Unit 2, Working in Health and Social care

Roles 

There are many types of Doctor: 

General Practitioners (GP), provide a Primary Care for the sick. 

Specialist Practitioners, Learn to practice in one field and develop their skills and expert knowledge. Example Cardiologist. 

Roles 

• Diagnosis 
• Disscuss and Review Treatment 
• Prescribe 
• Monitior Impact 
• Preventaive  care  
• Immunisation 
• Health Care Education 

Senior Doctors who has specialised in their field of medicine, there are many different types of consultant   

• Cardiologist - Heart 
• Psychiatrists - Mind 
• Oncology-Cancer 
• Paediatrics  - Kids 
• Geriatrics - Elderly 

Nurse Provide care and support for the ill there are many types of Nurse; 

• Adult Nurse 
• Mental Health Nurse 
• Paediatrics Nurse 
• Learning Disability Nurse 
• District Nurse 
• Neonatal Nurse 
• Health Visitor 
• Practise Nurse
• School Nurse  

Midwives are a Nurse like Healthcare Practitioners who care for Babies and their mothers. A Midwife has many roles Antenatal - During Pregnancy and Post-natal - After the pregnancy. Midwives Usually Conduct in Hospital but they sometimes hold a clinic in homes or GP Practises.     

• Hospital midwives are midwives who are based in a hospital obstetric, or consultant unit, a birth centre or midwife-led unit, and they staff the antenatal clinic, labour ward, and postnatal wards.
• Community midwives often work in teams and provide a degree of continuity of care. In pregnancy, they see you either at home or at a clinic. When you go into labour they are available for a home birth, or in a few places, they may come into the labour ward in the hospital to be with you. Once your baby is born, they’ll visit you at home for up to ten days afterwards. Community midwives also provide postnatal care for women who have been looked after during labour by hospital midwives.

HCA help nurses with different roles in different settings 

• observing, monitoring and recording patients' conditions by taking temperatures, pulse, respirations and weight
• communication with patients, relatives and carers
• assisting with clinical duties
• personal care including infection prevention and control, food, personal hygiene and overall reassurance, comfort and safety
• promoting positive mental/physical/nutritional health with patients
• checking and ordering supplies

Working in many settings such as 

• GP's Surgeries 
• Hospitals 
• Community settings 
• Nursing Homes. 

Social Workers support people of all ages through difficult times, their aim is to ensure that vulnerable people are safe and protected. 

• Family, child or school social work involves providing assistance and advocacy to improve the social and psychological functioning of children and their families. These social workers attempt to maximize the academic functioning of children as well as improving the family’s overall well-being. These professionals may assist parents, locate foster homes, help to arrange adoptions and address abuse. In schools, they address problems such as truancy, bad behaviour, teenage pregnancy, drug use, and poor grades. They also advise teachers and act as liaisons between students, homes, schools, courts, protective services, and other institutions.
• Public health social workers are often responsible for helping people who have been diagnosed with chronic, life-threatening or altering diseases and disorders, helping connect patients with plans and resources in order to help them cope. 
• Addictions and mental health social workers offer support and services to those struggling with unhealthy grounding techniques, connecting them with facilities that serve to teach healthier behaviours and get patients back on track. 

Occupational therapists work with people of all ages who are having difficulty in carrying out the practical routines of daily life, for example, washing and bathing, housework, cooking or getting to the shops. These problems may be the result of a disability, physical or psychological illness, an accident or the frailty of older age. The occupational therapist will agree on specific activities with an individual that will help them to overcome their barriers to living an independent life. Occupational therapists may work in people’s homes, GP practices, residential and nursing homes, prisons, social services and other council departments and in hospitals.

Youth workers generally work with young people between the ages of 11 and 25. They aim to support young people to reach their full potential and to become responsible members of society. They work in a range of settings, including youth centres, schools and colleges. They may be employed by the local council but youth workers are also employed by a range of religious and other voluntary organisations. Youth workers are not always based in a particular building, especially if they are working with young people on the streets.

