26,99 €
Mehr erfahren.
- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Fundamentals
- Sprache: Englisch
Fundamentals of Care is an accessible introductory textbook for all health care assistants; assistant practitioners and social care support workers who are undertaking the newly introduced, mandatory Care Certificate, as well as offering a resource for providing care and support. Practically focused, each chapter begins with the outcomes associated with each standard, which helps contextualise and focus the reader on the content and relevance to the Care Certificate. The book also includes exercises to encourage the reader to stop, look, listen and act, thinking cap activity promotes further thinking and application to care and support provision along with case studies and resource files. Written to help the reader come to terms with the role and function of the heath and care assistants, Fundamentals of Care offers support to those undertaking the Care Certificate and to assist those who already work as health and care assistants, helping them in their quest to enhance safe and effective care.
Sie lesen das E-Book in den Legimi-Apps auf:
Seitenzahl: 499
Veröffentlichungsjahr: 2017
Ähnliche
Table of Contents
Cover
Title Page
Preface
The chapters
What’s in a name?
Reference
Acknowledgements
How to use your textbook
Chapter 1: Health and social care provision in the UK
Introduction
An historical view
The NHS in the four countries
Provision of services
Regulation and monitoring of services
Professional regulation
Primary care services
Secondary care services
Tertiary care services
Ambulance trusts
Mental health trusts
Community health services
Social care and support
Assessment of care needs
Assessment of health needs
Chapter summary
Chapter 2: Working with others, teamwork
Introduction
Teamworking
Teams and teamworking
Team dynamics
Barriers to effective teamworking
Conflict
Chapter summary
Chapter 3: Understanding your role
Introduction
Who are you?
Job description
Agreed ways of working
Policies and procedures
Codes of conduct
Responsibility
Accountability
Delegation
Relationships
Chapter summary
Chapter 4: Your personal development
Introduction
Lifelong learning
How learning takes place, learning styles
Strategies to help with learning
Personal development plans
Appraisal
Your personal development plan
The personal development portfolio
Supervision
Training and development
Core learning
Giving and receiving feedback
Chapter summary
Chapter 5: Duty of care
Introduction
Duty of care
Your duty of care
Concerns
Promoting independence
Providing information
The constitution, complaints, comments and compliments
Raising concerns
Untoward incidents
Negligence
Conflict
Responding to conflict
Chapter summary
Chapter 6: Equality and diversity
Introduction
Legislation
Equality duty
Human Rights Act
Defining terms
Labelling, stereotyping and prejudice
Inequality
People with learning disabilities and those with mental health problems
Cultural sensitivity
Chapter summary
Chapter 7: Working in a person‐centred way
Introduction
Working in a person‐centred way
Person‐centred values
Enabling
Coordinated care
Personalised care
Person‐centred planning
Supporting people
Advanced care planning
The environment of care
Minimising discomfort, distress or pain
Responding to a person’s discomfort
Self‐esteem
Personal identity
Promoting wellbeing, identity and self‐esteem
Chapter summary
Chapter 8: Communication
Introduction
Care, compassion and communication
Communication
Types of communication
Verbal communication
Non‐verbal communication
Working in teams
Communication and language needs
Communication aids
Barriers to effective communication
Strategies to reduce barriers to communication
Preserving confidentiality
Chapter summary
Chapter 9: Privacy and dignity
Introduction
Protecting information
Disclosure
Implementing respect, privacy and dignity
Informed choice and choosing options
Assessing risk
Equality and diversity
Promoting independence
Chapter summary
Chapter 10: Fluids and nutrition
Introduction
Food and drink safety
Protecting people
Personal protective equipment in food hygiene
Nutrition and hydration
The Eatwell plate
Hydration
Poor hydration and nutrition
Helping people with their nutrition and hydration
Chapter summary
Chapter 11: Awareness of mental health, dementia and learning disability
Introduction
Mental health conditions
Service provision
Depression
Anxiety
Bipolar disorder
Psychosis
Dementia
Learning disabilities
The social model of disability
Assessing and making a diagnosis
Mental capacity
Assessing capacity
Chapter summary
Chapter 12: Safeguarding adults
Introduction
Safeguarding
Types of harm and abuse
Safeguarding vulnerable adults: the principles
A person‐centred approach
Safeguarding Adults Boards
Identifying and managing risk
Suspected or disclosed abuse
Reporting concerns
Chapter summary
Chapter 13: Safeguarding children
Introduction
Safeguarding and welfare
Child abuse and maltreatment
Impact of parents or carers on a child’s health and wellbeing
Types of abuse
Physical abuse
Emotional abuse
Sexual abuse
Neglect
Radicalisation
Trafficking
Female genital mutilation (FGM)
Gang abuse
Children and social media
The rights of the child
What to do if you have concerns of suspected or alleged abuse
Escalating concerns
Chapter summary
Chapter 14: Basic life support
Introduction
The heart
The lungs
Basic life support
The AVPU scale for checking a response
Cardiopulmonary resuscitation (CPR)
Airway obstruction
Documentation
Automatic external defibrillators
Chapter summary
Chapter 15: Health and safety
Introduction
The law
Health and safety policies
Hazards in the workplace
Workplace hazards
Working with hazardous substances
Reporting health and safety hazards
Risk assessment
Accidents and incidents
Medicines
Moving, handling and assisting
Fire safety awareness
Working safely
Managing stress
Chapter summary
Chapter 16: Handling information
Introduction
Key legislation
The electronic patient record
Making concerns known
The use of social media
Chapter summary
Chapter 17: Infection prevention and control
Introduction
Roles and responsibilities
Transmission of infection
The chain of infection
Breaking the chain
Safe disposal of waste
Sharps disposal
Safe management of laundry
Personal protective equipment (PPE)
Chapter summary
Chapter 18: Questions you always wanted to ask
Introduction
Chapter summary
Annotated bibliography
Index
End User License Agreement
List of Tables
Chapter 01
Table 1.1 NHS values and the NHS constitution
Table 1.2 UK professional regulators
Table 1.3 Some professionals who deliver primary care
Table 1.4 The care plan
Chapter 02
Table 2.1 Teamworking
Table 2.2 Some barriers to effective teamworking
Chapter 03
Table 3.1 Considerations prior to delegating
Table 3.2 Strategies that can help you to maintain professional boundaries
Chapter 04
Table 4.1 Some examples of evidence that can be included in a personal development portfolio
Table 4.2 The appraisal checklist
Table 4.3 Some training and development opportunities
Table 4.4 Some of the principles of helpful feedback
Chapter 05
Table 5.1 Events, errors, near misses and incidents
Table 5.2 Some tips on how to manage conflict
Chapter 06
Table 6.1 Some elements of legislation that impact on the role and function of the health and care worker
Table 6.2 The nine main pieces of legislation that have merged to become the Equality Act 2010
Table 6.3 Protected characteristics
Table 6.4 Examples of labelling, stereotyping and prejudice.
