Working in your service users’ best interests

Your duty to act in the best interests of your service users at all times

According to the Health Professions Council (HPC) your first duty as a registrant is to ‘act in the best interests of service users’ (HPC 2008 p3, p8.). The HPC Standards of conduct, performance and ethics state that:

You are personally responsible for making sure that you promote and protect the best interests of your service users. You must respect and take account of these factors when providing care or a service, ...You are responsible for your professional conduct, any care or advice you provide, and any failure to act...You must be able to justify your decisions if asked to. (HPC 2008, p8)

It is absolutely clear that you must always consider and act in the best interests of your service users and that you must be able to give reasons for anything that you do.  It is core to the duty of care that you have for your service users. More information is available from the Code of ethics and professional conduct (COT 2010a).
 

What does it mean?

To work in your service users’ best interest is to use your professional skills and reasoning to ensure their optimum health, wellbeing and safety, focusing your service(s) and basing your intervention(s) on their needs, choices and aspirations. It is not about doing what you think is right based upon your own personal beliefs and opinions. Even when a service user refuses intervention or chooses to follow an alternative course of action, you can still act in their best interests, by doing all you reasonably can to maintain their safety and wellbeing.
 

Safeguarding

You have a legal obligation to protect any vulnerable people, of any age, with whom you work or have contact in the course of your professional duties. You must also be aware of and fulfil all the requirements as laid down by legislation and guidance in terms of recruitment and reporting practices. 
 

A possible conflict of interest

In some circumstances there can be a conflict of interest, when organisational structures and/or resources put limitations on the services that practitioners can offer. Local, national and environmental resources are finite and at times priorities will have to be identified and choices made, while complying with legal requirements, and national and/or local policy (COT 2010a, section 3.2). When legislation requires you, your primary responsibility is to the service user, not your employer, for example, when contributing to a statement or coordinated support plan of special educational needs.
 
When resources are limited it may not be possible to meet the full needs or aspirations of your service users, but you can still ensure that you work in partnership with them, and that your practice is in their best interest. Where service deficiencies may endanger the health and safety of service users and carers, you have a duty to report this to the relevant service manager (Great Britain. Parliament 1998a, section 43B, point (1)d).
 

2. Working in your service users’ best interests – standards

Please note, it is recognised that it is not always possible to ascertain or accommodate your service users’ wishes for mental capacity or legal reasons. In such circumstances you must always act in your service users’ best interests and abide by legal and local requirements.

2.1 You recognise the human rights of your service users and always act in their best interests

Criteria
2.1.1 You respect the human rights of your service users
2.1.2 Your decisions and actions are always in the best interests of your service users  
2.1.3 Where necessary, you act as, or arrange for, an advocate to promote the best interests of service users
 
More information is available from the Code of ethics and professional conduct (COT 2010a, section 2.2), human rights and equality legislation. 

2.2 You treat your service users with respect and dignity at all times

Criteria
2.2.1 You acknowledge the uniqueness of each of your service users
2.2.2 You treat your service users with respect at all times
2.2.3 You enable your service users to preserve their dignity
2.2.4 You enable your service users to have privacy 
More information is available from the Code of ethics and professional conduct 

2.3 You practise in a non-discriminatory manner, treating all your service users with equality and fairness

Criteria
2.3.1 You offer equal access to your service(s), according to their remit, without any bias or prejudice
2.3.2 You do not allow your views about an individual’s background or personal life choices to influence your behaviour toward him or her, or the care that you provide
2.3.3 You recognise the importance of your service users’ backgrounds, languages, cultures and faiths in their occupational performance
2.3.4 You incorporate your service users’ backgrounds, languages, cultures and faiths into any service planning, individual assessment and/or intervention where possible
2.3.5 You act to stop any forms of discrimination in your workplace
2.3.6 Your service users can complain effectively and without fear of victimisation
2.3.7 You work towards the inclusion and involvement of service users and their carers in their own communities 

2.4 You work in partnership with your service users and their carer(s), putting them at the centre of your practice

Criteria
2.4.1 Your service users and their carers are involved in all  decisions concerning the intervention they receive
2.4.2 Your assessments and intervention are shaped by the occupational needs of your service users, their choices and wishes, within legal and organisational constraints
2.4.3 Your service users and their carers are involved in evaluating the outcomes of their intervention
2.4.4 You consider the views of service users and their carers when planning new services or reviewing current ones

2.5 You uphold your service users’ right to make choices over the care that they receive and the plans that they wish to make

Criteria
2.5.1 You provide information, in an accessible format, to enable service users to make informed decisions and choices over their care 
2.5.2 You inform your service users about the risks and benefits of the care that is offered to them and the choices they may make
2.5.3 You enable and support your service users in the taking of reasonable positive risks
2.5.4 You respect the choices and wishes of your service users and their carers
2.5.5 When your service users do not follow your recommendations, you still do all you reasonably can to maintain their safety and wellbeing
2.5.6 Where your service users do not have capacity, you work with others, e.g. those with lasting power of attorney, to act in their best interests

2.6 You ensure the safety of service users at all times

Criteria
2.6.1 You ensure that all reasonable steps are taken to ensure the health, safety and welfare of any person involved in any activity for which you are responsible
2.6.2 You assess and manage any risks that may affect your service users, to  avoid or reduce the likelihood of adverse events (See section 9.2)
2.6.3 You do not do anything, or allow anyone else to do anything, that you believe will put the health or safety of a service user in danger
2.6.4 Systems are in place to enable you to report concerns about the safety of a service user without detriment to the service user or yourself
2.6.5 You take appropriate action to protect the rights of children, young people and vulnerable adults, following national and local guidance
 
More information is available from the Code of ethics and professional conduct (COT 2010a, section 2)
 
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These standards link with:
Code of ethics and professional conduct, section(s) 2.1; 2.2; 2.3; 3.1; 3.34.2; (COT 2010a) 
Common core principles to support self care, principle(s) 1 (Skills for Care, Skills for Health 2008)
Doing well, doing better: Standards for health services in Wales, standard(s) 2; 9; 10; 11 (Welsh Assembly Government 2010)
Guidance about compliance: essential standards of quality and safety, outcome(s) 1; 2; 4; 7 (CQC 2010)
National care standards - principles, principle(s) 1; 2; 3; 6 (SCRC 2002)
Quality standards for health and social care, section(s) 5.3.1; 5.3.3; 6.3.2; 7.1; 7.3 (DHSSPS 2006a)
Rehabilitation standards: hallmarks of a good provider, standard(s) 4 (UKRC 2009)
Standards of conduct, performance and ethics, standard(s) 1 (HPC 2008)
Standards of proficiency: occupational therapists, section(s) 1a (HPC 2007)
The NHS knowledge and skills framework and the development review process, core dimension(s) 3; 6, dimension(s) Health and wellbeing (DH 2004)