personal preferences; these must be fully considered when planning
and delivering support. For example, a person may be independent at
home with support workers but unable to cook for themselves. Meals
on wheels or delivery of frozen meals may appear to the care worker
to be the best option; however, the person may not like frozen food,
or the routine of meals on wheels. They may have a neighbour who
wishes to be involved in the care of the person and would like to take
a meal to them. It is therefore important not to go for the most
obvious option, but to involve the person in the choices and options
available for them. Respect the needs and wishes of the person first,
before suggesting options that just focuses on the practical need of
the person without thinking about their personal preferences.
Activity 2
Listing different types of services
Prepare a list of the different types of service provided by the setting in
which you work. Remember to include all the aspects of the service
you provide – if you work in residential care, you will need to list all
parts of your service, such as social activities, providing food and
providing entertainment. If you work in a person’s own home, you
may need to list food preparation, cleaning, personal care and so on.
Make a note about the factors of a person’s life which you would
need to take into account in order to provide a holistic assessment of
their needs. You may wish to have a look back at some of the factors
discussed in Section 1.1.
Record ways in which you may need to adapt the services you provide
because of some of the factors you are taking into account.
12
3. Be able to maintain records of

3.1 Recording information about
implementation of care plan activities
All organisations have their own documentation. It is important that
all contributions are clearly recorded. Accurate record keeping is vital.
If records are not accurate, it can have an effect on the support
that a person receives. Some support plans are now maintained
electronically. Check with your supervisor your responsibilities relating
to completing support plans; it may be that you do not complete the
initial support plan, but maintain records and comment on a day-to-
day basis about, for example, the support that you have given to the
person. Day-to-day records contribute to assessing if the support plan
in place is effective.
Records of care contribute to the overall quality of the service any
organisation offers and they are likely to be included in any file audit
undertaken during inspection processes. The support planning
process, if it is well conducted, provides a vital opportunity for people
to contribute and to make choices about the care package they
receive. Support plans which are badly prepared and carelessly
undertaken rob people of the opportunity to take decisions which
affect their lives significantly, and they also result in an ineffective use
of scarce and valuable resources.
Doing it well
Recording information
•• Remember that all records relating to people are legal documents.
•• All entries must be clear, accurate, factual and written in black ink.
•• Remember that the Data Protection Act rules must be followed with
regards to information collection, use and recording. (Check back in
Unit HSC 028 for the responsibilities under the Data Protection Act
and the principles of good record keeping.)
3.2 Recording indications that care plan

activities may need to be revised
A support plan is a ‘plan’ and is therefore subject to change. It is a
guide to be followed in order to support the person effectively. But
remember that circumstances and needs change, and unless these
changes are reported and recorded, the plan of support may stay the
same and will not fulfil its original purpose. It is probable that you will
be providing the hands-on support and you are more likely to notice
the small changes.
13
Case study
Noticing changes in needs

Casey is supporting Gerald with his personal care. In the like this. He has therefore asked Casey to help him to
past Gerald has been able to manage his hygiene put his socks on.
independently if Casey had everything ready and on
1. What benefits will Casey’s reporting of small
hand for him. However, recently Casey has noticed that
changes like this have for Gerald?
although Gerald can still manage to wash and dress
2. Why is it important to report both improvements
himself, he is finding it more difficult to bend down
and deterioration?
because his hips appear to feel stiff and sore if he bends
Case study
Noticing changes in circumstances

Barah has a long history of mental health problems lone parent, and Barah has a married sister, Rebecca,
which she has experienced since her late teens; she is with two children. Following the death of her mother,
now in her early 40s. She experiences episodes of Rebecca decided to move nearer to Barah. They have
elation and disinhibition, and at other times depressive always been close, and Rebecca has always encouraged
episodes. Barah has regular medication which controls Barah to maintain her treatment regime and to make
her mental health most of the time and she has a use of support services. Rebecca moved into a new
comprehensive care programme, with her community house in the same area as the hostel a few weeks ago.
psychiatric nurse as her care coordinator. She lives in a
1. Is this change significant for Barah? Why?
hostel and receives support from hostel-based support
2. What could be the benefits for Barah?
workers and the staff at the day centre she attends
3. Are there any potential disadvantages?
each day.
4. How could Barah’s care programme be affected?
Barah’s family have lived in a town about 10 miles away
from Barah – her mother, who died last year, was a
14
4. Be able to contribute to
reviewing activities in the
care plan
4.1 Your role and the roles of others in
reviewing care plan activities
It will be decided at the outset how a particular care package will be
Reflect monitored, and the methods will be decided and agreed by the
Do you find it daunting to make a person and their carers. Your feedback will be an essential part of the
contribution to a review, or any process. A monitoring process will involve:
meeting, especially if there is a room
•• the person receiving the service
full of people? It can help to make
•• their carers or family
notes in advance about what you
•• other healthcare professionals
want to say. Remember, your role is
•• the service provider – whose performance will be monitored.
essential – no one, apart from the
person and their family, has as much The purpose of reviews
information as you do. You are the
Reviews are essential because care situations very rarely remain the
person undertaking the hands-on
same for long periods of time. As circumstances change, the package
care and you have a vitally important
of care may need to be reviewed in the light of those changes. At
view about changes in needs and
agreed intervals, all of the parties involved should come together to
how the person is benefiting – or
reflect on whether or not the package of care is continuing to do the
not – from the present provision.
job it was initially set up to do. If there were no reviews, the
arrangements would continue for years regardless of whether they
were still meeting care needs.
Activity 3 A review will gather together all the information about the
Reviews in your circumstances of the person, the service provided and the service
workplace provider. It will give all those concerned with the care of the person
the opportunity to express their opinions and to be involved in a
Find out the arrangements for discussion about how effective care provision has been and the
reviews in your workplace. Check changes, if any, that need to be made.
how often they are undertaken,
who attends them and who is 4.2 Feedback from the individual and
responsible for arranging them.
Ask if you could attend a review as
others on how well specific care plan
an observer in order to find out activities meet the individual’s needs
what happens.
and preferences
Obviously the most important person in any monitoring process is
the person receiving the service, so they must be clear about how to
record and feed back information on the way the care package is
working. This can be through:
•• completing a checklist on a regular basis (weekly or monthly)
•• maintaining regular contact with the care manager/coordinator,
either by telephone or through a visit
15
•• using an electronic checking and monitoring form which would

be emailed on a regular basis to the care manager/coordinator
•• recording and reporting any changes in their own circumstances
or changes in the provision of the care package.
The following is an example of a form that can be used to obtain
feedback from a person about the services they receive.
Have there been any changes in Not really – much the same
your health since the last report?
If so, please say what.
Have there been any changes in My sister has come to live a few
your circumstances since the last streets away
report? If so, please say what.
Are the services you receive still Yes, still very good, but don’t
giving the support you need? need day centre on Thursdays
now as my sister takes me out
every Thursday
How would you like the services Cancel Thursday at the day
to change what you receive? centre, but everything else is fine
A feedback form.
Monitoring by carers and families

Carers and families are likely to participate in the monitoring of a care
package in similar ways. You will need to make sure that carers are
willing to participate in monitoring and they do not feel you are
adding yet another burden to their lives.
Monitoring by other healthcare professionals

Maintaining contact between reviews with other professionals who
may be involved with the person is an essential part of the monitoring
process. The most effective method of doing this is to agree the types
of changes which will trigger contact. For example:
•• the GP may be asked to notify the care manager of any significant
health changes or hospital admissions
•• the community nurse may be asked to notify any problems in
compliance with treatment, or changes in the person’s ability to
administer their own medication, or changes in home conditions
•• the physiotherapist may be asked to notify any significant changes
in mobility.
16
A physiotherapist may be asked to report any significant changes in a person’s

mobility.
There may be other professionals involved, such as occupational or

speech therapists, depending on the circumstances of the person. The
principles of monitoring remain the same.
Feedback from care professionals

Your role in administering the plan of care means that you are in an
ideal position to identify changes in a person’s circumstances that
may mean a service is no longer appropriate. It may need to be
increased, decreased or changed in order to meet a new situation.
The changes do not have to be major, but they can have a significant
impact on a person’s life.
4.3 Contributing to a review of how well

specific care plan activities meet the
individual’s needs and preferences
Who is involved in the review process?
Any review should attempt to obtain the views of as many people
as possible who are involved in the care of the person. The most
important people at the review are the person and their carers or
family. You, as the person (or one of the people) providing services
from the plan of care, are a very important contributor. The key
worker or care manager/coordinator is also central to the review
process, as is any organisation providing the care.
17
It is also important that others with an interest in the care of the

person have the opportunity to participate in a review. This may
include a:
•• GP
•• health visitor
•• community psychiatric nurse
•• community occupational therapist
•• physiotherapist
•• speech therapist
•• welfare rights support worker
•• representative of a support group.
It may also include anyone else who has been a significant
contributor to the life and care of the person concerned. The status
of all the participants should be equal, in that everyone has the
opportunity to give a view and to contribute to the discussion.
However, the key person who must agree to any review decision is
the person concerned.
How do you think the person you support might feel about their review?
18
Doing it well
Review checklist
1. Does the person understand what a review is?
2. Do their carers also understand what a review is and its purpose?
3. Is the review arranged at an appropriate time to check the
progress?
4. Is this an annual review or has it been triggered by a change in the
person’s circumstances?
5. Does the review cover whether the person continues to need the
same level of support and services, whether there have been any
changes, what the original support plan intended, and the results
of the monitoring?
6. Has the person been asked when and where would be convenient
for the review?
7. Has it been explained to the person which decisions the review is
able to take in respect of their continuing care provision and the
development of a new support plan?
8. Has the person been offered an advocate in order to help them
prepare for the review, to support or to speak for them at the
review?
9. Does the person know who is responsible for making sure that the
review meeting is managed?
10. Does the person know all of the people who will be at the review?
11. Can all of the participants contribute either in writing or verbally?
12. Do all the participants in the support plan know that they can
request a review?
13. Have carers been consulted about the appropriate time and
location for the review?
14. Have crèche facilities been offered for anyone who needs them so
that they can attend?
During the review, everyone should be given a chance to contribute.

If the person receiving care has chosen to use an advocate to present
their point of view, this person should have every opportunity to
contribute on the person’s behalf. If some choose to communicate in
writing or by other means, such as email, then those comments must
be taken into account. If there have been any changes in
organisational policies or access to resources, or changes in the
circumstances of the service provider, these are also key matters and
should be fed into the review for consideration.
You will have the opportunity to contribute your feedback and
observations about the way in which the service meets the present
needs of the person and what changes may be needed.
19
4.4 Contributing to agreement on

changes that may need to be made to the
care plan
How to identify significant changes which affect the
care package
Throughout any monitoring and evaluation process, you are looking
for and responding to change. It is important you are clear about the
difference between types of changes which require action, and those
that are simply a part of everyday life and do not involve a major
rethink of a care package. For example, a person who inherits
£50,000 will experience significant change, whereas someone who
receives a £1.20 per week increase in income support will not! Both,
however, have experienced a change in their financial circumstances.
Similarly, someone who changes from working two days each week
to a full-time job experiences a significant change which will involve
alterations in the care package they receive. But someone who
changes from working two days each week as a telephonist to
working the same two days as a receptionist is unlikely to need
significant changes in any care package.
Change in financial
circumstances
Deterioration or improvement Changes in nature of local

in physical condition neighbourhood
Change in level of Changes Changes in housing

family support in people’s conditions
circumstances
Close of a local Change in level of friends’

resources or facility or neighbours’ support
Change of personnel in Deterioration or improvement

agencies involved in support in mental condition
Changes in people’s circumstances.
20
Case study
Reviewing and monitoring Mr Gough’s needs

Mr Gough is 79 and has been receiving support at 1. What should happen now for Mr Gough?
home to assist in basic daily living tasks such as 2. Who should be involved in considering the next
shopping, cooking and maintaining his home. Over the steps?
past six months, however, he has become increasingly 3. How can you make sure that Mr Gough is involved
frail and is now finding it difficult to wash and dress in the process?
himself. His personal hygiene is deteriorating as a result 4. In what ways can changes such as these be
and he has recently developed a skin rash. monitored?
5. Who is responsible for monitoring changes for Mr
Gough?

LO1 LO3
This outcome requires you to prepare and implement Recording any signs of discomfort or changes to a
support plan activities. You will need to show your person’s needs or preferences will mean that their
assessor that you know where you can find information support plan will need to be revised. You will need to
about the persons that you support and specific support show your assessor that you are fully aware of any
plan activities. With a person’s agreement, make a note changes that will impact on support plans. Your
of the information that would be needed in order to assessor may suggest that you write a reflective account
inform their plan of support. You could use your of a situation when you have reported and recorded
organisation’s form or make one yourself, and show it changes, and explain how the information that you
to your assessor when you have finished. shared impacted on the support plan. Your assessor
may also ask you for other examples of change that
LO2
might impact on support plans.
This outcome requires you to demonstrate that you can
LO4
competently help with support plan activities. Assessor
observation is the most appropriate method of This learning outcome requires you to demonstrate your
assessment and this must be carried out in real work ability to contribute to the reviewing process. In order
environments. Your assessor will need to observe you to demonstrate competence for this outcome, you will
carrying out activities in accordance with the person’s need to contribute actively to the review process. Your
support plan as well as encouraging active participation assessor will want you to provide evidence to show that
by the person. Sometimes it is necessary for you to you feed back how well the support plan activities meet
adapt actions in order to suit the person’s needs and the needs of the people you support. If it is appropriate
preferences at that time; you will need to provide your assessor may observe you; however, if it is not
evidence that you can adapt to such changes – your appropriate, they may suggest that you collect a
assessor may suggest that you complete a self-reflective witness testimony from a senior colleague who was
account in order to evidence this. present.
21
Legislation
•• Children Act 1989

•• www.cqc.org.uk (Care Quality Commission (CQC))
•• www.scie.org.uk (Social Care Institute of Excellence)
•• Bradley, A., Murray, K. and Couman, L. (2007) My Life Plan:
Interactive Resource for Person-centred Planning, Pavilion Publishers
•• Health, H. and Watson, R. (2005) Older People: Assessment for
Health and Social Care, Age Concern
•• Mansell, J., Beadle-Brown, J., Ashman, B. and Ockenden, J. (2010)
Person-centred Active Support, Pavilion Publishers
22
Index
A I
active participation 11–12 importance of following support plans 10–11
adapting to suit preferences 12 information sources 8–9
agreeing changes 20–1
L
legislation 22
C
choices 6
control of support plans by people 7–8
M
monitoring 15–17
E P
education, past, of people 3
preferences of the person 4–5
employment, past, of people 3
English skills 4, 9
R
records 13–15
F reviewing 15–19
factors affecting people 2–4
revisions 13–14
families as information source 9
feedback 15–17
functional skills 4, 9 S
further reading 22 social factors 3
G
generic 5
H
health of people 2–3
holistic approach 2
23
Unit HSC 2028
Move and
position individuals in
accordance with their
plan of care
This unit is primarily concerned with those people who are most
dependent upon your assistance. The level of assistance they
need can vary from needing help to get out of a chair to being
completely dependent on others to move them, to turn them
over and to alter their position in any way, for example, if they
are unconscious or paralysed.
It is essential that people are moved and handled in a sensitive
and safe way. This is also vital for you as a worker, to prevent
injury to yourself. It is possible to minimise the risk to both you
and the people whom you support by following the correct
procedures and using the right equipment.