Chapter 07
Table 7.1 Working in a person‐centred way
Table 7.2 The principles associated with person‐centred values
Table 7.3 Health Foundation’s four principles that underpin person‐centredness
Chapter 08
Table 8.1 Factors that can have a detrimental impact on effective communication
Table 8.2 Indicators to support best practice for communicating
Chapter 09
Table 9.1 Respect and dignity
Table 9.2 Some of the ways the health and care worker can promote a person’s dignity
Chapter 10
Table 10.1 Components of a balanced diet
Table 10.2 Some signs, symptoms and consequences of malnutrition
Table 10.3 Some equipment available to support people in eating and drinking independently
Chapter 11
Table 11.1 Mental health statistics
Table 11.2 Some physical symptoms that people with depression may experience
Table 11.3 Some treatment options for depression
Table 11.4 Psychological, physical and behavioural symptoms associated with anxiety
Table 11.5 Some symptoms associated with dementia
Table 11.6 Two most common causes of dementia
Table 11.7 Degrees of learning disability
Table 11.8 Some barriers that can prevent people with a disability from living independently
Table 11.9 Legal frameworks and policy and guidance
Table 11.10 Principles to be followed when assessing capacity
Chapter 12
Table 12.1 Types of abuse
Table 12.2 Principles of safeguarding adults
Table 12.3 Issues that should be considered when a person discloses
Table 12.4 Immediate action to be taken if you see abuse or if abuse is disclosed to you
Chapter 13
Table 13.1 An overview of some elements of relevant legislation that may impact on the welfare of children
Chapter 14
Table 14.1 The DRSABCD acronym
Table 14.2 The AVPU scale for checking a response
Table 14.3 The ABCDE approach
Chapter 15
Table 15.1 Elements of legislation associated with health and safety at work
Table 15.2 What to do in emergency situations
Chapter 16
Table 16.1 The eight data protection principles
Table 16.2 The principles of good record keeping
Chapter 17
Table 17.1 Pathogens and some diseases that they may cause
Table 17.2 Modes of transmission
Table 17.3 Standard precautions
List of Illustrations
Chapter 01
Figure 1.1 Some key dates and events since the inception of the NHS.
Chapter 03
Figure 3.1 Three intertwined aspects of responsibility.
Chapter 04
Figure 4.1 A SMART goal system.
Chapter 05
Figure 5.1 Duty of care.
Chapter 07
Figure 7.1 The interrelationship of values and the person.
Figure 7.2 Factors associated with wellbeing.
Chapter 08
Figure 8.1 The components of effective communication.
Chapter 09
Figure 9.1 The closely intertwined interrelated connections between respect, privacy and dignity.
Figure 9.2 Risk assessment: a cyclical approach.
Figure 9.3 Dependence/independence continuum.
Chapter 10
Figure 10.1 Food hygiene.
Figure 10.2 Food hygiene, hand washing.
Figure 10.3 The Eatwell plate.
Figure 10.4 Urine colour chart.
Chapter 11
Figure 11.1 Mental health conditions and interrelationships.
Figure 11.2 Severity of depression on a continuum.
Figure 11.3 The cycle of stigma.
Chapter 14
Figure 14.1 The heart and blood flow.
Figure 14.2 An overview of the respiratory system.
Figure 14.3 Adult basic life support flow chart. (Automatic external defibrillator (AED)).
Figure 14.4 Jaw thrust.
Figure 14.5 Chest compressions.
Chapter 15
Figure 15.1 Workplace hazards.
Figure 15.2 The five steps associated with a risk assessment.
Figure 15.3 Components required to support a fire.
Figure 15.4 Some aspects of the physical and psychological impact of stress.
Chapter 17
Figure 17.1 The chain of infection.
Figure 17.2 Hand‐washing technique.
Figure 17.3 The five moments of hand washing.
