Health and Social care

Doctors

They provide medical care for patients who are sick.

Their role is to:

  • Diagnose, treat, monitor and prevent illness
  • Provide prescriptions for treatment 
  • Arrange preventative care i.e. flu immunisation
  • Refer pateints to other health professionals i.e. specialist doctors or therapist
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Specialist doctors (Consultants)

They are expert in training in particular areas.

Their role is to:

  • Diagnose, treat, monitor and prevent illness in particular areas i.e. cardiology (heart)
  • Liaise with other health professionals i.e. nurses to carry out treatment in hospitals
  • Contribute to teams for ongoing patient care
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Nurses

They are trained to carry out medical duties at the level of seniority and specialism.

Their role is to:

  • Monitor and care for the daily chronic and acute medical needs of patients
  • Support doctors in giving treatment and prescribed drugs
  • Work to restore health and wellbeing
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Midwives

They work mainly in hopsital maternity units, clinics and homes.

Their role is to:

  • Monitor the prenatal development and the health of babies and mothers
  • Provide postnatal care, supporting mothers, babies and families after the birth
  • Help to deliver babies
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Healthcare assistants

They are trained to help with daily personal care and to support wellbeing.

Their role is to:

  • Work under the guidance of qualified professionals i.e. nurses / doctors
  • Meet care needs i.e. washing, feeding and making beds
  • Monitor health by taking temperature , pulse respiration rate and weight
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Occupational therapists

They facilitate recovery and overcome practical barriers.

Their role is to:

  • Identify issues people may have in everyday life, i.e. washing, feeding and dressing
  • Help people to work out practical solutions
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GP surgeries and local health centres

  • Patients go here first when they need medical advice
  • Doctors diagnose the patients illness, they may issue a prescription for medication or refer patients to other services
  • Nurses might carry out treatment or health screening, or take blood tests
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Hospitals

  • Patients go here for treatment that a GP can't give
  • Patients are referred by their GPs to specialist and medical teams
  • Specialist doctors may issue a prescription for specialist medication or refer patients to surgeons for operations
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Clinics

  • Patients go here to be treated for specific conditions
  • Patients are referred by their GPs to specialist clinics based in hospitals and in community
  • Trained personnel i.e. doctors and nurses work in clinics
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Home

  • Care is provided for housebound people or those who are recovering from medical treatment i.e. operations
  • Most people prefer to recover at home and some who are dying prefer to be nursed at home
  • Care may be provided at home for births
  • Patients are treated at home by community- based nursing and midwifery staff
  • Doctors carry out home visits
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Care manager

They are responsible for the day to day running of a residential care setting.

Their role is to:

  • Recruit and manage staff
  • Control the budget
  • Are responsible for ensuring that the services in the care setting meet National Care Standards
  • Put policies and procedures in place and make sure they are adhered to
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Care assistants

They are trained to help people of all ages who need to carry out their day to day routines in homes, day care centres and residential care home.

Their role is to:

  • Meet personal needs i.e. washing , toilet and dressing
  • Assist in monitoring health and wellbeing, by liaising with other professionals
  • Help with transport, household tasks and taking people shopping
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Social workers

They are trained to help a wide range of people of all ages to find solutions to their problems.

Their role is to:

  • Protect vulnerable people from harm, and abuse
  • Help people to live independently
  • Support children who live apart from their families and support their foster carers
  • Help people with mental health problems, learning difficulties or physical disabilities
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Youth workers

They help the personal & educational growth of people aged 11-25 to help them reach their full potential in society.

Their role is to:

  • Manage and administer youth and community projects and resources
  • Monitor and review the quality of local youth work provision and work with families and carers
  • Support individuals in other settings i.e. outreach work relating to drinking etc
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Support workers

They provide care support to a range of service users in homes, centres and residential care.

Their role is to:

  • Vary their duties depending on the needs and wishes of the individual
  • Support individuals' overall comfort and wellbeing
  • Help people who need care and support to live as independently as possible
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Residential care settings

  • These are settings where people who can't be cared for at home or who feel that they can no longer cope with living on their own are looked after
  • They may provide full- time or temporary respite care to give a  break to carers or those who struggle living on their own
  • Social care workers provide residents with personal care i.e. washing , dressing and feeding
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Domiciliary care

  • Social care workers provide care for people in their own home
  • Care wokers help people lead their daily lives by supporting independence
  • Social care workers might help people with shopping, cleaning and transport
  • Social care workers can provide carers with a short break from their duties
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Daycare centres

  • They are used by older people and those of physical & learning disabilities
  • They provide respite care
  • Social care workers might take part in leisure activities with people attending
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Benefits for people in residential care

  • Trained staff meet people's needs and support them
  • Specialist support is available for those with more complex care needs
  • Companionship is provided by other residents and staff
  • A range of stimulating activities is offered
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Difficulties for people in residential care

  • Losing some or all of their independence
  • Reluctance to leave their own homes
  • Isolation from family and friends
  • Cost of care 
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Responsibilities of doctors and specialist doctors

Key medical responsiblities:

  • Diagnosing illness
  • Prescribing treatment to promote healing and recovery
  • Referring patients to specialists
  • Liaising with multi-disciplinary teams

Key non -medical responsibilities:

  • Creating and maintaining relationships of trust with patients
  • Observing, listening and responding
  • Maintaining patient records
  • Maintaining confidentiality
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Responsibilities of nurses

Key medical responsibilities:

  • Observing condition of patients
  • Administering drugs and injections
  • Carrying out routine investigations
  • Preparing patients for operations

Key non-medical responsibilities:

  • Providing care and counselling
  • Healing with recovery and rehabilitation
  • Writing patient care plans
  • Planning patient discharge from hospital
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Responsibilities of midwives

Key medical responsibilities:

  • Diagnosing, monitoring and examining pregnant women
  • Providing prenatal care i.e. screening tests
  • Assisting during labour
  • Supervising pain management

Key non-medical responsibilities:

  • Preparing and reviewing patient care plans
  • Arranging and /or providing parenting and health education
  • Providing support and advice on the care of newborn babies
  • Providing support and advice following miscarriage, termination and neonatal death
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Responsibilities of healthcare assistants

Key medical responsibilities:

- Monitoring patient conditions by the following:

  •  taking temperature
  • pulse and respiration rate

- Taking blood samples

- Carrying out health checks

- Weighing patients

Key non -medical responsibilities:

  • Washing, dressing patients
  • Helping with patient mobility
  • Supporting day to day routines
  • Supporting and delivering health education
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Responsibilities of occupational therapists

Key medical responsibilities:

  • Being aware of acute medical conditions and how to overcome them in context i.e. A&E and acute medicine

Key non-medical responsibilities:

  •  Advising on specialist equipment to assist with daily activities
  •  Assisting people to return to work
  •  Coaching people with learning difficulties
  •  Enabling rehabilitation
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Responsibilities of care managers

Key responsibilities:

  • Day to day running of residential care settings
  • Supervising work of care assistants
  • Ensuring quality of care meets standards and adheres to relevant legislation
  • Ensuring suitable staff are available

Key skills, qualities and tasks:

  • Creating and maintaining relationships of trust with residents
  • Maintaining accurate and relevant records
  • Observing, listening and responding to resident concerns
  • Maintaining confidentiality
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Responsibilities of care assistants

Key responsibilities:

  • Providing daily personal care
  • Carrying out general household tasks
  • Carrying out other routine roles as required by supervisor or service user
  • Liaising with other health professionals

Key skills, qualities and tasks:

  • Working in different care settings
  • Observing and reporting changes in health and wellbeing of service user
  • Making service users feel at ease
  • Maintaining confidentiality
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Responsibilities of social workers

Key responsibilities:

  •  Maintaining a professional registration
  •  Working within regulatory guidelines
  •  Keeping informed of changes in policy and procedure
  •  Liaising with other agencies

Key skills, qualities and tasks:

  • Preparing and reviewing case files of clients
  • Taking difficult decisions
  • Working with a variety of service users of different ages
  • Ensuring continuity of care
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Responsibilities of youth workers

Key responsibilities:

  • Demonstrating values which underpin youth work
  • Completing a background check with the DBS
  • Continuing professional developement (CPD)
  • Acting as a mentor to young people

Key skills, qualities and tasks:

  • Working across different sector
  • Developing projects with schools and other organisations
  • Offering advice on topics i.e. sexual health using language which is accessible to young people
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Responsibilities of support workers

Key responsibilities:

  • Following instructions of health and care professionals
  • Implementing care plans agreed with social workers
  • Supporting members of families who provide care with parenting, financial and domestic skills
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Physical disability support at home

  • Ensuring that they have access to all the rooms
  • Ensuring that facilities are within reach and not floor level
  • Ensuring that if necessary hoists are available in bedrooms and bathrooms
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Physical disability support in skl setting

  • Ensuring that service users can access classrooms and labs
  • Ensuring that disabled children have access to play facilities & exercise facilities
  • Ensuring that the curriculum is adapted to meet their needs
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Physical disability support at work

  • By providing awareness training for work colleagues
  • By providing support worker to help the person in the workplace
  • By providing extra time, if necessary to complete tasks
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Physical disability support in leisure setting

  • By providing accessible changing facilities
  • By providing a suitable signage i.e. braille
  • By providing access to adapted seating and spaces for elevated wheelchair viewing
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Policies and procedures are in place to...

  • Ensure the health and safety of service users and health and social care workers
  • Support the day to day routines of service users
  • Enable the needs and preferences of service users to be met
  • Promote independence among service users
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Responsibilities of workers in h&sc settings

  • Providing equipment and adaptations to support people to be more independent
  • Following policies and procedures in place in their work setting
  • Providing personal care i.e. washing, feeding and dressing
  • Enabling rehabilitation
  • Supporting routines of service users i.e. daily family life, education and leisure activities
  • Assessment and care and support planning, involving service users and their families
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What is discrimination?

Discrimination is where someone:

  • is treated unfairly and unequally because of who they are
  • experiences prejudice that has been put into place
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What is direct discrimination?

Treating someone worse, differently or less favourably because of their characteristics. E.g. harassment and victimisation.

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What is indirect discrimination?

When an organisation's practices, policies or rules have a worse effect on some people than others. E.g. pregnancy and maternity discrimination, if pregnant women or new mothers are treated unfairly or are disadvantaged.

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Equality Act 2010

The equality act 2010 protects people from discrimination by:

  • employers
  • health and care providers i.e. hospitals and care homes
  • schools, colleges and other education providers
  • transport services i.e. buses, trains and taxis
  • public bodies i.e. government departments and local authorities
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Characteristics protected by the Equality Act 2010

  • Gender reassignment
  • Age
  • Disability/ capability 
  • Race
  • Marriage status / civil partnership
  • Religion or belief
  • Sex gender
  • Sexual orientation
  • Pregnancy and maternity
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Actions against discrimination

Where people have a protected characteristics, it is possible to do something voluntarily to help them. This is called  "positive action" and may take place if they:

  • are at a disadvantage
  • have particular needs
  • are under -represented in a type of work or activity
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Adapting provision of services

-Traveller showing anti-discriminatory practices e.g.

  • Enable to access to GP services at new locations
  • Ensure that hostile language is not used

-Transgender person showing anti-discriminatory practices e.g.

  • Use gender terminology which is acceptable to the service user
  • Recognise any associated mental health issue

Person with hearing impairments showing anti-discriminatory practices e.g.

  • Providing hearing loops in GP surgeries
  • Use BSL to communicate
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H&sc challenging discrimination

  • Doctors should consult patients notes to check the patient's preferred language & preferred methods of treament
  • Nurses should ask whether the patient prefers a male or female nurse
  • Social workers should advise on actions the service user can take to address any discrimination they experience
  • Occupational therapists should help people to live independently by ensuring appropriate kitchen equipment for different cultures i.e a wok and chopsticks might be preferred
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What is empowerment?

Empowerment means giving individuals information & support so they can take informed decisions and make choices about their lives in order to live as independently as possible.

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How to empower service users?

  • Giving individualised care
  • Promoting users' dignity
  • Dealing with conflict in an appropriate way 
  • Enabling users to express their needs and preferences
  • Promoting independence
  • Providing support that is consistent with users' beliefs, cultures and preferences
  • Promoting users rights, choices and wellbeing
  • Balancing the rights of individuals with those of other service users and staff
  • Putting users at the heart of provision
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Promoting individualised care.....

