benchmarking tool - ehrc - home
TRANSCRIPT
page 2
Authors
Debbie Bannister
Laura Nicholson
Emma Ward
Amy Lee
Kulvinder Kaur
Richard Whitehead
Dr. Alex Cookson
Dr. Beth Greenhill
Also available:-
1) Keeping Me Safe and Well Risk Assessment
2) Human Rights Joint Risk Assessment and Management Plan
3) Speaking Up for Myself Group
4) Standing Up for My Rights Booklet
5) Accessible Information Pack
This manual is a Mersey Care NHS Trust publication and should not be reproduced without the authors’ permission. The manual
can however be printed and used clinically as part of a validation process. If you wish to take part in our validation project please
contact the authors below. The validation process will contribute to any further revisions to the document.
For further information and training opportunities contact:-
© <2008> Mersey Care NHS Trust. All rights reserved. This material may be copied for
use within NHS organisations only on the understanding that Mersey Care NHS Trust is
acknowledged as the developer of the material on all copies and that this copyright statement
is retained.
Contents
Introduction to Human Rights 3
Use of this tool 4
1. Human Rights Joint Risk Assessment and Management Plan (HR-JRAMP) documentation 4
2. Physical Intervention 6
3. Staffing 7
4. Health Action Plan and other health issues 8
5. Involvement 10
6. Essential lifestyle plan and daily living 12
7. Activities and employment 15
8. Housing (A) 17
9. Housing (B) 20
page 3
Introduction to Human Rights
The Human Rights Act was introduced into UK law in 1998, coming into force in 2000. It provides the legal framework by which
rights can be implemented. The Act means that all public authorities (including NHS Trusts and Social Services), have an obligation
to ensure that people’s rights are respected in all that they do. Public authorities also have a positive obligation to ensure that
people’s rights are not breached. Anyone who is a ‘victim’ under the Human Rights Act can claim a breach of their rights against a
public authority in UK courts, and through tribunals, hearings and complaints procedures.
Aside from legal obligations, the Human Rights Act provides public authorities with a base from which rights can be made real.
Taking proactive steps to promote human rights can improve the provision of services and ensure that service users are able to
enjoy their rights in a meaningful way.
Human rights are underpinned by a set of core values known as the ‘FREDA’ principles. These are:
Fairness
Respect
Equality
Dignity
Autonomy
These principles find their expression in a range of human rights laws. Human rights laws act as a vehicle for making these core
values real in people’s lives.
The rights are:
Article 2 – The right to life
Article 3 – The right not to be tortured or treated in an inhuman or degrading way
Article 4 – The right to be free from slavery or forced labour
Article 5 – The right to liberty
Article 6 – The right to a fair trial
Article 7 – The right to no punishment without law
Article 8 – The right to respect for private and family life, home and correspondence
Article 9 – The right to freedom of thought, conscience and religion
Article 10 – The right to freedom of expression
Article 11 – The right to freedom of assembly and association
Article 12 – The right to marry and found a family
Article 13 – N/A
Article 14 – The right not to be discriminated against in relation to any of the Right contained in the European Convention
Article 1 Protocol 1 – Right to peaceful enjoyment of possessions
Article 2 Protocol 1 – Right to education
Article 3 Protocol 1 – Right to free elections
In essence, employing a Human Rights Based Approach (HRBA) promotes a shared sense of entitlement, encourages personal
responsibility and upholds respect for the rights of others; whilst accounting for issues of equality and diversity.
If you are interested in learning more about Human Rights and how they are applied to healthcare, please refer to ‘Human Rights in
Healthcare – A Framework for Local Action’ (DOH, 2008).
page 4
Use of this tool
This tool assesses how human rights are being incorporated into the lives of people supported by ‘complex care pathways’. It
evaluates the extent to which a human rights based approach is taken by the services they use; whether these services are being
provided by health, local authorities, or private and voluntary sector organisations.
The tool should be completed on an annual basis, with the exception of Section 8 (Housing, Part B). This section should be
completed only when the service user is due to move accommodation, in order to assess the suitability of their first choice of
accommodation.
At the initial stage of the pathway, a Care Programme Approach (CPA) coordinator, social worker and manager of the package
should be identified to take responsibility for completing the tool. They should also be responsible for actioning any suggestions that
result from the evaluation, developing a plan, and setting the review date for the following year. These details should also be sent to
the commissioners of the package. Acceptable scores will vary between sections. There are also key questions (highlighted in red)
for which a score of ‘0’ will always require immediate attention, regardless of the overall score for the section.
Normative standards are in the process of being developed, against which complex care packages will be assessed at one, two,
and three years after the service user has returned to their local community. An acceptable level of human rights based thinking and
service user inclusion at year three will be greater than that expected in year one. It is hoped that all services will use the results of
this tool to highlight areas in which they can improve.
