What is duty of care?

Duty of care means always acting in the best interests of the people you support, keeping them safe from harm, and never abusing the trust placed in you. It applies to every worker in health and social care, at every level, all the time - not just during 'formal' tasks.

It sits alongside your employer's duty of care to you (safe systems, training, equipment) and your duty of care to colleagues and the public.

Duty of care vs duty of candour

These are often mixed up:

• Duty of care = the day-to-day responsibility to keep people safe and act in their best interests.
• Duty of candour = the legal duty to be open and honest when something has gone wrong, including telling the person or their family, apologising, and explaining what happened and what will be done about it.

Dilemmas in duty of care

Sometimes duty of care can conflict with a person's right to make their own choices (their autonomy), for example someone refusing help or wanting to do something risky. The correct approach is not to simply stop them, but to:

• Support the person to understand the risks (informed choice)
• Carry out a risk assessment and look at ways to reduce the risk
• Involve the person, family and other professionals
• Record everything and escalate to a senior/manager if unresolved

Safeguarding - the basics

Safeguarding means protecting adults and children from abuse, harm and neglect. Common types of abuse: physical, sexual, psychological/emotional, financial, neglect, discriminatory, organisational, domestic, and modern slavery/human trafficking. Self-neglect is also a safeguarding concern.

Signs of abuse can include unexplained injuries, sudden behaviour or mood change, weight loss, poor hygiene, unexplained money problems, fearfulness around a particular person, or withdrawal.

What to do if you suspect abuse

• Ensure immediate safety first
• Listen, do not promise to keep it secret, do not investigate yourself
• Report to your manager/safeguarding lead straight away, following your workplace policy and local safeguarding procedures
• Record what was said/seen accurately, using the person's own words where possible, as soon as possible after the event
• Every organisation must have a safeguarding policy and a named safeguarding lead

Whistleblowing

If you raise a concern and nothing is done, or the concern is about your own manager, you can whistleblow - reporting outside your immediate line management, e.g. to a senior manager, CQC, or the relevant regulator. The Public Interest Disclosure Act 1998 protects workers who whistleblow in good faith from being dismissed or victimised.

Common mistakes

• Confusing duty of care with taking away someone's choices
• Keeping a disclosure secret because you were asked to
• Failing to record concerns in writing, promptly and factually
• Not knowing who the safeguarding lead is
• Assuming 'no physical injury' means it is not abuse (financial and psychological abuse leave no marks)

What person-centred values means

Person-centred values means putting the individual at the heart of everything you do, not the organisation or the routine. Care and support is planned and delivered around what matters to that specific person, not a one-size-fits-all approach.

The Care Certificate (Standard 1) sets out the core person-centred values you must show in practice:

• Individuality - treating each person as a unique human being
• Rights - upholding legal and human rights, including the right to be treated with respect
• Choice - supporting people to make their own decisions wherever possible
• Privacy - respecting personal space, information and dignity
• Independence - enabling people to do as much for themselves as they can
• Dignity - treating people in a way that preserves their self-respect
• Respect - valuing a person's beliefs, culture and preferences
• Partnership - working with the person, their family and other professionals as a team

Dignity in practice

Dignity is about how a task is done, not just whether it is done. Examples of dignity in care:

• Knocking before entering a room and waiting for a response
• Covering someone appropriately during personal care
• Speaking to the person, not over them, to a colleague or relative
• Using the name and title the person prefers, not a pet name like 'love' or 'dear'
• Explaining what you are about to do before you do it

Person-centred approaches vs person-centred values

Person-centred values are the beliefs underpinning practice. Person-centred approaches are the practical tools used to apply them, such as care plans, life histories, and daily records that are written with the person, not just about them. Always work from an up-to-date, individual care plan rather than assumptions or habit.

Common mistakes to avoid

• Doing things 'to' or 'for' a person instead of 'with' them
• Assuming you know best because of the person's age, diagnosis or disability
• Rushing personal care tasks, which strips away dignity
• Talking about the person in front of them as if they are not there
• Treating a care plan as fixed rather than reviewing it regularly with the person

Key legal grounding

Person-centred values link directly to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, particularly Regulation 9 (person-centred care) and Regulation 10 (dignity and respect), both enforced by the CQC.

Why communication matters

Good communication is central to safe, person-centred care. It builds trust, reduces mistakes, and helps you spot changes in a person's health or mood. Poor communication is one of the biggest causes of complaints and safeguarding concerns in care settings.