Empowerment allows service users to:

  • understand the choices that they can make about their care
  • contribute to decision- making
  • take control of their lives
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What are rights?

Rights are entitlements that everyone should receive. People's rights are protected by the laws of UK i.e. the Human Rights Act 1998 & the Equality Act 2010.

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Key rights....

  • Independence
  • Privacy
  • Safety and security
  • Equality
  • To be free from discrimination
  • To express needs & preferences
  • Dignity
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Promoting the rights to dignity and independence

Dignity:

- respecting a person's dignity 

Example:

  • Providing privacy for a patient who is using the bathroom in hospital

Independence:

- promoting independence through freedom, choice and support

Example:

  • Allowing an older person to choose where they wish to live, either in their own home or a residential care setting
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Promoting the rights to express needs & preference

Express needs and preferences:

- providing active support to enable choice consistent with individual beliefs, cultures & preferences.

Example:

  • Support those who need help to express their needs and preferences
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Promoting the rights of safety and security

Safety & security:

- changing legislation

Example:

  • The ban on smoking in public places

- dealing with conflict by applying clear policies & procedures

Example:

- Applying policies regarding:

  • residents with dementia who assault staff they fail to recognise
  • what to do if communication breaks down between social workers and other agencies
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Promoting the rights of safety and security

- protecting from risk or harm, by implementing procedures & training

Example:

  • Applying measures  to deal with violent behaviour of people attending  A&E who are affected  by alcohol or drugs

- encouraging behaviour change

Example:

  • using education and training i.e. as healthy living campaigns

- balancing individual rights with those of other service users & staff

Example:

  • Providing clear training & policies so all are cared for and protected appropriately
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Promoting the rights to equality

Equality:

- ensure equal opportunities & access to services

Example:

  • Fair allocation of budgets for provision of different services
  • Accountability through local authority representation
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Promoting the rights to have freedom

Freedom from discrimination:

- providing clear guidelines for practice & complaints procedures

Example:

  • Registering complaints, investigating them and receiving feedback
  • Official recognition of and investigations into abuse
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Possible risks in care....

  • Abuse by other service users and /or staff
  • Inadequate supervision of facilities i.e. bathrooms
  • Inadequate supervision of support staff i.e. when moving patients
  • Lack of illness prevention measure i.e.clean toilets, hand- washing facilities & safe drinking water
  • Infection due to lack of clean facilities & equipment
  • Inadequate of harmful substances
  • Lack of maintained first aids
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Managing risks in care...

  • Using risk assessment to indentify possible sources of harm
  • Staff training to manage risks
  • Clear codes of practice 
  • Appropriately qualified staff
  • Ensuring all staff have DBS check
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Reporting incidents & accidents.......

Stages of reporting incidents & accidents:

  • Detect incident or accident
  • Record accident or incident
  • Report incident or accident to relevant person
  • Classify incident or accident according to type and severity
  • Prioritise issues for appropriate actions
  • Propose preventative measures
  • Implement changes to working practices
  • Monitor effectiveness of changes in preventing future incidents
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Barriers to incident reporting

  • The incident or accident is seen as not important at the time
  • The incident form is too long or requires too much detail
  • Care staff have other, more pressing duties
  • Staff may not know about reporting procedures
  • It may be difficult to access the person who needs to receive  the incident/ accident report
  • There may be pressure from managers not to report incidents / accidents
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Problems with evidence.....

  • Inconsistent witness statements
  • Lack of detail in statements
  • Poor recall of events
  • Written evidence that conflicts with other types of evidence e.g. from CCTV
  • Low standard of written English
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4 key points about complaint procedures

  • All care settings must have them in place
  • All care settings must enable service users to access & use them
  • They are checked when care providers are inspected
  • They can lead to service improvements
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Service users have the rights to complain for….

  • complaints to be dealt with within an appropriate time frame
  • complaints to be taken seriously
  • full & thorough investigations of concerns raised
  • information about the outcomes of investigations into their complaints
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The Data Protection Act 1998

It sets out the rules governing the processing and use of personal information in H&Sc settings and many other organisations.

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Data must be......

  • used fairly and lawfully
  • used for limited and specifically stated purposes
  • used in a way that is adequate, relevant & not excessive
  • accurate
  • kept safe & secure
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Data in health & social care

  • Name
  • Address
  • Date of birth
  • Emergency contact details
  • Education and qualifications
  • National insurance number and tax code
  • Gender
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Confidentiality

In health and social care setting means restricting access to information about a service user to individuals who are involved in their care, unless permission to disclose the information is given by the service user.

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How is confidentiality ensured?

  • By applying the requirement of the DPA 1998
  • By adhering to legal and workplace requirements specified by codes of practice in h& sc setting
  • By securely recording, storing and retrieving medical and personal information
  • By maintaining confidentiality to safeguard service users
  • By following appropriate procedures where disclosure is legally required
  • By respecting the rights of service users where they request non- disclosure or limited disclosure of their personal information
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Recording and storage of data

The act covers the policies, procedures and systems for:

Storing information:

  • Confidential information should be stored in locking filing cabinets, in a locked room

Accessing information:

  • Members of staff in the organisation who can access to this information should be clearly identified

Sharing information:

  • Information should only be shared with other professionals who have a need and a right to know it
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Accountability to professional bodies

Professional bodies regulate and monitor the people working in H&Sc settings

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Example of professional bodies in England

  • The Nursing & Midwifery Council (NMC)
  • The Royal College of Nursing (RCN)
  • The Health & Care Professions Council (HCPC)
  • General Medical Council (GMC)
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Example of professional bodies in Wales

Care Council for Wales (Social care)

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Example of professional bodies in Northern Ireland

The Northern Ireland Social Care Council (NISCC)

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Regulation

Is a law which sets the standard of professional conduct required of people who work in h& sc settings

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Regulation of workers

People who work in h& sc settings must follow the regulations set out by professional bodies which regulate services in their sector.

This means that workers must:

  • Follow codes of professional conduct
  • Be familiar with and able to apply current codes of practice
  • Ensure that revalidation procedures are followed e.g. nurses must make a health and character declaration in order to be registered
  • Follow procedures for raising concerns (whistle blowing)
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Codes of professional conduct

Professional organisations published codes of practice for members which must be followed. If a member is accused of failing to meet the standards set, this will be investigated and in extreme conditions the member can be removed from the profession.

