Code of conduct for Healthcare Support Workers

Working to standard: a code of conduct for support workers in

health care

1. Introduction

1.1 Welcome to this code of conduct for support workers in health care.

1.2 As a health-care support worker, you play a vital role in:

• helping the NHS deliver its services

• protecting patients from harm and
• valuing all aspects of equality and diversity.

What you do has a big impact on the quality of health care for people
who use the service.

1.3 This code of conduct is necessary because the work you do as a

member of the health-care team is very important. The code is a list of
statements that set the standard for how you should work on a
day-to-day basis.

1.4. The code is here to help you, your employer and the patients1 you
work with. It is based on the basic principle of protecting the public,
and mirrors what is required of all ‘regulated’ health-care professionals
you work with.

1.5. You can use the code to check that you are 'working to standard'.
Your employer can use it to make sure that the service is meeting the
standards and that both the public and the patients' safety is assured.
Employers can also use it to help them understand what kind of service
they can expect from you and your colleagues.

1.6. The statements are based on existing good practice. You'll probably
find you are already working to standard in most, if not all of them. If not,
the code will show you how you can change the way you work to make
sure you are working to standard.

1.7. The statements are designed for all health-care support workers in
Scotland, wherever you work and whatever job you do. So, it is a

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The term 'patient' is used throughout the code. However, in practice you may hear patients being referred to as
'service users', 'clients' or 'residents'. Basically, the term means any person that you come into contact with who
needs care.

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national code of conduct that will help to make sure that patients all
over the country can get the same high-quality, safe and effective
service from health-care support workers.

1.8. Your employer also has a code of practice to guide how they treat
you as a worker and how they can support you to achieve these
standards.

2. Where has the code come from?

2.1. The code was developed by a working group brought together by

the Scottish Executive. The group worked very closely with similar
groups in other parts of the UK to make sure that the statements in the
code are the right ones. The group took special care to make sure that
the code is in keeping with 'like' codes in other relevant sectors, such as
social services.

3. Working 'to standard'

3.1 As a support worker, you are expected to work to a certain standard.

You need to be able to do your job properly, behave properly, and do the
right thing at all times. This is essential to protect patients and others
from harm. Patients and their relatives, your employer and your
colleagues all expect this, and you should expect this of yourself.

3.2 But what does this mean on a day-to-day basis? It means that in
your work, you should always be of ‘good character’ 2. This means that
you should always display the characteristics outlined in paragraphs
3.2.1 to 3.2.13 below.

2
Ongoing work by the Nursing and Midwifery Council ( NMC) on good health and good character has defined
‘good character’ as: ‘someone who is capable of safe and effective practice at all times’. It is important that
healthcare support workers can provide safe and effective care at all times. To assess good character, employers
will take up character references and check for a satisfactory Disclosure Scotland criminal records check.

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Good character

3.2.1. Accountability - making sure that you can always 'answer' for
your actions or omissions.

Make sure you are happy with the things you do (actions) and the things
you don’t do (omissions) in your daily work and that you can justify them
to patients, your supervisor, your employer and others. You must carry
out only the tasks agreed in your job description or specification so that
your employer knows what you are likely to be doing and, based on this,
agrees to accept liability (known as ‘vicarious liability’) for your actions.

How will I know if I'm 'working to standard’ on accountability?

When you are working to standard on accountability, you may be asked

to explain anything that you do or do not do with, or for, the patient. So,
you need good reasons for the way you have acted. Your employers will
draw on the knowledge and skills you have used when they judge your
actions. Make sure that you record your actions in line with your
employer’s procedures. By taking part in ongoing monitoring of your
performance, you are showing you are aware of your accountability.

3.2.2 Awareness - being honest with yourself and others about what
you can do.

Know yourself, what you can do and what you can’t do. The safety of
your patients is your first priority. Always ask colleagues for help if you
have any worries or concerns about your abilities.

How will I know if I'm 'working to standard' on awareness?

When you're working to standard on awareness, you'll know yourself

well enough to know what you can do. You'll show you understand that
some procedures can only be carried out by people who have had
special training, and that, in certain circumstances, you need permission
from qualified staff before you do certain things with patients. If you feel
you're being asked to do something you haven't been trained to do, and
that you don’t have the skills to do it, you will speak up.

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3.2.3. Integrity - always do what is right to protect the patient.

Always do your best to make sure nothing you or anyone else does, or
does not do, will harm the patient's mental or physical health or delay
their recovery.

How will I know if I'm 'working to standard' on integrity?

When you're working to standard on integrity, you will be protecting

patients every way you can, taking into account all aspects of equality
and diversity. You should be prepared to report issues that cause you to
worry.

3.2.4. Advocacy - doing your best for patients and their relatives.

This means being responsible for promoting and protecting the interests
of patients, many of whom may not be able to protect their own interests.
This could involve speaking up for patients to make sure that what is
best for each individual is always taken into account.

How will I know if I'm 'working to standard' on advocacy?

When you're working to standard on advocacy, you'll be putting patients'

interests first at all times and making sure that you are meeting their
wants and needs. All patients are individuals with different likes and
dislikes and you must acknowledge their equality and diversity to make
sure that you treat them equally and fairly.