Types of communication

• Verbal: spoken words, tone, pace, volume
• Non-verbal: facial expression, eye contact, gestures, posture, touch (over 90% of meaning in face-to-face exchanges can come from tone and body language, not words alone)
• Written: care plans, handover notes, emails, texts
• Communication aids: pictures, symbols, Makaton, British Sign Language, hearing loops, translation services, big-print or braille documents

Adapting communication

Every individual has different needs and preferences. Always check a person's communication and language needs, wishes and preferences, recorded in their care plan, and adapt your approach: slow down, use short sentences, use an interpreter, use an advocate, or use an aid. Never assume someone cannot communicate just because they cannot speak.

Barriers to communication

Common barriers include sensory loss (sight or hearing), dementia or cognitive impairment, language differences, environment (noise, poor lighting), jargon, and emotional state (fear, pain, embarrassment). Reduce barriers by choosing a quiet space, facing the person, checking understanding, and giving time to respond.

Confidentiality: the core rule

Confidentiality means only sharing personal information with people who have a genuine need to know, and on a need-to-know basis. It is a legal duty under the UK GDPR and the Data Protection Act 2018, and it underpins the Caldicott Principles used across health and social care.

When you can break confidentiality

You must share information, even without consent, when:

• Someone is at risk of harm (safeguarding concern, abuse or neglect)
• There is a risk to public safety or a serious crime
• It is required by law or a court order
• The person lacks capacity and it is in their best interests

Always report to your manager or safeguarding lead and record what you shared, when, and why.

Common mistakes to avoid

• Discussing service users in public areas, corridors, or on social media
• Leaving records, screens or notes visible to others
• Assuming a locked door or a whisper makes gossip acceptable
• Failing to check understanding after giving information
• Ignoring an individual's preferred communication method

Recording and reporting

Records must be accurate, factual, legible, dated, timed and signed. Never falsify or delete records. Store paper records securely (locked cabinets) and electronic records with password protection, and only for as long as necessary in line with your employer's data retention policy.

Why this topic matters

Health, safety and infection control run through every shift. The law places duties on your employer AND on you personally - you cannot say 'that's management's job' and walk away from a hazard.

Key legislation

• The Health and Safety at Work etc. Act 1974 is the main law. Employers must provide a safe workplace, safe equipment, training and PPE free of charge.
• The Management of Health and Safety at Work Regulations 1999 require employers to carry out risk assessments.
• RIDDOR 2013 means certain injuries, dangerous occurrences and diseases must be reported to the Health and Safety Executive (HSE).
• COSHH (Control of Substances Hazardous to Health) covers safe storage, labelling and use of cleaning chemicals and other hazardous substances.
• Manual Handling Operations Regulations 1992 require a risk assessment before any lifting or moving task, and use of equipment (hoists, slide sheets) instead of manual lifting wherever possible.

Infection prevention and control (IPC)

• Hand hygiene is the single biggest defence against infection - wash hands for at least 20 seconds, and always before/after contact with an individual, after using the toilet, before food, and after removing gloves.
• Use Personal Protective Equipment (PPE) - gloves and aprons are single-use, put on and removed in the correct order, and disposed of in the correct clinical waste bin.
• Follow the correct order for putting on PPE: apron, then mask (if needed), then gloves. Remove in reverse, gloves first, then apron, then wash hands.
• Use colour-coded equipment (e.g. colour-coded cloths, mop heads) to stop cross-contamination between areas such as kitchens, bathrooms and clinical areas.
• Report and record any spillage of bodily fluids immediately and clean using the correct spill kit and PPE.

Your personal responsibilities

• Attend all mandatory training (moving and handling, fire safety, infection control) and keep it up to date.
• Report hazards, near misses, incidents and accidents straight away, using your workplace's incident reporting system.
• Only use equipment you've been trained and assessed as competent to use.
• Follow your employer's fire evacuation procedure and know where the assembly point and fire extinguishers are.

Common mistakes to avoid

• Thinking PPE is optional if you're 'only popping in for a minute' - it's not.
• Reusing gloves between individuals - always change gloves and wash hands between each person.
• Attempting a manual lift alone when the care plan states two carers or a hoist are needed.
• Not reporting a near miss because 'nothing actually happened' - near misses must still be logged so hazards can be fixed before someone is hurt.

