Health and Social Care - Unit 2: Learning Aim B

• Provide health & social services are financed & directly the government 
• Primarily funded by taxation & small proportions of funds of NI contributions 

Primary healthcare: provided by doctors, dentists, opticians 

Secondary healthcare: hospital services which GP further refers service users to consultants e.g physiotherapy 

Tertiary healthcare: specialists consider specific & complex care units e.g spinal injury units

NHS Foundation Trust

• work with GP & LA to provide support

service provided by trust include:

• adult & community nursing services
  
• pallatative/end of life care
• urgent care centres
• health visiting/school nursing 

Adult Social Services

Care trusts established are responsible for both NHS mental health service & LA provision 

Support provided can take forms including:

• domiciliary care
• day centres: provide care, stimulation, company
• sheltered housing schemes

Primary care trusts 

• provide better continuity of care between NHS provision & social care support necessary

Children's services 

Aim: support & protect vulnerable children, young people, families & young carers

• Services to safeguard from abuse, help parents and cares, practical help in the home, support of children centres 
• practical health at home
• day care for under 5 years old, after-school support

GP Practices 

• Aim: use holistic approach to care
• Role: make initial diagnoses to refer individuals 
• GP increasingly work as members of multi-disciplinary teams 
• funded by government as part of NHS 

Assessed through workload of patients they take into account:

• age, gender and levels of mobility 
• number of people who live in resdential homes - geenerates higher overload 

Futher payments: if deemed high quality service, support premisies or necessary equipment e.g computers

Key points 

• Known as charities 
• Include: Shelter, NSPCC, Samaritans 
• heavily rely on charitable donations & may recieve support from local government 
• social services provided by voluntary sector managed independently from government 
• charities provide services for NHS, adult social services, children's services

Key features of the voluntary organisation are:

• not run for personal profit 
• use volunteers for some of services 
• managed independently from government  

NCVO (national council for voluntary organisation) - body that supports and promotos of voluntary sector

Key points:

• private sector managed by commercial companies 
• often provide services for central government &  local authorities including NHS, adult social care & children's services

Private sector companies are funded by:

• fees paid directly by service users
• payments from health insurance companies
• grants & other payments from central & local gov for services 

Hospital department provide in and outpatient services 

Hospital departments for:

• Orthopaedic: people with bone disorders 
• Radiology: using X rays
• Psychiatry: mental ill health 
• Cardiology: heart conditions 
• Geriatric: frail elderly 
• Oncology: cancer

Day centre hospice care, residential care, domiciliary care

Domiciliary service include: 

• small maintenance jobs
• installing security equipment 
• delivery of meal
• transport 
• providing company & arranging social activities 

Self-referral: when person contacts care provider personally and access primary healthcare services

Professional referral: when health or care professional contacts another service provider requesting support

Third-party referral: friend, neighbour or relative contacts health or care service on person's behalf

Assessment 

• local authorities carry out community care assessment 
• community care assessment: professional assessment of care need provided by LA which provides help & advice in accessing services
• carers have right to carer's assessment to see if they need support to carry out caring activities 
• The Care Act (2014) set out carers' legal rights for assessment & support

Communication: 

• users feel discriminated against therefore can't communicate easily with care providers

Scarce Resources:

• long waiting time for hospital appointments

Financial:

• cost & difficulty in providing care for children & other dependents while service user attends care setting

Inconvenience of location:

• cost of travel can be a barrier as financial support is always available

Language:

• English may not always be a service users language & interpreters aren't available all the time 

To be entitled to care & support from local authority: 

1. physical & mental impairment or illness

2. inability to achieve 2 daily activities (outcomes):

• prepare & eat food
• wash themselves or their clothes 
• manage their toilet needs
• dress appropriately, esp in cold weather
• move around house easily 
• keep their house clean & safe
•  maintain family or close relationships
• access work, training, education, volunteering 
• use local facilities, shops
• carrying out caring responsibilties 
• meet outcomes likely to affect health & wellbeing 

if eligible is met called National eligibility criteria, LA has duty to make sure needs are met

Charities & patient groups:

• respresent service users when need of contacting & lialising with offical agencies 
• MENCAP: support service user by lialising with oarganisation such as local council housing department, social services 
• SHELTER: provides, advice, guidence & support with those with housing problems

Complaints policies

All care settings have formal complaint procedures, have responsibility to ensure service users, families, informal carers understand how to access & use complaint procedures if unhappy with quality of care

If service user complains they have right to:

• have complaint dealt with effeciently & in timely way
• have complaint formally investigated 
• be told outcome of complaint 

Care Quality Commission (CQC): responsible for monitoring & inspecting health services & adult care services

Aim: ensure hsc services are of high quality & delievered safely, effectively, compassionately

Monitor & inspects :

• NHS trust hospitals, GP provision, clinics, dentists, domilcilary care, residential care, accomodation

All providers of services must register with CQC

Excutive agency sponsoered by department of health, following implementions of Health & Social Care Act 

Aim: To protect & improve public health & wellbeing of people in England & to reduce health inequality 