3.2.5. Sensitivity - respecting the patient.

Every patient is an individual with real feelings and emotions. When

working with patients, think about how they may be feeling and what is
the most appropriate response to their situation.

How will I know if I'm 'working to standard' on sensitivity?

When you're working to standard on sensitivity, you'll be treating patients

and their relatives politely while being aware of the situation they are in
and their reactions to it. For example, they may be feeling confused,
angry or frustrated. It is important that you are sensitive to this and do
not take their reactions personally.

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3.2.6. Objectivity – treating all patients in the same way.

It is the duty of public bodies and their employees to promote equality.

Personal feelings about patients must not interfere with the standard of
your work. By law, you must provide all patients with high-quality care
which reflects their individual needs, whatever their race, sex, sexuality,
age, religious belief or disability3. This means that you owe patients a
‘duty of care’ and they can expect a ‘reasonable’ standard of care from
all workers.

And, it is important to maintain clear boundaries when caring for

patients. This means that you should always have a ‘professional’
relationship with your patients. If you have any strong feelings about a
patient’s religious, social or cultural beliefs, you should tell your manager
as soon as possible so they can take appropriate action.

How will I know if I'm 'working to standard' on objectivity?

When you're working to standard on objectivity, you'll be working to the

same high standard with every patient you work with. It should not
matter to you what the patient is like as an individual, what colour or
religion they are or how they live their life. You will see all patients as
worthy of your respect and best efforts.

3.2.7. Consideration and respect - making sure that patients are

always treated with dignity.

Consider and respect patients’ privacy to make sure that neither you nor
they are ever placed in an embarrassing situation.

How will I know if I'm 'working to standard' on consideration and

respect?

When you're working to standard on consideration, you'll always show

thoughtfulness for patients’ feelings and needs. You’ll protect patients to
make sure that they are never unnecessarily exposed to embarrassing
situations — whether in front of relatives, fellow patients or healthcare
workers.

3
The Disability Discrimination Act 1995 states you must make sure that disabled patients receive the same
quality of service as all other patients. You should be aware that this may mean you have to treat disabled
patients more favourably than you treat others to deliver an equal level of care.

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3.2.8. Consent - telling patients what you intend to do and listening
carefully to what they say about it.

Working in partnership with the patient at all times is a basic principle

that you must keep to at all times. Always explain to patients what you
intend to do with them, even when it is basic care or routine procedures,
and only continue with your planned work once the patient agrees to it.
You must check that this agreement is written in the patient records, and
you should report any concerns that the patient or a relative has to your
supervisor.

How will I know if I'm 'working to standard' on consent?

When you're working to standard on consent, you'll be demonstrating

that you will always make sure that the patient knows what you are
planning to do and is happy with it. If the patient cannot give consent for
themselves, because of their age or condition, you must always check
with a relative or a senior member of staff. If the patient or relative has
not agreed to what you plan to do, you must not do it. Always check
with a senior member of staff if you are in any doubt.

3.2.9. Confidentiality - protecting the patient's privacy.

Confidentiality is essential to protect the interests of patients. It is a main

feature of any code of conduct and of most terms and conditions of
service in a health-care environment. So you must make sure that you
don't give out personal information about patients, or about their
condition or treatment, to anyone other than colleagues in the team who
need to know the information to help in the patient's care. If you do not
protect the patient’s right to confidentiality, you may be breaking
data-protection laws. If you feel that a patient is at risk of harm, and that
you need to speak out, you should tell your supervisor. You should not
discuss patients with anyone out of work.

How will I know if I'm 'working to standard' on confidentiality?

When you're working to standard on confidentiality, you'll maintain a

professional attitude at all times when handling patient information and
you won’t 'gossip' about patients to anyone at any time. When you do
pass on information to a colleague as part of your job, you will take care
to be accurate and clear in what you say or write.

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3.2.10. Co-operation - working effectively with your colleagues as part
of a team.

Value the part you play in the team and respect the part played by other
members of the team.

How will I know if I'm 'working to standard' on co-operation?

When you're working to standard on co-operation, the contribution you

make to the team will be valued. You'll be communicating effectively,
sharing information and working to meet the team’s shared goals in the
best interests of the patient.

3.2.11. Protection – making sure you don't put patients and colleagues
at risk of harm.

Make sure patients, visitors and colleagues are protected from dangers
and risks and that nothing you do, or don’t do, results in harm or risk to
others.

How will I know if I'm 'working to standard on protection'?

When you're working to standard on protection, you'll know the dangers

patients and colleagues face at work and will do what you can to reduce
risks of accidents or harm. You will also make sure you report any
concerns you have to a supervisor to reduce risks in the future.

3.2.12. Development – trying to increase your own knowledge and skills

by talking to patients and colleagues and looking for opportunities to
learn.

If you are interested in your work and feel comfortable using the
knowledge you need to carry out your job, you will be able to offer a
better service to patients and you should feel more motivated as a result.

How will I know if I'm 'working to standard' on development?