1. anatomy and physiology in relation to moving and
positioning individuals
2. current legislation and agreed ways of working when
moving and positioning individuals
3. how to minimise risk before moving and positioning
individuals
4. how to prepare individuals before moving and
positioning
5. how to move and position an individual
6. when to seek advice from and/or involve others when
moving and positioning an individual.
1
1. Understand anatomy and

physiology in relation to moving
and positioning individuals
1.1 Anatomy and physiology of the
human body in relation to the importance
of correct moving and positioning
If, as part of you role as a care worker, you are required to assist
Key term people to move or help to reposition people, it is important that you
Anatomy – the physical structure understand the related anatomy and physiology. Having an
of the body understanding of basic anatomy and physiology can help reduce the
risk of harm to yourself or others when undertaking moving and
Physiology – the normal functions
handling procedures.
of the body
The following diagrams show the muscular and skeletal systems of
the body.
The muscular system. The skeletal system.
2
Move and position individuals Unit HSC 2028
Muscles work like levers and allow the bones at a joint to work like
hinges. Muscles pull and move the bones at particular joints; this
Key term makes the joint move and therefore the body moves. When a muscle
Contract – get shorter contracts, it pulls the bones at a joint in the direction that it is
designed to move. With reduced mobility, muscles can become
floppy and make movement slower and more difficult, but when
muscles are used on a regular basis, they remain firm and move more
easily.
Activity 1
When supporting moving and positioning activities, it is important to
Keep moving remember that muscles can only move the bones at a joint as far as
Bend and straighten your arm. the joint allows. For example, the elbow and knee joints have limited
While you are doing this, look at movement; trying to extend these joints beyond their range can cause
and feel the muscles in your upper painful damage to the joint.
arm. What have you noticed? How Nerve fibres run all the way through the body and send impulses to
far back does your elbow go? Why muscles, which enable the muscles to contract and relax. Nerve fibres
can you not go further than this? are delicate structures and can easily become damaged through poor
What would happen if you tried to moving and handling techniques.
go further than the normal position
of the elbow?
1.2 Impact of specific conditions on
correct movement and positioning
There are a number of conditions that can have an impact on the
correct movement and positioning of people.
Arthritis
People suffering with arthritis will often have stiff painful joints and
frequently have limited movement in the affect areas. Care needs to
be taken when moving or positioning arthritic people, to reduce the
possibility of causing pain and discomfort. You also need to be aware
of the limited movement of arthritic joints and not attempt to move
these beyond their limits.
Parkinson’s disease
Sufferers of Parkinson’s disease may experience limb rigidity that can
affect normal movement and positioning. When assisting people to
find a comfortable position, in either a bed or chair, be careful not to
force the rigid limb further than it is able to, as this could damage the
joint and cause discomfort or pain. People with Parkinson’s disease
have slower reaction times and it may take a person longer to initiate
movement. It is therefore important to give people suffering from this
condition time to move and not rush them. People may not be able
to tell people if they are in pain, so you should look for non-verbal
signs of pain or discomfort.
3
Amputation
The loss of a leg can affect how well a person can move depending
on where it has been amputated, for example, below or above the
knee. Artificial limbs can help people to move, but these benefits also
vary depending on where the limb has been amputated.
Cerebral palsy
People who suffer with cerebral palsy may have contracted muscles
or joints causing a fixed rigid limb. Care staff must be aware of the
needs of people who suffer with cerebral palsy and ensure that
effective communication skills are used when assisting people to
move or reposition.
Stroke
A stroke can have a devastating effect on somebody; it may leave a
person with no long-term effects, with a permanent weakness down
one side of their body or, at worst, in a deep coma from which they
never recover. When moving and handling people who have suffered
from a stroke, you will need to be aware of the extent of the stroke
and what parts of the body have been affected.
2. Understand current legislation

and agreed ways of working
when moving and positioning
individuals
2.1 How current legislation and agreed
ways of working affect working practices
related to moving and positioning
Every time a care worker moves or supports the weight of a person,
they are manually handling that person. Unsafe moving and
handling techniques can result in injury to either the care worker or
the person they are assisting to move. According to Health and
Safety Executive (HSE) statistics, almost 50 per cent of all accidents
reported each year from the health and social care sector involve
manual handling and in particular from assisting people with
Key term mobility. In 2001/2002 there were a reported 40.4 per cent
handling accidents from social work activities alone!
Legislation – laws
To reduce the risk of injury to care workers and people being
supported, legislation is in place to protect people. The Health and
Safety at Work Act 1974 makes it a legal requirement for employers
to ensure that the health, safety and welfare of their employees is
maintained and employees have a duty to take reasonable care of the
health, safety and welfare of themselves and other.
4
The Manual Handling Operations Regulations 1992 (amended 2002)

came into effect on 1 January 1993 and address moving and
handling in the workplace. These Regulations were updated in 2002
to better integrate the European Directives on the moving and
handling of loads.
The Regulations impose duties on employers, self-employed people
and employees. They state that employers must avoid all hazardous
manual handling activities where it is reasonably practicable to do so.
If this is not possible, they must assess the risks in relation to the
nature of the task, the load, the working environment and the ability
of the handler, and take appropriate action to reduce the risk to the
lowest level reasonably practicable. Employees must follow
appropriate work systems introduced by their employer to promote
safety during the handling of loads.
If you are responsible for assisting somebody to move, it is the joint
responsibility of both the employer and yourself to ensure your safety
and that of the person being moved.
The HSE provides guidance about the weights that can be safely
lifted, but these are a general guide and are for objects, not people
who can move, fidget, protest and cooperate. However, these
guidelines are useful in showing how little weight can be lifted safely.
10 kg 5 kg
3 kg 7 kg
Shoulder height
Shoulder height 20 kg 10 kg
7 kg 13 kg
Elbow height
Elbow height
25 kg 15 kg
10 kg 16 kg
Knuckle height
Knuckle height
20 kg 10 kg
7 kg 13 kg
Mid lower leg height Mid lower leg height

3 kg 7 kg 10 kg 5 kg
Wome n Men
Guidance on lifting (source: Getting to Grips with Manual Handling, HSE).
5
Each box in the diagram above shows guideline weights for

lifting and lowering.
Observe the activity and compare to the diagram. If the lifter’s
hands enter more than one box during the operation, use the
smallest weight. Use an in-between weight if the hands are close
to a boundary between boxes. If the operation must take place
with the hands beyond the boxes, make a more detailed
assessment.
The weights assume that the load is readily grasped with both
hands, and the operation takes place in reasonable working
conditions with the lifter in a stable body position.
Reduce the guideline weights if the handler twists to the side
during the operation. As a rough guide, reduce them by 10 per
cent if the handler twists beyond 45 degrees, and by 20 per cent
if the handler twists beyond 90 degrees. Any operation involving
more than twice the guideline weights should be rigorously
assessed – even for very fit, well-trained people working under
favourable conditions.
There is no such thing as a completely ‘safe’ manual handling
operation. But working within the guidelines will cut the risk and
reduce the need for a more detailed assessment.
(Source: HSE 2004.)
Workplace policies and procedures will also affect the way you move
Functional skills and position people in the care environment where you work. For
Maths example, if you work in a casualty department or an emergency
operating theatre, you may be required to logroll patients who have
This gives you the opportunity to suspected fractures to the spine. This will involve taking some of the
estimate results and use data to patient’s weight, but there should be agreed ways of working that
assess the likelihood of an outcome. identify the number of people required to perform this specific
manoeuvre.
If you work in a residential care home, you may be required to roll
Activity 2 people to help them with their personal care needs or turn people to
prevent pressure areas from developing. Within the workplace, you
What does our policy
will probably have a written moving and handling policy that
say? addresses these issues. It is your responsibility to read workplace
Each workplace is different and will policies and procedures and to ensure you follow them.
have different policies relating to
moving and handling. Find the
moving and handling policy for
your workplace and note the key
points that affect your practice
when moving and positioning
people.
6
2.2 Health and safety factors to take into

account when moving and positioning
individuals and any equipment used
There are a number of health and safety factors that you need to
consider before attempting to move or position people, and you then
need to plan what you are going to do. These factors include:
•• the activity
•• the environment
•• the people being moved or positioned
•• yourself and others
•• equipment that may be used.
The activity
When considering the activity, you should ask yourself some
questions to help plan the manoeuvre. Some questions you may ask
could include the following.
•• What activity are you assisting with? Are you helping the person
to stand, roll, walk or turn?
•• If you are assisting someone to walk to the bathroom, how far do
you need to go?
•• Who else could help you?
•• How long will the activity take?
The environment
Before undertaking the activity, you will need to consider the
environment and try to identify potential hazards. You may need to
consider some of the following.
•• Are there any obstacles or obstructions, which may increase the
risk of you or the person tripping over?
•• Are the floor surfaces level, dry and free from obstacles such as
frayed carpet edges or uneven rugs?
•• Is there enough space to undertake the activity?
The people being moved or positioned
The person who is being assisted to move or who is being positioned
will be at the heart of the activity. It is therefore important to consider
them when planning the activity. Some questions to consider may
include the following.
•• What can they do for themselves?
•• How much support will they require?
•• How can you promote their independence throughout the
activity?
•• Does the person have experience of the activity?
•• Are there any medical devices attached to the person such as
catheter bags, intravenous drips or wound drains?
•• What is the person’s weight and height?
7
Yourself and others

Before attempting to assist somebody to move, it is important to
consider your suitability, and that of any colleagues who will be
helping to undertake the activity. Some points to consider are as
follows.
•• Have you received moving and handling training?
•• What is your general state of health and well-being?
•• Are you wearing suitable clothing to perform moving and
handling procedures?
•• Is your footwear well fitting and supportive?
Equipment that may be used

When planning a moving and handling activity, you may identify that
a piece of equipment is required such as a hoist, walking frame or
slide sheet. Before using any equipment, you should check that the
equipment is:
•• available •• in good condition
•• clean •• in good working order.
Does your work clothing allow for free

You must also consider the person being assisted – find out if they
movement when moving and handling have used the equipment before and if so, whether there were any
people? problems.
Remember you should only use equipment that you have been
trained to use.
You should consider these factors each time you carry out any activity
that involves you in physically moving a person from one place to
another. A suggested checklist is shown below. This can be used to help
identify health and safety factors that you need to consider before
moving and handling somebody. You may need to adapt this checklist
to fit your own place of work and the circumstances in which you work.
1. Is the person weight-bearing?

2. Is the person unsteady?
3. What is the general level of mobility?
4. a) What is the person’s weight?
b) What is the person’s height?
c) How many people does this lift require? (Work this out
on the scale devised by your workplace.)
Functional skills
5. What lifting equipment is required?
Maths 6. Is equipment available?
You can practise converting metric 7. If not, is there a safe alternative?
to imperial measurements by 8. Are the required number of people available?
working out a person’s weight and 9. What is the purpose of the move?
height.
10. Can this be achieved?
8

English: Reading Undertaking moving and handling activities
You are using your reading skills to Before undertaking any moving and handling activities, check that:
read and understand the main points •• you have received moving and handling training
in the text, and use the information •• you are wearing the correct clothing
to answer the set questions. •• the environment is safe
•• any moving and handling equipment is safe and clean
•• you have help if you need it
•• you are involving the person being moved.
Case study
What a pain!
Karolina has just begun a new job as a Health Care When Karolina gets Arthur into the shower, he insists
Assistant (HCA) in a busy general surgical ward. She is he can stand unaided and wash himself, but Karolina is
paired up with Margaret, another HCA, and is asked to unaware that Arthur should be sitting down. She goes
work with her and assist patients with their personal to get a towel for him, but upon her return, she finds
care needs. Arthur on the shower floor. He asks Karolina to help lift
him up, which she does, but as she straightens, she
Margaret and Karolina have been asked to look after
turns to sit Arthur on the commode and feels a sudden
bay 5, which is a six-bedded male bay. All the patients
sharp pain in her back and is unable to move. Karolina
have had operations for leg fractures. Four of the men
pulls the emergency cord for help.
say they are able to meet their own care needs, but
Arthur and David say that they require assistance. When help arrives, Karolina has to explain what has
Margaret tells Karolina to go and help Arthur while she happened. The ward sister is not happy!
assists David; Karolina feels unable to say no, as she is
1. How could this situation have been avoided?
new. However, because Karolina has not completed any
2. What did Karolina do wrong?
moving and handling training, she is unaware that it is
3. Was Margaret at fault, and if so, why?
the hospital policy not to lift patients and that lifting
4. When Karolina found Arthur on the floor, what
equipment, such as a hoist, should always be used.
should she have done?
3. Be able to minimise risk before

moving and positioning individuals
3.1 Accessing up-to-date copies of risk
assessment documentation
Risk assessments are formal documents used to identify risks
associated with certain activities. Some care establishments use
generic risk assessments, which are fine to use; however, if a generic
risk assessment form is used, it needs to be followed up with
9
thorough risk assessment of each task. For example, a hospital or

large care home may use a generic moving and handling risk
assessment for the entire organisation, but this will then be adapted
to meet the needs of each specific area and each person where the
care is to be delivered; this could even include somebody’s home.
Under health and safety legislation, employers have a responsibility to
examine and assess all procedures taking place in the working
environment, which involve risk. All risks must be noted and assessed,
and action should be taken to diminish the risks as far as realistically
possible. Employers are required to provide adequate equipment for
moving and positioning people who require assistance.
Health and safety legislation places responsibilities on both the
employer and the employee, and both must take active responsibility
for reducing risk.
The employer’s duties are to:
•• avoid the need for hazardous moving and handling as far as is
reasonably practicable
•• assess the risk of injury from any hazardous moving and handling
that cannot be avoided
•• reduce the risk of injury from hazardous moving and handling, as
far as reasonably practicable
•• review moving and handling policies and procedures on a regular
basis.
Employees’ duties are to:
•• follow appropriate systems of work laid down for their safety
•• make proper use of equipment provided to minimise the risk of
injury
•• cooperate with the employer on health and safety matters; a care
assistant who fails to use a hoist that has been provided is putting
themselves at risk of injury, and the employer is unlikely to be
found liable
•• apply the duties of employers, as appropriate, to their own
manual handling activities
•• take care to ensure that their activities do not put others at risk.
The risk assessments completed by your employer will be general risk
assessments for your work environment. Every time you move or
position somebody, you will need to make an assessment of the risks
involved in performing that activity. Even if you assist the person every
day, you must still assess the risks on every occasion before starting
the activity.
It is important to remember that no two lifts are the same and there
will always be some aspect that will be different. These aspects could
be to do with the person, their mood or just how they are feeling on
that particular day. The environment may have changed since the
last activity, or it could be about you and your health.
10
3.2 Preparatory checks using the care plan

