Unit 2

Key roles in healthcare

Doctors (GPs)- provide medical care for patients.They work mainly in surgeries and loca communities. They diagnose, treat, monitor and prevent illness. Provide prescriptions for treatment and arrange preventative care, such as flu immunisation. Refer patients to other health professionals, such as specalist doctors and therapists.

Specalist doctors- have expert training in particular areas. They work mainly in hospitals and clinics. They diagnose, treat, monitor and prevent illness in specalist areas, such as cardiology (heart), oncology (cancer), paediatrics (children) and geriatrics (elderly). Liaise with other professionals, such as nurses, to carry out treatment in hospital. Contribute to teams for ongoing patient care.

Nurses- are trained to carry out medical duties at their level of senority and specalism, mainly in hospitals, surgeries, clinics and homes. Specialisms include hospital critical care nursing, cardiac nursing, surgical care and oncology nursing. Nurses 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.

Key roles in healthcare

Midwives- work mainly in hospital maternity units, clinics and homes. They monitor the prenatal development and health of mothers and babies. Help deliver babies. Provide postnatal care, supporting mothers, babies and families after the birth.

Healthcare assistants- are trained to help with daily personal care and to support wellbeing. They work mainly in hospitals, clinics, residential care and homes. They work under the guidance of qualified professionals, such as nurses or doctors. Meet care needs, such as washing, toileting, making beds, feeding and mobility. Monitor health by taking temperature, pulse, respiration rate and weight.

Occupational therapist- facilitate recovery and ovecome practical barriers. They work mainly in hospitals, clincs, residential care and homes. They identify issues people may have in everyday life, such as with dressing, shopping or working. Help people to work out practical solutions.

Healthcare settings

GP surgeries and local health centres- Pateints go here first when they need medical advise. Doctors diagnose the patient's illness. They may issue a prescription for medication or refer patients to other serivces. Nurses might carry out treatment or health screening, or take blood tests.

Hospitals- Patients go here for treatment that a GP cannot give. It is where operations are carried out, and Accident and Emergency (A&E) departments and some walk-in centres are located. Patients are referred by their GPs to specalised medical teams. Specialist doctors (consultants) may issue a prescription for specalist medication or refer patients to surgeons for operations.

Clinics- Patients go here to be treated for specific conditions. Patients are referred by their GPs to specalist clinics based in hospitals and in the community. Trained personnel, including doctors and nurses, work in clinics.

Home- This is where care is provided for housebound people or those who are recovering from medical treatment such as an operation. Patients are treated at home by community-based nursing and midwifery staff. Doctors carry out home visits when necessary.

Key roles in social care

Care manager- Responsible for the day-to-day running of a residential care setting. Care settings include hospices, supporterd housing and homes for people who need nursing or help with day-to-day living, who have conditions such as dementia or who are disabled. Care managers recruit and manage staff. Control the budget. Responsible for ensuring that the services in the care setting meet the National Care Standards. Put policies and procedures in place and make sure they are adhered to.

Care assistants- Trained to help people of all ages who need care to carry out day-to-day routines, in homes, day care centres and residential care. They meet personal needs, such as washing, toileting, dressing and feeding. Assist in monitoring health and wellbeing by liaising with other professionals. Help with transport, household tasks and taking people shopping.

Social workers- Trained to help a wide range of eople of all ages to find solutions to their problems. They work mainly in social care centres, homes and clinics. They protect vulnerable people from harm or abuse, help people to live independently, support children who live apart from their families, and support their foster carers and supports. Help people with mental health problems, learning disabilities and physical disabilities. Support refugees and assylum seekers.

Key roles in social care

Youth workers- Help the personal, social and educational growth of people aged 11-25, to help them reach their full potential in society. They work mainly in youth centres, schools and colleges. They 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, including outreach work relating to drinking, drugs, smoking, violence and relationships.

Support workers- Provide care support to a range of service users in homes, centres and residential care, supporting other social care workers. They vary their duties depending on the needs and wishes of the individual. Support individuals' overall comfort and wellbeing, under supervision of professionals. Help people who need care and support to live as independently as possible, also working with families.

Social care settings

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. Socail care workers provide residents with personal care, such as washing, toileting and dressing.

Domiciliary care- Social care workers provide care or people in thier own home. Care workers help people lead their daily lives by supporting their independence. Social care workers might help people with shopping, cleaning and transport, such as taking them to a doctor's appointment. Social care wokrers can provide carers with a short break from their duties.

Daycare centres- These are used by older people and those with physical and learning disabilities. They provide respite care. Social care workers might take part in leisure activities with people attending.

Following policies and procedures

Health and social care organisations have guidelines that describe the working procedures that should be followed to ensure that the care provided meets service user user's needs. Policies and procedures aim to ensure that all staff and volunteers work within the law and to the highest professional standards. 