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Safeguarding regulations

  • Protect service users from harm, abuse, neglect and promote their health and wellbeing
  • Safeguarding and prevention of harm takes place in the context of person-centered support & personalised care, with individuals empowered to make choices and supported to manage risks
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Example of safeguarding

  • In hospital, make sure all equipment is sterile
  • In a residential care home, use hoists to help residents out of bed
  • At a nursery, ensure play areas are safe
  • In GP surgeries, ensure patient information is kept confidential
  • Ensure all staff have a DBS declaration
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Safeguarding children

Health and social care workers should:

  • Protect children from maltreatment
  • Follow their organisation’s safeguarding policies for protecting children and the actions to take if a child is abused
  • Prevent impairment of children’s health and development
  • Protect children from infection
  • Take action to enable children to have the best outcomes
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Local Safeguarding Children Board (LSCB)

The Children Act 2004 requires every local authority to have a local Safeguarding Children Board.

The job of the LSCB is to…

  • Make sure everyone understands how important it is to keep children safe
  • Make sure that all agencies that are part of the LSCB are doing the best job
  • Report to the Department of Health
  • Look into cases where children are badly hurt or have died
  • Keep a check on information about child deaths
  • Give advice to all agencies
  • Listen to children’s views and ideas
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Safeguarding adults

The Care Act 2004 introduced new safeguarding duties for local authorities where they provide care for adults.

These include the following:

  • Making enquires where there is a safeguarding problem
  • Hosting safeguarding adults board
  • Carrying out safeguarding adult reviews
  • Arranging for the provision of independent advocates
  • Leading a multi-agency local adult safeguarding system
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Why is partnership important?

  • It improves the lives of vulnerable adults and children
  • It means service users don’t have to give the same information to other h&sc workers
  • It improves information sharing between professionals
  • It improves the efficiency of the care system as a whole
  • It helps the service user feel that they are being treated like a whole person (holistic care)
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Difficulties in partnership

Problems with partnership working include:

  • Failure to communicate information between services
  • Lack of coordination of h& sc services
  • Delayed discharges from hospital
  • Health and social care providers with different IT systems that can’t communicate with each other
  • Cuts in funding that prevent effective partnership working
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Partnership with families

Working in partnership in h& sc may include the following:

  • Working with a service user’s informal carers, friends and family to plan
  • Aid decision- making
  • Enable support with other service providers

It is important to be working with both professionals and non-professionals, showing respect for all expertise and opinions, and accepting help when you need it.

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Holistic approaches

A holistic approach takes account of a person’s wider needs (PIES) and seeks to meet these needs to promotes health and wellbeing.

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Advantages of holistic approach

  • Care is more personalised
  • Other issues which contribute to the individual’s ill health may be identified and addressed
  • Being viewed as a whole person  can improve an individual’s health and wellbeing
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Disadvantages of holistic approach

  • Most people only want their illness or symptom treated
  • Generally doctors don’t look for other issues using diagnosis
  • Health and social care workers are not employed or skills to manage all aspects of an individual’s need
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Advocacy

Advocacy allows people to:

  • Express their views and concerns, so that they are taken seriously
  • Access information and services
  • Defend and promote their rights and responsibilities
  • Explore choices and options
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Internal monitor roles

  • Lead nurses or senior nurses – oversee a group of wards that can deal with a problem if the ward staff are unable to do so
  • Doctors – are medical consultants who oversee diagnosis, investigations and treatments
  • Matrons- are in charge and take responsibility for ensuring excellent patient experience and safety
  • The ward sister or charge nurse- oversee the whole ward
  • Nurse specialists – offer expert and specialist advice on a range of treatments
  • Healthcare assistants – help qualified nurses to meet care needs
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Whistleblowing

Is when a member of staff might raise concerns about patient care, such as when the health and safety of a patient is put at risk. These concerns are reported to the relevant staff in the hospital, i.e. nurses / doctors

Whistleblowing helps to maintain best practice. When whistleblowing policies are not followed:

  • Bad practice could continue, harming individuals
  • There will be more complaints from service users
  •  Staff may perform less or leave
  • The service provider may receive negative reports
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Monitoring care externally

Organisations that are external to care settings use codes of practice and regulations to govern how h& sc workers carry out their roles.

Inspections

External bodies monitor services, including through inspections.

These cover:

  • Analysis of internal data and trends
  • Investigation of complaints
  • Observation of service delivery
  • Collection of service user feedback
  • Interviews with staff
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Criminal investigation

  • Are pursued where sexual, physical, financial or emotional abuse is suspected
  • Must take account of safeguarding 
  • Follow referrals from individuals who suspect that a crime has been committed 
  • Follow referrals to the police form care providers, CCGs and specialised care settings such as prisons
  • May lead to the suspension or dismissal of care workers following an investigation
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Public sector services

The public sector organisations that provide h& sc services are financed and directly managed by the government.

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Primary healthcare

Primary health care provides the first point of contact such as GPs, Dentists, Opticians and Pharmacists who gives access to day to day services for patients and refers them to relevant specialists where needed.

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Secondary healthcare

These are normally accessed by the GP who makes a referral to a consultant or other specialist i.e. oncology (cancer)

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Tertiary healthcare

Provides specialist and normally complex services. For e.g. specialist spinal injury units or hospice care.

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Health public bodies

NHS Foundation Trusts and GP services are public sector organisations which provide NHS services for adults and children.

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Social care public bodies

Local authorities are public sector organisations which provide social care services for adults and children.

These include:

  • Help in the home
  • Support for carers
  • Financial support
  • Equipment to enhance independence
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Commissioning

Commissioning of services means:

  • Planning service specification- e.g. What services will consist of
  • Agreeing service procurement – e.g. The process of obtaining the necessary services
  • Monitoring delivery – continuous quality assessment e.g. Checking that the services provided meet the needs of service users
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What do local authorities do?