Typical youth work activities include:

• delivering programmes relating to young people’s concerns, such as smoking, drugs, binge drinking, relationships and dealing with violence
• organising residential activities and projects
•  running sports teams
• initiating and managing community projects with young people
•  working with parents to support the healthy development of their children

Care assistants provide practical help and support for people who have difficulties with daily activities. This may include supporting older people and their families, children and young people, people with physical or learning disabilities or people with mental health problems. Care assistants work in a wide range of settings, such as in clients’ homes, at daycare settings, in residential and nursing homes and in supported or sheltered housing complexes. Their exact duties will vary according to the needs of the clients but could include:

• helping with personal daily care, such as washing, dressing, using the toilet and feeding 
• general household tasks, including cleaning, doing laundry and shopping
• paying bills and writing letters
• liaising with other health and care professionals.
• Sometimes care assistants will work with only one person, providing intensive support to enable them to manage everyday life.

Care managers have a key leadership role within residential care settings. They manage the provision of residential care for:

• adults and young adults with learning difficulties
• older people in residential care or nursing homes 
• people in supported housing
• people receiving hospice care.

Care managers are responsible for the routine running of the residential care setting, including appointing suitable staff and managing staff teams, managing the budget and ensuring that the quality of care meets the standards required by the sector. Care managers will manage and supervise the duties of the care assistants working in their
setting 

The support worker role is closely linked to the healthcare or nursing assistant role discussed earlier. Support workers, however, may work under the supervision of a range of health and care professionals, including physiotherapists, occupational therapists and social workers. Family support workers, for example work with and support social workers. Once the social worker has identified what is needed, the support worker may work closely with the family to help implement the plan. They may provide support with parenting skills, financial management or domestic skills.

Responsibility 

Following policies and procedures in health and social care settings Health and social care organisations have guidelines that describe the working procedures that should be followed to ensure that the care provided meets service users’ 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
• equality and diversity policy
• medication policy
• safeguarding policy
• Disclosing and Barring Service (DBS) referral policy
• death of a resident procedures
• complaints policy.

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

Which may play a significant part in supporting an individual’s recovery from illness and other physical disorders. For example, cancerous tumours such as breast lumps may be removed by surgery if cancer is diagnosed at an early stage. Older people may require joint replacement surgery, such as hip or knee joints. Health and care workers in the community have an increasingly important role in supporting people recovering from surgery. This may include visits from the district nurse to monitor progress and provide specific treatments, including changing dressings. Physiotherapists and occupational therapists, where necessary, support mobility and promote independence in carrying out daily living activities. Social workers may provide additional emotional support and ensure that the patient is accessing the services available. Home care workers may provide practical help in the home, including preparing meals where this is seen as necessary. A patient’s recovery will continue after discharge from a hospital. Community support is particularly necessary as there is a trend to discharge people as soon as possible following surgery.

Is treatment using high-energy radiation. Treatment is planned by skilled radiotherapists working alongside a team that includes radiographers and specially trained nurses. Although radiotherapy is often used to treat cancer, it can be used to treat non-cancerous tumours or other conditions, such as diseases of the thyroid gland and some blood disorders. Patients may need support from their GP on completion of the treatment to ensure full healing. Common side effects of some forms of radiotherapy include itchiness and peeling or blistering of the skin.

Involves either moving a body part or organ from one person’s body to another’s (known as an allograft) or from one part of a person’s body to another location in their own body (known as an autograft). The purpose of the transplant is to replace the patient’s damaged or absent organ. Organs that can be transplanted include the heart, kidneys, liver, lungs, pancreas and intestines. The most commonly performed transplants are the kidneys followed by the liver and the heart. A living donor can give one kidney, part of their liver and some other tissues, such as bone marrow. However, other transplants come from donors who have recently died, so in the recovery period following surgery the person receiving the transplant may need the support of a counsellor. Highly skilled surgeons and their teams will carry out the transplant. However, many more care professionals will be involved in preparing the individual physically and mentally for surgery and caring for the person following their transplant. For example, specialist nurses, physiotherapists, occupational therapists, counsellors and social workers may provide post-operative support

Changing the pattern of daily routines and habits that are damaging to health can be very challenging, but may be very important in improving a person’s health. Counselling and the support of self-help groups may be crucial in implementing and sustaining lifestyle changes. For example, introducing a more healthy diet, taking more exercise, reducing the amount of alcohol consumed and stopping smoking. Healthcare professionals, such as GPs, practice nurses and district nurses, can assist individuals to set up self-help groups, for example by allowing them to meet in a room in a GP practice.

many specialist agencies support and promote the health and well-being of service users, especially those who have specific illnesses or disorders. Healthcare professionals can inform their service users about these agencies, some examples include:

• Age UK – provides services and support to promote the health and well-being of older people. 
• Mind – provides advice and support for people with mental health problems and campaigns to raise awareness and improve services for people with mental illnesses. 
• YoungMind – is committed to improving the mental health of children and young people, through individual support and through campaigning for improved services.
• The Royal National Institute of Blind People (RNIB) – supports people affected by sight loss, both people who are partially-sighted and those who are blind.
• ]Alzheimer’s Society – provides information and support for people living with dementia, their families and their carers. It also funds research and promotes awareness of this condition.