Figure 1: Progression of human rights based care
1. Human Rights Joint Risk Assessment and
Management Plan (HR-JRAMP) Documentation
During the completion of the HR-JRAMP, balanced decision making should be used to ensure that management strategies are
assessed in terms of the impact on the human rights of the service user and those directly involved with the service user. The
strategy should be proportionate to the risk. The NHS trust and local authority are accountable to ensure plans and strategies are
assessed in terms of human rights impact.
Service user involvement is essential in the development of risk management plans. This is crucial in maintaining the service user’s
right to respect for a private and family life, home and correspondence (Article 8). The service user should be given as much
independence as possible and be given the maximum choice. They should be supported in judging the potential harm and benefits
of risky behaviour and the intervention. In addition, the FREDA principles are likely to be applicable if service user is not being
treated fairly, or with dignity.
page 5
0 No Unacceptable.
1 Yes Service user not involved.
2 Yes The risk screen was individualised to promote
service user involvement.
0 No Human Rights guidelines were not consulted.
1 Yes Guidelines were consulted.
2 Yes Guidelines were consulted and this process was documented.
0 No Unacceptable.
1 Yes Service user not involved in development of plan.
2 Yes Service user involved in development of plan.
0 No Unacceptable.
1 Yes Service user not involved.
2 Yes Identified with service user.
0 No Unacceptable.
1 Yes Service user not involved in development.
2 Yes Service user involved in development and the
strategies are integrated into their care plan/CPA documentation.
0 No Staff/service user not consulted.
1 Yes Staff consulted.
2 Yes Service user involved through Essential Lifestyle Plan (ELP)
/Staying Well Plan/Advanced Statement.
0 No No strategy work has been completed with service user.
1 Yes Service user involved in development.
2 Yes Service user involved in development and this is integrated into
their care-plan/CPA documentation.
0 No There is no Advanced Statement
1 Yes Service user involved in development.
2 Yes Service user involved in development and this is integrated into
their care-plan/CPA documentation.
1 Was the Risk Assessment
completed within 6 weeks
of allocation?
2 Was the risk considered in
terms of relevant human
rights?
4 Have early warning signs of
challenging behaviour/mental
health relapse been identified?
3 If high levels of risk were
identified, has a HR-JRAMP or
Intermediate Risk Assessment
and Management Plan
(I-RAMP) been produced?
5 Are relapse prevention
strategies in place? (e.g. early
warning signs documented)
6 Have proactive and reactive
strategies been developed?
7 Has ‘Staying Well’ or other
coping strategy work been
completed with the service
user?
8 Has the service user made an
Advanced Statement?
Total score for section 6 /16
page 6
2. Physical InterventionPhysical intervention should be treated with caution as there is a very real risk of breaching a service user’s human rights.
Particularly relevant articles in terms of restraint include: the right to respect for private and family life (Article 8) and the right not to
be tortured or treated in an inhuman or degrading way (Article 3).
Article 8An important aspect of Article 8 is psychological and physical integrity. Restraint has the potential to breach article 8 if the service
user’s human rights are not considered. It must be ensured that any action of restraint is balanced and proportionate to the risk. The
least restrictive option must be used at all times and should be in accordance with the FREDA principles (i.e. the service user
should be treated with fairness, respect and dignity in the case of restraint). In regard to the items outlined below, article 8 could be
breached easily if for example the service user is not asked about their preference regarding physical intervention.
Article 3If restraint was very severe and used with excessive force (i.e. not proportionate to the risk), it could potentially be considered
inhuman or degrading treatment. If this is suspected, action should cease immediately because article 3 is an absolute right that
should not be compromised.
0 No Unacceptable.
1 Yes But not reassessed at appropriate intervals.
2 Yes Physical assessment carried out every 6 months.
0 No Unacceptable.
1 Yes But these were not recorded.
2 Yes Service user’s preferences are recorded and discussed as part
of the multidisciplinary team (MDT) but the intervention is
proportionate to the risk.
0 No Unacceptable.
1 Yes Physical intervention is only used as a last resort.
2 Yes Physical intervention is only used as a last resort and is always
the least restrictive and proportionate intervention. The service
user’s preferences are taken into account.
0 No None received – unacceptable.
1 Yes Staff receive appropriate Managing Violence and Aggression
(MVA) training.
2 Yes Staff receive appropriate Managing Violence and Aggression
(MVA) training with frequent refreshers.
0 No No de-briefing takes place.
1 Yes But there is no set protocol for this.
2 Yes There is a set protocol for this.
0 No No de-briefing takes place.
1 Yes But there is no set protocol for this.
2 Yes There is a set protocol for this.
1 Has a physical
assessment of the person
been carried out prior to
using physical intervention
strategies?
2 Has the service user been
asked about their
preferences regarding
physical intervention (e.g.
type, by whom)?