and the moving and handling risk
assessment
Before assisting somebody to move, it is important that you access
up-to-date information regarding their:
•• moving and handling requirements
•• ability to cooperate
•• health condition
•• moving and handling requirements.
The two documents that you should access are the person’s support
plan and their moving and handling risk assessment. Both these
documents should be read in conjunction with each other, as the
support plan will provide specific information on the person
themselves and should include information such as:
MENTS
AN REQUIRE
SUPPORT PL
21. 12. 72
REMENTS Date of Birth
AN REQUI res to both
SUPPORT PL
ke r
Name Dani el Ba mpound fractu
RT A res ulting in open co
Date of Birth
21.12.72 Relevant infor
mation d on right leg.
sight of woun
nt infection at 01.03.11
Nam e Da nie l Ba ke r
mp ou nd fractures legs. Subseque Da of Plan
te
ulting in open co b Unit
mation RTA res Unit W ood ru sh Re ha
Relevant infor Date
to both legs 02.02.11 irement
Date of Plan ge t Nursing Requ Achieved
Rehab Unit Planned Activ
ity Tar
Unit Woodrush Date e
Date fection of th
Nursing Requ
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ge t Achieved 14.03.11 obility has
Planned Activ
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te 08.02.11 ilise Continue
Da
of pressure crutches to mob been delayed.
SUPPORT PL 08 .0 2.1 1 1) Assess risk ou t su pp ort uc ing su pport whilst
ectsAN REQUIRE and address an
y wi th red
To minimise eff MsoENresTS y.
Name Daniel of immobility from the obser ving safet
Baker issues arising
Date of Birthassessment. SUPPORT PL
Relevant infor
mation RTA res 21.12.72 AN REQUIRE 1. Encourage lifting
to both legs ulting in open co MENTS e bed,
mpound fracture ysiotherapist
gesph
Name Daniel To
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Unit Woodrush 28 .0 2.11 1) Ar ran
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Nursing Requ m. Da to
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To minimise eff t Pl an ne e m ov ement
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of immobility 1 1) Assess ris.0k 3.11 ReduceAc suhie ved ity Target
07 of press1) Nursing Requ
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To safely usesores and addr ureserving08
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crutches to issues arising fro 2) Withdraw ph l cru 14.03.11 1. Due to an in Achieved
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mobilise witassessment. support giv obilise fection of the
without support wound full m
To safely use support support. obility has
crutches to mo 28 .02.11 1) Arrange phys be en delayed. Contin
bilise iotherapist ue
with support assessment an reducing supp
d input. ort whilst
2) Encourage an ob ser vin g safety.
d support To exercise leg
short walks to 1. Encourage
and from the muscles whils lifting
bathroom. t
lying in bed of legs from th
To safely use e bed,
crutches to 07 .03.11 1) Reduce supp in dividually, to
ort whilst a height
mobilise without observing safet of 12(twelve) cen
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support 2) Withdraw ph measured from
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support giving to exe rci se thigh muscle
only verbal three times da s
support. ily.
2. Encourage
movement
of toes to incre
ase blood
flow throughou
t the day.
The support plan is important and must be read prior to moving or positioning somebody.
11
•• what the person can do for themselves

•• the level of support required by the person from care staff
•• the person’s limitations, for example, any medical conditions
which need to be taken into account
•• how the person mobilises
•• how often the person needs to be repositioned
•• any problems or benefits from moving and handling equipment
that the person has used.
A moving and handling risk assessment may contain similar
information to somebody’s support plan, but it will focus on reducing
the risk of harm to the person and the care worker from moving and
handling activities. Risk assessments identify possible hazards that
have the potential to cause harm; these hazards will include the
moving and positioning activity, the environment, the person, the
equipment that will be used, yourself and other care workers.
ASSESSMENT FORM FOR PATIENTS WHO REQUIRE Examples

MANUAL HANDLING Tasks:
✔ Sitting/standing
Patient’s name……………………………… District nurse………………………………………… ✔ Toileting
✔ Bathing
Body build Obese Above average Average Below average Tall Medium Short ✔ Transfer to/from bed
Weight (if known)…………………………………… Risk of falls High Low Methos/control measures:
Organisation
Problems with comprehension, behaviour, cooperation (identify)…………………………………… ✔ Number of staff needed?
✔ Patient stays in bed
…………………………………………………………………………………………………………
Equipment
Handling constraints e.g. disability, weakness, pain, skin lesions, infusions (identify) ✔ Variable height bed
✔ Hoists
………………………………………………………………………………………………………… ✔ Slings/belts
✔ Bath aids
Tasks (see example)…………………………………………………………………………………… ✔ Turntable
✔ Sliding aids
…………………………………………………………………………………………………………
Furniture
Methods to be used (see examples)…………………………………………………………………… ✔ Reposition/remove
………………………………………………………………………………………………………… Problems/risk factors:

Task
Describe any remaining problems, list any other measures needed (see examples) ✔ Is it necessary? Can it be
avoided?
………………………………………………………………………………………………………… ✔ Rest/recivery time
Patient
…………………………………………………………………………………………………………
✔ Weight, disability, ailments?
Environment
✔ Space to manoeuvre?
Date(s) assessed ……………… ……………… ……………… ……………… ✔ Access to bed, bath, WC?
✔ Steps/stairs?
Assessor’s signature ……………… ……………… ……………… ……………… ✔ Flooring uneven? OK for
hoist?
Proposed review dates ……………… ……………… ……………… ………………
Carers
✔ Fitness for the task, frshness
or fatigue?
Finishing date …………………… ✔ Experience with patient?
✔ Skill (handling, equipment)?
A risk assessment form for moving and handling.
12
Activity 3
What does your assessment say?
Read the moving and handling support plans and risk assessments for
people you support within your work setting.
1. What information do they tell you?

2. How does the information help you plan for moving and handling
activities?
3. Can you think how your documentation could be improved?
3.3 Identifying any immediate risks to

the individual
Just because you have read somebody’s support plan and risk
assessment, it does not mean that all the risks have been identified
and that others may not occur. It is important that you check the
person, equipment and the environment before undertaking any
moving and positioning activities. For example, you should consider if
the person is still able to cooperate with the activity, and check for
catheter bags, intravenous drips or wound drains and that equipment
is clean and safe. You may also want to check that the person’s
footwear is suitable for the activity and check the floor for any
Are wet or slippery floors always obstacles. It is particularly important to watch out for freshly washed
properly identified in your workplace? floors and wet floor signs.
When positioning people who are unable to move themselves, such
as those who have suffered from a severe stroke, it is important to
Key term remember to check their pressure areas, particularly the elbows, heels
Sacrum – the bony part of the and sacrum. Poor positioning techniques can cause pressure areas
back located at the base of the to develop.
spine
3.4 Actions to take in relation to identified
risks
Once risks have been identified on a risk assessment form, risk control
measures will be put in place to minimise the risk of harm. For
example, it may be identified that the care worker is at risk of back
injury from adopting an awkward position such as twisting or
bending while assisting somebody to stand. This risk could be
removed or minimised by:
•• using a stand aid
•• ensuring there is sufficient space to undertake the activity
•• encouraging the person to do as much for themselves as possible
•• ensuring all care staff supporting the person have received moving
and handling training, so they are aware of the correct techniques
to use
•• ensuring there are sufficient numbers of staff for the task.
13
However, there are some situations where it is difficult to remove

hazards, such as when working in someone’s own home. In situations
such as this, your employer will still perform a risk assessment and put
risk control measures in place, but what they will not be able to do is
remove the environmental hazards such as lack of space, worn
carpeting and beds of a fixed height and width that cannot be moved.
As a care worker, it is your responsibility to ensure that you follow the
risk control measures put in place by your employer. Failure to do so
could result in injury to the person you are supporting, or yourself.
Prior to undertaking a moving or positioning activity, you may notice
a risk that has only recently developed such as a change in the
person’s ability to cooperate with the activity or a change in their
health – we all have off days! If you identify a new risk, you need to
identify risk control measures that will enable you to remove or
Activity 4 minimise the risk. If somebody’s health condition has changed,
resulting in them being unable to assist in the activity, you may need
What does your risk
to use equipment like a hoist, or you may need to ask a fellow
assessment say? colleague to assist you. Before undertaking a moving or positioning
Look at the moving and handling activity with somebody whose health condition has changed, you
risk assessments for people you should ask a senior carer or your manager for additional advice and
support. guidance.
1. What risks have been Whatever action is taken or risk control methods put in place, you will
identified? need to document this in the person’s support plan along with an
2. What control measures are in explanation of why you needed to deviate from the person’s risk
place? assessment. It is also important to document if somebody refuses to
3. What actions do you need to be moved or positioned, because if their health suffers as a result of
do as a care worker? not being moved and you have not recorded this, it will be deemed
that the move did not take place and it will be seen as your
responsibility.
3.5 Action to take if the individual’s

wishes conflict with their plan of care in
relation to health and safety and their risk
assessment
Sometimes workplace polices and procedures in relation to moving
and handling may conflict with someone’s wishes. For example, some
workplaces have adopted ‘no-lifting’ policies which mean that hoists
are used for all people – but what if a person does not want to be
hoisted? If dealt with incorrectly, this could leave people feeling
unvalued, humiliated, distressed and degraded. You could also find
yourself in trouble, because the person’s basic human rights may have
been violated.
To prevent conflicts from developing between people and workplace
policies relating to moving and positioning, it is best to involve people
in their own risk assessments and mobility support plans in the first
14
place, if appropriate. Risk assessments should focus on the needs of

the person, not just the needs of the service provider. Where possible,
people should be placed at the centre of the planning process and
given choice over their moving and positioning requirements, as they
will have the best knowledge of their own mobility. The wishes of the
person need to be balanced with the need to ensure that care staff
are not put at risk through moving and positioning activities.
Balancing the wishes of somebody with the rights of care workers will
help promote a person’s independence, autonomy and dignity.
However, sometimes, a person’s condition can change and their
mobility can improve as well as deteriorate. This may lead to them
changing their mind on how they wish to be moved or positioned. If
their wishes conflict with their plan of support, it is important that
you document this in the person’s support plan and inform your
Reflect manager. If the person wants to do more for themselves, you should
Think about how people are encourage this, but be aware of their limitations – are they trying to
encouraged to participate actively in do too much too soon? If the person refuses to be moved or turned,
their moving and positioning you should encourage them to move as much as possible by
support plan and risk assessment. themselves. As a care worker, you need to inform people of any risks
Do you offer choice to the people associated with their actions such as the risk of developing pressure
you support? How could you sores or a possible deterioration in their health, such as developing a
improve what you do? chest infection. It is important that you document information in the
support plan clearly, along with any actions that you have performed.
3.6 Preparing the immediate environment

To reduce the risk of injury from carrying out a moving or positioning
activity, it is important to ensure there is sufficient space to perform the
activity and any potential hazards are removed before starting the
procedure. You will need to consider the requirements of the person
you are supporting and any other people involved in the activity.
When assisting a person to stand and move from one location to
another, you will need to make sure there is room for you to stand by
the person and support them and that there is sufficient room for the
person to stand and move. If you are using equipment such as a
walking frame or hoist, you will need to ensure there is sufficient
room for this too. To create the space required, you may need to
move furniture or other pieces of equipment that are in the way,
because if these are in the way and limit the amount of space you
have, they will be causing a hazard and a potential risk to you and the
person you are supporting. You may also want to check the floor to
make sure there are no trip hazards such as a shoe or curled rug.
If you work in a hospital or nursing home environment, you may need
to turn patients to help prevent pressure sores from developing.
Before commencing the turn, you should ensure you have enough
space in which to perform the move. This may mean you will have to
move the bed away from a wall or move a bedside locker. You will
also need to ensure that any equipment attached to the patient is
15
free to travel during the activity. You may need to consider catheter
bags, intravenous fluids or wound drains. Failure to consider these
factors could result in causing the patient undue pain and/or
discomfort.
Is there sufficient space to perform moving and positioning tasks here?
How could this have been prevented?
It is important to remember that if you are working in a care setting

or in somebody’s own home, you should make sure that any furniture
is returned to its original position after the activity. This will ensure the
person will be able to locate their personal items in their usual places
and feel reassured by the familiar surroundings.
16
3.7 Standard precautions for infection

prevention and control
When assisting a person with moving or positioning activities, you will
need to consider the standard precautions that you will use to
minimise the risk of infection. As a minimum you will need to ensure
that you wash your hands before and after the activity. However,
hand washing alone may not be sufficient for the activity you are
involved in.
When risk assessing the moving or positioning activity, you will also
need to assess the risk of infection. The chances are that if you are
assisting somebody to walk from the living room to the dinning room
in a residential care home or within the person’s own home, hand
washing alone may be sufficient. If, however, you are assisting with
the repositioning of a patient who has had a severe stroke and is
incontinent, you will probably consider hand washing, gloves and an
apron. Once you have performed the activity, you should remove
aprons and gloves, and dispose of them according to your
organisation’s policy. You must wash your hands after patient contact
and before moving on to the next person. If you work in the
community, you may not have access to a sink to wash your hands,
so your employer should provide you with antibacterial hand gel
which can be used until you can wash your hands. Hand gels should
only be used as an interim measure until you are able to perform a
proper hand wash; they are not a suitable replacement for good hand
washing.
Uniforms must be kept clean and tidy, and you should wear a clean
uniform every day. Tunics should have short sleeves to prevent them
It is important to maintain your personal from dragging in body fluids when undertaking moving and
hygiene and to wear sensible clothing positioning procedures. Remember: do not go to the shops in your
when assisting people.
uniform, because you could be spreading bacteria and infectious
agents!
Activity 5
Personal hygiene is also important in the fight against infection. You
Keep it clean should keep your nails short; this also helps prevent accidently
harming the person when you are assisting them to move. Hair
Find out what your workplace
should be kept clean and long hair tied back out of the way. Watches
policy is on infection control when
and rings should not be worn because they can scratch the person
assisting with moving and
and rings can harbour bacteria.
positioning activities. What are
your employer’s responsibilities and
what are your responsibilities?
17
Case study
Lifting policies and the rights of people

Vivien is a senior care worker and works at Badgers interested and tells Martin that he is a health and safety
Rest, a short-stay residential care home for people who risk, and he needs to lose some weight.
have suffered a stroke at an early age. Martin is 45 and
Martin feels angry and upset, and tells Vivien he will be
is at Badgers Rest because he had a stroke last year. He
making a formal complaint. Vivien tells him he can do
is currently unable to look after himself at home,
what he wants and that it will make no difference to
because he weighs 26 stone and the stroke left him
her decision, because health and safety law always
with a slight left-sided weakness. Martin is able to
comes first.
weight bear, but he needs support. However, Badgers
Rest have a no-lifting policy and the staff hoist him Later in the day, Martin’s son comes to visit and sees
because he is classed a bariatric patient. that his father is upset. Martin explains the situation to
his son, who becomes angry and tells him that he will
Martin has refused to be hoisted today as he feels that
go to the Citizens Advice Bureau for legal advice.
it is undignified and he wants to mobilise as soon as he
can to get home. The care staff report his behaviour to 1. Is Badgers Rest right to have a no-lifting policy?
Vivien, who tells Martin that unless he agrees to be 2. What does the HSE say about no-lifting policies?
hoisted, he will have to stay in bed, because she is not 3. Have Martin’s human rights been violated?
prepared to risk the health and safety of the staff. 4. Was it possible to have a situation that ensured the
Martin tries to explain to Vivien that he is able to weight safety of the staff and promoted Martin’s
bear and only needs some support, but Vivien is not independence? Explain what you would do.
Key term Functional skills