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 fulfilling life. These programmes are particularly important after someone has a heart attack or a stroke, or following an accident that has significantly reduced their mobility or their reaction speed. Rehabilitation 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 .

Adaptations 

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 broken a limb or are recovering from surgery or a stroke, or who have a progressive disease such as multiple sclerosis, motor neurone disease or muscular dystrophy or are simply ageing and have less strength in their bones 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.

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 broken a limb or are recovering from surgery or a stroke, or who have a progressive disease such as multiple sclerosis, motor neurone disease or muscular dystrophy or are simply ageing and have less strength in their bones 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 cutlery with thick, light handles that are easy to hold for people with arthritis 
• feeding cups or angled straws for drinks 
• egg cups and plates with suctioned bottoms 
• special gadgets to help people who can only use one hand to take the lids off jars and tins, and others to help with peeling potatoes and buttering bread, kettles on tipping stands and adapted plugs to help with 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 support people with a range of physical conditions, including epilepsy, arthritis and visual impairments. Some people with chronic conditions may need highly sophisticated equipment in their home to manage an independent life. For example, people with chronic bronchitis, emphysema or a coronary heart condition may need oxygen cylinders at home and people with kidney failure may need dialysis equipment. 

Assistive technology and a very wide range of other resources are available to support people with disabilities and 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 
•  ensuring wheelchair access to all learning spaces 
•  additional time in examinations for learners who are dyslexic 
• enlarged text for people with poor vision.

Keeping clean, enjoying a meal and using the toilet when needed are tasks and activities that most people are able to take for granted and do for themselves. However, when people become either physically or mentally ill, or they have a disability, these everyday 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 impact 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 hygiene 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 where specific help is needed 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.

who provide support for people living in their 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 carers providing personal care. Equipment includes

•  walk-in baths
• showers suitable for the use of wheelchair users 
•  non-slip bathmats 
• bath and shower seats 
•  handrails 
•  bath lifts and hoists 
•  adapted taps 
• bedpans and commodes 
• female and male urinals. 

Healthcare professionals must also be aware of and respect religious and cultural differences related to personal cleanliness, for example: 

• Muslims and Hindus normally prefer to wash in running water rather than have a bath 
• Muslims and Hindus often prefer to use a bidet rather than use paper after using the toilet 
• Sikhs and Rastafarians do not normally cut their hair Hindus and Muslims would strongly prefer to be treated and supported by someone of the same sex. 

Eating and drinking is vital for life itself, but meal times are also a social activity and ideally an enjoyable occasion. Dining areas should be clean and a pleasing environment. Most people in care settings are able to feed themselves. However there will be clients who experience difficulties because of their physical condition, because they are confused, or because they are emotionally unsettled. They may be depressed or unhappy in the setting and find it difficult to eat.

Some people will be capable of feeding themselves with minimal assistance and often using specially designed eating and drinking equipment, such as those referred to earlier in the unit, will allow them independence. Many people have specific dietary requirements. This will sometimes be related to religious belief, sometimes to physical disorders and sometimes to personal choice, for example: 

• vegetarians do not eat fish, meat or meat-based products – this could include jelly vegans do not eat meat or any animal-related products, including eggs, cheese, cow’s or goat’s milk 
• Muslim and Jewish people do not eat pork and they require their meat to be killed and prepared for consumption in a particular way, Muslims eat halal products and Jews kosher foods
• Hindus and Sikhs do not eat beef 
• people with coeliac disease require a gluten-free diet other people have specific allergic reactions to particular foods
• allergic reactions to nuts, strawberries, dairy products and shellfish are particularly common.

As was discussed earlier in this unit, health and care professionals’ skills are wide ranging and cover many specialities. However, despite the differences in skills, experience and specialist knowledge, all health and care professionals are likely to take a similar approach to planning and evaluating care. Often referred to as the care planning cycle (see Figure 2.1), this approach involves:

• assessing the individual healthcare needs of their service users
• agreeing to a care plan that promotes the service user’s health and wellbeing 
• evaluating the effectiveness of the care implemented.

