Legislation and Guidance for Protecting Vulnerable Patients

Introduction

The author of this essay aims to answer two questions. Firstly, Describe the factors that may create a patient group that experiences vulnerability, inequality and discrimination. And secondly, as a registered Paramedic, how would you and your organisation protect the vulnerable patient? Describe the legislation and guidance that governs these actions. To achieve this the author will focus on the following patient groups. Ethnicity, gender, disability and social class. The author has chosen these subjects as he feels it is something the frontline paramedic has regular exposer to seeing both ends of the social class, multiple disability’s, genders and Ethnicity’s in their line of work. The author will explore the factors that can create these patient groups and then focus on the legislation relevant to an operational paramedic.

Part 1. Describe the factors that may create a patient group that experiences vulnerability, inequality and discrimination.

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in part one of this essay the author will go through individual groups that can make up patients that registered paramedics will attend on a day to day basis. The author will explain what each of these groups are and how vulnerability, inequality and discrimination could affect them. In part one the author will talk about ethnicity, Gender, disabilities and social class.

Ethnicity

According to the office of national statistics, there were approximately 64.6 million people living in the UK mid 2014. Of these 56.2 million (87.2%) were White British (Irr.org.uk, 2018) The UK is a multi ethnic society with large groups of Africans, Caribbean and south Asian communities originally from the commonwealth. (Vertovec, 2018) depending on what Ethnic back ground someone is from creates multiple issues in what they seek medical help for and their knowledge of available help for them. This lack of knowledge makes certain ethnic groups vulnerable and at risk of becoming sicker than if they were to seek help early on in their condition. Ethnic inequality was first recorded within the UK in 1845 with the poor health and high mortality rate of the Irish in England (Smith et al., 2018). this has risen over time with more ethnic groups moving to the UK.

Ethnic groups can be made to feel vulnerable as they may not have knowledge of what is considered wrong within British society and therefore be treated wrongly causing them harm. They can face discrimination in their local areas or in the workplace based on there ethnicity. Ethnic group could also be discriminated against by healthcare professionals, an example of this could be that due to a HCP (Health care Professionals) personal views or language barriers within a health care setting meaning that they do not receive the level of care they could.

Gender

Gender is described as either one of the two sexes (male or female). This is a group that paramedics daily meet within a healthcare setting. Either gender is subject to situations that can make them vulnerable. Alone female walking down an unlit street is no more vulnerable than a lone male. It is important for paramedics to realise that one gender is not more susceptible to vulnerability than another, be that physical vulnerability or emotional vulnerability. Paramedics should take in to consideration each patient equally and treat them accordingly.

Inequality and discrimination can also affect gender groups in several forms. Be this in the home where females are expected to complete certain tasks or are not allowed to take part in activities due to their gender. Or in the workplace where a male may be faced with discrimination. One such example would be a male nurse in a healthcare environment that is widely filled by females. Inequality affects genders in ways such as work place pay where some females get paid less than males for the same work.

Disabilities

Disabilities covers a wide range of conditions that can affect a person going about their day to day life. Disabilities can be either physical or mental. Although the general public widely recognise that a wheelchair user may be disabled, and paramedics will always be presented with someone who may have a disability. Most disabilities are not easy to spot straight away, and some patients may cope extremely well as it’s a condition they have come accustom too. Some disabilities are the ones listed below:

• Vision impairment
• Deaf or hard of hearing
• Mental health conditions
• Intellectual disability
• Acquired brain injury
• Autism spectrum disorder
• Physical disability

Peoples disability can make them susceptible to fall into the groups of discrimination inequality and vulnerability. People who suffer with Autism or other mental health conditions can become vulnerable due to people not understanding their condition and how it affects them and therefore treating them differently to others. people with physical disabilities can be affected by access to certain locations, a greater need to engage with health care professionals. Or not being given a job based on the disability you have i.e. not being shortlisted for a job because you are hard of hearing and therefore wear hearing aids is a form of direct discrimination.

Social Class

Social Class can be defined by the three following factors:

• economic factors (wealth, income, occupation)
• political factors (status, power)
• cultural factors (lifestyle, education, values, beliefs). (Equalitiesinhealth.org, 2018)

People with higher social economic position in society have a greater array of life chances and more opportunities to lead a flourishing life. They also have better health (The marmot review, 2010)

People with higher income are able to have better health care and receive treatment sooner on private healthcare as oppose to those on lower incomes who may have to wait longer or not be able to get specific treatment on the NHS.

Social class also takes into consideration as stated in point 3 peoples education lifestyles values and beliefs. This could mean patients not wanting certain procedures carried out as it is against their belief i.e. a Jehovah witness not wanting to receive a blood transfusion as it is against their belief.

As a registered Paramedic it is important that you protect vulnerable patients that you may encounter on a day to day basis while attending jobs. This is important as a lot of vulnerable patients contact the service in their time of need. The HCPC standards of proficiency states that a paramedic always needs to act in the best interests of service users (Standards of proficiency, n.d.).

All paramedics are registered health professionals through the HCPC (Health and care professions council). The HCPC has a code of conduct that states all paramedics must:

1. Promote and protect the interest of service users and carers.
2. Communicate appropriately and effectively.
3. Work within the limits of their knowledge and skills.
4. Delegate appropriately.
5. Respect Confidentiality.
6. Manage risk.
7. Report concerns about safety.
8. Be open when things go wrong.
9. Be honest and trustworthy
10. keep records of their work. (Standards of conduct, performance and ethics, 2016)

The author of this essay believes that the code of conduct holds all the essential aspects of safeguarding vulnerable patients and promoting equality for all of them. it ensures also that all paramedics follow the fitness to practise (Standards 8 and 9) and therefore act in a professional manner.