The specific policies in place in a care setting will vary according to the client groups served and the particular function of the setting. These policies may include:

• Health and Safety policy- ensuring all staff, residents, volunteers and visitors are safe.
• Equality and diversity policy- ensuring all service users are treated equally with diverse backgrounds.
• Medication policy- all medication is stored correctly and given within a specific timeframe with the correct dosage given.
• Safeguarding policy- to keep staff, residents, volunteers and visitors safe from harm.
• Disclosing and Barring Service (DBS)- ensuring those who work with young children and vulnerable adults have a clear DBS.
• Death of a resident procedures- adhered to and meet accoridngly.
• Complaints policy- all service users and staff have the right to complain and have their complaint dealt with.

Healing and supporting recovery

Prescribing medication- This has traditionally been the the doctor's role. However some nurses have undergone additional training and taken the role of nurse prescribor. Some other healthcare practitioners, such as, dentists, chiropodists and physiotherapists, may prescribe some medications in certain circumstances.

Surgery- May play a significant part in supporting an individual's recovery from illness and other physical disorders. Health and care workers in the community have an increasingly important role in supporting people recovering from surgery. A patients recovery will continue after discharge from hospital.

Radiotherapy- A treatment using high-energy radiation. Treatment is planned by skilled radiotherapists working alongisde a team that includes radiographers and specially trained nurses.

Organ transplant- Involves either moving a body part of organ from one person's body to another's (known as allograft) or from one part of a person's body to another location in their own body (known as autograft). The purpose of the transplant is to replace the patient's damaged or absent organ.

Healing and supporting recovery

Support for lifestyle changes- Changing the pattern of daily routines and habits that are damaging to health can be very challenging, but may be important in improving a person's health. Counselling and the support of self-help groups may be crucial in implementing and sustaining lifestyle changes.

Accessing support from specialist agencies- Many specialist agencies support and promote the health and wellbeing of service users, especially those who have specific illnesses or disorders. E.g. Mind, Age UK, Alzheimer's Society.

Rehabilitation -Enabling rehabilitation

Enabling rehabilitation can be a major improvement if adapted well on an individuals personal and emotional health and wellbeing. By providing effective rehabilitation it can help improve a person's self-esteem and confidence to help promote independence.

The purpose of a rehabilitation programme is to enable a person to recover from an accident or serious illness and to live, as far as possible, an independent and fulfiling life. These programmes are particuarly important after someone has a heart attack or a stroke, or following an accident that has significantly reduced their mobility or their reaction speed.

Rehabiltation programmes may also be a central part of treatment for people who have a mental illness. The specific programme will vary according to the person's physical and psychological needs and their home and family circumstances, including the level of support from their family, friends and carers. Rehabilitation may include support from physiotherapists, occupational therapists, counsellors or psychotherapists.

It may also include using complementary therapies. Complementary therapies are not considered conventional medical treatment, and so may not be available as part of an individual's NHS care.

A vast range of equipment is available to support people to remain independent when carring ou their routine daily activities. There are many reasons for people needing temporary or permanent assistance with mobility or other activities of daily life and their needs are usually assessed by a physiotherapist or occupational therapist. Other healthcare professionals, such as doctors and nurses, may refer a service user to a physiotherapist or occupational therapist for assessment. Care assistants and a healthcare assistants often provide ongoing support in using equipment effecively and adaptions to increase a service user's independence.

Equipment to increase mobility- At the simplest level, mobility appliances allow people to be more physically active and more independent in carrying out daily routines. For example, people with arthritis, people who have a broken limb or are recovering from surgery or a stroke, or who have a progressive disease such as multiple scelorsis, motor neurone disease or muscular dystrophy or are simply ageing and have less stength in their homs and muscles. 

Mobility aids include: Walking sticks. Walking frames, including tripods and tetrapods. Wheelchairs, manual or electric. Adapted shopping trolleys. Stairlifts. Adapted cars, or other motorised transport.

Individuals may need a range of other appliances to support daily living activities and to promote their independence. These could include:

• Special cultery, with thick, light handles that are easy to hold for people with arthritis
• Feeding cups or angled straws for drinks
• Eggs cups and plates with suctioned bottoms
• Special gadgets to help people who can only use one hand to take the lid off jars and tins, and others to help with peeling potatoes and buttering break, kettles on tipping stands and adapted plugs to help when using electrical appliances.
• Special dining chairs and armchairs adapted to meet individual needs
• Bathing aids such as walk-in baths and showers, bath and shower seats
• Raised toilet seats for service users who find it difficult to sit down and stand up again
• Adapted computer keyboards and, where necessary, screens to suppor people with a range of physical conditions, including epilepsy, arthritis and visual impairments.

Providing personal care is majorly important to ensure that the service user feels respected and has their own privacy but allowing them to be as independent as possible.

When people become physical or mentally ill, or they have a disability, daily activities become a challenge. There are clearly important reasons, in terms of physical wellbeing, why people should be clean, eat well and be able to use the toilet when necessary. Dealing with these very personal areas of life has an impac on self-esteem and general confidence. It cannot be overemphasised how important it is for health and care workers to approach these intimate areas of a person's daily life with thoughtfulness and sensitivity.