Anti-discriminatory practice is a core value and principle that guides the work of health and care professionals. It is based on legal requirements as outlined in the Equality Act 2010. It underpins the policies and practices of care settings, and in the codes of practice of all care professionals. The anti-discriminatory practice aims to ensure that the care needs of service users are met regardless of differences in race, ethnicity, age, disability or sexual orientation and that the prejudices of staff or other service users are appropriately challenged. Legislation exists to ensure that vulnerable groups of people are not discriminated against.

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 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 or their informal carers. If you are a domiciliary care worker, for example and work alone there should be a lone workers’ policy in place with specific guidance for dealing with any situation where you feel vulnerable, such as dealing with conflict and aggressive behaviour.

is the responsibility of employers to ensure the health and safety of all who work for their company or organisation. Employers are also responsible for the safety of volunteers, learners on work placement and all visitors, including those visitors providing technical or professional services, for example plumbers, electricians and visiting care professionals. The Health and Safety at Work Act (1974) governs the requirements of employers and employees to ensure that they maintain a safe working environment for all. Employers must: 

• ensure that the organisation has a robust health and safety policy and that there is someone with official responsibility for 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 or injury 
• 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 accidents and incidents. 

If a child or vulnerable adult shares information that raises concerns about their personal safety, or they disclose that they are being abused, you should follow the setting’s safeguarding policies. As an employee or volunteer, you should listen carefully and avoid asking questions. Let the service user tell their story in their own way and in their own words. In this instance, you will have to explain to the service user that the information must be shared with somebody more senior. All care settings will have a designated safeguarding officer who will take over responsibility for investigating the claim or accusation. The safeguarding officer will ask you to provide a written record of what you have been told.

• 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, particularly if this involves contact with body 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 needles and syringes to avoid needle-stick injuries and to ensure that infection is not passed on through viruses carried in the blood or bacteria.
• 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. 
• Wearing protective 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. 
• Cleaning all equipment according to the agreed procedures of your setting. 
• Wearing protective clothing for any activities that involve close personal care or contact with body fluids. 

There are particular illnesses, diseases and serious accidents that health and care providers must officially report. These are called ‘notifiable deaths, injuries or diseases’ and are covered by the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) (2013). Notifiable illnesses include diphtheria, food poisoning, rubella (German measles), tuberculosis (TB) and notifiable incidents occurring 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 care service use an accidental form to report the details of all accidents and incidents, which are recorded in an accident book. these reports are required by law and are regularly monitored 

There are particular illnesses, diseases and serious accidents that health and care providers must officially report. These are called ‘notifiable deaths, injuries or diseases’ and are covered by the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) (2013). Notifiable illnesses include diphtheria, food poisoning, rubella (German measles), tuberculosis (TB) and notifiable incidents occurring 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 care service use an accidental form to report the details of all accidents and incidents, which are recorded in an accident book. these reports are required by law and are regularly monitored 

To protect all service users, staff and visitors from harm and infection, you must ensure that hazardous waste is disposed of properly. This includes disposing of protective clothing, syringes, soiled dressings, nappies, incontinence pads and bodily fluids. 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 your 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, eg 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, eg urine, vomit or blood - Flushed down a sluice 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 Sterilisation Services (CSSD) for sterilising and reuse

The provision of first aid in health and care settings is governed by the Health and Safety (First-Aid) Regulations (1981). Provision for first aid should be ‘adequate 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 occurring in care settings must be recorded, either in the accident book or by 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, particularly if the casualty is claiming compensation for injury, or if there is an accusation of criminal negligence.

All care organisations must have complaints procedures and these are also checked when the setting is inspected. Complaints should not be regarded as a purely negative activity but rather as a source of information that will help improve the service. Complaints procedures vary in different organisations but will follow a very similar format. If a service user, a member of staff or a volunteer complains, they have a right to: 

• have their complaint dealt with swiftly and efficiently 
• have a proper and careful investigation of their concerns 
• know the outcomes of those investigations 
• have a judicial review of the facts, if they think the action or the decision is unlawful 
• receive compensation if they have been harmed either physically or psychologically as a result of the situation about which they are complaining.

The Data Protection Act (1998), which came into force in March 2000, sets out the rules governing the processing and use of personal information in health and social care settings and in many other organisations, including credit agencies, clubs and many other organisations that hold information about their members. The act covers information stored electronically on computers, mobile phones and on social media sites. It also covers most paper-based personal information. It is against the law to have photographs of service users without their permission.