4 Are staff adequately trained in
the use of physical
intervention?
3 Is physical intervention always
used in the appropriate
context?
5 Is the service user de-briefed
after the use of physical
interventions?
6 Are the staff involved de-briefed
after the use of physical
interventions?
7 Other areas of concern / good practice (please give details below).
Total score for section 2 /12
page 7
3. Staffing
Service users should have as much autonomy as possible (e.g. being involved in choosing their staff team) and feel as though they
are treated with fairness and respect. For example, staff should be able to communicate effectively with the service user.
Staff need to be aware of what their responsibilities are in terms of the Human Rights Act. Empowerment is a key principle and
increasing staff awareness of human rights empowers staff and thus has a direct positive effect on the service user. Accountability
is also an important aspect of the human rights based approach. Staff are accountable for their work and need access to
appropriate supervision for support and advice. Having a procedure in place for service users to complain about actions of a staff
member is one way of ensuring accountability. Staff’s human rights will normally be respected by the balancing procedures outlines
in the HR-JRAMP.
Article 8When considering the staff team, the right to respect for private and family life is particularly important (Article 8). If the team are
based in the service user’s home they will have a significant impact upon their life. If for example, members of staff cannot
communicate properly with the service user, this may have a negative impact on their psychological integrity. It could also result in
the service user not being treated with respect and dignity.
Article 14Article 14: prohibition of discrimination comes into play for some aspects of staffing (e.g. around communication or any specific
training required). For example, If a staff team are working with a service user with autism but have had no training, it could be seen
as discrimination because staff will not be able work and communicate with them effectively.
0 No No human rights training takes place.
1 Yes Staff have access to written documents about human rights.
2 Yes Staff have received training in human rights.
0 No The service user is not involved.
1 Yes The service user plays a role in choosing their staff team.
2 Yes The service user is fully involved in the interview and selection
process, and receives training to help develop necessary skills.
0 No Unacceptable.
1 Yes There is a system in place through which the service user can
raise issues/concerns about staff members.
2 Yes The complaints procedure is discussed with the service user and
is available in an accessible format.
0 No No regular team meetings take place.
1 Yes Regular team meetings are held.
2 Yes Regular team meetings are held and the service user is invited to
attend for some or all of the meeting.
0 No Only when there is an incident or problem.
1 Yes Staff and MDT meet regularly but without service user
involvement.
2 Yes Staff and MDT meet regularly and the service user is invited to
attend all/part of these meetings.
0 No Unacceptable.
1 Yes Staff are regularly supervised.
2 Yes Supervision is provided by appropriately trained and skilled
senior staff.
1 Are all staff trained in human rights?
2 Is the service user involved in choosing
the staff team?
3 Are procedures in place for the service
user to complain about the actions of a
staff member?
4 Are regular team meetings available
for direct care staff?
5 Do direct care staff have regular contact
with the MDT (i.e. clinicians, project
manager and social services)
6 Are staff given regular supervision?
page 8
0 No Unacceptable
1 Yes CRB check complete and relevant mandatory training received
(or due to be received).
2 Yes And all staff have a good understanding of why such training and
checks are necessary.
0 No There is no training around the Mental Capacity Act.
1 Yes Some discussion of the MCA and DOLS included in training
sessions on other topics.
2 Yes Staff have received training focussing on the importance of the
MCA and DOLS.
0 No Staff have received no training in specific clinical areas relevant
to the service users.
1 Yes Staff receive relevant training.
2 Yes Staff receive relevant training and their training needs are
regularly reviewed and discussed in supervision.
0 No There are communication difficulties.
1 Yes Staff are aware of effective communication styles and the
importance of this.
2 Yes Staff are competent and effective communicators with the
person.
0 No No formal training given.
1 Yes Brief training given/covered in other training.
2 Yes Detailed training on alternative forms of communication has been
given.
0 No The process doesn’t encourage staff to learn from the incident.
1 Yes Documentation reminds staff to think how they could have acted
differently.
2 Yes Reflective practice of person-centred and human rights-based
approaches is encouraged in staff training and supervision.
0 No There is no policy – unacceptable.
1 Yes All staff are aware of whistle-blowing policies.
2 Yes All staff are aware of whistle-blowing policies and confident in
using them if the need arises.
7 Have staff been CRB checked and
completed relevant mandatory training
(including safeguarding Adults,
safeguarding children & trust/company
policies).
8 Have staff had training around the
Mental Capacity Act (MCA) and
Deprivation of Liberty Safeguards
(DOLS)?
9 Are staff provided with adequate training
to support the service user? e.g.
Training around:
• Autism
• Challenging behaviour
• Mental health
10Are staff aware of how to communicate
effectively with the service user?
11 Are staff aware of alternative forms of
communication? e.g.
• Non-verbal cues
• Challenging behaviour
• Self injury
• Social withdrawal
12Are staff encouraged to be
reflective when completing
critical incident forms?