Carers must discuss usual routines and preferences in terms of personal hyiene and diet with clients. For example, when washing the client may prefer a bath to a shower, or a thorough wash to either of these. Most people would prefer to take personal responsibility for these tasks and wash in private. Independence should be encouraged, but specific help is indeed the client's dignity and privacy should be preserved. Toilet and bathroom doors should be closed and shower curtains drawn. You should follow the policies and procedures of your setting to ensure the safety and dignity of your service user while carrying out these intimate tasks.

Domiciliary care workers, who provide support for people living in thier own homes, will often provide personal care of this type. In a residential home care assistants will provide this support and in hospitals it will be a regular task for healthcare assistants working on the ward.

A wide range of equipment is available to extend the independence of people in terms of their personal hygiene and to support in terms of their personal hygiene and to support carers providing personal care. Equipment includes:

• Walk-in baths
• Showers suitable for the use of wheelchair users
• Non-slip bathmats
• Bath and shower seats
• Hand rails
• Bath lifts and hoists
• Adapted taps
• Bedpans and commodes
• Female and male urinals.

Religious and cultural differrences related to personal cleaniness must also be made aware of.

Supporting routines of service users is incredibly important. Health and social care professionals must work with the service user and adapt to their day-to-day family life, education, employment and leisure activities to adapt a normality approach when caring for them.

Alhough many health and care staff have expert knowledge and high-level skills in particular areas, they will also try to address the wider personal needs that may emerge while working with their service users. This could include, for example a nurse not just attending to a service user's physical needs but also being aware of their wider social, emotional, spiritual and educational needs. Addressing these may be just as important for a speedy and successful recovery as the medical interventions and physical care that needs to be delivered and monitored.

In attending the needs of the 'whole' person, health and care professionals will want to support clients in developing and maintain a fulfilling and satisfying daily life. This will involve being aware of the community in which their clients live, their work, their family circumstances, their general financial position and their interests, hobbies and aspirations. It also includes being aware of the support provided by family, friends and neighbours, who are often referred to as informal carers. These wider considerations can be as important to a person's recovery as medicines and other clinical interventions.

Health and care professionals' skills are wide ranging and cover many specialists. However, despite the differences in skills, experience and specialist knowledge, all health and care professionals are likely to take a similiar approach to planning and evaluating care.

Often referred to as the care planning cycle, this approach involves:

• Assessing the individual healthcare needs of their service users
• Agreeing a care plan that promotes the service user's health and wellbeing
• Evaluating the effectiveness of the care implemented.

The process is cyclical, interventions and changes may be introduced at any point in the process. Adjustments may be introudced at any point in the process. Adjustments may be necessary, for example in response to changes in the client's health or social circumstances, the resources that are available, the specific expertise of the staff or multi-disciplinary team or changing levels of support from informal carers.

When planning care, professionals will assess the needs and agree the appropriate care with the service user and wheere appropriate with family members and other informal carers. Informal carers often contribute to the reviews and evaluations of care provision and to discussions about alternative strategies.

Identifying discrimination

Discrimination is where someone is treated unfairly because of who they are, treated unequally because of who they are or experiences prejudice that has been put into practice. Examples of anti-discriminatory practice in health and social care include; accessible signage, leaflets in many languages, access to buildings, policies such as anti-bullying in schools and longer appointments for people with learning disabilities.

Types of discrimination

1. Direct discrimination: treating someone worse, differently or less favourably because of their characteristics. Examples include harrassment (e.g. recieving abusive comments) and victimisation (e.g. being treated badly because you complained)

2. Indirect discrimination: when an organisation's practices, policies or rules have a worse effect on some people more than others. An example is pregnancy and maternity discrimination, if a pregnant women or new mothers are treated unfairly or are disadvantaged. 

Action against discrimination

When people have a protected characteristic, it is possibl to do something voluntarily to help them. This is called 'positive action' and may take place if they are at a disadvantag, have particular needs, are under-represented in a type of work or activity.

Equality Act 2010

The Equality Act 2010 protects people from discrimination by:

• Employers
• Health and social care providers, such as hospital and care homes
• Schools, colleges, and other education providers
• Transport services, such as buses, trains and taxis
• Public bodies such as government departments and local authorities.

Characteristics protected by the Equality Act 2010 are; age, gender reassignment, pregnancy and maternity, religion and beliefs, martial or civil partnership status, disability, race, sexual orientation.

Ensuring access- there are different  ways to ensure access and adapt services to accomodate user needs, including varying forms of communication and physical needs.

Traveller- enable access to GP services at new locations, ensure that hostile language is not used. 

Transgender person- user transgender terminology which is acceptable to the service user, recognise any associated mental health issues.

Person with a hearing impairment- providing hearing loops in GP surgeries, use British Sign Language to communicate

Asylum seeker- provide translation services if needed, recognise cultural preferences

Child with emotional and behavioural difficulties- provide peer mediation and mentoring in schools, provide nurture groups in primary schools as example of early intervention strategy.