Guide
Cover
Table of Contents
Begin Reading
Pages
iii
iv
xi
xii
xiii
xiv
xvi
xvii
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
138
131
132
133
134
135
136
137
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
Fundamentals of Care
A Textbook for Health and Social Care Assistants
IAN PEATE OBE
Professor of Nursing, Head of School
School of Health Studies, Gibraltar
Visiting Professor
St George’s, University of London; Kingston University, London
This edition first published 2017 © 2017 by John Wiley & Sons Ltd.
Registered officeJohn Wiley & Sons Ltd., The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial offices9600 Garsington Road, Oxford, OX4 2DQ, UKThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK111 River Street, Hoboken, NJ 07030‐5774, USA
For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley‐blackwell
The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.
The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organisation or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organisation or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.
Library of Congress Cataloging‐in‐Publication data are available
ISBN: 9781119212201
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Cover image: © Dean Mitchell/Getty Images.
Chapter opener images reproduced courtesy of Anthony Peate.
Preface
The provision of health and social care along with support provided to people is changing and will continue to change. In the healthcare sector in England there is to be a new nursing associate role, to provide greater support for nurses and help to bridge the gap between healthcare support workers and nurses. The nursing associate will be trained through the apprenticeship route. Once trained they will work alongside healthcare support workers to deliver hands‐on care, freeing up time for existing nurses so they can use their specialist training to focus on clinical duties and take more of a lead in decisions around patient care.
This text has been written for staff who are new in their role as well as for those who are already employed as a healthcare assistant, assistant practitioner, care support worker or those who provide support where there is direct contact with people receiving services. The book will also be suitable for those who are contemplating undertaking the role of nursing associate. Adult social care workers who provide direct care in residential and nursing homes or a hospice, or home care workers will also find the content of this book applicable to their sphere of work. It is acknowledged that roles undertaken will vary in different health and social care settings.
In England in April 2015, the Care Certificate was introduced. The Government now expects that all those working as healthcare assistants and adult social care workers will undertake learning related to the standards of the Care Certificate as part of their induction programme. The Cavendish Review, published in July 2013, was one of the key drivers for the creation of the Care Certificate.
An Independent Review into Healthcare Assistants and Support Workers in the NHS and social care settings was undertaken in 2013 (Cavendish, 2013). It was estimated that there are over 1.3 million frontline staff who are not registered with a regulatory authority but who now deliver most of hands‐on care in hospitals, care homes and the homes of individuals (Cavendish, 2013). The Cavendish Review (requested by the Secretary of State for Health in the wake of the publication of the Francis Inquiry into Mid‐Staffordshire NHS Foundation Trust) examined what could be done to ensure that unregistered staff in the NHS and social care treat all people with care and compassion.
The review revealed how disconnected the systems are that care for the public, and amongst other things proposed new common training standards across health and social care, grounded in what the best employers already do. It proposed a Certificate of Fundamental Care, written in plain English, to make a positive statement about caring necessitating the Care Quality Commission (CQC) to require all workers to have achieved this Certificate prior to working unsupervised.
There are often inconsistent approaches to the training and development of healthcare assistants and adult social care workers, with varying quality. The Care Certificate has been created to address these variances. The Care Certificate consists of 15 standards; these standards address the Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England but can also be applied to the three other UK countries.
The Care Certificate applies across the health and social care sectors and is portable between sectors and organisations. The Care Certificate covers the learning outcomes, competencies and standards of behaviour that are expected of support workers in the health and social care sectors. The Care Certificate defines the required values, behaviours and competencies that carers must demonstrate, aiming to ensure that the care and support offered is caring, compassionate and of a high quality.
Each of the standards related to the Care Certificate has specific outcomes and competencies that are associated with them; these must be achieved in order for one to be eligible for a Care Certificate; assessment of both knowledge and competence is required. It is not the purpose of this book to replace the Care Certificate standards; however, working through the various chapters will enable the reader to develop their knowledge and apply this to their work.
The Care Certificate cannot be completed through completion of e‐learning or completing a workbook alone. E‐learning or workbooks can support the attainment of knowledge but the assessment of the required skills has to be undertaken in the workplace.
The chapters
There are 18 chapters in the book. The first chapter provides an overview of health and social care provision, and Chapter 2 outlines the importance of working with others as a member of a team. Fifteen chapters are dedicated to the Care Certificate, and the final chapter, Chapter 18, provides support to the health and social care worker in addressing questions, queries and concerns that they may have or have experienced in the workplace.
The text adopts an engaging practical approach, and where appropriate practice exercises have been incorporated encouraging the reader to stop, look, listen and act, to take stock and carry out activities pertinent to the chapter. Where appropriate the student will be encouraged to interact with chapter content by completing activities, engendering curiosity. Reflection comes in the form of thinking activities.
Where appropriate at the beginning of the chapter the outcomes associated with each standard will be reproduced, contextualising and focusing the reader on the chapter content and relevance to the Care Certificate. There is an opportunity for readers to self‐assess. Readers can rate their current knowledge and skills prior to reading each chapter in relation to the chapter content. Each chapter ends with a case study reflecting chapter content. A resource file is included, inside which are resources that will help the reader to seek support and access further information should this be needed. These include links to the World Wide Web or references to appropriate literature.
An annotated bibliography has been provided. The purpose is to provide the reader with further information to support their learning.
What’s in a name?
The terms used to describe the relationship between those who provide care and offer support and those who are the recipients of those services vary; for example, user, service user, consumer, patient, client, survivor and expert are used. This text uses the terms ‘people’ or ‘person’ to describe those who receive or access services.