• 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 information – 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 social care settings. They are also embedded in the codes of practice of the professional bodies that regulate health and care staff, discussed earlier in this unit, such as the General Medical Council, Nursing & Midwifery Council and the Health and Care Professions Council. 
• 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 the safety and security of service users and to respect their right to the confidentiality of personal information.

As you have seen, the 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 Professionals Council (HCPC). The specific regulations vary according to a 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 personal 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 be investigated and, in extreme circumstances, the member can be removed from the professional register and barred from professional practice. The professional 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

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. CPD requirements will always include evidence that members have a current and up-to date understanding of safeguarding regulations.

In April 2015, a Care Certificate was introduced for newly appointed health and social care workers who are not members of the regulated professional bodies that were discussed earlier, that is the GMC, the NMC and the HCSC.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 starters 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 certificate requires that healthcare support workers and adult social care workers in England: 

• 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 of their carers, at all times 
• 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 right to confidentiality 
•  strive to improve the quality of healthcare, care and support through CPD
• uphold and promote equality, diversity and inclusion

Multi-discriminatory Working

Different care professionals often work together as a team to promote the health and wellbeing of their service users. For example, the care manager of a residential home may work with GPs, district nurses and physiotherapists to meet the needs of their residents. Social workers with responsibility for children may work with the health visitor, the school nurse, school teachers and the educational psychologist to meet the children’s needs. These teams may include not only the health and care workers discussed earlier in the unit but also representatives from voluntary organisations. The emergency services, including the police and the education services, may also be represented. When professionals co-operate in this way by working together as a team, it is called a multi-disciplinary team

If a service user is known to and supported by a number of different agencies or professionals, it is essential that those carers work as a team. There have been a number of high-profile cases of child abuse, for example the abuse and tragic death in February 2000 of Victoria Climbié while in the care of her aunt, and the death of Baby P (Peter Connelly) in 2007 following months of abuse. Part of the reason for the death of these children was identified as a lack of ‘joined-up working’. Both children lived in the London Borough of Haringey. The professionals and the agencies working there did not pass on crucial information. 

At formal team meetings it will be expected that, where possible, the service user will be present, their advocate, translator and/or interpreter will be there, informal carers will be invited along with all other professional staff who contribute to the support, planning and evaluation of the care provided. The service user’s presence and/or their representatives is crucial to ensure the empowerment of the client or patient. It is the key opportunity for the service user to express their views and preferences and to contribute to the planning and delivery of their support.

The work of a multi-disciplinary team ensures that a holistic approach is taken to planning and implementing a care programme. It means health and care professionals must not only provide their specialist support but also see this in the context of the wider needs of the service user. At a care planning meeting the physical, social, emotional, spiritual and intellectual needs of the service user will be considered. The care plan must meet the needs of the ‘whole person’.

Monitoring  at work 

In addition to working in interdisciplinary teams as discussed in the previous section, people who work in health and 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 the manager. In an early-years setting, for example, the nursery manager will manage the early-years’ practitioners at the setting and in a reception class the nursery teacher will manage the earlyyears educator. If staff performance falls short of the practice expected, it will be the line manager’s responsibility to address the issues with the staff concerned and take the 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.

All health, care and early-years settings in the United Kingdom are regularly inspected by independent, government-financed agencies. For example in: 

•  England, health and care provision is inspected by the Care Quality Commission (CQC) 
•  Northern Ireland, health and care provision is inspected by the Regulation and Quality and Improvement Authority (RQIA) 
•  Wales, care provision is inspected by the Care and Social Service Inspectorate Wales (CSSIW) and health by Healthcare Inspectorate Wales (HCIW) 
• Scotland, on 1st April 2011 the work of the Care Commisioner passed to a new body, the Care Inspectorate; regulation of independent healthcare has passed to Healthcare Improvement Scotland. Early years and education services are inspected by: 
• Ofsted, in England 
•  the Education and Training Inspectorate (ETI), in Northern Ireland 
•  Her Majesty’s Inspectorate for Education and Training in Wales 
• Education Scotland, in Scotland.

Whistleblowing is when a member of staff is aware that the quality of care at their workplace 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 administrator or a manager.