Bariatric – a term used for a person
English: Writing
whose weight exceeds 25 stone
When responding to questions, you will have the opportunity to write
clearly and coherently, using enough detail to cover the necessary
points. You will need to proofread work to ensure that spelling,
punctuation and grammar are accurate. Information should be
presented in a logical sequence for clarity.
18
4. Be able to prepare individuals

before moving and positioning
4.1 Effective communication with the
individual to ensure that they understand
the details and reasons for the action/
activity being undertaken, and agree the
level of support required
The use of effective communication is extremely important when
preparing people for moving or positioning. Most people who have a
disability will be knowledgeable about how to deal with their
disability. You should involve the person in their move or positioning
activity and ask them for the most effective ways for them to be
moved. This will also help to avoid undue pain and discomfort during
the moving or positioning activity.
If you are supporting somebody who is being moved or positioned for
the first time, you will need to explain the reasons for the activity and
what you will be doing. You will need to find out from the person
what they can do for themselves, so you can promote their
independence as far as possible. Effective communication skills will
need to be used when supporting somebody, which will include:
•• slow, clear speech
•• eye contact
•• avoiding medical terminology and jargon that might confuse the
person you are supporting.
If the person becomes upset, you may need to use appropriate touch
to comfort and reassure them. People who suffer with dementia may
be confused and might not be able to contribute actively to
discussion about the best way to carry out the moving or positioning
activity. If this is the case, it is essential that you consider the best
options for the person.
How does discussing the person’s preferences about being moved help?
19

English: Speaking and Preparing people for moving and positioning
listening activities
When moving somebody, you will •• Explain what you are going to do.
have the opportunity to present your •• Find out what is comfortable for the person.
verbal information to them using •• Agree the level of support required.
clear speech and appropriate •• Find out what the person can do for themselves.
language. •• Reassure the person.
Unconscious or semiconscious people should also have procedures

explained to them, because there is evidence to indicate that people
who are unconscious can sometimes still hear what is going on. By
talking to and reassuring the unconscious patient, you are also
demonstrating respect for them.
4.2 Obtaining valid consent for the

planned activity
Prior to moving or positioning somebody, you must obtain the valid
consent of the person. This is consent that has been given voluntarily
by somebody who has been appropriately informed about an activity
and who has the capacity to understand what the activity involves.
To obtain valid consent, you will need to explain to the person being
moved or positioned what you are planning to do, how you plan to
do it and any risks involved. Before giving you their consent, the
person may ask you specific questions about the activity. For example,
they may ask about equipment that is going to be used and if it is
safe. You need to answer these questions and ensure the person is
happy before undertaking the activity. Consent should be gained
each time you prepare to perform the activity, because a person may
change their mind. The consent you gain from people for moving and
Reflect positioning activities does not have to be written on a consent form,
as verbal consent is sufficient, but you should record the main facts
Reflect on how you obtain valid
discussed in the person’s support plan. Failure to obtain valid consent
consent from people you help to
could result in allegations of assault being made against you.
support. Do you obtain valid consent
each time you perform an activity? People who lack the capacity to make a decision about being moved
Should we have to obtain consent for or positioned, such as people with dementia or who are unconscious
simple activities such as moving or due to a stroke or other condition, should not have their care needs
positioning, especially when the ignored. People who are deemed to be incapable of giving valid
activity is designed to minimise the consent will fall under the Mental Capacity Act 2005. This will allow
risk of further harm such as the consent to be given on behalf of the person. This consent may be
development of a pressure sore? How given by a relative, a legal advocate such as a solicitor or a care
could you improve your practice? professional, provided they can demonstrate that the activity was
undertaken in the best interests of the patient.
20
5. Be able to move and position an

individual
5.1 Ensuring that the individual is
positioned using the agreed technique
and in a way that will avoid causing
undue pain or discomfort
Once you have carried out all the preparations for the moving or
Activity 6 positioning activity, you can then perform the activity, but it is
Stick to the plan important that you undertake this activity in accordance with the
person’s support plan. This will have the techniques for the activity
Look at the support plans for documented, along with information about the level of support
people you support with moving or required.
positioning. Are the plans up to
date and do they provide you with
By following the information within the person’s support plan, you
information about the best way to
can reduce the risk of causing undue pain or discomfort. For example,
move the people concerned?
if a person is very anxious when they are being hoisted, this
information should be recorded on the support plan, along with any
Explain how you use the support action taken. This will allow other care workers to be aware of any
plan to help you plan somebody’s issues and enable them to carry out the manoeuvre without causing
moving or positioning activity. additional distress, pain or discomfort.
5.2 Effective communication with any

others involved in the manoeuvre
Functional skills
Most moving and positioning activities will require more than one
English: Speaking and care worker. It is important when more than one care worker is
listening involved in a manoeuvre that there is effective communication
between the care workers and that one of the care workers takes the
This activity will give you the
lead. If you are to work effectively as a team, you will need to follow
opportunity to have a group
some simple rules.
discussion where you can contribute
your findings. You can use the
•• Carry out a risk assessment.
information from the support plan to
•• Decide who is going to lead the activity.
present your ideas and opinions.
•• The person leading the activity must check that everyone is ready.
•• They will agree the action word to be used such as ‘One, two,
three, lift’ or ‘Ready, steady, move’.
•• Everyone must follow the instructions of the person leading the
activity.
When assisting somebody to transfer from a bed or chair to a
wheelchair, it is possible that this activity can be done with one care
worker providing assistance. The care worker may need to steady the
person as they use the transfer board. However, if the person
requiring assistance has additional risk factors such as being obese or
tall, or has a serious disability, then alternative transfer methods
should be considered such as a hoist. You may also need to think
about whether you need more people to help with the activity.
21
You may be required to help turn people in their beds because they
are unable to do this for themselves. This may be because they are:
•• unconscious following a stroke or an operation
•• suffering with a severe illness such as motor neurone disease
•• paralysed
•• recovering from an operation.
When supporting positioning activities, you should:
•• follow the support plan and risk assessment
•• perform the manoeuvre with at least two workers
•• ensure one care worker leads the activity so both care workers
work together as a team and move the person at the same time.
This will help prevent injury to yourself and/or the person.
•• roll the person using a transfer aid such as a glide sheet or board
•• support the person with pillows or packing to prevent them from
rolling back on to their back.
When the person needs to be turned again, the pillows can be
removed and the person may be allowed to lie on their back for a
while. The next time they are turned, they will be placed on to their
opposite side.
5.3 Aids and equipment that may be used

Activity 7 for moving and positioning
Effective Some moving and handling equipment is covered by the Lifting
Operations and Lifting Equipment Regulations (LOLER). This came into
communication force in 1998 and covers risks to health and safety from lifting
Think about examples of when you equipment provided for use at work. LOLER requires that equipment is:
have used effective communication
•• strong and stable enough for the intended load
when moving or positioning
•• marked to indicate safe working load
people. Write a brief account
•• used safely – the equipment’s use should be organised, planned
explaining why effective
and executed by competent people
communication is important when
•• subject to ongoing examination and inspection by competent
undertaking moving or positioning
people.
activities. What are the potential
dangers of uncoordinated moves? Hoists, slings and bath hoists are covered by the Regulations. They
state that a competent person must thoroughly examine equipment
that is used to lift people at least every six months, and examine other
equipment at least every year.
In your workplace, it is important that you check lifting equipment
every time you use it to ensure it is safe, clean and appropriate for the
person. If you discover the equipment is worn, damaged or appears
to be unsafe, you should withdraw it from service, label the
equipment with a faulty label and report it to your supervisor. You
must do this even if it means having to change the person’s moving
and handling assessment. It is not acceptable to take risks with
equipment which may be faulty. It is better for the person to wait for
22
the moving activity or be moved in a different way rather than being

exposed to the risk of harm from potentially unsafe equipment.
Before using equipment, you should also make sure that you have
been trained to use the equipment and that you have read the
instruction manual for each piece of equipment you use. The manual
will include a safety checklist, so make sure you follow it.
There are many different types of moving and positioning equipment
used within care settings to assist with moving and positioning
activities. These can be split into three main categories:
•• equipment that takes the full weight of the person, such as hoists,
slings and slide sheets
•• equipment that takes some of the person’s weight, such as slide
boards and slide sheets
•• equipment that is designed to assist the person to help
themselves, such as lifting handles, grab handles and raised toilet
seats.
Lifting handles above a bed can help a person to move themselves.
Using equipment
Before using a piece of equipment, it is important that you read the
instruction manual and follow the manufacturer’s instructions. You
should attend equipment training events organised by your employer.
Hoists
There are two main types of hoist.
•• Ceiling hoists are fixed to the ceiling and run along a track. They
take up less room than a portable hoist and can be fitted to a
ceiling in a person’s home.
•• Portable hoists take up more room than a ceiling hoist and may
not be possible to have in a person’s home; however, they can be
moved from one room to another.
23
Both hoists require the person being moved to be placed in a sling.

Slings are colour-coded by weight ranges, so it is important that you
confirm the weight of the person being moved and use the
corresponding sling. When placing the sling on the person, you must
ensure that the seams of the sling face outwards, as these are rough
and can easily damage delicate skin. When attaching the sling to the
hoist, take care not to pinch the skin, as this can be painful and cause
the person undue discomfort. Once the sling has been attached to the
hoist, the person can be lifted and moved to the required location.
Remember, you must familiarise yourself with the hoists in your
workplace and request training before you attempt to operate them.
Have you used a hoist in your workplace?
Slide sheets
Slide sheets are made from thin pieces of friction-free material which
slide over each other; some are designed for single use only and some
can be washed and then reused. The slide sheet requires at least two
people standing on opposite sides of the bed. The slide sheet is
placed half under the person and half under the sheet the person is
lying on. One worker then pulls and the other pushes. The sheet,
complete with person, slides easily from one worker to the other. It is
important that slide sheets are not shared between people, as this
increases the risk of infection. Each person should have their own
slide sheet, which should be laundered or disposed of after use.
Slide boards
A slide board is a small board made from wood or plastic that is
placed between a bed and a chair or wheelchair. The person then
slides across the board from bed to chair, and vice versa. The care
worker should provide some assistance by steadying the board and
giving verbal encouragement.
24
Turn discs
Turning discs are used to turn the person, in either a sitting or
standing position, and can be useful for patients who are able to
stand. They are particularly useful for getting in and out of vehicles.
Lifting handle
A lifting handle is normally fixed above a person’s bed and hangs
from a metal frame. It is designed to allow the person to pull the
upper part of their body off the bed so they can reposition themselves
and thus enables them to be more independent.
Handling belts
A handling belt is a broad belt which goes around the person’s waist.
The belt has handles on the outside which enables the care worker to
assist the person to rise from a chair, or provide support by holding on to
the handles. The belt prevents the person from being held by the arms.
5.4 Using equipment to maintain the

individual in the appropriate position
Once somebody has been successfully positioned, they may not be
Activity 8 able to maintain the new position without the use of additional
specialist equipment such as pillows, one-way glide anti-slip sheets
What equipment do
and wedges.
you use?
Pillows
Find out what moving and
Apart from being used to help position somebody’s head, pillows are
handling equipment is available for
also commonly used to help maintain a person’s position once they
you to use within your workplace.
have been turned on their side, to prevent them from falling on to
Write a guide describing to how
their back again. For example, a person who is slipping in and out of
you should use each piece of
consciousness may roll on to their back without realising. This may
equipment.
increase their risk of developing a pressure sore, if they have already
been lying on their back for a while, or of choking on their vomit.
Pillows can also be used to provide support for people who have a
one-sided weakness, such as that caused by a stroke. If the person is
placed in a chair, the pillow can be placed under their weak arm to
Functional skills help prevent it from dropping to the side or in their lap.
English: Writing One-way glide anti-slip sheets
Use the correct format for writing One-way glide anti-slip sheets come in a variety of sizes and can
your guide. Write clearly and normally be used on any surface such as a bed, chair or wheelchair.
coherently, ensuring that sufficient The sheets work by only sliding in one direction. The direction of
detail is include so that the reader movement is normally indicated with arrows, and the sheet helps
can benefit from your guidance. stop the person sliding forward in their chair. The sheet is positioned
Proofread work to ensure that all on a chair or wheelchair before the person sits down and because the
sentences make sense and that sheet will slide one way, the person can be assisted further back in
spelling, punctuation and grammar the chair quite easily. If the sheet is used to maintain an upright
are accurate. Use suitable language position in bed, the sheet is placed under the person and like in the
at all times. chair, the person can be supported to sit up in the bed without sliding
down.
25
Wedges
If you work in a clinical setting such as a maternity ward, you may
need to use wedges to help position the expectant mother. The
wedge is inserted under the right side of the patient, which tilts them
Key term to the left. This action takes the pressure of the baby off the mother’s
Vena cava – a large vein that returns vena cava and allows normal blood flow back to the heart.
blood to the right atrium of the heart
5.5 Encouraging the individual’s active
participation in the manoeuvre
It is important that you encourage people to participate actively as
much as possible in any moving and positioning activity. When people
become unwell or go into hospital, there is a temptation for them to
Activity 9 believe that they can do far less than they are capable of. In the past,
some staff encouraged this behaviour because they found it quicker
Maintain that position! and easier to take over and do things for the person, rather than wait
Investigate the positioning for them to do it for themselves. However, it is the responsibility of all
equipment you use within your care staff to actively promote the independence of people. For
work setting and write a brief example, you could promote a person’s independence by
statement about each piece of encouraging them to get out of bed.
equipment.
You can encourage somebody to turn over in the bed rather than
manually rolling them. This could then allow you to change their
bedding, assist them with a bed bath or to change their clothes.
There are some simple instructions to help the person to do this.
1. Ask the person to turn their head in the direction you want them
to move.
2. Ask them to bend the leg on the other side and put their foot flat
on the bed.
3. Ask them to reach across their body with their opposite arm. This
will help the upper part of their body to turn into the roll. By
pushing their foot into the bed, they should be able to turn
themselves over.
If a person needs to use a bedpan, you can get them to assist in the
move by following these instructions.
1. Ask the person to place their arms by their side and bend their knees.
26
2. Ask them to keep their feet flat on the bed and lift their bottom by pushing
down on their feet and hands.
Encouraging people to participate actively in moving and positioning
activities is important as it can increase their self-esteem and promote
their independence, as well as making the procedure easier for the
care worker.
Doing it well
Encouraging people to actively participate
•• Use encouraging words.
•• Reassure them that you are there to help.
•• Build up their confidence and get them to do a little more each day.
•• Ensure you do not push them too far too soon.
•• Point out the benefits of participating.
•• Give choice.
5.6 Monitoring the individual throughout

the activity so that the procedure can be
stopped if there is any adverse reaction
Throughout the moving or positioning activity, it is important that the
person is continually monitored so the manoeuvre can be stopped if
there are any adverse reactions. If the person is able to tell you if they
are in pain or do not feel well, encourage them to inform you of any
pain or discomfort during the activity. You should also talk to the
person throughout and provide support and encouragement, and ask
them if they are OK. Observational skills are also necessary to ensure
the person is safe at all times. For example, when hoisting a person,
ensure all their limbs are within the hoist or that the material of the
sling is not pinching their skin.
When caring for an unconscious person, they will be unable to tell
you if they are experiencing pain or discomfort. It is therefore
important that you use effective observation skills and look and listen
for signs of pain and discomfort, such as facial grimacing or groaning,
and that you stop the activity immediately if you notice any of these
signs.
27
5.7 How to report and record the activity