Terminology, job titles and roles in healthcare also vary; these can include: Assistant Practitioner, Care Assistant, Healthcare Support Worker, Maternity Support Worker, Nursing Assistant, Occupational Therapy Assistant, Physiotherapy Assistant, Radiography Assistant, Speech and Language Therapy Assistant and Senior Care Assistant. In Adult Social Care these roles and titles may include: Activities Worker, Day Care Assistant, Day Care Officer, Domiciliary Care Worker, Home Care Worker, Nursing Home or Hospice Nursing Assistant, Personal Assistant, Reablement Assistant, Residential Care Worker, Senior Home Care Worker and Support Worker.
I have enjoyed writing this text and I sincerely hope that you enjoy reading it and that you are able to apply the content to the care and support that you offer people.
Ian PeateGibraltar
Reference
Cavendish, C. (2013) The Cavendish Review. An Independent Review into Healthcare Assistants and Support Workers in the NHS and Social Care Settings. Available at:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/236212/Cavendish_Review.pdf
(accessed August 2016).
Acknowledgements
I would like to thank the library staff at Gibraltar Health Authority for their help. My partner, Jussi Lahtinen, for his encouragement, and Mrs Frances Cohen who, without hesitation, provides me with support and inspiration.
How to use your textbook
Features contained within your textbook
Care certificate outcomes lists the key learning points from the chapter.
Take stock allows you to rate your current knowledge and skills prior to reading the chapter.
‘Thinking cap’ boxes give further insight into conditions and cases.
‘Stop, look, respond’ boxes provide exercises to encourage you to think what you might do in a certain situation.
Case scenarios give a real‐life case based around the chapter content.
Resource file lists some places you can look for more information.
Chapter 1Health and social care provision in the UK
Care certificate outcomes
There are no care certificate outcomes for this chapter. This chapter aims to:
Introduce the reader to health and care provision across the UK.
Emphasise the fact that the four different countries of the UK adopt different approaches to care provision whilst still being a part of the wider National Health Service.
Offer the reader some insight into past and present issues surrounding health and social care.
Take stock
Rate your current knowledge and skills prior to reading this chapter. Put a tick in the box that you think applies to you with regards to the standard being discussed.
Key:
I know this
I have a good level of knowledge or skills regarding this aspect of the standard. I make use of the knowledge and skills identified on a regular basis, feeling confident in my ability and performance. I do not need a refresher.
Satisfactory
My level of knowledge and standard of skills meet the criteria associated with the standard. I use the skills and knowledge from time to time. I might not always feel confident in my capability, I would benefit from a refresher.
I require a review
I do not feel that I have the skills and/or the knowledge that would enable me to meet the standard in a confident and competent way. The knowledge and skills I used to have are no longer valid. I will require a refresher.
This is new to me
I have never worked in a caring role before or I have never covered this topic before. I will need further training and development in this area.
Standard
Self‐assessment
Understand health and social care provision in the UK
I know this
Satisfactory
I should review this
This is new to me
Discuss the role and function of the NHS nationally and locally
I know this
Satisfactory
I should review this
This is new to me
Describe how health and social care services are regulated and monitored
I know this
Satisfactory
I should review this
This is new to me
Highlight aspects of health and social care offered and provided by the NHS, the private and voluntary sectors
I know this
Satisfactory
I should review this
This is new to me
Differentiate between primary, secondary and tertiary services
I know this
Satisfactory
I should review this
This is new to me
Develop an insight into the assessment of health and social care needs for individuals and communities
I know this
Satisfactory
I should review this
This is new to me
Introduction
The ways in which health and social care provision are provided have changed over the years and it is very likely that they will continue to change. The four countries of the United Kingdom (UK) – Northern Ireland, Wales, England and Scotland – each have devolved responsibilities for the provision of health and social care service within their borders. This means that each country sets its own priorities for care provision. Often, because of these transferred responsibilities (transferred from central government), discussing the issue in a general manner can become complex. The focus of this chapter will be predominantly on the provision of health and social care service in England.
An historical view
Care, being cared for, providing care is an essential human need in order for the full development, maintenance and sustaining of human beings. The tradition of caring has often been associated with women – a female activity that focuses on the individual, the family and groups of people. Care and cure are two very different entities and it could be implied that throughout history care has not been awarded the same importance as cure. Cure it could be suggested has gained more attention because of the public recognition of a range of supposedly lifesaving and life‐sustaining new technologies and, tentatively, because it is very often associated with males, whereas care is seen as a traditional female activity. However, there cannot be any curing without caring, and the notion of care has been rooted in our history through examples such as religious (or spiritual), social, political, educational and economic contexts.
Health and disease are ever‐present factors of the human state, and throughout history the need for some kind of support and care of individuals and populations has varied. People have always helped other people during times of need (there is also evidence where people have failed to respond to the needs of others), paving the way for the development of systems of care and the fundamental beginnings of health and social care as we know it today. We are all likely to be recipients of care.
The National Health Service
On 5 July 1948, the National Health Service (NHS) was established with the aim of healthcare being free at the point of delivery. Figure 1.1 provides a timeline concerning the NHS since its inception in 1948.
Figure 1.1 Some key dates and events since the inception of the NHS.
Source: http://www.nhs.uk/Tools/Pages/NHSTimeline.aspx
The NHS in the four countries
There are several differences between NHS services in England and the other three home countries:
Northern Ireland has a fully integrated health and social care service and Scotland has passed legislation to achieve this goal.