Settings 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 receive. 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 example, 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 or areas of concern to the external agencies – for example, Ofsted, CQC or CSSIW. If organisations responsible for inspecting settings receive complaints this may lead to a prompt and often unannounced inspection of the care setting.

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.

Sectors 

The public sector organisations that provide health and social care services are financed and directly managed by the government. For example, the National Health Service is a public sector service. It is primarily funded by taxation and a smaller proportion of funds come from National Insurance contributions. The majority of the services available are free to service users when they need them, but they do pay for them through their regular tax and National Insurance contributions. The public sector health services and systems of organisation in the four countries that make up the United Kingdom generally work independently of each other, but there is no discrimination when individuals/service users move from one part of the UK to another. The four organisations are:

• National Health Service England (NHS England) 
• Health and Social Care in Northern Ireland 
• NHS Scotland 
• NHS Wales.

• Primary health care is provided by GPs, dentists, opticians and pharmacists. Primary health care services are normally accessed directly by the service user when needed
• Secondary health care includes most hospital services, mental health services and many of the community health services. These are normally accessed via the GP, who makes an appropriate referral to a consultant or other healthcare specialist, such as a hospital physiotherapist, a psychologist or community nurse, and requests an appointment for further examination or specialist treatment. Members of the public and the emergency services have direct access to the accident and emergency services of hospitals. 
  
• Tertiary health care provides specialist, and normally complex, services. For example specialist spinal injury units or hospice support. Referral to these services is by health professionals who have identified the need. 

In England, hospitals are managed by hospital trusts, most of which are now NHS Foundation Trusts . Foundation trusts were established in 2004. Although their services are largely financed by government, they are independent organisations. NHS Foundation Trusts are managed by a board of governors, which may include patients, staff, members of the public and members of partner organisations. The aim of the NHS Foundation Trust is to move decision-making from a centralised NHS to local communities, in order to respond to local needs and wishes. Trusts that have not achieved foundation status are still managed centrally. Mental health services may be provided through your GP, or support may be needed from more specialist service providers, for example counsellors, psychologists or psychiatrists. More specialist support is normally provided by Mental Health Foundation Trusts. Mental Health Foundation Trusts are managed by the community, including people who use the mental health services. Patients, their familiesand friends, local organisations and local residents can become members of the foundation. The members elect governors who have responsibility for the quality and range of care provided. The services provided by a Mental Health Foundation Trust include provision of psychological therapies, the support of psychiatric nurses and very specialist support for people with severe mental health problems. Community Health Foundation Trusts work with GPs and local authority social services departments to provide health and care support. The services provided by the trust may include: 

• adult and community nursing services 
• health visiting and school nursing 
•  physiotherapy and occupational therapy and speech therapy services ▸▸ palliative /end of life care walk in/urgent care centres 
•  specialist services, such as managing diabetes, sexual health or contraceptive services.

Adult social care provision is for people over 18 years of age who have disabilities, mental health problems or who are otherwise frail, due to age or other circumstances and who are unable to support themselves without specific and planned assistance. Adult social care services are the responsibility of local authority social service departments. The support provided can take many forms, including: 

• care in the service user’s own home – such as help with cooking, cleaning, shopping and a wide range of other personal daily needs 
• day centres to provide care, stimulation and company 
• sheltered housing schemes 
• residential care for older people, people with disabilities and people suffering from mental illness 
• respite care or short-term residential care provided principally to give families caring at home a rest and a break from their responsibilities 
• training centres for adults with learning difficulties.

Children’s services are the responsibility of local authorities. Their aim is to support and protect vulnerable children and young people, their families and also young carers. The local council’s children’s departments are required to work in close collaboration with other care providers, and crucially with the NHS and the education services. Support for children and their families can include: 

• services to safeguard children who are at risk from abuse or significant harm, including sexual, physical, emotional harm or neglect
• day care for children under 5 years old, and after-school support for older children 
• help for parents and carers with ‘parenting skills’ 
• practical help in the home 
• support of a children’s centre 
• arrangements for fostering and adoption.