13Are all staff aware of whistle-blowing
policies and confident to use them?
14Other areas of concern/good practice (please give details below)
4. Health Action Plan and Other Physical Health Issues.
When developing the Health Action Plan (HAP) and planning how to meet the service user’s health needs it is important to consider
the FREDA values and the Human Rights Act. Not having a HAP, for example, has the potential to impact on a number of rights. In
extreme cases, lack of consideration of health issues could breach the right to life (Article 2). The case studies highlighted in the
‘Death by Indifference’ report (Mencap, 2007) demonstrate how serious this is.
Article 8
Article 8, the right to respect for private life, is particularly relevant to this section as it includes a right to physical and psychological
integrity. If the service user is not supported with dignity, respect and autonomy with regard to personal hygiene for example, this
could impact on their right to respect for private life.
Article 3
Article 3, prohibition of torture and inhuman and degrading treatment, could be breached in extreme cases. For example, if a
service user is not supported with personal hygiene and is left in a wet bed for prolonged periods, or if PRN is given without
consent of the service user when there is no protocol in place.
Article 14
If appropriate procedures are not in place, the right not to be discriminated against (Article 14) could potentially be breached
alongside another right, such as the right to respect for private life. This could occur if the service user is unable to access
appropriate health checks, health advice or intervention because of their learning disability.
Total score for section 3 /26
page 9
0 No Unacceptable.
1 Yes Service user not involved in development.
2 Yes Service user involved in development.
0 No This is not discussed.
1 Yes Personal hygiene is discussed in a sensitive manner with the
service user by members of staff who understand these issues.
2 Yes Steps are also in place to support self esteem and promote
independence in this area.
0 No This is not discussed.
1 Yes Discussion only.
2 Yes And information in an appropriate format has been provided for
the service user to keep.
0 No This is not discussed.
1 Yes The benefits have been informally discussed.
2 Yes These have been informally discussed and information has been
provided in an appropriate format.
0 No Such alternatives have not been considered.
1 Yes Medication is the dominant form of treatment but therapeutic
approaches are regularly attempted.
2 Yes Therapeutic approaches are used as a longer term strategy to
support the service user in managing their challenges.
Medication is used rarely, but appropriately.
0 No Unacceptable
1 Yes and the protocol is followed and regularly reviewed
2 Yes The protocol is followed, reviewed and the service user can
Or N/A access it or not applicable because the service user does not
have PRN medication.
0 No Unacceptable.
1 Yes This has been discussed with the service user.
2 Yes This has been discussed and the information has been provided
Or N/A in an accessible format. Where appropriate, the service user has
control over taking their medication.
0 No Unacceptable.
1 Yes Staff receive relevant training.
2 Yes Staff receive relevant training and their training needs are
regularly reviewed.
1 Has a Health Action Plan been
produced, and updated within the last
12 months?
2 Is the service user supported as
necessary to understand the
importance of personal hygiene and
do staff understand what poor
personal hygiene may mean to the
person e.g. mental health concerns/
abuse?
3 Have sexual health issues and
contraception been discussed with
the service user?
5 Have therapeutic approaches (e.g.
psychological therapy, aromatherapy,
massage) been considered, for use
instead of or in addition to medication
(in particular, PRN medication used to
control behaviour)?
6 Is there a PRN protocol?
7 Is the service user aware of any
medication they take, what it is for,
and any possible side-effects it might
have?
8 Do staff who administer medication
receive training on what different
medication is for, the possible side-
effects, etc?
4 Is the service user aware of thebenefits of a healthy lifestyle? E.g.
• Healthy eating• Regular exercise• Impact of smoking and excessive
drinking
9 Other areas of concern/good practice (please give details below)
Total score for section 4 /16
page 10
5. Involvement and Confidentiality
The service user should be given as much autonomy, choice and independence as possible. The principle of accountability is also
important. In this context accountability involves service users being able to complain about aspects of their care. In order to
promote involvement, complaints procedures should be easy for service users to follow. Additionally, it is best practice to ensure
that complaints procedures adhere to the principles of a fair trial because otherwise the right to a fair trial (Article 6) could
potentially be breached. This is true of both the person making the complaint and the person being complained about.
It is important to empower service users so that they know what their rights are and how to claim them.
Article 8
Article 8, the right to respect for private and family life is especially important in this section as it covers being involved in decisions
about your own life. Service users are better able to be involved in decisions if they have information and correspondence in an
accessible format. If a service user’s citizenship is not encouraged or their documentation is not kept confidential Article 8 could
also be potentially breached.
Article 14
If the service user has not been granted access to documents such as their HR-JRAMP or their Essential Lifestyle Plan because
they have a learning disability, Article 14, the right not be discriminated against, could potentially be breached alongside their right
to respect for their private life.