Focus of all public health organisations is on protection & improvement of health of community or population

Public health: organised strategies to prevent disease, promote health & prolong life in population

Measures that PHE uses to carry out its responsibilities:

• setting up health promotion prgrammes to improve the nation's health, example PHE ran campaign 'Be clear on Cancer' 
• research projects to improve our knowledge of public issues & generate strategies to address problems
• taking measures to protect nations health when theres public concern such as new virus

Office for standards in Education, Children's Service & Skills:

Regulates & inspects services that educates children, young people & adults or care inspection of:

• state funded schools, colleges
• adult education prvoiders
• private agencies 
• nurseries, pre-schools

Inspectors make judgement about overall effectiveness of provider relating to:

• quality of teaching, learning, assessments
• personal development, behaviour & welfare
• outcome for children & learners

National Insititue for Health & Care Excellence: responsible for providing guidence on current best practice in hsc

• Publishes guidence & advice that aim to control & improve hsc provision 

NICE provides:

• guidence on most appropriate treatments for people with specific conditions e.g cancer
• evaluation of whether procedures are safe & effective to be used
• assessment of costs & effectiveness of treatments
• recommendations about best practice, based on recent research
• support for health promotion campaigns & healthy living advice 

New responsibilities for social care: aim to provide smoother transition for service users moving from health services to social care services

NICE has jurisdiction in England & Wales & recommendation is national, providing consistent approaches 

Care and Social Services Inspectorate Wales:

responsible for regulation & inspection of care provision includes:

• residential care homes, nursing homes, domiciliary, nurses agencies, children homes, child minders, fostering & adoption agencies

CSSIW publishes report on outcome of its inspections

CSSIW aims:

• provide independent assurance about quality & availabilty of social care
• safeguard adults & children, making sure rights are protected
• improve care, encouraging & promoting improvements in safety, quality & availability of social care service
• provide independent professional advice to those who plan health and care provision 

HIW inspects all healthcare provision provided by NHS & independent organisations, private & charitable organisations 

Responsbilties include:

• hospitals, clinics, mental health & substance misue services, youth offending teams, death in prisons 

HIW Aims:

• contribute to improvinf safety & quality of healthcare services
• improve citizens' expeerience of healthcare in Wales
• stregthen voice of patients & public in way health services are reviewed
• ensure timely, useful, accessible & relevant information about safety & quality of healthcare in Wales 

Her Majesty's Inspector of Education & Training in Wales

• organisation responsible for inspection of education & training 
• work is specifically linked to education & training, inspection of children's social services is largely the responsibility of CSSIW

Responsibilities include inspection of:

• schools, further education colleges, work-based learning providers, adult & community learning provision

Makes judgemnts on the quality of provision by addressing three questions

1. How good the outcomes are?

2. How good is provision?

3.  How good is leadership and management?

KEY POINTS

• Regulation & Quality Improvement Authority
• Responsible for regulation of both care & health services 

Inspects services provided by both statutory & independent organisations including:

• childrens homes
• domiciliary care service 
• residential centres
• nursing agencies 

overall responsibility to improve health & social wellbeing of people living in Northern Ireland

PHA manages by:

• developing effectove health protection strategies 
• developing policy to improve health & wellbeing of population
• conducting research & development activities to identify the causes of poor health
• recommending strategies to improve health of nation

Ran a compaign to urge to takes steps to reduce their liklehood of having stroke World Stroke Day 

NICE:

• Does not have direct responsibility for control & improvement of health & social care services in Northern Ireland 
• Has direct link with Northern Ireland Department of Health, Social Services & Public Safety (DHSSOSNI) - Department regularly & systematically reviews NICE recommendations & applies them in NI where appropriate

Education & Training Inspectorate (ETI)

ETI responsible for inspection & improvement of educational services of NI which includes educational services provided in:

• early years, pre-school education
• primary secondary schools
• further education colleges 
• youth work

When reporting quality of provision in schools & colleges, ETI uses descriptors to report on quality of provision:

• achievements & standards 
• provision for learning
• leadership & management

CQC in England, CSSIW & HIW & RQIA in Northern Ireland require service providers to register with them before offering care services 

When service providers register, there are checks to ensure neccessary standards of safety & resources are met to ensure high standards of care. 

Once registered, services are monitored and includes regular inspection:

• Inspection teams make judgements by robust evidence, on quality of provision (whether care is safe, effective, well-managed)

National regulators pulishes National Minimum Standards NMS of provision in settings they inspect

Main sources of evidence used to support judgements are:

• feedback from service users, families, friends, staff at setting
• written reports of care practice & procedures
• information from other local organisations linked
• records of complaints
• on-site inspection of practical care provision

How organisations & individuals respond to regulation & inspection

Weaknesses in provision may be identified that managers are unware of areas of concern therefore may feel vulnerable & may feel unable to make improvements needed

To support care providers, regulators publish guidence that outline what they expect to see:

CQC publishes outcomes for each inspection & health & care provision is graded according to quality of work 

In Northern Ireland, RQIA assesses whether National Minimum standards are met, partially, or not met