Scotland and Wales have integrated boards (as opposed to trusts) that commission services at a local level.
Scotland has the Scottish Intercollegiate Guidelines Network (SIGN) for their clinical guidance as opposed to the National Institute for Health and Care Excellence (NICE).
Scotland
In Scotland health and social care policy and funding are the responsibility of the Health and Social Care Directorates of the Scottish Government. There are over 160,000 staff who work across 14 regional NHS Boards, seven Special NHS Boards and one public health body. Around 12,000 of these healthcare staff are engaged under independent contractor arrangements.
The NHS in Scotland is completely devolved and responsibility for it lies wholly with the Scottish Government. The Cabinet Secretary for Health and Wellbeing and Scottish Government set out their national objectives and priorities for the NHS that should be delivered and monitored via NHS Boards and Special NHS Boards.
In 2004 the 14 NHS Boards were replaced by trusts, which cover all of Scotland. These are all‐purpose organisations that plan, commission and deliver NHS services for their respective area. They take overall responsibility for the health of their communities and commission all services including GP, dental, community care and hospital care. These boards are also required to work together on a regional and national basis ensuring that specialist healthcare – such as neurosurgery – is commissioned in an effective manner. Locally the boards have representation or partnerships with community health and social care teams, and there is also a close involvement of local authorities, patients and the public.
The population of Scotland is estimated to be in the region of 5.3 million, with a healthcare budget of around £13 billion.
Northern Ireland
The healthcare service in Northern Ireland offers health and social care to its population and is administered by the Department of Health, Social Services and Public Safety.
The Health and Social Care Board carries overall responsibility for the commissioning of services and it does this through five Local Commissioning Groups. The five Local Commissioning Groups have a responsibility for commissioning health and social care and do this by addressing the needs of their local population.
There are five Health and Social Care Trusts that have responsibility for providing an integrated health and social care service in their regions. The Northern Ireland Ambulance Service is seen as a sixth trust.
There is a Patient and Client Council that exists to provide an independent voice for patients, carers and communities. An independent organisation, the Regulation and Quality Improvement Authority, encourages continuous improvement through a programme of inspections.
The Public Health Agency is charged with the responsibility to improve health and wellbeing, provide health protection and input directly into commissioning, and does this through the Health and Social Care Board.
The population of Northern Ireland is estimated to be in the region of 1.8 million, with a healthcare budget of around £4.3 billion.
Wales
In Wales the NHS is devolved, and the Welsh Government assumes responsibility. There are seven Local Health Boards that plan, secure and deliver healthcare services for their populations.
There are three national trusts in Wales:
The Welsh Ambulance Services
Velindre NHS Trust (providing specialist services in cancer and other national support)
A Public Health body for Wales
Representing the health and wellbeing interests of the public in their districts are seven Community Health Councils (CHCs). The Board of Community Health Councils in Wales is responsible for monitoring the performance of the CHCs, the conduct of members and performance of officers as well as operating a Complaints Procedure. It is the aim of the CHC to make sure that when people across Wales speak about their NHS, those responsible for providing health services listen – and act.
The population of Wales is estimated to be in the region of 3.2 million, with a healthcare budget of around £6.5 billion.
England
High‐quality care for all, now and for future generations, is the mission of NHS England. NHS England aims to provide everyone with greater control of their health and wellbeing, supporting them to live longer, and enjoy healthier lives by providing high‐quality health and care that is compassionate, inclusive and constantly improving. People are said to be at the heart of everything that the NHS does.
The values that underpin the role and function of the NHS are enshrined in the NHS Constitution (Table 1.1).
Table 1.1 NHS values and the NHS constitution
Respect and dignity
Commitment to the quality of care
Compassion
Improving lives
Working together for patients
Stop, look, respond 1.1
The NHS Constitution
In the list below (the values that underpin the NHS) make notes about how, on a daily basis, you make responses to these vales as you offer care to people.
Value
Example
Respect and dignity
Commitment to the quality of care
Compassion
Improving lives
Working together for patients
The population of England is estimated to be in the region of 50 million, with a healthcare budget of around £100 billion. The Department of Health (DH) in England provides strategic leadership for public health, the NHS and social care. It is the Secretary of State who has overall responsibility for the work of the DH.
Thinking cap 1.1
Health and social care services
Think about the health and social services in the country where you are working. Compare some of the services that are offered in the other three countries. What are the good things about health and social care services where you work and what could be improved? Do you think any ideas for improvement in services could come from one or more of the other three countries?
Provision of services
Various aspects of care are offered and provided by the NHS. However, it must be remembered that it is not just the NHS that provides care; the independent and voluntary sectors also provide care and services to people. The provision of care can take place anywhere where there are people, within the NHS, the private and independent care sector, or in the voluntary care sector. The Health and Social Care Act 2012 provides for fair competition for NHS funding to independent, charity and third‐sector healthcare providers; this was introduced with the intention of providing greater choice and control to patients in choosing their care.
The provision of care will be influenced by a number of factors, for example, an ageing population, changing disease patterns, the issue of consumerism and technological advances. Often the provision of care is split between two areas of care:
acute care;
chronic care.
The provision of care also takes place within the following settings:
primary care;
secondary care;
tertiary care.