Person with physical disabilities- provide accessible rooms in clinics, support participation in sport and exercise in schools.

Health and social care professionals must challenge discrimination

Professionals should always challenge discrimination, whether it is based on a person's characteristics or background (direct discrimination) or caused by an organisation's policies and procedures that do not adapt to meet the needs (indirect discrimination).

For example:

• Doctor's should consult patients notes to check the patient's preferred language and preferred methods of treatment.
• 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 therapist should help people to live independently by ensuring appropriate kitchen equipment for different cultures (e.g. a wok and chopsticks might be preferred).

Empowerment is a key value which underpins health and social care services. People who work in health and social care setting must empower the service users they support. Empowerment means giving individuals information and support so they can take informed decisions and make choices about their lives in order to live as independentley as possible.

Empowering service users can consist of; giving individualised care, promoting user's dignity, dealing with conflict in an appropriate way, putting the users at the heart of service provision, balancing the rights of individuals with those of service users and staff, promoting user's rights, choices and wellbeing, providing support that is consistent with users' beliefs, cultures and preferences, promoting independence and enabling users to express their needs and preferences.

Empowering individuals is central to the work of many people who work in health and social care and it requires a wide rang of skils. The ways in which adults might be empowered are sometimes different to the ways whikch children and young people are empowered. For example, where a very young is involved, it will probably not be possible to empower them in the same way as an adult or an adolescent because they might not understand what they are being told or what they might be expected to do.

Rights are entitlements that everyone should recieve. People's rights are protected by the laws of the UK such as the Human Rights Act 1998 and the Equality Act 2010.

Characteristics protected by the Equality Act 2010 are:

• Dignity
• Independence
• Privacy
• To express needs and preferences
• To be free from discrimination
• Equality
• Safety and security

Characteristics protected by the Human Rights Act 1998 are:

Age, disabiltiy, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation.

Living in a multi-cultural society can present many challenges for care providers. For example:

• If service users speak little or no English, information will need to be presented in a range of languages, translators may be necessary and support may need to be given to access English lessons.
• There may be a need to provide a wide range of foods for people with different relgious requirements, for example Jews and Muslims do not eat pork, Hindus and Sikhs do not eat beef and many Budhists are vegetarian.
• Religious observances may be need to be considered, for example Muslims will need a prayer room and opportunity to pray up to five times a day, Roman Catholics may want to attend Mass on Sundays and other holy days, Jews may want to attend the Synagouge on Saturdays.

A professional carer must be aware of individual differences and ensure, through discussion and planning, that the importance of these needs to the service user are fully respected and not ignored. If service users are empowered, they will contribute to the planning of their own care and to the polices and procedures at the healthcare setting.

Support to express needs and preferences can be expressed efficently by many professionals or family and friends. Translators and interprets, signers, advocates or family and friends can be this person to help a service user to express fully their needs and preferences.

• Translators and intepreters are concerned with communicating meaning from one language to another. This is obviously essential for many people where English is not their first language, but also includes communication between people using sign language and those using spoken English, for example translating British Sign Language or Makaton to spoken English. Signers play a key role in ensuring that people with hearing impairments can fully participate in meetings and communicate thier preferences and care needs.
• Sometimes people with communication problems need somebody else to speak for them in meetings, complete forms or write letters for them. For example, the increasing proportion of the population who suffer from dementia, people with a learning difficulty or people who have suffered brain damage following an accident, may not be able to communicate their needs and preferences.
• An advocate may speak for the client and express their views. In the care sector advocates are often volunteers. They aim to gain the trust of service users who have communication are oftne volunteers. They aim to gain trust with them to represent their communication difficulties and find ways of communication with them to represent their views to the cares.

Tension and conflict between service users, and between service users and their carers, is sadly very common. Challenging behaviour could be defined as any behaviour that puts the service user or anybody else in the setting at risk or significantly affects their quality of life. This may include excessive rudeness, aggression, self-harm or disruptiveness.

Professional carers and other staff should be trained to deal with conflict. Conflict may erupt in any care setting, such as in GP practices, hospital wards, residential care homes for the elderly, residential care homes for young adults, residential care homes for people with learning disabilities or when providing domiciliary care.

Conflict may develop between service users and their doctors or nurses, between care workers and their clients, and between the service users themselves and their informal carers. If you are a domiciliary care worker, for example and work alone there should be a lone worker's policy in place with specific guidance for dealing with any situation where you feel vulnerable, such as dealing with conflict and aggressive behaviour.

When dealing with conflict, care practitioners need to....

• Stay calm
• Try to see both sides of the argument or issue
• Listen carefully
• Never resort to aggressive behaviour

If it seems that the situation may lead to violence, wherever possible:

• Make sure you know where the doors or other exit points are
• Remove anything that could be used as a weapon
• Allow the aggressor personal space, do not stand too close to them
• Summon help as soon as possible, by using a panic alarm, shouting for help or by phoning, the police or security.

