Welcome to the next in our series looking at the CQC fundamental standards and what they mean in practice for social care services.
For this article, we will look at Regulation 10: Dignity and Respect.
At first glance, Regulation 10 may seem straightforward and is easy to overlook as a regulation as it may appear to be a bit loose and hard to be regulated against – most providers would say they treat people with dignity and respect. However, the regulation is much wider than simply being polite or kind. Another challenge with this fundamental standard is that there is not a clear, tangible piece of evidence that you can focus on; it requires a holistic and more general approach to satisfy CQC.
It requires people to be always treated with dignity and respect while they are receiving care and treatment. It specifically identifies that privacy, autonomy, independence, involvement in the community and relevant protected characteristics need to be consistently met.
These requirements make Regulation 10 a far-reaching fundamental standard, cutting across many aspects of care and CQC’s assessment framework.
What does Regulation 10 require?
The starting point is simple and the regulation states that ‘Service users must be treated with dignity and respect’, but it goes deeper than that, and then identifies specific areas providers need to consider. These include:
1. Privacy
This includes the need to recognise and respect a person’s privacy not just during personal care, but also in conversations, relationships and other information.
Providers need to be aware and check on how privacy is understood and acted upon in all aspects of the person’s life when using the service. Checks should be made in the following areas; this list is not comprehensive but highlights some areas that should be monitored:
- Do staff knock before entering people’s rooms?
- Is personal care provided privately?
- Are conversations about people’s care handled appropriately?
- Are people’s belongings and information respected?
2. Autonomy and independence
Regulation 10 specifically requires providers to respect people’s autonomy and independence. People should be supported to make choices and do as much as possible for themselves. Sometimes it can be easier for staff to take over, particularly when the service is busy, but convenience should not unnecessarily remove someone’s independence. Encouraging independence should always be the priority.
Care plans and risk assessments should be developed with the person whenever possible and used to record how independence is going to be promoted. It should be noted that doing something for someone is not always the same as providing good care.
3. Involvement in the community
Regulation 10 also requires providers to support people’s involvement in the community. This might mean maintaining relationships, attending clubs, visiting shops, going to places of worship, volunteering or continuing activities that are important to the person. The focus should be on what matters to the person supported, rather than simply what activities the service provides.
4. Protected characteristics
Regulation 10 requires providers to have due regard to relevant protected characteristics under the Equality Act 2010. This is a very important, wide-ranging requirement that needs to be understood by all staff. The issues surrounding protected characteristics are defined in separate legislation but basically mean that people cannot be discriminated against because of their age, gender reassignment, marriage or civil partnership, being pregnant, disability, race including colour, nationality, ethnic or national origin, religion or belief, sex or sexual orientation.
These characteristics should be recognised in any assessment or care plan and staff should all receive training and understand about protected characteristics as well as the wider Equality Act 2010.
5. Communication is part of dignity
Respectful communication is central to Regulation 10. People should be spoken to, not spoken about in front of others. Staff should avoid patronising language and understand how each person communicates. Where someone has difficulty communicating, the responsibility is on the service to find ways to understand them, and to ensure that they can be understood and express their wishes. Again, care plans should be used as a guide and to direct how staff support individuals that use the service.
Why Regulation 10 is so important?
Regulation 10 is particularly significant because it is wide-ranging. CQC quality statements such as kindness, compassion and dignity, treating people as individuals, and independence, choice and control reflect many of the principles embedded in the regulation, and provide a clear route to enforcement if breaches are found.
But concerns about dignity can also raise questions about person-centred care, consent, safeguarding, equality, communication, independence and leadership.
For example, staff routinely speaking over people may initially appear to be a dignity issue. But on closer inspection, it could indicate poor person-centred care, limited choice and control and wider cultural or leadership problems.
This means Regulation 10 can provide CQC with evidence of wider concerns about the quality and culture of a service.
What should providers do?
Managers should regularly observe practice and look for:
- Personal care being rushed or lacking privacy
- Staff making decisions without involving people
- Preferences being recorded but not followed
- People being discouraged from making choices because it is easier for staff
- Patronising or inappropriate language
- People not being supported to maintain important relationships or community connections
- Communication needs not being properly understood
- Care plans describing people’s needs but saying little about what matters to them
If any of the above issues are seen to be taking place, providers should address concerns and not ignore the issues.
How the issues are resolved is a big question but could result in:
- Increased training
- More observational audits and monitoring of practice
- Managers leading by example and being more of a presence to support and guide staff
- Reviewing the culture of the service
- Receiving more feedback from people with an involvement with the service to get a wider view of concerns
- Clearer assessments, care plans and risk assessments
Getting Regulation 10 right
Ultimately, Regulation 10 is about how we value the people we support. A useful question for providers and managers is:
‘If I were receiving this care, how would I feel about the way I was being treated?’
Dignity is often found in the small things — being listened to, having choices respected, being given privacy, being treated as an individual and knowing that your voice matters. Because Regulation 10 is so broad, getting it right is about more than complying with one fundamental standard; it is far reaching and can impact across the service and the CQC’s view of you as a provider
Dignity and respect should be visible throughout the service — in care plans, in staff behaviour, in people’s choices and, most importantly, in people’s experience of the care they receive.
Look out for the next instalment in our Fundamental Standards series,covering Regulation 17: Good Governance