Standards 6 and 7 set out requirements for registered paramedics to ensure that any concern for a patient’s wellbeing is reported to the relevant agencies to protect that patient from harm or potential risk

Equality Act 2010

The equality act 2010 encompasses and applies to all aspects of employment, business, healthcare and education. The equality acts purpose is to ensure people are protected from discrimination both at work and in the wider society. At present the act protects nine specific groups against discrimination. They are age, race, sex, sexual orientation, gender reassignment, religion and belief, marriage and civil partnership and maternity and pregnancy (Nursing & Midwifery council,2016).

As a paramedic the patients that you might attend will be from lots of the groups stated above. A paramedic must treat patients fairly and without prejudice (HCPC,2016)

Mental Capacity Act (MCA) 2005

The Mental Capacity Act (MCA) 2005 applies to everyone involved in the care, treatment and support of people aged 16 and over living in England and Wales who are unable to make all or some decisions for themselves. The MCA is designed to protect and restore power to those vulnerable people who lack capacity (Scie.org.uk, 2018).

For a person to display capacity they must be able to display that:

• Understand the information relevant to the decision
• Use or weigh up that information as part of the decision making process
• Communicate their decision (whether by talking, using sign language, or by any other means)

A person is said to lack capacity in relation to a specific matter if at that time they are not able to make a decision for themselves due to an impairment or disturbance to brain or mind. Be that temporary or permanent (Legislation.gov.uk,2005)

Within the act are several safeguards set in place to protect the person concerned. These safeguards are as follows:

• The Presumption of capacity. Clinicians should presume that patients have capacity. They must be subsequently proved not to have capacity if this is the case.
• Reasonable steps must be made to assist the person concerned in making their own decision. Clinicians must support patients to make a decision where they have capacity to do so.

The Data Protection Act 1998 (DPA)

The data protection act 1998 (DPA) is an act set out by parliament in the United Kingdom which legislates the way in which information about living people may be used, handled and stored. The main purpose of the act is to protect people from the possible abuse or misuse of information personal to them (Rouse,2008).

Every day frontline paramedics are exposed to sensitive information. This can be from details passed to them on there mobile data terminals of jobs they are attending, medical records or information received from other health care professionals regarding to patients. It is therefore essential that paramedics are aware of how this information is used, handled and stored.

The act itself has specific set of principles to make sure information is:

• Used fairly and lawfully.
• Used for limited, specifically stated purposes.
• Used in a way that is adequate, relevant and not excessive.
• Accurate.
• Kept for no longer than is absolutely necessary.
• Kept safe and secure.
• Not transferred outside of the European economic area without adequate protection. (Legislation.gov.uk,1998).

It is the paramedics responsibility to ensure that the majority of the principles above are maintained. Standard 5 of the HCPC code of conduct states that registered paramedics should “respect confidentiality” (HCPC,2016)

Aspects of the principles set out that an individual paramedic would not be expected to maintain would be point 7 “Not transferred outside of the European economic area without adequate protection” this would fall down to the company/trust that the individual paramedic is employed by.

Humans right act (HRA) 1998

The human rights act is an act that became applicable in the UK in October 2000. The act states the basic rights and freedoms that everybody is entitled to. The act it self has 30 parts to it in total but some of the more relevant ones to paramedic practise are stated below.

• Article 2: the right to life. This ensures patients receive the right care and correct treatment to sustain life.
• Article 3: The probation of torture. This means any torture found would be reported by the health care professional and also that adequate measures where taken during care to ensure painful procedures were not done so without first giving sufficient analgesia.
• Article 5: the right to liberty and security. This allows the patient to decline treatment, or observations that they do not wish to be done.
• Article 14: The prohibition of discrimination. This ensures everyone is treated fairly and not discriminated against, enabling equal opportunity in regard to available healthcare.

Safeguarding Adults

A person in the United Kingdom over the age of 18 is legally classed as an adult. Adults can become vulnerable and at risk. The care act 2014 is about Protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances (GOV.UK, 2010)

As part of the care act 2014 there are 6 principles as below:

1. Empowerment People being supported and encouraged to make their own decisions and informed consent
2. Prevention It is better to take action before harm occurs.
3. Proportionality The least intrusive response appropriate to the risk presented.
4. Protection Support and representation for those in greatest need.
5. Partnership Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse.
6. Accountability and transparency in safeguarding practice (Scie.org.uk, 2017).

Safeguarding Children

The children’s act 1989 is made more robust by the children’s act 2004. The children’s act 2004 places a duty or responsibility on local authority’s and their partners to work in a multidisciplinary way. By the authorities working in this way the wellbeing of the children is better protected and promoted. Partners would include those such as health service providers, police and professionals from the voluntary sectors (NSPCC,2018).

Registered paramedics are duty bound by the health and care professions council (HCPC) code of conduct, government legislation and local policy’s to adequately safeguard and take appropriate action for a child that they believe to be at risk.

Conclusion

In conclusion the author of this essay set out to answer a two-part question. Part one was to talk about vulnerable patient groups. This essay concentrated on ethnicity, gender and disability’s, and then as a paramedic what would the author and his organisation do to protect the vulnerable groups. This essay has highlighted a small amount of some of the many vulnerable patient groups that paramedics will encounter on a day to day basis while operating on frontline ambulances. The author has then researched the legislation that is applicable to the patient groups mentioned above and believes that the code of conduct of the HCPC and the legislation laid out above rightfully protects these vulnerable patient groups as long as the paramedic follows it.

References

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