noting when the next positioning
manoeuvre is due
Once a person has been moved or positioned, it is important that any
information gained from the activity is shared with other people
involved in their care, so that they are aware of any changes or
important updates. For example, you may have identified a more
effective way of moving the person or used a slightly different
technique which the person preferred, or it may just be that you need
to record the time of a routine turn.
However, you may have noticed a change in the person’s condition,
such as:
•• mood change
•• reduced cooperation
•• being quieter than normal
•• loss of confidence
•• signs of increased pain.
This information should be recorded in the person’s support plan and
must be reported to your supervisor. Any changes may be indications
of an overall change in the person’s condition and must never be
ignored.
The information you record should be:
•• clear
•• easily understood
•• a good description of the person’s needs
•• accurate
•• signed
•• dated.
If the support plan is for somebody who requires regular positioning,
it will state how frequently this should be done. It is important that
once the person has been repositioned, you update their support plan
and sign, time and date it so that others know the person has been
positioned. If the support plan does not show this information, it will
be assumed that the activity has not taken place. If the person
develops a pressure sore and you have not recorded the activity in
their support plan, it will be assumed that you neglected your duty
and you could be accused of abuse.
28
Case study
Lena’s fall
Bryn works for a large care agency that specialises in sees the information about the seat being used in the
home care. He has just returned to work on the early shower and asks Lena about it. She explains why she
shift following a two-week holiday. Bryn quickly settles has been using it, but Bryn says that the seat is not safe
back into work mode and becomes busy assisting to use and removes it. He assists Lena to the shower
people in their own homes with their personal care and encourages her to do as much for herself as
needs. possible. He suggests that she calls him when she has
finished or if she needs help.
Lena has Parkinson’s disease and has lived on her own
since her husband died two years ago. Up until recently, When Bryn leaves, Lena struggles to get into the shower
she was able to walk with the aid of a walking stick, but and becomes unsteady on her feet, wobbles and falls to
over the past two weeks her ability to walk has the floor. She becomes upset and shouts for help. Bryn
decreased and she has required a walking frame to get arrives and assists Lena back to her feet, helps her to
around. Lena has also been finding it difficult to stand dry and dress herself, and assists her back to the living
for long periods of time; however, she is very room. Lena gets angry with Bryn and said that this
independent and likes to have a shower every morning. would not have happened if she had used her seat. She
While Bryn was away, another care worker had been tells him that she feels humiliated.
coming in to assist Lena. They suggested to Lena that
1. What should Bryn have done when he discovered
because she likes a shower, but cannot stand for long,
that Lena was using a seat?
she should sit on a seat and then when she has finished
2. Was he right to take the seat away?
she can call for assistance. Lena liked this idea because
3. What else could Bryn have done?
it promoted her independence and so did this, using an
4. How could he have supported Lena so she did not
old plastic seat that was in the garage.
feel humiliated?
When Bryn arrives, he and Lena start to talk about his
holiday; Bryn takes a quick look at the support plan,
29
6. Know when to seek advice from

and/or involve others when
moving and positioning an
individual
6.1 When advice and/or assistance should
be sought to move or handle an
individual safely
There should be sufficient information provided in a person’s moving
and risk assessment and mobility support plan regarding the number
of people required to safely move or handle somebody safely, along
with the equipment that is needed and the best techniques to use.
However, there may be occasions when further advice and/or
assistance will be required, such as when:
•• a person’s condition has changed
•• there is an emergency
•• there is a lack of or damaged equipment
•• the person refuses to cooperate
•• there has been a change in your health
•• you have not received training for moving and handling
equipment.
A person’s condition has changed

If somebody’s condition deteriorates, they may not be in a position to
give valid consent for the planned activity or the planned move may
need to be amended to take this into account. A person’s condition
can improve as well as deteriorate and you may find the person you are
assisting is able to do more for themselves than before. You should
confirm with a senior member of staff that it is acceptable for the
person to become more independent and to amend their risk
assessment and support plan as necessary. For example, if you were
supporting somebody who had recently suffered a heart attack, you
might want to restrict the amount of activity they undertake.
There is an emergency
Although you may have a policy explaining what you need to do in
the event of emergency such as if someone slips in the bath or if
there is a fire, it is important to remember that the emergency may
take you by surprise. For example, somebody could suddenly be taken
ill with a suspected heart attack in the middle of a manoeuvre. It is a
good idea to practise regularly what to do in the event of an
emergency and to consider whom you would need to summon to
help complete the activity safely and provide immediate care for the
person.
30
There is a lack of or damaged equipment

Equipment that is damaged or faulty can cause serious harm or injury
and should be withdrawn from use until it has been repaired or
replaced. If equipment has been withdrawn from service, it may
mean there is insufficient equipment to perform the manoeuvre. You
will need to seek advice on how else to perform the moving activity
or ask for it to be reassessed.
The person refuses to cooperate

Occasionally, people may refuse to cooperate with care workers. This
is unfortunate and, if not dealt with correctly, can lead to anger and a
breakdown of trust on both sides. If somebody fails to cooperate with
a moving and handling request, you should remain professional and
try to encourage the person to see the benefits of what you are
doing. You may need to reach a compromise, which is perfectly
acceptable, provided the compromise is safe for both the person and
yourself. If the person will not compromise, you will need to ask a
senior to step in. You must never perform a moving and handling
task without the valid consent of the person or their advocate, if they
have been appointed one under the Mental Capacity Act 2005.
There has been a change in your health

As a care worker, your health and well-being are important, especially
if you are required to participate in moving and handling activities. If
there is a change in your health condition, such as back problems,
muscle sprains or you become pregnant, you will need to inform your
employer, so that moving and handling risk assessments can be
reviewed.
You have not received training for moving and

handling equipment
Before undertaking moving and handling activities or using moving
and handling equipment, you must ensure you have received recent
and up-to-date training. It is your employer’s responsibility to ensure
moving and handling training is available for employees. It is your
responsibility as an employee to attend training sessions provided by
your employer. If you have not received training, you will need to talk
to your manager before attempting to perform moving and handling
activities. Working beyond your capabilities and knowledge may
result in harm or injury to the person you are supporting or yourself.
6.2 Sources of information about moving

and positioning individuals
Risk assessment and support plans are some sources of information
available about moving and positioning people. However, these are
specific documents for the person you are support. For more general
information about the moving and positioning of people, you should
31
refer to your organisation’s policy for moving and handling. This will
probably include information on, for example:
•• how to perform and record moving and handling risk assessments
•• staff training requirements, including frequency of refresher
training
•• what to do when a person can not give valid consent
•• where equipment is purchased and servicing requirements
•• what to do in an emergency
•• how to record adverse reactions
•• how to report staff injuries.
The Health and Safety Executive (HSE) provides a range of resources
including downloadable and printable materials that provide
information on employers’ and employees’ responsibilities. The
information provided ranges from general information about the law
and the Manual Handling Operations Regulations to suggestions
about how care settings can apply the law while meeting the needs
of people.
Moving and handling training advisors are another good source of
knowledge and will be able to support you with general moving and
handling questions.
Legislation
•• Lifting Operations and Lifting Equipment Regulations (1992) (LOLER)

Below are some books, websites and agencies you can look up to
continue your study of this subject. You may also find it useful to make
contact with local physiotherapists and occupational therapists who visit
your workplace or are based in your local area.
•• www.backpain.org (Back Care, charity for healthier backs, tel: 0845

130 2704)
•• www.csp.org.uk (Chartered Society of Physiotherapy)
•• www.equalityhumanrights.com (Equality and Human Rights
Commission)
•• www.hse.gov.uk (Health and Safety Executive, tel: 0845 345 005)
•• www.manualhandlingguide.co.uk (Manual Handling Guide)
•• Oddy, R. (1998) Promoting Mobility for People with Dementia
(second edition), Age Concern
•• BackCare (2005) The Guide to the Handling of People (fifth edition)
•• BackCare (1998) The Handling of Patients (fourth edition)
32

LO1 LO4
Learning outcome 1 will require you to demonstrate to Your assessor will want to see you preparing people
your assessor your knowledge of the anatomy and before moving and positioning them. However, it may
physiology in relation to the moving and positioning of not always be appropriate for your assessor to observe
people. To do this, you could draw and label a diagram you with certain people. You should therefore ask a
of the skeletal system and explain how joints work. You colleague or a senior member of staff to write a witness
could also explain how some conditions can affect how testimony to support you undertaking this activity. You
well a person is able to move. may want to write a reflective account to support this
testimony.
LO2
LO5
Your assessor will want to know that you understand
the legislation and agreed ways of working when Learning outcome 5 requires you to demonstrate to
moving and positioning people. You could write a short your assessor that you are able to move and position
summary of your understanding of the Manual Handling people. Like learning outcome 4, it may be
Operations Regulations and explain some of the health inappropriate for your assessor to observe you with
and safety factors that should be taken into account certain people, so you may need to obtain an
when moving and positioning people. observation from a colleague or senior member of staff.
You could write a guide for your assessor to explain
LO3 how you would support somebody to move or be
You will need to show your assessor how you minimise positioned.
risk before moving and positioning people. To help you LO6
to produce evidence for this, you could show your
Learning outcome 6 requires you to tell your assessor
assessor the risk assessment forms that you use within
when to seek advice from and/or involve others when
the workplace and explain how you use them to
moving and positioning somebody. You could do this
minimise risk. You could also ask a senior member of
by having a professional discussion with your assessor
staff to write a witness testimony to explain how they
and talking about when you may need help or advice
have seen you minimising risks before undertaking
and where you could obtain additional information
moving and positioning people.
about moving and positioning people. You could
consider looking at the HSE website (see ‘Further
reading and research’) to help you with this.
33
Index
A H
active participation 26–7 hand-washing 17
advice, seeking 30–2 handling belts 25
amputation 4 health and safety 4–9
anatomy 2–3 Health and Safety at Work Act 1974 4
anti-slip sheets 25 hoists 23–4
arthritis 3 hygiene, personal 17
assistance, seeking 30–2 I
B information sources 31–2
bariatric 18
L
C legislation 4
cerebral palsy 4 lifting handles 25
changes in conditions 15, 28 Lifting Operations and Lifting Equipment Regulations
communication (LOLER) 22
between care workers 21–2
with people 19–20 M
conditions, impact on movement/positioning 3–4 Manual Handling Operations Regulations 1992 5
conflict with people’s wishes 14 Mathematics 6, 8
consent, obtaining 20 monitoring people 27
contract 3 muscular system 2–3
cooperation, refusal of 14, 30
P
E Parkinson’s disease 3
emergencies 30 personal hygiene 17
English skills 9, 18, 20, 21, 25 physiology 2–3
environment, preparation of 15–16 pillows 25
equipment policies 6
health and safety 7 preparation of people 19–20
lack of/damaged 31 procedures 6
to maintain position 25–6
for moving and positioning 22
types of 23–6
F
functional skills
English 9, 18, 20, 21, 25
Mathematics 6, 8
further reading 32
34
R T
recording activities 28 training 31
reporting activities 28 turn discs 25
risk
actions to take 14–15 U
assessment documentation 9–10 uniforms 17
conflict with people’s wishes 14
environment, preparation of 15–16 V
identifying 13 vena cava 26
minimising 9–18 W
preparatory checks 11–12 wedges 26
S
sacrum 13
skeletal system 2
slide sheets/boards 24, 25
stroke 4
support plans 21
35
Unit SS MU 2.1
Introductory
awareness of
sensory loss
To ensure that the knowledge and skills are addressed in this unit, it is essential that
you become aware of the differing needs of people with sensory loss and how you
can help to improve on your work practices to support and empower them. Many
care providers or health professionals are not aware that hearing and vision losses
are more prevalent as a person ages, and that the threat to independence and
quality of life can be devastating with the combined loss of both hearing and vision
even more so.
You will become aware that there are significant numbers of people in the UK who
have a sensory loss. This can mean sight loss, hearing loss or dual sensory loss. This
unit will allow you to have an awareness of the impact of sensory loss on the
person. With a single sensory loss, the person normally relies on the other senses to
compensate. However, people missing both senses have a unique disability which
requires specialist communication skills alongside ongoing support.

1. the factors that impact on an individual with sensory loss and steps that
can be taken to overcome these
2. the importance of effective communication for individuals with sensory
loss
3. the main causes and conditions of sensory loss
4. how to recognise when an individual may be experiencing sight and/or
hearing loss
5. how to report concerns about sensory loss.
1
1. Understand the factors that

impact on an individual with
sensory loss and steps that can be
taken to overcome these
1.1 How a range of factors can have
a negative and positive impact on
individuals with sensory loss
Approximately 95 per cent of the information about the world
Activity 1
around us comes from our hearing and sight. We read books,
Using your senses magazines and correspondence, we talk to each other face to face or
on the telephone and we listen to our music on the television or the
On your way to work, consider the
radio. The environmental information lets us know what is going on
following.
– body language and facial expressions, conversations, computer keys
•• Listen to people talking – can tapping, lawn mowers being used in gardens and so on. To
you hear what they are saying? understand the world around us we rely a great deal on our senses.
•• Can you hear any birds? When people have any sensory loss, then their mobility and
•• What colours are flowers in any communication are greatly affected. This can lead to increased
nearby gardens? loneliness and even isolation in some cases.
•• Can you negotiate around
Throughout this unit you will encounter many terms for sensory loss.
obstacles in your way?
RNID suggest that when talking about a person with a hearing loss it is
•• Did you speak to anyone on
good practice to use the terms of ‘Deaf’, ‘hard of hearing’ or ‘having a
the way to work?
hearing loss’. British Sign Language (BSL) users use a capital ‘D’ in Deaf
Imagine not being able to do these to highlight that they belong to the Deaf community. The Royal
fully. Would this have a negative or National Institute for the Blind (RNIB) use the terms ‘blind’ or ‘partially
positive effect on you? sighted’ and Sense advise that hearing and vision loss is termed
‘deafblindness’. Sensory loss in all areas can be congenital or acquired.
Impact on communication
Many blind and partially sighted people lose the ability to see gestures
and facial expressions which are an important aspect of spoken
communication. It is hard to know when someone is speaking to
them personally or to someone else, or that they may have walked
away. This can have a very negative impact on a person. We will
explore more in Section 1.2 when we identify steps to overcome
factors which may have a negative impact.
Communication in a written format can be difficult for a person with
sight loss. Paper used may be too shiny, the text may be too small,
there may be whole sentences made up of capital letters or centring
and underlining may have been used. Communication by email and
text can be equally hard to access, and this can lead many blind or
partially sighted people to discontinue using their computer and/or
mobile telephone.
2
Introductory awareness of sensory loss Unit SS MU 2.1
Hearing loss interferes with face-to-face communication and can

often cause older people to feel that they are isolated and excluded
from everyday conversations. With background noise becoming a
problem, many people with a hearing loss often miss what is being
communicated. This can also affect communicating on the telephone
or listening to the news on the radio. Older people who are losing
their hearing often rely on their eyesight to compensate for their
hearing loss. In conversation, they will endeavour to watch the other
person’s face and lips, and use clues about the context to try to
respond appropriately.
However, people who are losing both their hearing and their vision
will find it difficult to look for clues in the conversation. This will be
particularly severe with a person who has central vision loss, as this
then may completely remove the ability to read lips or to see faces. To
avoid deafblind people becoming devoid of knowledge about the
outside world or having a limited contact with a variety of other
people, sources of support should be forthcoming.
Impact on information
One of the needs of people with a sensory impairment is to be able
Key term
to obtain information. Whether this is written, spoken or signed
Accessible – able to be obtained, information, it needs to be in an accessible format.
used or experienced without
A person who has sight loss wants to be able to carry on writing as
difficulty
long as possible for tasks such as making lists, keeping appointments
and reading private correspondence. If a person is losing their sight,
then it can have a detrimental effect on maintaining their dignity and
confidentiality. Access to written information specifically for people
with a vision loss is not readily available and information is not
forthcoming.
Furthermore, people with a hearing loss may need access to
information that is not in a written format – for example, by
telephone, face-to-face and signed information. People use the
telephone to pass on information or to keep in touch or enjoy having
a one-to-one conversation in person. This can be very difficult for a
person with a hearing loss if the means of accessing information is
not in a suitable format for them.
The impact on information is greatly enhanced when a person has a
dual sensory loss. It is important to all of us to be able to have access
to information independently and not to have to rely on someone
else. This removes or reduces independence and privacy. Everybody
has the right to be able to access information and should be afforded
the opportunity to do so privately and independently.
3
Activity 2
How you gather information
Spend a day looking at how you gather information.
1. Have you used a landline or mobile phone, or used a mobile’s

texting facility to send a message?
2. Have you read a newspaper or magazine?
3. Has your supervisor at work given you instructions to carry out
a task?
4. Have you spoken to your friends about your plans for the
weekend? Reflect on the negative impact of completing the
above tasks with a sensory loss. Write a short account of your
feelings.
Impact on familiar layouts and routines