  • They commission organisations to provide social care services
  • Commissioned organisations can be in the public, private or voluntary sector
  • Commissioned services for adult social care include residential care homes and nursing homes
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NHS Foundation Trusts

  • Run hospitals
  • Provide mental health services
  • Provide community health services
  • Provide children’s health services
  • Work in partnership with other organisations
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Private and voluntary sectors

Private - services are provided by businesses, which are usually run for profit 

E.g. in health care providers - Boots and BUPA

E.g. in social care providers - Residential care homes and nursing homes

Voluntary/ Third – Non – profit making organisations which provide services alongside those provided by public and private sector organisations

E.g. in health care providers - Hospices and Macmillan Cancer Support nurses

E.g. in social care providers - Age UK and Mind

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Support services

1)   How sexual health services support service users

  • Sexual health services are provided by GP and young people services
  • They provide advice about STIs, contraception, pregnancy etc
  • Provide contraceptives and medication
  • Free and available to everyone
  •  Target specific groups i.e. those at high risk of pregnancy or infection

2)   How MENCAP supports people with learning disabilities

  • MENCAP provides residential care for people with a learning disability
  • It provides education services
  • Trains people to work with those who have a learning disability
  • It promotes awareness of learning disability
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Hospital Setting

Hospital settings:

Hospitals provide both inpatient and outpatient services. Inpatient services include treatment for individuals whose condition requires 24- hour specialist support. Outpatient services include regular clinics, day surgery and other specialist daytime care.

  • GP will refer patients to the hospitals as they can’t carry out operations
  • Hospitals provide emergency care by A & E departments
  • A service user has the right to choose which hospital they attend and choose which consultant nurse to see female or male
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Hospice care

The aim of hospice care is to improve the quality of life for people who have a terminal illness.

Staff in hospices:

  • Take care of people’s PIES needs
  • Aim to control the pain and other symptoms experienced by the patient through palliative care
  • Care may extend to support during the bereavement period
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Palliative care

Palliative care is offered to people towards the end of their lives.

  • It is a multi-disciplinary approach to specialised medical care for people with serious illnesses
  • It is active and holistic
  • It focuses on providing patients with relief from symptoms, pain and the physical and mental stress of a serious illness
  • It regards as paramount the management of pain and other symptoms, and provision of psychological, social and spiritual support
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Types of domiciliary care

  • Formal care – this is provided by staff i.e. carers / care assistants
  • Informal care – this is provided by relatives, family member or by children
  • Voluntary sector – both formal and informal care is often provided by people and services within the sector
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Workplace care

  • Codes of practice and health and safety regulations are designed to ensure the safety of all people in H&Sc settings
  • People who use services need to be safe and so do people who work there
  • A health and safety officer might give advice on safety at work
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Respite care

  • Respite care gives an informal carer a short break away from caring from a patient
  • The Care Act 2014 sets out the rights of adults who provide care. One of these rights is an assessment of their needs as a carer, which might include respite care
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Access to services

Referral

  • Self-referral – this is where a person contacts the doctor or a dentist personally, by making a phone call
  • Third party – this is where a friend or neighbour contacts a health or care service on another person’s behalf. For example, a neighbour may ring the social services department on behalf of a frail elderly person to request care support
  • Professional referral – this is when a health or care professional contacts another service provider to request support for a service user. For e.g. a GP referring a service user to the hospital consultant
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Assessment

People who may require personal care will have a needs assessment which will be carried out by a social services.

It will consider:

  • Their needs and how these impact on their care
  • The things that matter to them i.e. getting dressed
  • Their choices and goals i.e. if they wish to take up a new activity
  • The types of services, information, advice and resources which will prevent or delay further needs from developing, helping the person to stay longer
  • The needs of their family
  • The limitation of cost and service provision
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Eligibility criteria

In order to decide whether a person is entitled to care and support from the local authority, a social services department assessor, usually a social worker, must consider whether these needs:

  • Arise from, or are related to, a physical or mental impairment or illness
  • Make them unable to achieve two or more specified outcomes i.e. prepare and eat food, manage their toilet needs & dress appropriately according to the weather
  • Impact significantly on wellbeing as a result of being unable to meet these outcomes

An adult is only eligible for personal care if they meet all three of these out comes.

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Barriers to services

People with specific needs that cause difficulties in accessing services include:

  • People with learning and physical disabilities
  • People with mental ill health
  • Older people
  • Children
  • Refugees
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Individual preferences

These can affect to health and social care services and include, for example:

  • People with religious and / or cultural beliefs who reject certain medicines
  • People who exercise their right to be treated in a local hospital
  • People wo have terminal illness may prefer not to have treatment
  • Women who prefer to receive care from women
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Other factors affecting access

Language – if English is not a service user’s first language may need a translator to support them

Hearing impairment – if a service user can’t hear properly won’t be able to communicate without aids to support them

Geographical – people who live in certain areas may not get the same level of services as others i.e. fertility treatments are less available

Financial – cost and difficulty in providing care for children i.e. long waiting times for hospital appointments or treatment

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Organisations

Patient groups:

All NHS organisations have legal duty to involve the public in decisions about running local health services. Patients should be listened to and actions taken to meet their concerns.

What they do:

  • Represent the interests of people with health needs
  • Provide feedback on NHS services
  • Provide volunteers
  • Take part in research carried out by the NHS
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Charities

NSPCC – this charity helps to encourage the government to introduce polices and laws that support the protection of children

Mental Health Foundation – this charity works to improve the lives of those with mental illness. It carries out research, promotes service development and seeks to achieve good mental health for all

Shelter – this provides advice, guidance and support for people with housing problems and will represent them when they liaise with council officials, are applying for housing benefit

Stonewall – this works to promote awareness of lesbian, gay, bisexual and transgender (LGBT) issues to reduced prejudice and discrimination

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Charites serve different service groups by….

  • Carrying out research
  • Providing advice and services
  • Raising money
  • Preventing discrimination
  • Changing public attitudes
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Representing interests of service users

Complaints policy - the settings have a responsibility to ensure that their service users and, where appropriate, their families and other informal carer, understand how to access and use complaints procedures if they are unhappy with the quality of care provided.   These procedures and outcome of any complaints will be checked whenever the setting is inspected.

If a service user complains, they have a right to:

  • Have their complaint dealt with efficiently and in an appropriate way
  • Have their complaint formally investigated
  • Be told the outcome of their complaint

Whistleblowing – this provide protection for staff who raises concern about the quality of care being poor at the work place.