Regulation and monitoring of services
Monitor
To protect the interests of patients in England, Monitor was established as the sector regulator for health services; it is the financial regulator of Foundation Trusts. Monitor issues licences to NHS‐funded providers, has responsibility for national pricing (in conjunction with NHS England) and helps commissioners make sure that local services continue if a provider is unable to carry on providing services.
Care Quality Commission
The independent regulator for quality in health and social care in England (including private providers) is the Care Quality Commission (CQC). It registers and inspects:
hospitals;
care homes;
GP surgeries;
dental practices;
other healthcare services.
If services are failing to meet fundamental standards of quality and safety, the CQC has the power to:
issue warnings;
restrict the service;
issue a fixed penalty notice;
suspend or cancel registration;
prosecute the provider.
Healthwatch
Healthwatch was set up as an independent consumer champion for health and social care. Its function is to represent the public's view on healthcare by gathering views on health and social care locally and nationally. In England every local authority has a Healthwatch. It is anticipated that through the Healthwatch network the voices of those who use the NHS will be heard. Healthwatch gathers these views by undertaking research in local areas, identifying gaps in service provision and feeding into local health commissioning plans.
Professional regulation
The various health and social care professions are regulated by specific regulators (Table 1.2).
Table 1.2 UK professional regulators
Regulator
Profession(s)
General Medical Council (GMC)
The independent regulator of approximately 260,000 doctors in the UK; established to:
Set the standards required of those doctors practising in the UK
Determine which doctors are qualified to work in the UK, oversees their education and training
Ensures doctors continue to meet the standards throughout their careers through a five‐yearly cycle of revalidation
Nursing and Midwifery Council (NMC)
The NMC regulates over 670,000 nurses and midwives in the UK. Key responsibilities include:
Setting professional standards of education, training, performance and conduct, and ensuring that these standards are upheld
Investigating nurses and midwives who are thought to fall short of its standards
The ability to take action when a nurse may be putting the safety of patients and others at risk
The General Dental Council (GDC)
The GDC regulates all dental professionals including dentists, dental nurses, technicians and hygienists
The Health and Care Professions Council (HCPC)
Regulates a number of professions including art therapists, biomedical scientists, chiropodists and podiatrists, clinical scientists, dieticians, hearing aid dispensers, occupational therapists, paramedics, social workers in England, and speech and language therapists
The General Pharmaceutical Council (GPhC)
The independent regulator for more than 70,000 pharmacists, technicians and pharmacy premises in the UK. In Northern Ireland this is the Pharmaceutical Society of Northern Ireland
The General Optical Council (GOC)
Regulates approximately 26,000 optometrists, dispensing opticians, student opticians and optical businesses
Primary care services
Most care provision is carried out in the primary care sector; over 95 per cent of care is delivered here. Care is delivered outside hospitals by a range of practitioners (Table 1.3).
Table 1.3 Some professionals who deliver primary care
Social workers
Teams of nurses
Prosthetists
Groups of doctors
Chiropodists
Midwives
Health visitors
Dentists
Pharmacists
Optometrists
Occupational therapists
Physiotherapists
Paramedics
Speech and language therapists
Stop, look, respond 1.2
Professional regulation
Match the professionals group listed in Table 1.3 to the regulator below
Regulator
Profession(s)
General Medical Council (GMC)
Nursing and Midwifery Council (NMC)
The General Dental Council (GDC)
The Health and Care Professions Council (HCPC)
The General Pharmaceutical Council (GPhC)
The General Optical Council (GOC)
For many patients, the professional healthcare they require will be provided in the community setting. In some situations, the care provided by and in the primary care sector may not be appropriate, or be unable to meet the needs of the patient. Referral to other services may therefore be required – those services are offered by the secondary care sector.
Secondary care services
This aspect of care provision occurs mainly through the acute hospital setting. The staff who work in this area have more readily available access to specialist and elaborate diagnostic aids and facilities, for example:
X‐ray department;
magnetic resonance imaging (MRI);
computed axial tomography (CAT) scans;
operating theatres;
special care baby units (SCBU);
microbiological laboratories;
various mental health care facilities.
Those who provide care in the primary care setting, for example the social worker, community nurse and GP, could be seen as the ‘gatekeepers’ to care provision in the secondary care sector, as they may make the necessary referrals to other health and social care providers. The transition from primary care to secondary care should be a seamless move just as the integration of health and social care services should also be seen as a seamless activity. The distinction between primary care and secondary and social care and healthcare are becoming more blurred.
Tertiary care services
Tertiary care is usually available in some larger hospitals. Tertiary care is provided by those with specialist expertise, with available equipment and facilities for caring for the patient with complex healthcare needs, for example:
intensive care units;
burns units;
oncology centres.
It is important to remember that most people receive their care and have their needs met in the primary care setting. Only a few will require secondary services, and even fewer will have to make use of tertiary care services. Health and social care workers and those who support them can be found working in all of these care settings.
Ambulance trusts
These trusts manage emergency care for life‐threatening and non‐life‐threatening illnesses, including the NHS 999 service. In some areas the ambulance trusts have been commissioned to provide non‐emergency hospital transport services and/or the NHS 111 service.
Thinking cap 1.2
NHS 111
What is the NHS 111 service? How does this differ from the 999 service? In what situations might you decide to use the 111 service or the 999 service?
Mental health trusts
Mental health trusts provide community, inpatient and social care services for a wide range of psychiatric and psychological illnesses. Mental health trusts are commissioned and funded by Clinical Commissioning Groups. Mental health services can also be provided by other NHS organisations, the voluntary sector and the private sector.