Sight plays a major role in the process of becoming accustomed to a
new situation or set of surroundings (orientation) and people often
lose a sense of what is around them and where they are, and
sometimes become unsure of where familiar things are. A person
who has sight loss can be left feeling isolated and apart from others.
An extensive loss of vision can result in:
•• an inability to negotiate the environment
•• a loss of sense of freedom
•• a loss of security
•• a loss of control in their environment.
These effects can make people feel very dependent on others.
Hearing loss causes its own problems with difficulty hearing
information, following conversation or asking for directions. This can
be very isolating for a person if their usual routine is to listen to a
programme on the radio, talk to people on the telephone or go for
coffee with friends in a noisy restaurant. Hearing loss impacts greatly
on gathering information and making informed choices.
People need to have confidence in moving safely around their own
homes and immediate local area, and also to go further afield. This
may be with or without a recognised mobility aid, such as a white
cane, red and white cane (to signify dual sensory loss) or guide dog.
The cost and lack of transport will be added obstacles for many
people.
For some people, assistance in the form of sighted guiding is
essential.
4
Activity 3
Guiding techniques
You should refer to sighted guiding techniques and practise with a
colleague how to guide a person correctly. You can download a
how-to guide from www.rnib.org.uk
1. How did you feel putting your confidence in another person to

guide you?
2. How safe did you feel being guided?
3. How confident were you in guiding someone?
4. Examine the consequences of incorrect guiding on a person with
sensory loss.
You will be able to demonstrate how to guide a person who has

sensory impairment to your assessor using sighted guiding.
Impact on mobility
Normal changes in sight due to the aging process include:
•• problems adapting to light changes
•• reduced peripheral vision
•• problems with glare
•• a need for increased lighting
Key term
•• general reduced acuity (seeing detail)
Accommodation – the process by •• reduced accommodation
which the eye changes optical •• problems with depth perception
power to focus on an object as its •• reduced colour sensitivity and contrast sensitivity.
distance changes
You will realise that good design in homes and buildings can help
with finding your way around more easily if you have sensory loss. It
is recommended that good colour and contrasting is used throughout
the premises. Good colour and contrast means being able to use it to
the maximum effect in enhancing spatial awareness and allowing
easier identification of key building features without sacrificing the
look of the building. This ensures that people who have some useful
vision can see door frames and edges of cupboards, and where the
walls start and end. This all helps with navigating around buildings
including the home, doctor’s surgery, bank or supermarket.
Alongside this it is important to have good consistent lighting
throughout the building. You should try to avoid glare, pools of
darkness or light and control daylight by using curtains or blinds.
Some local authorities have Communicator Guides or Guide-help
schemes, which enable a deafblind person to benefit from a better
quality of life with greater independence. Communicator Guides have
been described as the conduit allowing the deafblind person to
interact with the outside world. Tasks include helping with reading
letters and paying bills, escorting on excursions outside of the home
5
to doctors, banks or leisure activities. They enable the person to make

Activity 4
use of their remaining sight and hearing, and play an important role
Exploring other factors in reducing stress and increasing confidence.
that affect people with
sensory loss Doing it well
Take some time to explore other Colour and contrast
factors which may have a negative
•• Use light-coloured cups for black coffee and dark cups for milky tea.
or positive effect on a person with
•• Use a coloured plate or bowl that will contrast against your dining
sensory loss.
table or tray.
Look at communication, •• Use different-coloured chopping boards to contrast with food.
information, routines, layouts and •• A dark door frame stands out from white walls and doors.
mobility, and investigate ways of •• Highlight around light switches to make them stand out from the
lessening the negative impact. You wall.
may wish to research aids and •• Ceilings walls, doors and floors are critical surfaces that should be
equipment for sensory loss. Look sufficiently differentiated from each other.
more fully at colour and
contrasting, and lighting in the
home. 1.2 Steps that can be taken to overcome
factors that have a negative impact on
In the previous section we have looked at the negative impact of
sensory loss on communication, information, layout and routines and
mobility. Taking each of these in turn, you will be able to research
the steps needed to overcome some of the negative impact on
people.
You must ensure that people you support have regular access to sight
tests and that they continue to wear their glasses if prescribed. You
may be told that a person has a cataract that needs to be operated
Functional skills on and it would help if you were able to know more about cataract
operations. You can find this from any of the sight loss organisations
English: Speaking and at the end of the unit. Seeing clearly can help greatly with
listening communication.
Speaking and listening skills can be
practised by completing the task Doing it well
here. When communicating verbally,
it is important to present information Communicating with a person with sight loss
clearly using appropriate language •• Always say who you are.
and to be able to adapt your •• Always say what you are going to do and be specific.
contribution to suit the situation you •• Always talk directly to the person and use their name.
are in. It is also important to be •• Always stand in a place where you can be seen. If necessary, touch
aware of your body language. for attention.
Ensure you take an active part in the •• Always take the time to answer questions.
discussion and that you show •• Always tell the person that you are leaving them – do not just walk
effective listening skills. away.
6
Many people who have sight loss can sometimes benefit from having
their written communication in a larger font or on a different-
coloured paper for good colour contrasting and contrasting.
Communication by email or text can be accessed by having speech
Key term programs installed on the computer or mobile telephone.
British Sign Language (BSL) – a British Sign Language is the language of choice for a significant
way of communicating with people number of Deaf people in the UK. British Sign Language is a visual/
who cannot hear, using hand signals spatial language, which has its own grammatical rules using hand
instead of words shapes, hand movements and facial expressions to convey meaning.
The grammatical rules of BSL are completely different to the rules of
English.
Communicating with people with a hearing loss can be difficult if you
do not know how much hearing, if any, a person has left. You must
find out if they can hear in one ear better than another or if their
hearing loss is affecting both ears. Alternatively, you may have a
person who has had a substantial hearing loss for many years and
uses BSL.
You must ensure that people you support have access to a hearing
test at regular intervals, as hearing may deteriorate in later life. You
should ensure that people you support have assisstance with fitting
their hearing aids if prescribed, and with cleaning and replacing
Functional skills batteries if needed.
listening Doing it well
Speaking and listening skills can be Communicating with a person with hearing loss
practised by completing this task. •• Face the person you are speaking to.
When communicating verbally, it is •• A quiet well-lit room is best.
important to present information •• Do not shout, as this distorts the voice and lip patterns.
clearly using appropriate language •• Ensure light is on the speaker’s face.
and to be able to adapt your •• Stay in their field of vision.
contribution to suit the situation you •• If something is not understood, rephrase rather than repeat.
are in. It is also important to be •• Speak a little louder than usual.
aware of your body language. •• Speak a little more slowly than usual but not so slowly as to destroy
Ensure you take an active part in the the speech rhythm.
discussion and that you show •• Avoid distracting clothes, dangly earrings and, if male, beards which
effective listening skills. cover the lips.
The Deafblind Manual Alphabet

This is similar to BSL fingerspelling, but all of the manual alphabet is
concentrated on the person’s hand in which you point to different
finger positions on the deafblind person’s hand, or draw letter shapes.
People who are deafblind can communicate using BSL if they have
any remaining sight, and this is called Visual Frame Signing. Close
signing is a good alternative whereby signing is within close range to
accommodate a person’s vision.
7
Communicating with people who have a dual sensory loss is greatly

enhanced by using clear speech and clear print. People who have
substantial sight loss sometimes still follow the signs being used by
another person by putting their hands over those of the person who is
signing.
People with sensory loss need to access information on a daily basis.
This can be answering the telephone, reading a newspaper or talking
to someone.
Somebody with sight loss will need to have information presented in
their preferred format. This can be in Braille, large print, on disk, sent
by email or in their own language and one of the above formats. A
significant amount of people with sight loss will rely on clear print to
access information (you can read more fully on clear print guidelines
at www.rnib.org.uk).
Doing it well
Producing clear print
•• Document text size should be 12–14 pt, preferably 14 pt.
•• The font you choose should be clear, avoiding anything stylised.
•• All body text should be left-aligned.
•• Use bold sparingly; only highlight a few words rather than a
paragraph.
•• Keep the text layout clear, simple and consistent.
•• Do not use blocks of capitalised letters, and try not to use any italics
or underlining.
•• Text should not be overlaid on images.
•• The substrate or coatings should not be glossy or reflective.
•• Ensure the paper is thick enough to prevent show-through.
•• The contrast between the text and background should be as high as
possible.
•• All text should be the same orientation on the page.
•• Space between columns of text should be large enough to be
distinct.
•• Any information conveyed in colour or through images should also
be described.
People with hearing loss can ask their GP to be referred for a hearing
consultation. There is a wide range of hearing aids and equipment
available to people with hearing difficulties.
A number of people who are deaf or hard of hearing sometimes
prefer to communicate using lipspeakers. These follow the
conversation and repeat what is said but without using their voice;
this in turn makes it easier for some people to lipread.
People who are deaf or hard of hearing may access a speech-to-text
reporter. This uses a special keyboard to produce a verbatim (word for
word) report, which is displayed on a computer screen or a large
8
screen, via a data projector, for the deaf person to read. This is an
entirely different system to having a notetaker who will provide
summary notes, not a verbatim account of what is being relayed.
A telephone relay service is used by many people with a hearing loss
who wish to communicate by telephone. The message is relayed to
an operator, who sends the message by text to the person with
hearing loss. If there are no hearing people involved in the call, then it
is a straight text-to-text conversation which does not need the help of
an operator to translate speech to text.
The use of hearing aids greatly enhances communication for some
people who are hard of hearing. There are many types of hearing
aids, induction loops and conversers on sale at present and some
hearing aids are still available from the NHS.
This symbol indicates a loop system is present. Switching a hearing
aid to the T setting engages the telecoil. This shuts out background
noise because the microphone has been switched off, and ordinary
acoustic sound around you is no longer picked up by your hearing
aids. Only sound coming from a nearby magnetic induction loop is
being picked up.
You can look at www.rnid.org.uk for more advice on communication.
Somebody with sight loss may need to become more organised to
make things easier for everyday routines. Some ideas of organising
Where have you seen this symbol? belongings are as follows.
•• Medicines, cosmetics, cleaning agents can be kept in separate
cabinets and boxes. Using a contrasting coloured tape can help
Activity 5 with identification.
•• To help identify bank notes, you could fold fives once, tens twice
Belongings and
and twenties three times, or you could ask the bank to separate
adaptations notes and fold them differently or put plastic paper clips on
1. List other ways of organising different-sized notes.
belongings to help a person •• Organise food by cabinets and shelves, and use tactile clues to help
with sight loss and use the distinguish things – for example, put one rubber band around
equipment catalogues from tinned beans and two around soup. There are many kitchen aids
sensory organisations. to be found in catalogues supplied by sight loss organisations.
2. List the types of aids and •• Organise clothing so that it is easier to locate and match by
adaptations that would benefit keeping complete outfits together, keeping different-coloured
a person with hearing loss. socks, shoes and scarves in separate boxes or drawers, and
clipping pairs of socks together before washing them to keep
Now you have completed the two
them matched.
lists, check to see if any of your
•• A large clock can help with telling the time and this in turn helps
findings would be beneficial to a
with adhering to your familiar routines, such as appointments and
person with deafblindness, taking
mealtimes. There are also calendar clocks which announce the
into consideration at all times that
time and the date with an optional hourly announcement, that,
the person may or may not have
once activated, announces the time on the hour every hour.
some residual sight and hearing
left. Remember that if you are working with a person who is in a new or
unfamiliar place, you will need to walk them through a route. This
9
will also be needed for people who have a hearing loss or

deafblindness.
Do not move furniture or objects around in someone’s home without
discussing it first. This can be very frustrating to someone with a
sensory loss if they cannot access their own belongings.
You will have realised the importance of hearing aids and other
equipment for people who have a hearing loss and understand the
importance of communication on familiar routines and mobility.
Remember, there are no hard and fast rules on how to guide people
with sight problems but below are the guidelines the Royal National
Institute for the Blind (RNIB) offers because they are safe and sensible.
You may find the person you are guiding does not follow these
guidelines, but chooses to do something different that works for them.
Doing it well
Guiding a person with sight loss
•• Give instructions where necessary, but do not overdo it and be
careful not to push or pull the person you are guiding.
•• Match your pace to that of the person you are guiding.
•• Give them time to hold your arm securely before you start walking.
•• Remember to give adequate room round obstacles.
•• Watch out for hazards at head height, especially if the person you
are guiding is taller than you. It is very easy to walk someone into an
overhanging tree or shop canopy. Watch out for lamp posts and
bollards too. You may find people you are guiding prefer to walk on
the pavement edge to avoid such obstacles.
•• Explain loud noises that may alarm, such as roadworks or alarms.
•• Explain changes in ground surface – for example, if you are walking
from a pavement on to grass or gravel – or if paving slabs and road
surfaces are particularly uneven.
•• Keep your guiding arm still and relaxed. Do not start waving it about
or pointing at things.
•• Remember that older people or those with other disabilities may
need extra consideration.
The practical advice and information given here will help you feel
confident about guiding people with sight problems. Your offer to
guide will usually be welcomed; however, many people with sight
problems prefer to keep their independence. Also remember that for
some people, physical contact may be a problem due to their culture
or gender, or because they are protective of their personal space.
When you meet someone with a white cane or a guide dog,
remember they are not always totally blind. In fact, many people have
some useful vision but they might welcome your help at times – for
example, in an unfamiliar place or at night time.
10
Someone carrying a white cane with red bands on it or who has a

guide dog with a red and white harness indicates they are deafblind
and may be experiencing difficulties in particularly noisy or busy
environments. You may have to ascertain how much useful hearing
or sight the person has and adapt your help accordingly. You may
well have to use the deafblind alphabet to communicate or
encourage the person to lipread.
Do try to give precise verbal instructions – it does not help to point
and say, ‘It’s over there.’ And remember to say when you go away or
you might leave someone talking to an empty space!
You can find more information on guiding techniques at any of the
organisations listed at the end of this unit.
1.3 How individuals can be disabled by

attitudes and beliefs
Many people in the UK assume it is inevitable that, as we grow older,
sensory impairment will be a factor in the ageing process and is a
‘normal’ feature of growing old. With growing numbers of people
aged 60+ and with life expectancy rising, the increase in older people
who experience sight and hearing loss will also escalate. In the older
age group of 85+, the challenge will be accommodating older people
who are deafblind.
Many people with sensory loss have problems adjusting to their loss
and may go on to have depression or anxiety, lethargy or social
unhappiness which can affect their mental and physical well-being.
However, people who remain optimistic may have an improved
quality of life while coping with their sensory loss and maintaining
their social contacts.
Case study
Attitudes and beliefs