Changes in working practice required by inspection

If in inspection practice doesn't meet required standards, regulator can enforce change such as:

• requiring or recommending improvement to provider's policy & practice in specific areas, example to share good practice in provision of care
• issuing requirement notice or warning notice, to see out what improvements must be made
• making changes to care provider's registration to limity range of care able to be provided
• pursuing criminal prosecution in extreme cases, where there's inadequate safeguarding from abuse

England, Wales & Northern Ireland 

Nursing & Midwifery Council (NMC)

• responsible for regulating standard of professional practice of all nurses & midwives
• sets standards & formal code of practice required for N & M
• N & M have to provide evidence of contuning learning & training to remain on register
• all N & M required to register with NMC, who investigate allegations that their members not meeting standards set
• NMC has power to retrict nurses practice, example have them work under supervision
• if not on register then not permitted to practice

NMC exists to protect public & sets high standards:

• initial education & training of N & M
• continuing professional development 
• standards of professional practice
• standards of personal conduct, work & lesuire time

England, Wales & Northern Ireland

Royal College of Nursing (RCN)

• union & professional body representing nursing profession
• represents nurses in public, private & voluntary sector 
• aim: to maintain high standards in nursing practice through education & research activities

Health & Care Professions Council (HCPC) 

• promotes good practice & protects public from poor standards of care
• regulates hsc professional, 16 professions such as, physiotherapist, occupational therapist etc

to register as HSPC approved practitioner individuals must:

• have achieved relevant qualifications
• meet standards of professional practice & personal behaviour required by council 

HSCPC will investigate complaints & take appropriate action, serious misconduct, can icnlude suspension or permantant removal from register

General Medical Council (GMC)

• independent organisation from registration & regulation of doctors 

GMC: 

• oversees UK medical education & training 
• decides which doctors are qualified to work
• sets standards that doctors must meet in professional practice
• takes action to address shortfalls in standards of treatment that may put patients at risk

when concern raised about doctor's behaviour or practice the GMC investigates, if theres a concern GMC may restrict doctor's right to practice 

Care Council for Wales (CCW)

• CCW set up under Care Standards Act with aim of registering & regulating the social care workforce
• CCW confirms & registers staff working in children's or adult social care & early years

CCW checks that practitioners:

• have neccessary qualifications
• physically & mentally fit to practice & work in this area
• are of good character, which will involve Disclosure Barring Service Check (DBS)
• comply with CCW code of practice for social care workers

CCW investigates complaints & takes appropriate action to protect the public 

Northern Ireland Social Care Council (NISCC) 

• set up under Health & Personal Social Service Act
• overall aim: protect public & all service users by regulating the registration & practice of social work & social care workforce

NISCC responsible for:

• monitoring & regulating social care workforce in NI includes, social workers, social care workers, social care managers, work in day care, community settings, domiciliary 
• setting standards for training & professional practice of members of care workforce
• promoting professional development of workforce

overall purpose of regulation: protect public by setting standards of education, training, professional conduct & practice, to ensure high standards are maintained through health & care professional's careeer

Health & Care work fast changing area therefore stressful for care workers & requires continuing professional development 

If allegation is made that practitioner isn't meeting the standards expected, their regulator will investigate that complaint

Regulators have power to suspend members, require them to do extra training, restrict types of work 

Health & Social Act 2008, & linked regulations of 2014, requires that registered providers of care services must ensure suffcient numbers of qualified staff ti neet beeds if service users

Must provide or support training & professional development to ensure staff can carry out caring role

Social care settings, new staff required to complete introduction programme, meet requirements of Common Induction Standards 2010 within 12 weeks of commercing new job

Meeting National Occupational Standards

• they are standards of professional practice should be met in workplace
• NOS for people working in hsc sector are applicable throughout UK
• NOS underpins the codes of practice in care setting & curriculum for training of practitioners for professional bodies, example NMC

Undertaking professional development

• ensure they are following best practice & most up-to-date procedures based on research
• members of GMC, NMC, HCPC required to complete regular professional training to remain on registers 
• responsibility of care manager to ensure support staff who aren't members of professional organisations also regularly update & extend their skills

Internal & external complaints 

Care organisations required by regulators, which include professional organisations & inspection agencies, to have formal procedures to address complaints

Allegations of poor practice made against staff, will intially be addressed through organisation's internal disciplinary systems

Member of trade union/ professional association

support practitioners which support them if they are accused of professional misconduct or are in conflict in other ways with employers

Example: nurses belong RCN Royal College of Nursing, midwives to Royal College of Midwives, social workers UNISON

Following protocols of regulatory bodies

Protocols: accepted codes of practices & behaviour required of professionals by regulatory bodies

• Regulatory bodies such as GMC, NMC, HCPC provide protection for employees by ensuring standards expected of them are clean & transport
• As part of induction & ongoing training, health practitioners must understand professional responsibilities & protocols which they must practice

Whistleblowing

form of protection for all staff

if quality of care in organisation is poor & is going unchecked, whistleblowing will protect service users, other staff, sometimes provision

poor practice damages reputation of sector & can lead to investigations by professional organisations