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Regulation & inspection process

Inspectors carry out inspections, using experts to help reach judgments on quality. They need to know that the services are safe, caring, effective and well led.

How inspectors carry out inspections:

  • Identify the scope and purpose of the inspection
  • Gather views of service users
  • Gather information from staff
  • Observe service delivery
  • Review records
  • Look at documents and policies
  • Feedback at a meeting with the inspection team and senior staff
  • Publish findings
  • Take action to improve services where needed
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After the inspection

  • The service provider is graded – this may reflect a range of outstanding or fully met to inadequate or not met
  • Requirements or warning notices may be given, setting out improvements required and a timescale
  • Organisations and individuals may be asked to implement policy and / or practice changes
  • In some circumstances, a provider might be required to limit the range of services or to face criminal prosecution
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Actions in the response to inspection

Providers may need to:

  • Write and implement an improvement action plan
  • Implement enhanced staff training, for example to ensure familiarity with policies and codes of practice
  • Improve partnership working, such as when services have failed to protect vulnerable children
  • Ensure changes to work practice i.e. changes to hand hygiene procedures
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Improvements at a hospital

  • Monitor compliance with hand hygiene procedures
  • Store cleaning equipment correctly to avoid cross contamination
  • Provide better nutrition for patients
  • Complete documents accurately
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Improvement at an early years setting:

  • Replace unsafe equipment
  • Improve record keeping
  • Provide a rich learning environment that challenged and stimulates
  • Improve leadership and motivate staff
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Regulation and inspection in England

The Care Quality Commission (CQC) – this is responsible for monitoring and inspecting health services and adult social services in England.

Their role is to:

  • Register care providers
  • Monitor, inspect and rate services e.g. NHS trusts, independent hospitals and GP practices
  • Take action, including legal action, to protect service users
  • Be an independent voice, publishing regional and national views of quality issues in health and social care
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National Institute for Health Care Excellence

National Institute for Health Care Excellence – this provides national guidance and advice to improve health and social care.

Their role is to:

  • Produce evidence – based guidance and advice for service providers
  • Develop quality standards and performance measurements for organisations which provide and commission health, public health and social care services
  • Provide arrange of information services

NICE provides guidance:

  • NICE provides guidance about standards in care. It also advises on safety and effectiveness of medications, treatments and services, covering:
  • conditions and diseases i.e. cancer or diabetes
  • lifestyle and wellbeing i.e. sexual health
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Public Health England

Public Health England – this is a government body that protects and improves England’s health and wellbeing.

Their role is to:

  • Work as a part of regional and local health systems to reduced health inequalities
  • Protect the health of people in England
  • Share information and expertise to make improvements in the public’s health
  • Carry out research
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OFSTED

Office for Standard’s in Education, Children’s Services and Skills (OFSTED) – they regulate and inspect services that educate children, young people and adults or care for children. OFSTED regulates and inspects care provision for children and young people such as the following:

  • Nurseries, pre-schools and child minders
  • Fostering and adoption agencies
  • Quality of teaching, learning and assessment
  • Effectiveness of leadership and management

OFSTED publishes a report and the provision is graded:

  • Grade 1 – Outstanding
  • Grade 2 – Good
  • Grade 3 – Requires improvement
  • Grade 4 - Inadequate
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The Nursing and Midwifery Council (NMC)

Nursing and Midwifery council - this is responsible for regulating the standard of professional practice of all nurses and midwives in UK.

The NMC regulate nurses and midwives in the UK by:

  • Ensuring nurses and midwives have the right qualifications and skills
  • Standards of professional practice
  • Continuing professional development
  • Requiring nurses and midwives to challenge discrimination and review practice yearly
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The Health and Care Professional Council (HCPC)

The Health and Care Professional Council – this promotes good practice and protects the public, throughout the UK.

It set standards for health and professionals in:

  • Conduct and ethics
  • Performance and efficiency
  • Character and health
  • Education and training
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The General Medical Council (GMC)

The General Medical Council – this is an independent organisation for the registration and regulation of doctors.

The GMC:

  • Oversees UK medical education and training
  • Decides which doctors are qualified to work in this country
  • Sets the standards that doctors must meet in their professional practice
  • Take actions to prevent doctors from putting the safety of patients at risk
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The Royal College of Nursing (RCN)

The Royal College of Nursing – this represents nurses, midwives and health care assistants in the UK by:

  • Setting out the principles of nursing practice and nurse’s role and responsibilities in safeguarding
  • Ensuring accountability of practitioners, promoting continuity professional development (CPD)
  • Supporting diversity in nursing
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Meeting standards

National Occupational Standards (NOS) - describes best practice.

The NOS underpins the codes of practice in care settings

Example of standards:

  • Receiving visitors in h& sc settings
  • Providing advice and information to people who ask about h& sc services
  • Contributing to social care during emergency situations
  • Monitoring and maintaining health, safety and security of self & others
  • Supporting individuals to use medication in social care settings
  • Minimising the risk of spreading infection by cleaning, disinfectant and storing care equipment
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Performance criteria for meeting visitors

  • Ensure the visiting area is safe
  • Talk to the visitor to fins out why they are visiting
  • Maintain confidentiality
  • Seek help if unable to deal with a situation
  • Ensure that any information given to the visitor is accurate
  • Provide support to the visitor according to their needs
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What is codes of practice

It is a set of guidelines, sometimes based on legal regulations, which explains the way members of a profession must behave.

Why we need codes of practice:

Codes of practice are central to work in H&Sc. They:

  • are important guides to the best practice
  • inform practitioners of their rights and responsibilities
  • outline the behaviours and attitudes that service users can expect from service providers
  • help to achieve high -quality, safe, compassionate care and support
  • enable safety for the people who use health and social care services and for people who work with in them
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Training

Health and social care workers can access different forms of continuing professional development (CPD) & training at different points in their careers.

  • Before they work, workers must gain qualifications
  • Workers undertake induction before starting their jobs
  • Workers undertake training while post
  • Workers can access training provided by their regulatory bodies
  • Workers are trained by other, more experienced professionals
  • Nurses must revalidate every three years
  • CPD is mandatory for social workers who renew their registration
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Safeguarding employees

Following the protocols of regulatory bodies should safeguard employee’s day to day. In addition, membership of trades unions helps to safeguard their interest.