Teresa Bushell is 78 and lives by herself in her own work at home instead of catching the bus to the centre.
home in a seaside town in the south-west. Teresa is They also arrange for the hairdresser to come in even
widowed and has two children who live less than 20 though Teresa visits her local one regularly herself.
miles away. She has a good circle of friends. She Teresa begins to thinks that as she is now ‘blind’ she
attends a craft club and lunch club twice a week, taking cannot do anything for herself and that her life as she
the local bus to the church hall. knew it is essentially over.
Teresa has just been for her regular eye appointment at 1. Why do you think Teresa now thinks she cannot do
the hospital and is distraught at being told that her anything?
eyesight has deteriorated to such an extent that she is 2. Describe what the family is doing for Teresa in term
eligible to be registered blind. On hearing this news, of disabling attitudes and beliefs.
Teresa makes her way home and tells her children that 3. How would you explain to the family about support,
she is now going to be registered blind. The children aids and equipment for Teresa to enable her take
visit and arrange for meals and talking books to be part in all her activities independently?
delivered. They buy more craft items so that Teresa can
11
1.4 Steps that could be taken to overcome

disabling attitudes and beliefs
The ‘social model’ of disability starts from the point of view that all
disabled adults and children have the right to belong to and be
valued in their local community. Using this model, you start by
looking at the strengths of the person with the impairment and at the
social and physical barriers that obstruct them, whether at home or at
leisure.
Society provided ‘special’ welfare benefits and segregated ‘special’
services, and this frequently shaped the way disabled people thought
about themselves. The social model of disability makes the important
difference between ‘impairment’ and ‘disability’. The sensory losses
discussed in this unit are examples of impairments; people are
disabled by the environment, social and organisational barriers, and
people’s attitudes to disability.
You will have heard about personalisation by now as you work with
people who have sensory loss. Personalisation can mean viewing care
and support services in a completely new way by giving people more
choice and control over their lives. We all have our own strengths,
preferences and aspirations, and this does not change because we
have sensory loss. Personalisation means ensuring that everyone has
access to the right advice, advocacy and information, to help with
getting the right support that they need.
Personalisation is quite a new word, and there are different ideas
about what it could mean and how it will work in practice.
Activity 6
Personalised approaches
Some examples of personalised approaches are:
•• person-centred planning
•• person-centred care
•• person-centred support
•• independent living
•• self-directed support.
Research each of the terms so that you can discuss these with your
assessor. The personalisation agenda is changing every day, so you will
need to be up to date with your information.
You will find organisations at the end of the unit to refer to for
information.
12

effective communication for
2.1 What needs to be considered when
communicating with individuals with
sight loss, hearing loss or deafblindness
Sight loss
The RNIB suggests making things:
•• bigger
•• brighter
•• bolder.
Bigger
Making things bigger usually makes them easier to see. Using
easy-to-see products could help you in your daily life. Some examples
of these are:
•• clocks and watches with large numbers
•• big button telephones
•• large print books and calendars
•• thick black felt-tip pens to write notes with.
Brighter
Making things brighter by using better lighting can help to make
things easier to see. You should make sure that you have as much
light as you feel comfortable with for each task that you do.
It is often easier to see things if you shine a light directly on to what
you want to see. For example, when reading, it may be easier to see
the text if you use a lamp that can be adjusted to shine directly on the
page you are reading. This is called task lighting.
Everyone is different and you need to find the amount of light that
you are comfortable with.
Bolder
It is harder to see things that are similar in colour to the background
that they are on. Contrast is about how much something appears to
stand out from its background because of its colour or tone.
13
Activity 7
Sight loss
Sit down on an armchair in a busy room and put the blindfold on. Sit
still for 2 minutes. Then try to turn the radio on using the remote
control, and find your favourite radio channel.
1. Did anyone come and speak to you and did you know who
they were?
2. What other sounds could you hear in the room? Were there other
sounds you could not recognise?
Write a short report on the negative aspects of this activity and how
your experience could have been better using the right aids and
equipment – for example, talking radio. You can then discuss this task
with your assessor when you are asked about negative and positive
impact of sensory loss and what needs to be considered when
communicating with a person with sight loss.
Hearing loss
Activity 8
Hearing loss
Put on a pair of ear defenders (you can get these from your local DIY
store).
1. How much can you hear through them? The sounds you can hear
are very likely to be muffled.
Ask one of your colleagues to talk to you and give you a task to do.
2. Did you have to ask them to repeat the instruction?
Write a few short paragraphs on your feelings at not being able to

hear properly and what you could have done to make your hearing
clearer. Show this to your assessor so that they can see you are looking
at the impact of hearing loss.
As you have taken part in the activities using blindfolds and ear
defenders, you will realise the amount of background noise there can
be in any situation. You will have had experience of this yourself
when you go into a crowded room and wish to convey a message
to someone, but find it very difficult to hear clearly. Levels of
background noise in care settings may have to be looked at to
enhance comprehension and minimise background noise.
It can seem impracticable to reduce noise levels to an acceptable level
when, for example, vacuuming must be done, staff are talking,
televisions and radios are switched on. However, you can facilitate
communication between people by having conversations in private,
14
quieter rooms if possible and using task lighting so that light is

directed onto the person who is talking.
Deafblindness
By now you will be familiar with sensory loss and the impact
deafblindness can have on people in a range of situations. You must
remember that deafblind people can be people who:
•• are deafblind from birth or early years
•• are deaf from birth (acquired sight loss)
•• are blind from birth (acquired hearing loss)
•• become deafblind in later years from any of these groups
•• are deafblind with other complex needs
•• are older deafblind people.
It is important to know that:
•• a small sight loss can seriously affect deaf or hard of hearing
people
•• a small hearing loss can seriously affect a blind or partially sighted
person
•• the degree of sight or hearing loss is not as important as the
extent of the effect on a person’s life
•• communication, access to information and mobility are seriously
affected.
Activity 9
Deafblindness
Take a seat in a busy room next to a television. Put on ear defenders
and a blindfold.
1. Can you hear the television properly?

2. Without sight, can you work out what the advertisements are
advertising? You will find that some advertisements rely on sight
or hearing to get their message across.
Write a letter to an advertising agency to advise them on what could

be done to make advertisements accessible to all – for example, text
on the screen for hearing loss and spoken word for sight loss. You
should show this letter to your assessor to emphasise your knowledge
of communication/information for people who are deafblind.
15
2.2 How effective communication may

have a positive impact on the lives of
people with a sensory loss
There are many ways of communicating, including:
•• talk – face to face
•• talk – telephone, mobile, radio
•• gesture – formal as in sign language
•• gesture – informal hand movements
•• body language
•• eye contact
Reflect •• reading and writing
Consider the activities you have done •• emailing and text messaging.
so far in this unit on simulating
sensory loss. Although this can never 2.3 How information can be made
be a true reflection of how a person accessible to individuals with sensory loss
sees, hears, feels and copes with a
sensory loss, you will have some
The Disability Discrimination Act 1995 clearly states that disabled
indication on the impact of sensory
people should not be disadvantaged in accessing information or
loss on a person.
services. The Act also requires service providers to anticipate where
there may be barriers to accessing information or services and remove
Reflect on how you would like these barriers. The Act states service providers should make
someone to communicate with you if ‘reasonable adjustments’ to services by providing auxiliary aids and
you had a sensory loss. Would you like services to ensure disabled people are not disadvantaged.
someone to shout at you just because
you are deaf? Would you like someone The Equality Act 2010 provides a new cross-cutting legislative
to talk to a family member instead of framework to protect the rights of people and advance equality of
you because you are blind? Would you opportunity for all.
like to be ignored completely because You should know how to provide information in different formats for
no one knows how to use the people with a sensory loss and let your supervisor know that you do.
deafblind alphabet? This can include producing leaflets, letters and information in a
Write down your thoughts on person’s preferred format and knowing how a loop system works for
communication and the positive hearing aid users. It can also include having information on booking
impact it can have on a person if it is an interpreter/lipspeaker for people with a hearing loss. You should
done properly. ensure that you know about Typetalk and BT TextDirect, and how to
use these. You may wish to let your supervisors know that you have
this knowledge.
16
3. Know the main causes and

conditions of sensory loss
3.1 The main causes of sensory loss
Retina
Cornea
Lens
Optic
Pupil Macula nerve
Iris
To the
Vitreous
brain
A cross-section of the eye.
Part Description
Cornea Clear front window of the eye that transmits and focuses light into the eye
Iris Coloured part of the eye that helps regulate the amount of light that enters
Pupil Dark aperture in the iris that determines how much light is let into the eye
Lens Transparent structure inside the eye that focuses light rays on to the retina
Retina Nerve layer that lines the back of the eye, senses light and creates electrical impulses that travel
through the optic nerve to the brain
Macula Small central area in the retina that contains special light-sensitive cells and allows the eye to
see fine details clearly
Optic nerve Connects the eye to the brain and carries the electrical impulses formed by the retina to the
visual cortex of the brain
Vitreous Clear, jelly-like substance that fills the middle of the eye
Table 1: Parts of the eye.
Main eye conditions
Macular degeneration
The macula is a small area at the very centre of the retina. The macula
is very important and is responsible for what we see straight in front of
us, allowing us to see fine detail for activities such as reading and
writing, as well as our ability to see colour. Sometimes the delicate cells
of the macula become damaged and stop working, and there are
many different conditions which can cause this. If it occurs later in life,
it is called ‘age-related macular degeneration’ (AMD).
Broadly speaking, there are two types of macular degeneration or
AMD, usually referred to as ‘wet’ and ‘dry’. This is not a description of
what the eye feels like but what the ophthalmologist (eye specialist)
can see when looking at the macula.
17
Dry AMD is the most common form of the condition. It develops very
slowly, causing gradual loss of central vision. Many people find that
vision slowly deteriorates by gradual central blurring, and that the
colours fade away like in an old photograph. There is no medical
treatment for this type of AMD. However, aids such as magnifiers can
be helpful with reading and other small detailed tasks.
Wet AMD results in new blood vessels growing behind the retina; this
causes bleeding and scarring, which can lead to sight loss. Wet AMD
can develop quickly and sometimes responds to treatment in the early
stages. It accounts for about 10 per cent of all people with AMD.
Glaucoma
Glaucoma is the name for a group of eye conditions in which the
optic nerve is damaged at the point where it leaves the eye. This
nerve carries information from the light-sensitive layer in your eye, the
retina, to the brain where it is perceived as a picture.
Your eye needs a certain amount of pressure to keep the eyeball in
shape so that it can work properly. In some people, the glaucoma
damage is caused by raised eye pressure. Others may have an eye
pressure within normal limits, but damage occurs because there is a
weakness in the optic nerve. In most cases, both factors of high
pressure and weakness in the optic nerve are involved, but to a
varying extent.
Pressure is controlled in the eye through a layer of cells behind the iris
(the coloured part of the eye) which produces a watery fluid, called
aqueous. The fluid passes through a hole in the centre of the iris
(called the pupil) to leave the eye through tiny drainage channels.
These are in the angle between the front of the eye (the cornea) and
the iris, and return the fluid to the blood stream. Normally, the fluid
produced is balanced by the fluid draining out, but if it cannot
escape, or too much is produced, then your eye pressure will rise.
If the optic nerve comes under too much pressure, then it can be
injured. How much damage there is will depend on how much
pressure there is and how long it has lasted, and whether there is a
poor blood supply or other weakness of the optic nerve. A really high
pressure will damage the optic nerve immediately. A lower level of
pressure can cause damage more slowly, and then a person would
gradually lose their sight if it was not treated.
Please note: People over the age of 40 years with an immediate
family member diagnosed with glaucoma – parents, children or
siblings – are entitled to a free sight test every year under the NHS.
Diabetic eye disease
Diabetes can start in childhood, but more often begins in later life. It
can cause complications which affect different parts of the body, the
eye being one of them. There are two types of diabetes mellitus (as it
is known in full).
18
•• Type 1 diabetes commonly occurs before the age of 30 and is

the result of the body producing little or no insulin. Type 1
diabetes is controlled by insulin injections.
•• Type 2 diabetes commonly occurs after the age of 40. In this
type of diabetes the body does produce some insulin, although
the amount is either not sufficient or the body is not able to make
proper use of it. Type 2 diabetes is generally controlled by diet or
tablets, although some people in this group will use insulin
injections.
If you have diabetes, this does not necessarily mean that your sight
will be affected, but there is a higher risk. If your diabetes is well
controlled, then you are less likely to have problems or they may be
less serious. However, if there are complications that affect the eyes,
then this may result in loss of sight.
Most sight loss due to diabetes can be prevented, but it is vital that it
is diagnosed early. It can only be detected by a detailed examination
of the eye. Therefore, regular annual eye examinations are extremely
important, as you may not realise that there is anything wrong with
your eyes until it is too late.
Diabetes can affect the eye in a number of ways. The most serious eye
condition associated with diabetes involves the retina and, more
specifically, the network of blood vessels lying within it. The name of
this condition is diabetic retinopathy. This is usually graded according to
how severe it is. The three main stages are outlined in Table 2 below.
Stage Description
Background •• Very common in people who have had diabetes for a long time.
diabetic •• Vision is normal with no threat to sight.
retinopathy •• Blood vessels in the retina are very mildly affected; they may bulge slightly (microaneurysm)
and may leak blood (haemorrhage) or fluid (exudate).
•• Macula area of the retina remains unaffected.
Maculopathy •• Central vision gradually gets worse (this varies from person to person); it becomes difficult
to recognise distant faces or to see detail such as small print.
•• Peripheral vision is preserved.
•• This is the main cause of loss of vision and may occur gradually but progressively. It is rare
for someone with maculopathy to lose all their sight.
Proliferative •• This is rarer than background retinopathy.