0 No Not involved in any relevant meetings.
1 Yes Attended or invited to attend some relevant meetings.
2 Yes The service user makes an informed decision about attending
i.e. staff explain the purpose of the meeting and who will be
present etc. Where appropriate, the service user leads the
meetings and sets the agenda.
0 No Not informed about the existence of these groups.
1 Yes Informed briefly about these groups, but showed little interest in
attending
2 Yes The service user has been fully informed about these groups
and their potential benefits, with information provided for them
to keep as well as verbal information. They are supported to
attend a group if they wish to.
0 No They are unaware of their rights.
1 Yes An attempt has been made to explain the issue of the Service
User’s human rights to them.
2 Yes The Service User’s human rights have been discussed with
them, and a staff member has worked through the Human
Rights Act in an appropriate format, with the Service User
keeping this information.
1 Has the service user been involved
in relevant meetings?
2 Has the service user been invited to
a group to learn about their rights?
3 Is the Service User aware of their
human rights?
page 11
0 No Unacceptable.
1 Yes If the service user raised an issue with their care plan it would
be discussed.
2 Yes Positive and negative aspects of the package are regularly
discussed with the service user.
0 No Unacceptable.
1 Yes But reviews generally do not lead to changes unless problems
are highlighted.
2 Yes And reviewers are proactive in aiming to identify areas in which
the service user’s independence could be promoted.
0 No Not asked.
1 Yes Asked once.
2 Yes This is regularly reviewed
(e.g. each time a new service is involved).
0 No The person has no access.
1 Yes The service user has a copy of these documents.
2 Yes The service user has a copy in an appropriate format
(e.g. easy read).
0 No Unacceptable.
1 Yes Only staff or the service user are able to access these
documents.
2 Yes The importance of confidentiality is fully understood by both
staff and service users and support is provided to store these
documents in a secure place.
0 No The service user does not have any of these things.
1 Yes The service user has some of these things.
2 Yes The service user has all of these things or there are
demonstrable reasons why they do not, which have been
discussed with the service user.
4 Is there a way for the service user
to complain about or express
disagreement with their care plan?
5 Is the amount of support offered to
the service user reviewed at least
every 12 months? (i.e. to facilitate
increasing independence)
6 Has the service user been asked
whether they wish to receive
letters? (e.g. from health, social
services)
7 Does the service user have access
to the following documents?
• HR-JRAMP (if appropriate)
• Health Action Plan
• Essential lifestyle plan (ELP)
8 Is the confidentiality of the above
documents maintained?
9 Is the service user’s citizenship
encouraged? E.g.
• Passport
• Utility bills in their name
• Bank account in their name
• Registered on the electoral role
10Other areas of concern/good practice (please give details below)
Total score for section 5 /18
page 12
6. Essential Lifestyle Plan and Activities
When developing an Essential Lifestyle Plan (ELP) it is important that the FREDA principles and the Human Rights articles are
considered. The FREDA principles are relevant in all items in this section as generating an ELP involves treating service users with
respect and dignity and ensures they have autonomy in their daily lives and future. Meaningful involvement and participation of
service users in decisions about their lives is a particularly important and including the individual in the development of their ELP is
one way to make sure this occurs.
Article 8If the service user does not have (or is not involved in completing) an ELP, there is a very real possibility that their right to respect of
a private and family life could be breached. Article 8 is applicable to a range of issues that are relevant to service users’ daily lives,
including relationships, independent living, visits, diet, cultural and religious practices etc. It is important that plans are in place and
service users are involved in completing these plans in order to ensure that their choices and wishes are reflected. Furthermore,
staff need to make sure they are respecting service users’ wishes and enabling them to carry them out on a day to day basis.
Article 14Respecting and facilitating a service user’s cultural, religious, sexual, gender and political needs in their ELP is one way to ensure
that article 14: the right to be free from discrimination is not breached alongside the right to respect for private life.
page 13
0 No Unacceptable
1 Yes Service user not involved in development.
2 Yes Service user involved in development.
0 No Not involved in any of these decisions.
1 Yes Involved to some extent in some of these decisions.
2 Yes The service user is fully involved in all decisions affecting their
day-to-day life – they are supported by staff to understand the
issue involved, make their own informed decision, and
understand the eventual outcome.
0 No There is no information provided about this.
1 Yes Service user has been informed verbally of the appropriate
method.
2 Yes Service user has been informed about this verbally and been
provided with information in an appropriate format which they can
keep.
0 No Unacceptable
1 Yes The service user is treated with dignity and respect at all time
2 Yes The service user is treated with dignity and respect at all times;
they are involved in making decision to the maximum of their
ability.
0 No Unacceptable
1 Yes Partly met – for example the service user’s mail is private but the
telephone is in a public place.
2 Yes The service user’s mail and conversations are considered private
and the telephone is in a private place.