Possible risks in care

• Abuse by other service users and/or staff.
• Inadequate supervision of facilities, such as bathrooms.
• Inadequate supervision of support staff, for example when moving patients.
• Lack of illness prevention measures, such as clean toilets, hand-washing facilities and safe drinking water.
• Infection due to lack of clean facilities and equipment.
• Inadequate control of harmful substances.
• Lack of properly maintained first-aid facilities.

Managing risks in care

• Using risk assessments to identify possible sources of harm, assess the likelihood of them causing harm and to minimise the chance of harm.
• Staff training to manage risks.
• Clear codes of practice which are familiar to all staff, including safeguarding and control of harmful substances.
• Appropriately qualified staff.
• Ensuring all staff have Disclosure and Barring Service (DBS) clearance.
• Regular and evidenced checks of facilities and provision of safe drinking water.
• Availability of protective equipment and knowledge of infection control procedures.
• Procedures for reporting and recording accidents, incidents and complaints.
• Provision of maintained first-aid facilities.

Example risk: Specialist equipment, e.g. use of hoist to life immobile patient

Mitigation: Require sufficent staff trained in use of equipment to perform manoeuvre.

Employers must:

• Ensure that the organisation has a robust health and safety policy that there is someone with official responsibility for the health and safety at the setting
• Undertake a risk assessment to identify the risks and hazards at the workplace, and take action to reduce the likeliness of harm of injurty
• Provide up-to-date information on health and safety issues
• Provide health and safety equipment to carry out all procedures and treatments
• Provide health and safety training
• Keep a record of all incidents and accidents.

Employees must:

• Take reasonable care of their own safety and that of others in the workplace, including service users, colleagues and visitors
• Cooperate with their employer to carry out the agreed and required health and safety procedures of the workplace
• Not intentionally damage health and safety equipment at the setting, for example hoists.

Score- 1- mostly unlikely to happen- if it did happen the harm would be negligible and could be dealt with by an untrained person, e.g. applying a plaster.

Score- 2- unlikely to happen- slight injuries, e.g. catching a cold or the need for a few stitches

Score- 3- likely to happen- serious injuries, they may be physical or psychological and may take months or years to heal.

Score- 4- very likely to happen- could be permanent disability or even death.

The risk rating for a particular activity or procedure can be helpfully expressed numerically:      Risk rating= likelihood of risk x severity of the injury.

Rating 1 or 2= a minimisal risk rating- the existing practice would be seen as adequate.  Rating 3 or= a low risk rating- the existing practice should be reviewed to lower the level of risk. Rating 6 or 8= a medium risk rating- this should lead to specific action to improve safety. Rating 9,12 or 16= a high rating- this must lead to immediate action to improve safety and the activity should be stopped until proper measures are in place to reduce the risks identified.

Washing your hands before you start work and before you leave work, before eating, after using the toilet and after coughing or sneezing and before and after you carry out any personal care, particuarly if this involves contact with bodily fluids, clinical waste or dirty linen. Alcohol hand rubs are a further effective and swift procedure to ensure that hands are clean and provide further protection from contamination.

Safe handling and disposal of sharp articles such as needs and syringes to avoide needle-stick injuries and to ensure that infection is not passed on through viruses carried in the blood or bacteria. Wearing protection disposable gloves and aprons when you have contact with body fluids, or when you are caring for someone with open wounds, rashes or pressure ulcers, for example.

Keeping all soiled linen in the designated laundry bags, or bin, and not leaving it on the floor. Soiled linen should always be washed in a designated laundry room. When handling soiled laundry a protective apron and gloves should be worn. Hands must be thoroughly washed after handling soiled linen. Separate trolleys should be used for soiled and clean laundry to avoid cross-contamination and the spread of disease. Cleaning all equipment according to the agreed procedures of your setting. 

There are different disposal requirements for different types of substances and equipment. This includes cleaning fluids, harmful vapour and fumes. The Control of Substances Hazardous to Health (COSHH) Regulations (2002) provide guidance approved by the Health and Safety Executive for the safe disposal of hazardous waste. The policies and procedures used in the care setting will be based on this guidance. In care settings, different coloured bags are often used to ensure the safe and efficient disposal of hazardous waste.

Clinical waste, e.g. used bandages, plasters or other dressings- Yellow bag; waste is burned in controlled settings.

Needles and syringes- Yellow 'sharps box which is sealed; waste is burned in controlled settings.

Body fluids, e.g. urine, vomit or blood- Flushed down a sluce drain; area must then be cleaned and disinfected.

Soiled linen- Red laundry bag; laundered at the appropriate temperature

Recyclable equipment and instruments- Blue bag; returned to the Central Sterrilisation Service (CCSD) for sterilising and reuse.

Illnesses, diseases and serious accidents that must be recorded are called 'notifiable deaths, injuries or diseases' and are covered by The Reporting of Injuries, Diseases and Dangerous Occurences Regulations (RIDDOR) (2013). Notifiable illnesses include diphtheria, food poisoning, rubella (German measles), tuberculosis (TB) and notifiable incidents occuring at work include broken bones, serious burns and death.