  • The British Medical Association – is the trade union and the professional association for doctors and medical students
  • The Royal College of Nursing - is the trade union and the professional association for the nurses
  • The Royal College of Midwives - is the trade union and the professional association for the midwives
  • The unions Unite and Unison protect people who work in all occupations across healthcare
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Trade unions & professional associations

Trade unions – These an organised associations of workers, in trade, a group of trades, or profession.

They protect and promote the rights and interest of their members.

  • They may be involved when employees make complaints about how they are safeguarded
  •  They offer advice and legal support to protect members who work in H &Sc
  • Professional association – this is where they represent one group or type of worker i.e. doctors or teachers.
  • They also represent and protect the interest of the general public
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Regulatory bodies

Following the protocols of regulatory bodies safeguarding employees.

  • Some complaints may be dealt with using the organisation’s internal procedures
  • More serious breaches may involve external agencies i.e. regulatory bodies or the police
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Internal &external complaints are dealt

  • Complaints is made against h& sc employee
  • Employee has the right to be accompanied by a trade’s union representative or work colleague
  • Where possible, employee continues to work while complaint is investigated
  • Employee shouldn’t experience indirect or direct discrimination
  • Informal resolution e.g. with line manager
  • Formal resolution e.g. through human resources department
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Where is care given?

Care for people with specific needs and ill health is given in 6 settings:

  • Hospitals / day-care centres
  • GP surgeries
  • Hospices
  • Residential care homes / nursing homes
  • At home (Domiciliary care)
  • The workplace

Care is provided through four key settings:

  • Doctors
  • Nurses
  • Midwives
  • Healthcare assistants

All these staff help people who are ill to get better or learn to manage their conditions.

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Nurse’s role

Their role is to follow the correct procedures when working together. The procedures:

  • Follow the correct admission procedures, assessing specific needs
  • Provide correct information when answering questions from patient and family members
  • Use appropriate language when discussing illness with patient and family members
  • Ensure that patient preferences are respected and specific needs catered for
  • Provide & administer correct dosages of medications
  • Ensure notes are complete and accurate
  • Prepare patient for surgery where needed
  • Monitor recovery
  • Prepare care plans that are appropriate for specific needs, with clear support in place
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People with mental ill health

Care is through four main providers:

  • Family and friends
  • NHS
  • Charities i.e. Rethink or Mind
  • Private sector organisations i.e.  the priory group

Professionals aim to take a holistic approach to meet the needs of the whole person.

Types of mental problems:

  • Dementia
  • Alzheimer’s disease
  • Self – harm
  • Obsessive Compulsive Disorder (OCD)
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Preventing mental ill health (2)

Prevention is an important part of the process of caring for people with mental ill health. People can help themselves to maintain good mental health by:

  • Taking about their feelings
  • Taking a break
  • Keeping active
  • Eating well
  • Drinking sensibly
  • Caring for others
  • Accepting who they are
  • Keep in touch with loved ones and friends 
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People with a learning disability

The four key care priorities:

  • Choices for people and their families, so they have a say in their care
  • Care in the community, with personalised support provided by multi-disciplinary teams
  • Innovative services that offer a range of care options, with personal budgets, so that care meets individual needs
  • Providing early, intensive support for people who need it so they can stay independent in the community, near home

Care is through four main providers:

  • Family and friends
  • Support workers
  • Psychologists
  • Social workers
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The carer’s role

When caring for people with learning disabilities, they must follow the correct procedures.

Caring for people with learning disabilities of all ages:

  • Use language that a person can understand
  • Empathise
  • Treat the person with dignity
  • Report risk
  • Preserve independence
  • Ensure that the person’s preferences are respected
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What is personal budget?

Personal budget is a cash payment made directly to the service user so that they may pay for identified and necessary care services to be provided.

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People with physical and sensory disability

Types of sensory and physical disability:

  • Sensory – hearing or visual impairment  
  • Neurological – motor neurone disease
  • Spinal cord injury – spina bifida
  • Amputation – a limb is removed by a surgery

Care is through four main providers:

  • Family members and friends
  • Support workers
  • Physiotherapists
  • Specialist medical teams
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The carer’s role

When caring for people with sensory and physical disability they must follow the correct procedures:

  • Help the person to deal with the diagnosis
  • Support family members and relatives when they are told about the diagnosis
  • Ensure that care reflects the service user’s needs and preferences
  • Enable the person to access the h& sc they need
  • Help the person to get suitable equipment e.g. motorised wheelchair
  • Arrange for necessary adaptations for settings e.g. adapted shower
  • Support the person with self- care programme and care of specialised equipment
  • Help with access to benefits
  • Ensure that respite care is available
  • Help the person’s family to cope with adjustments to normal living
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Early years care

Children’s specific needs such as:

  • Learning disability
  • Physical disability
  • Exhibit behaviour which challenges
  • Severe illnesses
  • Victims of abuse or neglect

Care is through five main providers:

  • Parents
  • Family members and friends
  • Teachers
  • Specialist support workers (SSW)
  • Specialist medical staff who treat children (paediatricians)
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The carer’s role

When caring for children, carers must follow the correct procedures:

  • Keeping children safe
  • Ensuring a healthy environment
  • Providing an accessible learning environment
  • Encouraging children’s learning and development i.e. play
  • Enabling children to make a positive contribution
  • Enabling the welfare of the child is paramount
  • Ensuring that information about the child remains confidential
  • Promoting children’s right
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Children’s entitlement

Seven areas of Early Years Foundation Stage (EYFS) learning and development: Prime areas-

  • Communication and language: Following instructions including several ideas, open questions
  • Physical development: Crying, pen control
  • Personal, emotional and social development: Sticking out their tongues, using songs for body parts

Core areas-

  • Literacy: Reading / writing, make up stories
  • Mathematics: counters/ numbers, cooking i.e. weighing out the flour
  • Understanding the world: Environmental awareness – Recycling, walking in different environments
  • Expressive arts and designs: Gluing and sticking things together, colour mixing experiments and collages
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Later adulthood care

Rights:

Adult with specific care needs have the rights to:

  • choose their own GP
  • have equal and fair treatment
  • be consulted about the care they need
  • be consulted about their preferences
  • be protected from harm and risk
  • have access to complaints procedures
  • have access to advocacy and empowerment
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Safeguarding from risk

Some adults are vulnerable, which means that they are more likely to come to harm and must be safeguarded from risk.