0 No There are set times for snacks.
1 Yes The service user is able to have drinks and snacks on request.
2 Yes And they can access these facilities independently.
1 Has an ELP been developed?
2 Is the service user involved in
decisions that affect their
day-to-day life?
3 Is the service user aware of how
they can raise issues with their
support?
4 Is the service user treated with
dignity and respect in terms of their
appearance? (i.e. if clothes are
chosen for them, are they well-
fitting and appropriate, regular
haircuts, shaving, etc)
5 Is the service user treated with
dignity and respect in terms of
day-to-day communication? (e.g.
conversations, privacy of post)
6 Is the service user able to have
drinks and snacks when they
wish?
page 14
0 No Set meals are provided
1 Yes The service user can choose from a list of options.
2 Yes The service user is supported to contribute to planning their
weekly menu and can make their own meals/there is an
opportunity to do this if appropriate.
0 No This issue has not been assessed.
1 Yes or No Kitchen access has been assessed but the decision has not
been revisited.
2 Yes or No This issue has been thoroughly assessed and the conclusions
drawn have been acted upon. The appropriateness of kitchen
access for the service user is also re-evaluated at regular
intervals.
0 No This is not considered.
1 Yes There is no system in place for this, but if the service user asks
to do this, it is facilitated.
2 Yes The service user is encouraged and supported to undertake
domestic duties if appropriate.
0 No This is not considered necessary.
1 Yes Staff support the service user with their sexuality and intimate
relationships and to be safe.
2 Yes Staff support the service user with their sexuality and intimate
relationships and to be safe. Staff are responsive, respectful
and aware that their own values might affect the service user.
0 No There are no private areas available/there is a blanket policy
that all visits are supervised.
1 Yes The service user has partial privacy but full privacy has not
been considered.
2 Yes or No The service user can have full privacy during visits.
or
Where necessary, visits are supervised but this is due to
specific risks to the service user or their visitors and this is
regularly reviewed.
0 No The service user has not been asked about this.
1 Yes The service user is supported to attend some religious
meetings/festivals, but this is not always possible.
2 Yes The service user has been asked about their spiritual needs
and their preferences are acted upon at all times (if
appropriate)
0 No This is not considered.
1 No The service user has been asked about their needs and their
preferences.
2 Yes The service user has been asked about their needs and their
preferences are acted upon at all times.
7 Is the service user involved in
choosing their meals?
8 Does the service user have
access to a kitchen?
9 Can the service user undertake
household tasks if they wish? (in
order to increase their
independence and skills in daily
living)?
10Is the service user offered advice
and support with sexuality,
relationship and intimacy issues?
11 Does the service user have
privacy during visits if
appropriate?
12 Is the service user supported to
attend religious meetings /
celebrate religious festivals if
appropriate?
13 If desired, is the service user
able to access services specific
to their individual needs? (e.g.
cultural groups, gender specific
groups)
page 15
0 No This has not been considered. Unacceptable.
1 Yes or No The service user has access to their money or their access is
legally restricted. These decisions are not regularly reviewed.
2 Yes or No Staff actively support the service user to develop increasing
financial independence (e.g. the service user has their own
bank account).
Or
Staff restrict the service user’s access to their money for well
documented risk reasons/the service user has an appropriate
appointee. There are regular reviews of these decisions.
0 No This is a blanket policy about specific items.
1 No Access to some items is restricted for well documented risk
reason. This is not regularly reviewed.
2 Yes The service user has free access to their belongings unless
there is a current risk, this is regularly reviewed and all
decisions are well documented.
14 Is the service user supported to
manage her/ his own money?
15 Does the service user have
free access to his/her own
belongings?
16 Other areas of concern/good practice (please give details below)
7. Activities and Employments
It is important that service users are able to participate in the life of the community through accessing education, community groups
and activities. As well as having a direct impact on human rights, this also prompts consideration of the FREDA principles. The
service user should have as much choice, independence and autonomy as possible in regard to their chosen social
activities/employment. They should also be treated fairly. If the service user does work for example, they should not be exploited
and should be paid an appropriate wage. Ensuring that service users are given a choice in activities is important to enable
autonomy and empowerment.
Article 8Article 8, the right to respect for private and family life, is particularly relevant as it includes respect for meaningful participation in
the community, learning new skills and having access to a range of activities – and being able to make choices about employment
and activities.
Article 14If the service user is denied the opportunity to participate in the community or gain suitable employment for the fact that they have a
learning disability, Article 14, the right not to be discriminated against will be compromised alongside the right to respect for private
life.
Total score for section 6 /30
page 16
0 No No opportunities are available.
1 Yes The service user is taught new skills as the need arises.
2 Yes The service user is actively involved in discussions about what
new skills would be beneficial.
0 No No opportunities are available.
1 Yes The service user has the opportunity to access education.
2 Yes The service user is supported to access education if they wish
to (this is regularly discussed). The education is meaningful
and beneficial to the service user.
