Study findings suggest need for policy reconciliation between duty of care and promoting autonomy

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National policy in the UK surrounding the support of people with learning disabilities stresses the autonomy of people in receipt of support and the need for those who support them to maximise this. However, support workers also have a duty of care and can find these two policy objectives in conflict with each other. The researchers in this study set out to explore this potential conflict in relation to the support of people with Prader–Willi syndrome (PWS). Given the behaviours associated with PWS, the authors believed that this would clearly illustrate the potential tension between respect for autonomy and duty of care.

Using ethnographic methodology, the researchers carried out qualitative observations, semi-structured interviews and analysis of documents top look at the work of support workers in a residential group home.

They found that risk was central to care delivery at the home and that support workers often adhered to standardised risk management procedures. The provider organisation required support workers to promote independence. Many of the staff thought promoting the independence of service users was important. Some support workers deviated from standardised risk management procedures to allow service users a degree of independence as a way of managing the tensions between their differing duties

The authors conclude that there is clearly a tension between duty of care the recognition of autonomy at the level of service delivery in residential homes. Whilst the support workers in this study clearly attempted to manage this tension; the authors call for work at the level of provider organisations and national policy makers to help reconcile the duty of care with the duty to recognise service users’ autonomy.

Duty of care and autonomy: how support workers managed the tension between protecting service users from risk and promoting their independence in a specialist group home, Hawkins, R et al., in Journal of Intellectual Disability Research, 55: 873–884


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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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