Ethical principles to underpin decisions in adult social care

The Department of Health’s Responding to Covid-19: the ethical framework for adult social care is intended to aid ongoing response planning and decision-making to ensure that ample consideration is given to a series of ethical values and principles when organising and delivering social care for adults.

It also aims to support the work of professionals and others in the health and social care workforce who are developing policies and responding to the outbreak, in line with their own professional codes of conduct and regulations. Responding to COVID-19 as it develops will require making difficult decisions under new and exceptional pressures with limited resources, information or time. Such decisions may relate to individual care, or have wider impacts on the organisation and delivery of health and care services. Providers should note the principles can also be readily applied widely in the social care sector.

How to use the framework

It might be useful to use the framework as a checklist, although it is noted that the principles are not exhaustive. Providers are advised that every decision will require consideration of individual wellbeing, overall public good and the resources that are available.

Records of decisions

Decisions will need to be made in accordance with the law and official guidance issued and applicable at the time, and while meeting statutory duties and professional responsibilities.

Appropriate records must be kept of decisions taken and their justifications in order to ensure accountability and to share learning with others during and as the outbreak develops. (Providers will of course be aware of their record-keeping obligations pursuant to Regulation 17: Good Governance of the Health and Social Care Act 2009 (Regulated Activities) Regulations 2014 in any event).

It would certainly appear prudent to explain the rationale for any actions taken by reference to the principles and indeed the weight attributed to each alongside other legal and regulatory obligations. Providers should also expressly note the applicable principles in new guidance and protocols created as part of the response to the outbreak.

Values and principles

It is recognised that where resources are constrained and there are surges in demand, it may not be feasible to consider all the principles or the actions below them. Each principle must be considered to the extent possible in the context of each circumstance with appropriate risk management and considerations of individual wellbeing, overall public good and available information and resources.

In all instances, respect and reasonableness should be used as the fundamental, underpinning principles that guide planning and support judgements.

1. Respect

Recognise that every person and their human rights, personal choices, safety and dignity matters. Those making decisions should provide people with the opportunity to express their views on matters that affect their care and should respect people’s personal choices as much as possible.

2. Reasonableness

Ensure that decisions are rational and fair, practical and grounded in appropriate processes, available evidence and a clear justification. Those making decisions should ensure the decision made is practical with a reasonable chance of working. This should be considered alongside relevant equalities-related legal and policy frameworks as appropriate.

3. Minimising harm

Strive to reduce the amount of physical, psychological, social and economic harm that the outbreak may cause individuals and communities. This involves minimising the risk of complications if someone is unwell. We have covered the practical guidance in relation to residential care and shielding in earlier briefings. It is emphasised that those responsible should communicate that everyone has a role to play in minimising spread, for example by practising thorough hand-washing or social distancing.

4. Inclusiveness

Ensure people are given a fair opportunity to understand situations, be included in decisions that affect them, and offer their views. Those making decisions should provide appropriate communications to all involved, mindful of the accessibility of such information. No particular person or group should be excluded from involvement.

5. Accountability

Hold people to account. This includes being transparent about why decisions are being made. Those responsible must be prepared to justify decisions, ensuring that appropriate records are being kept. Within organisations this will also include:

• Providing an environment in which staff can work safely, effectively and collaboratively.
• Providing appropriate guidance and support to staff who may be asked to work outside of their normal area of expertise or be unable to carry out some of their daily activities.
• Having locally-agreed processes in place to deal with ethical challenges during and in the aftermath of the outbreak.

6. Flexibility

Being responsive, able, and willing to adapt when faced with change or new circumstances. Those making decisions should ensure that plans and policies have room for flexibility and innovation where necessary. Agile and collaborative working across the health and care sector is expressly encouraged.

7. Proportionality

Provide support that is proportional to needs and abilities of people, communities and staff, and the benefits and risks that are identified through decision-making processes.

8. Community

Commit to get through the outbreak together by supporting one another and strengthening our communities. All parties should work with and support one another to plan, respond and cope.

Sharing learning

Of particular importance will be to share learning with others as one provider’s experience may well better inform the practice adopted by others. This is mentioned within both the minimising harm and community principles. It is also recognised that local, national and global experiences will also provide guidance regarding the best way to treat and respond to the outbreak as the understanding of COVID-19 develops.

In the first instance, providers operating a number of homes will also need to carefully consider how they cascade learning across the organisation efficiently so that all services are able to develop consistent working practices which best protect both residents and staff.