However, less serious accidents and incidents must also be recorded. If somebody slips on a wet floor or trips over the trailing straps of a shoulder bag a record must be made, regardless of whether or not there is an injury.

Providers of health and care services use an accident form to report the details of all accidents and incidents, which are then recorded in an accident book. These reports are required by law and are checked when care settings are inspected.

Included in the accident form; information about the person completing the form, information about any witnesses, information about the injured person, information about the accident, information about the type of accident: what happened? Identifyng ways the accident could have been prevented, describe the accident using factual information, date form completed and review date.

Provision for first aid should be 'adeqaute and appropriate'. What is deemed as adequate and appropriate will vary from setting to setting. It is proposed that from September 2016 all newly qualified early-years practitioners will be required to complete paediatric first-aid training.

All first-aid incidents occuring in care settings must be recorded either in the accident book or b completing the setting's accident form. The report should include:

• The name of the casualty
• The nature of the incident/injury
• The date, time and location of the incident
• A record of the treatment given.

These records must be truthful and accurate. They may be used in courts of law, particuarly if the casualty is claiming compensation for injury, or if there is an accusation of criminal negligence.

Barriers to incident reporting- There are many barriers to incident reporting such as; the incident or accident is seen as not important at the time. The incident form is too long or requires to 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 need to recieve the incident/accident report. Or there may be pressure from managers not to report incidents and accidents.

Problems with evidence- Common problems with evidence in reports include; inconsistent witnesss statements. Lack of detail in statements. Poor recall of events. Written evidence that conflicts with other types of evidence, e.g. from CCTV or voice recordings. Low standards of written English.

Four key ponts about complaints- 1. All care settings must have them in place. 2. All care settings must enable servicde users to access and use them. 3. They are checked when care providers are inspected. 4. They can lead to service improvements.

The right to complain- Service users have the right for; complaints to be dealt with within an appropriate time frame. Complaints to be taken seriously. Full and thorough investigation of concerns raised. Information about the outcomes of investigations into their complaints.

Stages of reporting incidents and accidents

1. Detect incident or accident.

2. Record incident or accident.

3. Report incident or accident to relevant person.

4. Classify incident or accident according to type and severity.

5. Prioritise issues for appropriate actions.

6. Propose preventative measures.

7. Implement changes to working practices.

8. Monitor effectiveness of changes in preventing future incidents.

The Data Protection Act 1998 applies to both staff and service users in all health and social care settings. Staff must protect data about service users, and employers must protect data about staff.

Information about you- The Data Protection Act 1998 controls how personal information is used by organisations, businesses or the government. Data must be; used fairly and lawfully. Used for limited, specifically stated purposes. Used in a way that is adequate, relevant and not excessive. Accurate. Kept for no longer than is necessary. Handled according to people's data protection rights. Kept safe and secure.

Protection- There is strong legal protection for information about your; ethnic background, political opinions, religious beliefs, health, sexual health and preferences and criminal record (if you have one). 

Data that an employer in health and socail care can keep about their employees are; emergency contact details, education and qualification, name, details of any known disability, National Insurance number and Tax Code, gender, address, date of birth and employment history and work experience.

Recording and storage of data

The Act covers the policies, procedures and systems for:

• Storing information- Confidential information should be stored in locked filing cabinets, in a locked room. Information held electronically should be protected by a secure password.
• Accessing informaiton- Members of staff in the organisation who are allowed access to this information should be clearly identified. Staff should never have access to personal information, that they do not need to know. Where information is stored electronically, only the relevant staff should have personal access passwords.
• Sharing information- Information should only be shared with other professionals who have a need and a right to know it.

Legal and workplace requirements

• The principles and requirements of The Data Protection Act (1998) and the requirement for confidentiality are within the policies and procedures of all health and socail care settings. They are also embedded in the codes of practice of the professional bodies that regulate health and social care staff, such as the General Medical Council (GMC), Nursing & Midwifery Council (NMC) and the Health and Care Professions Council (HCPC).
• All employees and volunteers in organisations have a responsibility to ensure that the confidentiality of service users' information is protected. They also have a duty to actively promote respect for confidentiality throughout the setting. If they spot weaknesses in the procedures, for example the location of offices where personal care is discussed, they should feel confident to suggest improvements in the systems and arrangements. This is necessary to ensure that safety and security of service users and to respect their right to confidentiality of personal information.

Accountability to professional organisations

Standards of professional practice expected of professionals working in health and care settings are regulated and monitored by a range of professional bodies, including the General Medical Council (GMC), Nursing and Midwifery Council (NMC) and the Health and Care Professions Council (HCPC). The specific regulations vary according to profession. However, each professional organisation monitors the:

• level and content of the initial education and training of members of their profession
• ongoing professional development and the requirement to keep up to date, and to complete further training- often called Continuing Professional Development (CPD)
• standards of professional practice in their everyday work
• Standards of professional conduct, both at work and in leisure time.