Stop, look, respond 1.3
Mental health service provision
Mental health services can be provided by a number of organisations other than the NHS, for example, by the voluntary sector and the private sector.
Make a list of who these organisations are and identify if they are from the voluntary sector or the private sector and what their organisation does.
Organisation
Private or voluntary
Role of the organisation
Community health services
These services are delivered by foundation and non‐foundation community health trusts. Services include:
district nurses;
health visitors;
school nursing;
community specialist services;
hospital at home;
NHS walk‐in centres;
home‐based rehabilitation.
Stop, look, respond 1.4
Community health services
Choose one of the community health services above and discuss the role and function of the service. Complete the table.
Chosen service:
Who works in this service?
Where is the service located?
How do people access the service?
Are service users involved in the development of the service?
Is this a statutory, private or voluntary service?
Social care and support
Social care is provided to people who may be having difficulty in managing daily tasks at home and who may need extra support and care. The care and support system can be very complex and confusing, with a number of organisations involved in assessment, arrangement and provision of care. This complexity and confusion can aggravate a person’s ability to cope and manage.
There are several rules and regulations that govern how people pay for care and support or what their entitlements to care and support might be; this too can be difficult to understand. Help and advice is available from the government and also from those in the voluntary and independent sectors, for example the charity Age UK.
Examples of services that are available to help people with care and support needs can include:
Help at home with shopping, laundry and cleaning.
Intensive home care including washing, dressing and preparing a meal.
The provision of 24‐hour care in a care home or housing with a care scheme (this is also known as sheltered accommodation).
If a person is in need of care and support, instead of receiving directly funded and arranged services, they can request for cash payments for them to arrange their own care. This approach can provide greater choice and control over how their needs can be best met.
Some people may also be entitled to the provision of equipment and adaptations to help ensure that their home is more suitable in meeting their needs.
Assessment of care needs
There are a number of assessment procedures in place that will establish a person’s needs; these are often set by the local authority (eligibility of need). Each local authority has its own assessment procedure.
Each local authority has a duty to assess a person who appears to need care and support. They may need care and support as a result of a serious illness, physical disability, learning disability, mental health problem or frailty because of old age.
This may mean that an assessment is offered even if the person has not specifically requested one. The person can contact their local social services department and request for them to arrange a needs assessment. Usually, an assessment is carried out prior to a service being provided by the social services department of a local authority. If care is needed urgently, then the local authority may be able to meet those needs without performing the assessment.
Once it has been established by a local authority that a person has needs that conform to the national eligibility criteria, that authority has to ensure that those needs are met. Initially a care and support plan has to be drawn up, or in the case of a carer with eligible needs, a support plan is needed.
A care plan (sometimes this is called a care and support plan, or support plan if the person is a carer) sets out how the person’s care and support needs will be met. The person should be fully involved in the preparation of the care plan; they and anyone else they request should also be provided with a written copy (Table 1.4).
Table 1.4 The care plan
The care plan must set out:
The needs identified by the assessment
Whether and to what extent the needs meet the eligibility criteria
The needs that the authority is going to meet, and how it intends to do this
For a person needing care, for which of the desired outcomes care and support could be relevant
For a carer, the outcomes the carer wishes to achieve and their wishes concerning care provision, work, education and recreation where support could be relevant
The personal budget
Information and advice on what can be done to reduce the needs in question and to prevent or delay the development of needs in the future
Where needs are being met via a direct payment, the needs to be met via the direct payment and the amount and frequency of the payments
The person’s care plan should be individual, and they should be allowed to have as much involvement in the development of the plan as they wish
Reviews of the care plan
The care plan should be reviewed by social services within the first 3 months and then as a minimum at least annually.
If there are eligible needs, the local authority will check that the person normally lives in its area. Social care is not free; it may be that the person will have to contribute towards the cost of meeting their needs. Local authorities will do an assessment to determine if the person will have to contribute and how much this might be.
The local authority should not refuse to meet eligible needs based on cost; however, if there is more than one option, they are allowed to choose what it believes will be the most cost‐effective one.
If the person’s needs do not meet the national eligibility criteria, the local authority is required to provide information and advice on what support might be available in the community to support the individual.
The person may consider or choose to fund their own care and support in response to the needs that have been identified as a result of the assessment. If the person disagrees with the needs assessment or the care and support plan that has been formulated, there are processes in place that challenge decisions.
Assessment of health needs
Assessing a person’s (or population’s) health needs requires a systematic approach. The term ‘health’ is a complex one and can be defined as a positive concept that is associated with social, personal and physical capabilities. It concerns the ability of individuals and their perceptions of their ability to function and to cope with their social and physical environment, as well as with any specific illnesses and with life in general.
Individual healthcare needs are just that, individual; a one‐size fits all approach is unacceptable. Needs are identified by the person or in conjunction with healthcare professionals such as a nurse. Assessment tools are used to determine any healthcare deficit.
The needs of populations can be identified by engaging with those populations (including service user groups), and this is done in a number of ways with the aim of listening to and acting on what has been said. A range of health and social care professionals can contribute to identifying needs; these professionals may include clinical health scientists, social workers and doctors.
Chapter summary
The NHS is there for all of us; it was created out of the ideal that good healthcare should be available to all, irrespective of wealth.
The provision of health and social care in the UK is complex.
The four countries of the UK have devolved responsibility for health and social care.