diabetic •• Blood vessels in the retina may become blocked.
retinopathy •• New blood vessels form in the eye, but are weak and in the wrong place – growing on the
surface of the retina and into the vitreous gel.
•• These blood vessels can bleed very easily and cause scar tissue to form in the eye. The
scarring pulls and distorts the retina. When the retina is pulled out of position, this is called
retinal detachment.
•• The new blood vessels rarely affect vision, but the bleeding or retinal detachment may
cause vision to get worse. Eyesight may become blurred and patchy as the bleeding
obscures part of your vision.
•• Visual loss in this stage is often sudden and severe. Without treatment, total loss of vision
may happen.
Table 2: Stages of diabetic retinopathy.
19
Cataract
A cataract is a clouding of part of your eye called the lens. Your vision
becomes blurred because the cataract is like a frosted glass,
interfering with your sight. It is not a layer of skin that grows over
your eye, despite what you may have heard.
If your doctor or optometrist/optician has told you that you have a
cataract, do not be alarmed. Many people over 60 have some
cataract and the vast majority can be treated successfully. Early
cataracts may not affect your sight and do not need treatment. The
lens is a clear tissue found behind the iris, the coloured part of the
eye. The lens helps to focus light on the retina at the back of the eye
to form an image. To help produce a sharp image, the lens must be
clear.
Cataracts can give rise to blurry sight. This is very common. You may
notice that your sight has become blurred or misty, or that your
glasses seem dirty or appear scratched. You may also be dazzled by
lights, such as car headlamps, and sunlight and experience your
colour vision becoming washed out or faded.
Cataracts can form at any age. The most common type of cataracts is
age-related cataract. These develop as people get older. In younger
people, cataracts can result from conditions such as diabetes, certain
medications and other long-standing eye problems. Cataracts can
also be present at birth. These are called congenital cataracts.
Although researchers are learning more about cataracts, no one
knows for sure what causes them. There may be several causes. Some
studies have linked smoking, excessive exposure to sunlight and poor
diet with cataract development. Sometimes cataracts are caused by
other health problems such as diabetes.
The only effective treatment for cataracts is an operation to remove
the cloudy lens.
Main ear conditions

The ear consists of three main parts: the outer (the part you can see),
middle and inner ear. The outer ear opens into the ear canal. The
eardrum separates the ear canal from the middle ear. There are small
bones in the middle ear which help to transfer sound to the inner
ear. The inner ear contains the auditory (hearing) nerve, which leads
to the brain.
Vibrations or sound waves are sent into the air when they are
confronted by any kind of sound. These channel their way through
the ear opening, down into the ear, the canal, and then hit your
eardrum, causing it to vibrate. The vibrations are then passed to the
small bones of the middle ear, which transmit them to the auditory
nerve in the inner ear whereby vibrations develop into nerve impulses
and go directly to the brain, which interprets the impulses as sound
(voices, traffic, crying and so on).
20
Semicircular
canals
Anvil
Hammer Cochlea
Auditory
nerve
Stirrup
Pinna
Eardrum Round
window
A cross-section of the ear.
Conductive hearing loss

Many people have problems with their ears when they are children
and as adults. This can usually result from an obstruction in the outer
or middle ear – for example, an increase in ear wax or an ear infection
producing fluid. Conductive hearing loss is caused by anything that
stops sound moving from your outer ear to your inner ear. Other
possible causes of conductive hearing loss are:
•• middle ear infections
•• otosclerosis, a condition where the ossicles (three tiny bones) of
the middle ear harden and become less able to vibrate
•• damage to the ossicles – for example, by serious infection or head
injury
•• a perforated eardrum, which can be caused by an untreated ear
infection, head injury or a blow to the ear, or from poking
something in your ear.
Somebody with a conductive hearing loss will complain of not being
able to hear properly as the sounds are too quiet. The ensuing
hearing loss can be permanent or temporary, and is often corrected
with minor surgery or medication.
Sensorineural hearing loss
This type of hearing loss is sometimes referred to as sensory, cochlear,
neural or inner ear hearing loss.
Damage to the hair cells within the cochlea or the hearing nerve can
cause sensorineural hearing loss. As part of the ageing process, the
cochlea can become damaged and the condition is known as
presbycusis. However, there are several ways to cause sensorineural
hearing loss, including frequent exposure to loud sounds. This can be
listening to very loud music on headphones or sitting next to music
21
speakers at a concert. Temporary hearing loss can happen when a

person is exposed to loud sounds like a motorbike backfiring, a jet
plane or fire alarm bells.
Another cause is ototoxic hearing loss which can happen when
someone takes or is given a drug that causes hearing loss as one of its
side effects. These drugs can be some types of antibiotics,
chemotherapy drugs or anti-inflammatory drugs. Ocassionally, the
drug-induced hearing loss is temporary and can be reversed or
stopped. Other times it is permanent. People with hearing loss need
to be especially aware of the potential for ototoxic effects, as an
ototoxic drug can make an existing hearing loss worse.
Rubella, now a rare infectious disease due to vaccinations as a baby
or at school is a virus that can cause sensorineural hearing loss. The
virus can be caught in early pregnancy and pass through the placenta
to the unborn baby. It has been known to cause damage to a baby’s
sight, hearing, brain and heart.
There can be many other causes of sensorineural hearing loss – for
example, a head injury, benign tumours or a genetic predisposition.
You may wish to extend your knowledge by doing further research
on this topic.
Somebody with sensorineural hearing loss will have difficulty hearing
quiet sounds with the sounds becoming relatively indistinct, leading
to difficulty understanding speech.
3.2 The difference between congenital

Key terms and acquired sensory loss
Congenital – present at birth Sensory loss may be congenital or acquired.
Acquired – anything that is not
present at birth but develops some Activity 10
time later
Congenital or acquired?
Look up the following sensory conditions and decide if they are
Functional skills congenital or acquired.
English: Reading •• Cytomegalovirus

•• Swimmer’s Ear
When researching, you will be
•• Best’s Disease
practising reading skills to pick out
•• Charles Bonnet Syndrome
relevant information from the text to
•• Glue Ear
use for other purposes.
•• Retinitis Pigmentosa
•• Meniere’s Disease
•• Stargardt’s Disease
22
3.3 What percentage of the general

population is likely to have sensory loss
You will by now have researched information regarding sensory loss
from the major sensory loss organisations and will have a bank of
data to look at.
You will see that all sensory loss, sight loss, hearing loss and
deafblindness can be congenital or acquired, and you must state the
percentage of the population likely to have sensory loss.
As people age, they may experience sight and hearing loss or even
dual sensory loss, and you may find information from sensory loss
organisations to corroborate this fact. As people are living longer, it
could be that more older people than younger will have a sensory
loss, but it is up to you to reference these facts from the literature.
Your assessor will want to know how you came to your findings, and
you will be able to show data from sensory organisations showing the
population and incidences of sensory loss.
4. Know how to recognise when

an individual may be
experiencing sight and/or
hearing loss
4.1 The indicators and signs of sight loss,
deafblindness and hearing loss
Sight loss
You may have someone you support who is exhibiting signs of sight
loss. The list below shows how they might be behaving. See if you
can add any more signs to it from the people you have observed.
•• Moving about cautiously.
•• Holding books or reading material close to their face or at arm’s
length.
•• Overcautious driving habits.
•• Finding lighting either too dim or too bright.
•• Frequent eye glass prescription changes.
•• Squinting or tilting the head to see.
•• Difficulty in recognising people.
•• Changes in leisure activities.
•• Changes in personal appearance.
•• Bumping into objects.
•• Appearing disoriented or confused.
23
Hearing loss
You may have someone you support who is exhibiting signs of
hearing loss. Look at the list below and see if you can add any more
signs to the list from the people you have observed.
•• Not responding when you speak to them from behind.
•• Often asking people to repeat what they have said.
•• Not hearing when someone knocks at the door or rings the bell.
•• Complaining that people mumble or speak too quickly.
•• Having difficulty hearing when several people are present.
•• Needing the TV/radio/stereo to be louder than is usual for others.
•• Having difficulty following speech with unfamiliar people or
accents.
•• Having problems using the telephone.
Deafblindness
Look at the list for sight loss on the previous page. Now look at the
list for hearing loss. If you notice one or more signs from each list,
then you may find that the person you are observing has a sight loss
combined with a hearing loss. It would be beneficial to ask for help
from the sensory team in your local area (see Section 7 of the Local
Authority Social Services Act 1970).
Reflect 4.2 Where additional advice and support

•• How do you find someone who can be sourced in relation to sensory loss
knows how to use British Sign
Language?
•• Look on the Internet to find out
Activity 11
which sensory organisations offer You should make a list of the sensory support teams in your area and
emotional support. identify which team is in your catchment area. Ask people who are in
•• Do you know if your area has the sensory loss field to signpost you to local sensory societies. You
Communicator Guides? should also find out if your area has access to rehabilitation workers.
5. Know how to report concerns

about sensory loss
5.1 To whom and how concerns about
sight and/or hearing loss can be reported
It is imperative that you take time to understand the sensory loss of
people you support. This will mean looking at how people act in certain
situations. Look at the lists in the previous section. If you notice any of
the signs of sensory loss, it is your duty to report it to your supervisor.
24
Your supervisor will arrange for all people you support to have regular
access to sight and hearing tests. It may be part of your job role to
accompany them on these visits. You can then transfer information
from the optician’s report on to the support plans and daily reports.
This will enable you to provide care and activities that takes into
consideration their sensory loss.

LO1 between congenital and acquired sensory loss. You will
You will need to have looked at personalisation and also have researched the incidence of sensory loss in the
understand the differing types of support. You will be UK population being mindful of the different research
able to talk knowledgeably about the negative and methods used by each sensory organisation.
positive aspects of sensory loss on communication, LO4
information, mobility and familiar routines and layouts, Your assessor will want to know that you have
and be able to suggest ways of lessening the negative researched sources of support in your area. You will by
impact. You will be able to show the answers to the now know of some of the larger organisations that
case study and how people’s beliefs and attitudes on mainly help and support people with sensory loss, but
sensory loss can have a detrimental effect on them. You you will be expected to name local support groups and
will be able to show that you can help to dispel some of organisations. The assessor will also ask you questions
the beliefs and attitudes by your knowledge of of the main causes of sensory loss. You will need to
independence and empowerment. give accurate information on sight loss, hearing loss and
LO2 deafblindness, and be confident in your answers. You
It will be beneficial to you to show your assessor your may also be asked about supporting a person with
written activities throughout this unit, as this will show sensory loss and you will be able to refer back to some
your in-depth knowledge on communicating with of the activities you have taken part in.
people with a sensory loss. You can let your assessor see LO5
your reflective piece on communicating and answer You will need to be fully aware of your role in the
questions on the correct ways to communicate with organisation. You will have duties that are yours alone
someone with a sensory loss. You will have taken part in and you will have a duty to report situations and
three practical activities and written down your findings. information to someone higher in the organisation. If
Your assessor will ask you for your thoughts on sensory you do notice a person you support whose sensory
loss and especially the impact on communication. status is changed, then you must report it to your
LO3 supervisor. who will arrange for them to see the
You will be expected to know about the main causes of professionals. Your assessor will want to know what
sensory loss. You will have researched other sensory your duties are concerning people who have a sensory
conditions and have an understanding of the difference loss.
25
Legislation
Legislation can be found on www.legislation.gov.uk
•• Disability Discrimination Act 1995 and 2005

•• Health and Social Care Act 2008 (Regulated Activities) Regulations
2010
•• Local Authority Social Services Act 1970
•• Care Standards Act 2000
Regulations
•• Care Quality Commission (Registration) Regulations 2009

•• Care Home Regulations 2001
National Minimum Standards
•• National Minimum Standards for Care Homes for Older People (65+)
•• National Minimum Standards for Care Homes for Adults (18–65)

•• www.cpa.org.uk/cpa/putting_people_first.pdf (Putting People First)
•• www.in-control.org.uk (In control – self-directed support)
•• www.scie.org.uk (Social Care Institute of Excellence)
Sensory organisations
•• www.actionforblindpeople.org.uk (Action for Blind People)
•• www.bda.org.uk (British Deaf Association)
•• www.deafblinduk.org.uk (Deafblind UK)
•• www.gdba.org.uk (Guide Dogs for the Blind Association)
•• www.rnib.org.uk (Royal National Institute of Blind People)
•• www.rnid.org.uk (Royal National Institute for Deaf People)
•• www.sense.org.uk (Sense)
•• www.tnauk.org.uk (Talking Newspaper Association of the United
Kingdom)
There are many more local societies for sight loss, hearing loss and
deafblindness.
26
Index
A H
accommodation 5 hearing loss
acquired sensory loss 22 causes of 20–2
assessment requirements 25 and communication 14–15
impact of 2–6
overcoming impact of 7, 8–9
B signs of 24
British Sign Language 7
C I
information 3–4, 16
cataracts 20
communication 2–3, 13–16
conductive hearing loss 21 L
congenital sensory loss 22 legislation 25
D M
Deafblind Manual Alphabet 7 macular degeneration 17–18
deafblindness mobility 5–6
and communication 15
impact of 3, 4, 5–6
overcoming impact of 7–8
S
sensorineural hearing loss 21–2
signs of 24
sensory loss
diabetic eye disease 18–19
acquired 22
E attitudes and beliefs 11–12
ear conditions 20–2 causes of 17–22
English skills 6, 7 communication 13–16
eye conditions 17–20 congenital 22
functional skills 6, 7
further reading 25
F impact of 2–6
familiar layout and routines 4
legislation 25
functional skills 6, 7
overcoming impact of 6–11
further reading 25
percentage of population with 23
reporting concerns 24–5
G signs of 23–4
glaucoma 18 sight loss
causes of 17–20
communication 13–14
impact of 2–6
overcoming impact of 6–7, 9–11
signs of 23–4
27

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Yvonne Nolan

with Colette Burgess and Colin Shaw

SHC 21 Introduction to communication in health, social care or children’s and

Case study Case study

Getting ready for assessment

Further reading and research

In this unit you will learn about:

How do you think intimate communications can be identified?

The nature of communication is very different dependent on the

1.2 How effective communication affects

2. Write this record up as if you were at work and include everything

Communicating the same information to different people

1.3 Why it is important to observe

1. Write the names of several emotions (such as anger, joy, sadness,

Recognising the signals

Identifying body language

Giving out the signals

Communicating with people if appropriate. Many people find it comforting to

2. Be able to meet the

You should find out your employer’s policy on where such

Mr Perkins has communication difficulties following

This is important in order to ensure all that colleagues do not

Communication needs people have

Key term Physical disability

words for something they want to say, or to understand the

2.2 Communication methods that meet

•• Your work setting is likely to have a contact list of interpreters.

Can you see how you could use these cards?

Be prepared to learn words in the person’s language. You could try to

Meeting communication needs for someone with a

Telecommunication services such as minicom or typetalk are very

Meeting communication needs for someone with a

Meeting communication needs of people with a

•• using very simple, short sentences, speaking slowly, and then

Meeting the communication needs of people with a

Sometimes touch can be helpful.

Communication through actions

2.3 How and when to seek advice about

3. Be able to overcome barriers

Four communication barriers. Can you identify any others?

Communication Encouraging actions

Visual impairment •• Use touch to communicate concern, sympathy and interest.

Confusion or dementia •• Repeat information as often as necessary.

Physical disability •• Ensure that surroundings are appropriate and accessible.

Learning disability •• Judge appropriate level of understanding.

Key term 3.3 Ways to ensure that communication

Using body language

The messages are made clear by such things as facial expression,

Using verbal communication

Depending on the conversation and the circumstances, either type of

1. ‘Are you feeling worried?’

3.4 Sources of information and support

4. Be able to respect equality and

Can you imagine how angry this would make you?

What words mean

4.2 Communication that respects

5. Be able to apply principles

5.2 Confidentiality in day-to-day

Each organisation should have a policy which states clearly the

•• who the members of senior management designated to deal with

1. Have you ever betrayed

It might be considered a breach of your professional code of conduct

Security and confidentiality

Policies of the organisation