0 No Unacceptable
1 No Staff have considered these opportunities, but decided that it
was inappropriate for the service user.
2 Yes the service user is involved in one or more of these activities or
the service user is not involved in these activities, but they
have been discussed, and the service user has decided that
they do not wish to take part.
4 Is the service user currently
learning new skills or
competencies?
5 Does the service user have
access to appropriate
educational opportunities?
6 Is the service user involved in
the community? E.g.
• Do they have a job in the
community?
• Are they involved in education
in the community?
• Do they undertake voluntary
work in the community?
• Do they attend community
groups?
7 Other areas of concern/good practice (please give details below)
0 No They have no choice in the activities available.
1 Yes The service user is able to choose which activities to partake in
from those on offer.
2 Yes The service user is supported to access activities other than
those typically on offer (should they wish to) and attempts are
made to engage the service user in new things.
0 No Not discussed.
1 Yes Employment opportunities have been explored briefly.
2 Yes The service user has been supported by staff to fully explore
the possibility of employment.
0 No No pay received.
1 Yes Tokenistic pay received.
2 Yes Full pay received or N/A.
1 Is the service user given a
choice of activities?
2 Have employment opportunities
been explored with the service
user?
3 Are they given adequate pay for
any employment undertaken?
Total score for section 7 /12
page 17
8. Housing (A) (To be completed annually with sections 1-6.)
The Human Rights Act does not include an explicit article relating to a ‘right to housing’, although article 8 includes a right for
respect for the home you already have. A ‘home’ can include hospitals, care homes and in-patient settings if a service user has
been living there for a significant period of time. It certainly includes supported housing.
The FREDA principles need serious consideration when dealing with housing issues. For example, it is necessary to ensure service
user inclusion in decisions relating to where they want to live and how they are supported within their home (e.g. does the service
user have access to help and information regarding housing?).
Article 8 A right for respect for home is clearly pertinent, for example, is the place where the service user lives respected as their home by
support staff and other professionals?
Article 8 also highlights that a person should be given privacy within their home and personal life, which includes whether bathroom
doors can be shut and if the service user can have privacy to speak to friends and relatives.
Article 5 It is possible that the right to liberty could be implicated in housing issues if there are locks or security devices placed on doors or
windows to prevent the service user leaving their home.
page 18
0 No Unacceptable
1 Yes There are some aids in place, but more would be beneficial.
2 Yes The house or fittings have been adapted accordingly or N/A
0 No This has not been considered
1 Yes Some of the information is available in an appropriate format.
2 Yes All information is available in an appropriate format.
0 No This issue has not been considered with respect to the service
user in question (e.g. CCTV may be used despite the fact that
it is not necessary for this service user).
1 Yes This issue has been considered with respect to the service
user in question, and a compromise has been reached (e.g.
CCTV in communal areas only if necessary)
2 Yes No CCTV is used or CCTV is used only as a direct result of a
threat either to the service user or from the service user to
another individual. All other methods of reducing this threat
were exhausted before the introduction of CCTV, and this issue
has been discussed with the service user.
0 No This has not been considered
1 Yes The tenancy agreement has been discussed with the service user
2 Yes The tenancy agreement has been discussed with the service user
and they have been given an easy-read version of the agreement
to keep.
0 No This issue has not been considered.
1 Yes This has been considered or discussed with the service user, but
is inconsistently implemented
2 Yes This has been fully considered and discussed with the service
user, and the service user’s preferences are fully met.
0 No This has not been considered.
1 No This has been considered appropriate for well documented
reasons and is regularly reviewed. The service user is aware of
the reasons.
2 Yes But this is regularly reviewed. The service user is aware that this
is under regular review.
0 No This has not been considered
1 Yes The service user is involved in decisions about their bedroom.
2 Yes or N/A Decisions for the house were fully informed by the service user.
0 No Visits are not facilitated
1 Yes But there are some restrictions (e.g. restrictions on visiting times,
staff must be present, prior arrangements necessary, doors left
ajar). These reasons are documented.
2 Yes Visiting times are fully flexible and visits can be arranged for
people who live far away.
1 Have the service user’s physical
mobility and sensory impairment
needs been considered?
2 Is information within the house
provided in an appropriate
format (e.g. Braille, easy-read,
minority languages)?
3 Is the service user’s privacy
respected by refraining from the
use of CCTV?
4 Is the tenancy agreement
accessible to the service user?
5 Is the tenancy respected as the
service user’s home? (E.g. do
staff and the service users use
the same facilities and do staff
always knock before entering
the service users bedroom?
6 Does the service user have a
house key or the code for the
door?
7 Is the service user involved in
decisions about decoration and
furnishings?
8 If they wish to, can the service
user receive visitors at any time?
page 19
0 No Unacceptable
1 Yes There is written information available/advocacy has been
discussed with the service user.