There are various aspects of care offered and provided by the NHS; the independent and voluntary sectors also provide care and services to people.
To protect the interests of those who use services, service provision is regulated and monitored.
Professions are regulated by their professional bodies.
Care takes place in many places and this includes the primary, secondary and tertiary sectors.
There are a number of assessment procedures in place that will establish a person’s health and social needs.
Case scenario 1.1
Anna
Anna Chosky is a 64‐year‐old lady who presented to the accident and emergency department accompanied by her daughter (Desirée), who is her main carer. Anna has been experiencing increasingly severe dyspnoea on exertion and progressive oedema of the lower extremities. She reported that her breathlessness and coughing episodes had become particularly severe in the preceding 3 weeks and she was now at the point where she could not stand or walk for more than 1 to 2 minutes without becoming fatigued. Anna had been sleeping on the sofa downstairs. Desirée has been assisting Anna with her personal hygiene needs, doing her shopping, cooking her food and attending to household jobs such as cleaning.
Anna is assessed in the accident and emergency department and is diagnosed with exacerbation of chronic obstructive pulmonary disease (COPD).
She is admitted to a ward and is receiving treatment. After 4 days of treatment she is ready for discharge home and plans are being made with various health and social care agencies, a care plan is being formulated with her. A home visit with the occupational therapist is planned and suitable adjustments to her home environment to provide her with as much independence as possible are being instigated.
In the scenario identify what you think Anna’s needs are from a health and social care perspective. How can the health and social services assist Desirée in supporting her mother in her home?
Make notes of any words you do not understand in the scenario and write a definition of these words.
Resource file
Department of Health, Social Services and Public Safetywww.dhsspsni.gov.uk
GIG Cymru NHS Waleswww.wales.nhs.uk
NHS Scotlandwww.show.scot.nhs.uk
NHS Englandwww.england.nhs.uk
Chapter 2Working with others, teamwork
Care certificate outcomes
There are no care certificate outcomes for this chapter. This chapter aims to:
Impress on the reader the importance of working together in health and care settings.
Differentiate between groups and teams.
Describe teamwork.
Identify the various team members.
Appreciate the benefits of effective teamworking for people to whom you offer care and support.
Know how to be an effective teamworker.
Take stock
Rate your current knowledge and skills prior to reading this chapter. Put a tick in the box that you think applies to you with regards to the standard being discussed.
Key:
I know this
I have a good level of knowledge or skills regarding this aspect of the standard. I make use of the knowledge and skills identified on a regular basis, feeling confident in my ability and performance. I do not need a refresher.
Satisfactory
My level of knowledge and standard of skills meet the criteria associated with the standard. I use the skills and knowledge from time to time. I might not always feel confident in my capability. I would benefit from a refresher.
I require a review
I do not feel that I have the skills and/or the knowledge that would enable me to meet the standard in a confident and competent way. The knowledge and skills I used to have are no longer valid. I will require a refresher.
This is new to me
I have never worked in a caring role before or I have never covered this topic before. I will need further training and development in this area.
Standard
Self‐assessment
Understand the value of working in partnership with others
I know this
Satisfactory
I should review this
This is new to me
Explain the concepts of teams
I know this
Satisfactory
I should review this
This is new to me
Identify team members
I know this
Satisfactory
I should review this
This is new to me
Describe the ways in which teams work
I know this
Satisfactory
I should review this
This is new to me
Identify factors that can enhance teamworking
I know this
Satisfactory
I should review this
This is new to me
Discuss the skills required to be an effective team member
I know this
Satisfactory
I should review this
This is new to me
Introduction
Those who offer care and support to people do not work in isolation; they work with others and also in teams. What is meant and understood by the term ‘team’ can vary a great deal. In your job you work in partnership with a number of people. Effective teamwork in health and social care delivery can have an immediate and positive impact on safety for all. Working with others requires you to work in partnership in an effective and respectful way. To work effectively you must embrace the concept of effective teamworking. Teamworking, similar to interprofessional working, is defined in many ways and is often used synonymously with group working.
Teamworking
Effective teamworking has the ability to improve cooperation and partnerships and to enhance communications and working practices across various organisational boundaries. Teamworking does not take place in a vacuum; there are many factors that must be taken into consideration, such as the needs and interests of the various stakeholders.
The Health Act 1999 imposes a duty on all NHS organisations to work in partnership. The key aim of some legislation, for instance the Community Care Act 1990, is to promote closer and collaborative partnerships with service users. The aim is to provide those who use services with a service that is seamless and joined up; there is a need for coordination and continuity, and working in and as a team with effective communication channels can help this become a reality.
Stop, look, respond 2.1
Professional groups
Below is a list of different professional groups who you may have to work with in a collaborative manner when providing care or support:
Physiotherapists
Dieticians
Paramedics
Radiographers
Occupational therapists
Speech and language therapists
Social workers
Police
Doctors
Probation managers
Audiologists
Dentists
Opticians
Each of the above groups has its own unique professional culture. These professional groups have unique professional identities; however, they are expected to come together to work as a professional group, a team.
Now choose three of the professional groups and outline their role and function in relation to the people you care for or offer support to:
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
The importance of effective teams in health and social care is increasing as a result of a number of factors. For example:
The increasing complexity of needs.
An increasingly ageing population.
An increase in the number of people with chronic disease.
Technological advances.
An increase in public expectations.
The political agenda to ensure health and social provision come closer together.