When you're working to standard on development, you'll be taking every

chance you can to protect patient safety by improving the way you work.
This could be by attending a course, shadowing a colleague or listening
to feedback from patients. You'll continually monitor, evaluate and reflect
on what you do at work and try to do it to the best of your ability.

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3.2.13 Alertness - observing any changes that could affect a patient's
needs or progress.

Always try to notice when a patient isn't doing what you expect of them
and report your observations to an appropriate person.

How will I know if I'm 'working to standard' on alertness?

When you're working to standard on alertness, you will notice when

patients are 'just not right'. You'll notice, for instance, when the patient
can't move as well as usual or perhaps hasn't eaten their meal.
Reporting these observations will be in the best interests of the patient.

4. What this means for you

4.1. The code of conduct means that, as a health-care support worker,

you have a responsibility to work to standard. This means that you must
do the following.

4.1.1. Only do what your job description or specification allows you to

do. If you do something, or accept an instruction from another healthcare
worker to do something, that isn't within your job description or
specification or level of skill, you could be putting the safety of the
patient at risk and you could be disciplined. Let your manager or
supervisor know if you feel you are being asked to do something you
don't know how to, or something you know isn't in your job description or
specification.

4.1.2. It is within the code of conduct of all health-care professionals not

to delegate tasks unless they are sure that the person they are
delegating to has the skills and is happy to perform the task. The person
who delegates will remain professionally accountable for delegating the
task. However, if you accept the task, you will be accountable for how
well you perform it.

4.1.3. Make sure that you always follow the standard procedures for
carrying out tasks and duties.

4.1.4. Make sure that you obtain consent, in line with your organisation’s
policies, before doing anything to a patient.

4.1.5. Follow the rules on 'duty to care' (see paragraph 3.2.6). This
means you must always make sure patients and colleagues don't come

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to harm because of something you've done or something you have not
done, or because you've been careless or taken risks.

4.1.6. Making notes and keeping patients records up to date and

accurate is an essential part of care. You should only write down
information relevant to the care you have given to patients, and get an
appropriate person to sign the record in line with your organisation’s
policy. If you are not sure, ask for advice. As you are accountable for
anything you write, no matter how informal it might seem, what you write
can be used as evidence in any enquiry by your employer or the courts
in the future.

4.1.7. Raise issues you are concerned about with your line manager
where these relate to:

• how care is delivered

• the personal health, safety and security of patients or
• harm and abuse of patients.

5. Want to know more?

5.1. If you'd like to find out more about the issues in this code of conduct,
talk to your manager, supervisor, trade union representative or a
member of your relevant professional association. You could also have a
look at the following sources.

• The NHS Scotland Staff Governance Standard for NHS Scotland

employees.
• Blowing the Whistle - advice from the Royal College of Nursing on
how to speak up if you feel something is seriously wrong in your
workplace.
• The Duty of Care - a UNISON handbook to help health care staff
to carry out their duty of care to patients, colleagues and
themselves.
• The Nursing & Midwifery Council’s (and other professional
regulators) guidelines on records and record keeping. See
www.workinginhealth.com/standards for information on links to the
different regulatory organisations’ websites].
• Your organisation’s information on consent, confidentiality and
diversity and equality.

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Code of conduct for employees

Explanation of terms

Accountability – taking responsibility for what you do or do not do and

being able to give satisfactory reasons for all your actions and decisions
if asked to do so.

Advocacy – speaking out or acting to support the rights of a patient.

Alertness – being quick to see, understand and act in a particular

situation.

Awareness - taking a special interest in your patients and knowing

what is happening to them at any given time.

Confidentiality – not giving out information about patients to anyone

who is not on the team involved in their care. You must ask the patient
for consent before you can give out information in any other situation,
except where:
• it is essential to protect the patient or someone else from the risk of
significant harm or
• you are required by law or order of a court.

Consent – the patient must give consent voluntarily. You must give
them information about their condition and treatment which is accurate,
truthful and easy to understand. They must be able to understand the
information well enough to make an informed decision about their
treatment. If you are in doubt over a patient’s ability to give consent,
always check with a senior member of staff.

Consent (children and young people) – children under 16 can only

give consent if a qualified member of medical staff believes:
• they can understand information about their treatment and
• they can make an informed decision based on that information.

You should make sure you understand your organisation’s policies about
getting consent from children and young people.

Consideration – being kind to people and thinking about their feelings.

Co-operation - acting or working together for a particular purpose or

helping someone when they ask you to.

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Development – adding to your knowledge through learning.

Equality and diversity laws – the legal protection from discrimination

because of race, sex, sexuality, age, religious belief or disability.

Good character – by ‘working to standard’ on all the characteristics set

out in this code, you will be able to show that you are of good character.

Integrity – acting morally and honestly.

Objectivity – basing your actions on real facts and not being influenced
by your personal beliefs or feelings.

Protection - keeping patients and the public safe from injury, damage
or loss.

Respect - accepting the importance of someone’s rights or customs

and not doing anything that would harm them, or cause them offence.

Sensitivity – understanding what other people need, and being helpful

and kind to them.

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