Vulnerable people at risk include….

  • Individuals with mental ill health
  • People with dementia
  • Refugees
  • People who are no longer well to cope with everyday tasks
  • Individuals who have been abused
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The carer’s role

When caring for older people with specific needs, carers must follow the correct procedures:

  • Keep people safe by supporting them to manage risks
  • Enable person to live independently
  • Ensure that they can access the benefits they need i.e. personal budgets
  • Ensure that information about them remains confidential
  • Ensure that they don’t experience discrimination
  • Promote their rights
  • Provide medication when necessary i.e. between the person and family members over financial matters
  • Prevent self – neglect
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Example of specific needs

1) Development or progression of physical and mental conditions:

  • Treatment and medication to help manage conditions i.e. heart disease
  • Provision of support in the home i.e. dressing and washing

2) Involvement of family or friends:

  • Advice from specialist staff in the area (geriatrics) on ways to support the person and themselves
  • Person with dementia who is unable to express needs and preferences can be supported

3) Interventions to maintain physical and mental health:

  • Support i.e. exercise programmes and guidance to prevent osteoporosis
  • Guidance on nutrition i.e. eating a healthy diet
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Policies, procedures and regulations

Purpose of policies and procedures:

  • The needs & interest of at -risk of adults and children are always respected and upheld
  • The human rights of people at risk are respected and upheld
  • Interventions and responses are appropriate, timely and ethical
  • All decisions are taken in line with legislation which is active at the time
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Protecting service users

Regulation requires staff to follow codes of practice, guidelines and procedures which are designed to ensure that service users are protected and safe.

Effective implementation of these documents ensures that staff:

  • Work together to prevent, and protect service users from, abuse
  • Empower and support people to make their own choices
  • Investigate actual or suspected abuse and neglect
  • Provide service users to people who are experiencing abuse, neglect and exploitation
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Protecting staff

Policies and procedures are put in place to protect managers, professionals and staff working in public, voluntary and private sector organisations.

When H&Sc workers follow policies and procedures they are:

  • Implementing best practice to meet needs
  • Using the relevant skills required to work in their area
  • Working effectively with colleagues
  • Working within law
  • Adhering to guidelines that are designed to keep them safe at work i.e. using safe lifting techniques and infection control
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Key terms

  • Regulations - laws issued by the government
  • Codes of practice – guidelines which explains how members of a professions must behave
  • Guidelines – advice from regulatory bodies and how to follow codes of practice in workplace
  • Policies – a service provider’s statements of intent followed by a description of procedures to be followed to ensure that codes of practice and regulations are adhered to
  • Procedures – step by step guide that employees must follow when completing a task to the standard required by an organisation
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Working practices in healthcare

The five goals of the NHS Outcomes Framework (2015):

  • Preventing people from dying prematurely
  • Enhancing quality of life for people with long-term conditions
  • Helping people to recover from episodes of illness or following injury
  • Ensuring that people have a positive experience of care
  • Treating and caring for people in a safe environment and protecting them from avoidable harm
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Privacy, dignity & self-esteem

  • Staff should value the contribution that individuals can make to the life of home
  • Residents’ self-esteem is enhanced when they feel valued

They should:

  • have their own privacy
  • can choose how they dress, what they eat and what time they go to bed
  • decide how they want to be addressed by staff, other residents and visitors i.e. by their first name
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Independence, choice and control

Staff should allow residents time to do things themselves when they can and not take over or make them unnecessarily dependent.

Residents should be able to:

  • choose how they spend their time
  • decide how far they participate in the life of the home
  • decide how they maintain relationships with family, friends and the local community
  • have opportunities for emotional and sexual expressions
  • have access to external advice, representation and advocacy
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Diversity and individuality

Residents are living in the home with other people, they remain individuals with their own likes and dislikes.

Residents should:

  • feel that their needs will be responded to by staff, who understand the value of maintaining a sense of continuity & identity based upon the past traditions and practices
  • have opportunities to express and pursue religious & political beliefs i.e. observing dietary and dress requirements and having space for prayer
  • be able to attend places of worship
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Balancing safety and risk

The balance between risk and safety should be maintained.

An agreement should be reached which balances the risks against the individual’s rights. Residents should:

  • not be discouraged from undertaking certain activities solely on the grounds that there is an element of risk
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Working practices and children

Failures in the care system, particularly in relation to cases in which children have been killed or harmed, have led to inquiries & subsequent changes in working practices. In 2002, criminal record & other background checks became important for all people working with children and other vulnerable people.  

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The 6C’S

Courage - always to do the right thing for service users and to speak up when there are concerns 

Care - is provided for the patient throughout their life

Commitment - means that this vision for service users can be realised, and the needs of service users consistentley met

Competence - this means that the staff can understand their service user's needs & have the up to date expertise

Compassion - service users and their carers must respect and show dignity towards each other 

Communicaiton  - the ability to listen carefully to service users

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RIDDOR

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) – this is a health and safety that health and care providers must report i.e. serious accidents, diseases and illnesses. 

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COSHH

The Control of Substances Hazardous to Health (COSHH) – this is a health and safety regulation in which service users must be protected from harm and infection. 

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Assistive technology

These are available to support people with disabilities & other illnesses to meet their educational potential.

These include:

  • Adapted computers to meet the needs of visually impaired and blind people
  • Availability of signers and other communicators for hearing – impaired and profoundly deaf people
  • Additional time in examinations for learners who are dyslexic
  • Enlarged text for people with poor vision
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Religious respect

Muslims and Hindus:

  • Normally prefer to wash in running water rather than have a bath
  • Prefer to use a bidet rather than use paper after using the toilet
  • Prefer to be treated and supported by someone of the same sex

Sikhs and Rastafarians:

  • Don’t cut their hair
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Accessing support from Specialist Agencies

Age UK – provide services and support to promote health and wellbeing of older people

Mind – provides advice and support for people with mental ill health problems and use campaigns to raise awareness and improve services for people with these conditions

The Royal National Institute of Blind People (RNIB) – supports people affected by sight loss, both people who are partially – sighted or those who are blind

Alzheimer’s society – provides information and support for people living with dementia. It also funds research and promotes awareness of this condition

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