2 Yes An advocate has visited the service user to discuss the service
that they offer.
0 No Unacceptable
1 Yes But this has not been discussed with the service user.
2 Yes This is discussed with the service user and is available in easy-read.
0 No Unacceptable
1 Yes The service user was not involved
2 Yes The service user was involved
0 No Unacceptable
1 Yes The service user has been informed of this.
2 Yes The service user was involved in developing this process and fully
understands the conditions of their tenancy including potential reasons
for eviction.
9 Has the service user been told
about advocacy services?
10 Is there a procedure for making
complaints, suggestions and
changes and are these acted
upon?
11 Have steps been taken to
ensure reduction in the service
user’s vulnerability to
discrimination in the community?
12 Is there a clearly defined
tenancy agreement including the
process for eviction?
13 Other areas of concern/good practice (please give details below)
Total score for section 8 /24
page 20
9. Housing (B) (To be completed only when choosing new accommodation with regard to first choice.)
0 No No service specification has been written or none of the documents
listed were taken into account when writing it.
1 Yes Some of the documents listed were taken into account.
2 Yes All of the documents listed were taken into account.
0 No Unacceptable
1 Yes The service user has been asked for their views regarding the
accommodation.
2 Yes The service user’s preferences have played an important role in
decisions and have been met where appropriate.
0 No This has not been considered
1 Yes The service user has been asked for their views regarding the location.
2 Yes The service user’s preferences have played an important role in
decisions.
0 No This has not been considered
1 Yes The service user has been asked for their views regarding housemates.
2 Yes The service user’s preferences have played an important role in
decisions and have been acted on where appropriate.
0 No This has not been considered
1 Yes The service user will be able to meet housemates and staff before the
move.
2 Yes The move will be undertaken in stages with the service user spending
time with their new staff before moving and their old staff after moving.
If possible the service user will also stay overnight before the move.
0 No This issue has not been considered with respect to the service user in
question (e.g. CCTV may be used despite the fact that it is not
necessary for this service user).
1 Yes This issue has been considered with respect to the service user in
question, and a compromise has been reached (e.g. CCTV in communal
areas only if necessary)
2 Yes No CCTV is used or CCTV would be used only as a direct result of a
threat either to the service user or from the service user to another
individual. All other methods of reducing this threat would be exhausted
before the introduction of CCTV, and this issue would be discussed with
the service user.
0 No Unacceptable
1 Yes The house will need some adaptation in order to meet the service user’s
needs.
2 Yes The house needs no adaptation / all adaptations have already been
made.
0 No This has not been considered
1 Yes Some of the information is available in an appropriate format.
2 Yes All information is available in an appropriate format.
1 Has a service specification beenwritten that takes into account:• HR-JRAMP• Essential Lifestyle Plan• Health Needs Assessment• Pro-active and reactive
strategies• Early warning signs of relapse
2 Has the accommodation on offerbeen discussed with the serviceuser and their preferences takeninto account?
3 Have the service user’spreferences regarding locationbeen considered?
4 Have the service user’spreferences regardinghousemates (e.g. gender, age)been considered?
5 Will the service user beintroduced to housemates andstaff before the move?
6 Is the service user’s privacy berespected by refraining from useof CCTV?
7 Have the service user’s physicalmobility and sensory impairmentneeds been considered?
8 Is information within the houseprovided in an appropriateformat (eg Braille, easy-read)?
page 21
0 No Unacceptable
1 Yes Service user not involved.
2 Yes Service user involved.
0 No Visits are not facilitated
1 Yes Visits are facilitated when possible/appropriate
2 Yes Visits are facilitated when requested and visiting time are flexible
according to risk assessments
0 No This is an out of area placement so transport would be difficult.
1 Yes If appropriate, the service user will be able to have access to family
and friends.
2 Yes If appropriate, staff will facilitate access to family and friends.
0 No Visits will not be facilitated.
1 Yes But there will be some restrictions (e.g. restrictions on visiting times,
staff must be present, prior arrangements necessary, doors left ajar).
These reasons are documented and explained to the service user.
2 Yes Visiting times will be fully flexible and visits can be arranged for people
who live far away.
13 Other areas of concern/good practice (please give details below)
9 Have steps been taken toensure reduction in the serviceuser’s vulnerability todiscrimination in the community?
10 Will the service user besupported to visit family andfriends/receive visitors at anytime?
11 Will the service user haveaccess to family and friends (i.e.is the accommodation close tofamily)?
12 Will the service user be able toreceive visitors at any time?
Total score for section 9 /24
page 22
10. Additional Factors
It is important to consider any relevant life events or deterioration in physical or mental health and their potential impact on this
assessment. This may include bereavement, recurrent episodes of psychosis or physical health concerns. Please use the space
below to write any additional relevant information.