Professional organisations publish codes of practice for members which must be followed. If a member is accused of failing to meet the standards set, this will br investigated and, in extreme circumstances, the member can be removed from the professional register and barred from professional practice. The professionals organisation's regulations outline the formal procedures that will be used following a complaint or concern about the qualifications or professional practice of its members. This will include specific procedures to investigate unprofessional practice reported by professionals about their colleagues, known as whistleblowing.

Revalidation procedures

Each of the professional bodies requires its members to complete regular CPD in order to remain on the register. This may include, for example:

• Training on the use of new procedures or new treatments 
• Training on the use of new equipment
• Providing evidence that a registered person reviews and learns from their own practice.

Safeguarding regulations, raising concerns and whistleblowing- In April 2012, a Care Certificate was introduced for newly appointed health and social care workers who are not members of the regulated professional bodies, that is the GMC, NMC and the HCPC.

Employees who would normally complete this new programme include health or social care assistants, support workers and homecare workers.

The Care Certificate is not a statutory requirement, it is voluntary, and would normally be used alongside the specific induction programme for a work setting. It does, however provide an identified set of standards that health and social care workers should follow in their daily working life. Employers are expected to implement the care certificate for all new starts from April 2015. They will be required to meet its standards before they can work with patients. It replaces the Common Induction Standards (CIS) and the National Minimum Training Standards (NMTS).

The code of conduct incorporated into the new care certificate requires that healthcare support workers and adult social care workers in England:

• are accountable, by making sure they can answer for their actions or omissions
• promote and uphold the privacy, dignity, rights, health and wellbeing of people who use health and care services, and that for of their carers, at all time
• work in collaboration with colleagues to ensure they deliver high-quality, safe and compassionate healthcare, care and support
• communicate in an open and effective way to promote the health, safety and wellbeing of people who use health and care services, and of their carers
• respect a person's rights to confidentiality
• strive to improve the quality of healthcare, care and support through CPD
• uphold and promote equality, diversity and inclusion.

The Data Protection Act 1998 is designed to maintain confidentiality of personal information, including the health and social care histories of individuals.

How is confidentiality ensured?

• By applying the requirements of the Data Protection Act 1998
• By adhering to legal and workplace requirements by codes of practice in health and social care settings
• By secure 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.

Data storage

These methods of data storage are covered by the Data Protection Act 1998; computers, tablets and mobile phones, social media, written, paper records and photographs.

Staff's security responsibilities

Consider what security procedures a domestic care assistant might have to use if they store client information, such as phone numbers and addresses, on their mobile phone.

Key term: Confidentiality- in health and social care settings means restricting access to informaiton about a service user to individuals who are involved in their care, unless permission to disclose the information is given by the service user.

Remeber: there is more to storing data confidentiality than keeping documents under lock and key, and exam questions might ask you to explain. You mkight like to think, for example about the use of CCTV cameras in health and social care settings. These are in use to protect people who use services, and people who are working in health and social care settings. Photographs and images collected by CCTV can only be used in particular circumstances and for specific purposes. 

Professional bodies regulate the people who work in health and social care settings.

Examples of professional bodies

England

• The Nursing and Midwifer Council (NMC)
• The Royal College of Nursing (RCN)
• The Health and Care Professions Council (HCPC)
• The General Medical Council (GMC)

The Royal College of Nursing (RCN) sets the standards of professional practice required by its members. In order to continue their registration with the RCN and their ability to practice, nurses have to complete 450 hours of practice every three years.

Regulation of workers

People who work in health and social care settings have to follow the regulation set out by the 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 have to make a health and character declaration in order to be registered
• follow procedures for raising concerns (whistleblowing).

Workers who do not follow regulations might be disciplined by their employer, e.g. a Foundation Trust, or by a professional organisation, e.g. the RCN, or in some cases by the police when they have committed a crime. When workers are disciplined, this can mean that they have some responsibilities taken away from them or they can lose their professional status, e.g. if a nurse fails to complete enough practice hours, or for a serious malpractice, they can lose their job. If health and social care workers are prosecuted, they can be put in prison if the crime is serious enough. 

Key word- Regulation: Law which sets standards of professional conduct required of people who work in health and social care settingts. They are mandatory meaning they must be followed by law.

Why is partnership important?

Partnership working is important because it:

• improves the lives of vulnerable adults and children
• means service users don't have to give the same information to different health and social care workers
• improves information sharing between professionals
• improves the efficency of the care system as a whole (joined-up working)
• coordinates the way in which care is provided
• helps the service user feel that they are being treated as a whole person (holistic care), rather than as a series of untreated medical issues
• improves the planning and commissioning of care, so that health and social care services complement rather than disrupt each other.

Difficulties of partnerships

Problems with partnership working include:

• failure to communicate informaiton between services, for example, between social workers and the police in cases where children are in danger
• lack of coordination of health and social care services, so people do not recieve the care they need or experience duplication
• delayed discharges from hospital, mainly of older people; for example, when a patient cannot leave hospital because there is no available support in the community
• health and social care providers with different IT systems that cannot communicate with each other 
• cuts in findings that prevent effective partnership

Partnership with families- Working in partnership in health and social care may include working with a service user's informal carers, friends and family to plan, aid decision-making and enable support with other service providers. It is important to be willing to work with different people, both professionals and non-professonals, showing respect for all expertise and opinions, and accepting help when you need it. 