What equality, diversity and rights mean

Equality means everyone gets fair access and fair treatment, whatever their background. It does not mean treating everyone identically - it means giving people what they need to have the same chance of a good outcome.

Diversity means valuing and respecting differences between people - culture, faith, disability, sexuality, age and more. Inclusion means actively making sure people are not left out.

Rights are the legal entitlements people have, for example the right to be treated with dignity, to make choices, and to complain.

The Equality Act 2010

This is the key law. It brings together earlier anti-discrimination laws into one act.

It protects 9 protected characteristics:

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

Under this act it is unlawful to discriminate against someone because of any of these characteristics.

Types of discrimination

• Direct discrimination: treating someone worse because of a protected characteristic.
• Indirect discrimination: a policy or rule that disadvantages a group even if it applies to everyone.
• Harassment: unwanted behaviour that violates dignity or creates a hostile environment.
• Victimisation: treating someone badly because they made or supported a complaint.

Person-centred values in practice

Putting equality and rights into daily care means:

• finding out about a person's individual needs, beliefs and preferences
• adapting communication and support to the individual, not a one-size-fits-all approach
• challenging discrimination when you see it, including from colleagues, visitors or other service users
• reporting concerns through the correct channels
• promoting choice, dignity, privacy and independence

Common mistakes to avoid

• Confusing equality with treating everyone 'the same' - equality is about fair outcomes, not identical treatment.
• Forgetting that discrimination can be unintentional (indirect) as well as deliberate.
• Thinking diversity only refers to race or culture - it covers all 9 protected characteristics plus other differences.
• Assuming it is someone else's job to challenge discrimination - all workers have a duty to challenge it.
• Not knowing where to report a concern - always know your organisation's policy and who to escalate to.

Why fluids, nutrition and mental capacity sit together

Good hydration and nutrition are basic care needs, but you cannot deliver them well unless you also understand mental capacity, because some individuals cannot make or communicate decisions about eating and drinking. This topic tests whether you can spot risk, act within the law, and know when to escalate.

Fluids and dehydration

• Adults need roughly 1.5 to 2 litres (6 to 8 glasses) of fluid a day, more in hot weather, illness, or if vomiting or sweating.
• Older people have a reduced thirst response, so do not wait for them to ask for a drink.
• Signs of dehydration: dark concentrated urine, dry mouth and lips, headache, confusion, dizziness, low blood pressure, reduced skin elasticity ('skin tenting').
• Dehydration is a common and preventable cause of confusion, falls, UTIs and hospital admission in older adults.
• Always record fluid intake accurately on a fluid balance chart if one is in place, and report concerns promptly.

Nutrition basics

• A balanced diet follows the Eatwell Guide: plenty of fruit and veg, starchy carbohydrates, protein, dairy or alternatives, small amounts of fat and sugar.
• Malnutrition can happen alongside obesity; always look at the individual, not just their weight.
• MUST (Malnutrition Universal Screening Tool) is the recognised tool for spotting malnutrition risk - know that screening tools exist and must be used, even if you never need the exact scoring.
• Support eating and drinking with dignity: right position (upright), right pace, right consistency (some need thickened fluids or modified texture food if they have swallowing difficulties, known as dysphagia), and check likes, dislikes, cultural and religious needs.
• Report any sudden change in appetite, swallowing difficulty, choking, or weight loss straight away - these can be signs of a serious health problem.

Mental Capacity Act 2005 - the core rules

• Five principles: 1) assume capacity unless proven otherwise, 2) support the person to make their own decision first, 3) unwise decisions are not proof of incapacity, 4) any decision made for someone lacking capacity must be in their best interests, 5) choose the least restrictive option.
• Capacity is decision-specific and time-specific - someone may be able to decide what to eat but not manage their finances, and capacity can change day to day.
• The two-stage test: is there an impairment of the mind or brain, and does it mean the person cannot understand, retain, weigh up or communicate the decision?
• If someone lacks capacity around food or fluids, a best interests decision must involve family, advocates and the wider team, and use the least restrictive option.
• Never assume lack of capacity just because someone has dementia, a learning disability or mental health condition, or because you disagree with their choice.

Common mistakes to avoid

• Confusing 'unwise decision' with 'no capacity' - these are different things.
• Forgetting that capacity assessment is decision-specific, not a blanket label.
• Not reporting dehydration or nutrition concerns because they seem minor.
• Assuming all fluids must be plain water - tea, juice, soup and jelly all count.