A holistic approach takes account of a person's wider needs (physical, intellectual, emotional, social, cultural and spiritual) and seeks to meet these needs to promote health and wellbeing.

Advantages- Benefits of a holistic approach are that:

• care is more personalised
• other issues which contribute to the individual's ill health, such as stress or poor housing, may be identified and addressed
• being viewed as a 'whole person' and not a medical problem can improve an individual's general health and wellbeing.

Disadvantages- Disadvantages of a holistic approach are that:

• most people only want their particular illness or system treated
• generally, doctors do not look for other issues during diagnosis
• health and social care workers are not employed or skills to manage all aspects of an individual's needs.

Advocacy

Service users, their carers and other advocates should be involved in decision-making and planning support with service providers, working in partnership. 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.

A holistic approach is also known as a whole-person approach.

Line management

People who work in health and social care settings normally also work in hierarchical organisations and their work is monitored by senior members of staff. For example, in a care home, the care assistants will be managed by the care manager who will allocate tasks and set the routines and standards for the setting. The care manager will expect employees to follow these routines and meet the standards set. In a larger setting, there will often be senior care workers who manage a team of care assistants on behalf of their manager.

In an early-years setting, for example, a nursery manager will manage the early-years' practitioners at the setting and in a reception class the nursery teacher will manage the early-years educator. If staff performance falls short of the practice expectted, it will be the line manager's responsibility to address the issues with the staff concerned and take appropriate action. In the first instance this may be an informal conversation or warning. If the concerns are serious or there is no improvement in performance more formal action may be taken which could finally lead to suspension or dismissal.

Whistleblowing

Whistleblowing is when a member of staff is aware that the quality of care at their work place is dangerously poor and reports this to bring about change. They may inform the press or another, usually powerful, organisation outside the setting in which they work such as the police or a professional body. Whistleblowers may be employees at any level and working in any part of the organisation as a care worker, an adminstrator or a manager.

Criminal investigations

In extreme circumstances, such as cases of sexual, physical, financial or emotional abuse, or in other circumstances in which it is suspected that criminal law has been broken, the police may investigate. There have been high-profile cases where care staff have been found guilty and imprisoned following criminal investigations. For example following a Serious Case Review of the Winterbourne View residential home. This may also lead to health and care workers being removed from their professional register and being barred from professional practice.

Service user feedback

Setting will have a range of different systems for ensuring that service users and their families, friends or other informal carers can formally comment on the strengths and weaknesses of the service that they recieve. This may include:

• Regular meetings for service users to report concerns and to share ideas for the improvement of provision
• At a large setting, there may be a committee that represents all service users, for examle a parents and carers association at a pre-school setting 
• A suggestions box
• Service users may request a private meeting with a manager or governor of a setting
• Service users reporting good practice of areas of concern to the external agencies- for example Ofsted or CQC. If organisations responsible for inspecting settings recieve complaints this may lead to a prompt and often unannounced inspection of the care setting.

Internal monitors- Internal monitoring is a key part of line management, where staff have responsibility for other colleagues and for ensuring they deliver quality care. Health and social care workers must follow the codes of practice and policies in the settings where they work. People who work on hospital wards and responsible for monitoring the care which patients recieve. Because they work in hospitals, they are called the internal monitors. Staff with responsibility for othe colleagues are line managers.

Whistleblowing- Whistleblowing can take place in both social care and health settings. In a health setting, for example, a member of staff might raise concerns about patient care, such as when the health and safety of a patient is put at risk. The concerns are reported to the relevant staff in the hospital, such as the senior nurse, a doctor or one of the hospital managers. 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 or their representatives
• Staff may leave or perform less well
• The service provider may recieve more negative reports.

Whistleblowers are protected by law and should not be treated unfairly or lose their job.

Internal monitor rules

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

Organisations that are external to care settings use codes of practice and regulations to govern how health and social ncare workers carry out their roles.

Inspections- External bodies monitor services, including through inspections. These cover:

• Analysis of internal data and trends, for example on health outcomes
• Investigation of complaints
• Observation of service delivery
• Collection of service delivery
• Collection of service-user feedback 
• Interviews with staff.

Examples of external monitoring- External agencies may inspect care settings but visiting and observing practice. Service-user feedback takes place as part of the inspection process and can also be used informally to monitor care through everyday feedback from individuals recieving care and their family and friends.

Criminal investigations

Criminal investigations in care settings:

• are pursued where sexual, physical, financial or emotional abuse is suspected
• have to account of safeguarding
• follow referrals to the police from care providers, Clinical Commissioning Groups (CCGs) and specialised care setting such as prisons
• follow referrals from individuals who suspect that a crime has been committed
• may lead to the suspension of dismissal of care workers following an investigation.