General practitioner (GP) practices are often the first point of access to health and care provision. GPs have an extensive knowledge of medical conditions, including a wide range of physical disorders, and they also offer preventative healthcare. GPs work in local communities. Their role is to make initial diagnoses and to refer individuals, if necessary, to a specialist for further investigation and treatment. However, GPs increasingly work as members of multi-disciplinary teams, which may include nurses, health visitors and healthcare assistants. They also work closely with other agencies, including the education services, local authority social services and also the police. The GP and their team aim to use a holistic approach to care. GP practices are funded from central government as part of the National Health Service. They are funded according to their assessed workload from their patients. This takes into account: 

• the age of their patients 
• their gender 
• levels of morbidity and mortality in the area 
• the number of people who live in residential or nursing homes – this generates a higher workload 
• patient turnover – newer patients generate more work than established patients. 
• In addition, GP practices receive further payments from the NHS for the following: 
• if they are deemed to give a high quality service 
•  for certain additional services they may provide, such as flu immunisations 
•  for seniority, based on a GP’s length of service 
•  to support the cost of suitable premises and other necessary equipment, such as computers 
• to cover additional costs if the GP practice also dispenses medicines.

General practitioner (GP) practices are often the first point of access to health and care provision. GPs have an extensive knowledge of medical conditions, including a wide range of physical disorders, and they also offer preventative healthcare. GPs work in local communities. Their role is to make initial diagnoses and to refer individuals, if necessary, to a specialist for further investigation and treatment. However, GPs increasingly work as members of multi-disciplinary teams, which may include nurses, health visitors and healthcare assistants. They also work closely with other agencies, including the education services, local authority social services and also the police. The GP and their team aim to use a holistic approach to care. GP practices are funded from central government as part of the National Health Service. They are funded according to their assessed workload from their patients. This takes into account: 

• the age of their patients 
• their gender 
• levels of morbidity and mortality in the area 
• the number of people who live in residential or nursing homes – this generates a higher workload 
• patient turnover – newer patients generate more work than established patients. 
• In addition, GP practices receive further payments from the NHS for the following: 
• if they are deemed to give a high quality service 
•  for certain additional services they may provide, such as flu immunisations 
•  for seniority, based on a GP’s length of service 
•  to support the cost of suitable premises and other necessary equipment, such as computers 
• to cover additional costs if the GP practice also dispenses medicines.

Voluntary sector organisations are often known as charities. Voluntary organisations vary enormously in their size, history and the services they provide. They include some well-known groups, such as Shelter, the NSPCC and the Samaritans, and some very small organisations that are run solely by volunteers for specific needs or for a particular local community. Voluntary groups often rely heavily on charitable donations for their survival but may also receive support from central or local government. The social services provided by the voluntary sector (sometimes known as ‘third sector’ services) are managed independently from government, but government departments may sometimes pay charities to provide services on their behalf. Charities often provide services for the NHS, adult social services and children’s services. For example, MENCAP provides residential care, day care and educational services for people with learning difficulties, and service users can use their personal funding to access these services. Nacro (the National Association for the Care and Resettlement of Offenders) receives government funding for their work with offenders. The key features of a voluntary organisation are that they: 

• are not run for personal profit, any surplus income is used to develop their services
• usually use volunteers for at least some of their services
• are managed independently of central government or local authorities.

Private sector health and care provision is managed by commercial companies. These are organisations that need to make a profit in order to stay in business. Private care providers work in all sectors, including the provision of: 

• private schools 
• nursery and pre-school services 
• hospitals
• domiciliary day care services
• residential and nursing homes for older people 
• mental health services.

Private sector health and care provision is managed by commercial companies. These are organisations that need to make a profit in order to stay in business. Private care providers work in all sectors, including the provision of: 

• private schools 
• nursery and pre-school services 
• hospitals
• domiciliary day care services
• residential and nursing homes for older people 
• mental health services.

Private sector companies often provide services for central government and local authorities, including services for the NHS, adult social care and children’s services. Private sector companies are funded by: 

•  fees paid directly by service users 
•  payments from health insurance companies, such as Bupa, Saga or AXA – many people who choose private healthcare will subscribe to a health insurance scheme 
•  grants and other payments from central and local government for services provided on their behalf.

Hospitals provide both inpatient and outpatient services. Outpatient services include regular clinics, day surgery and other specialist daytime care. Inpatient services include treatment for individuals whose condition requires 24-hour specialist support. If you need to visit a hospital for specialist care, you will normally be referred by your GP. When a service user is referred to a hospital for specialist care, they have the right to choose which hospital they wish to attend as well as the consultant they would like to see. In hospitals, clinical departments are organised according to medical speciality. Some hospitals have accident and emergency services, which individuals can access directly for emergency treatment.

Day care centres, or day care units, are normally provided for specific client groups. In most places there will be day centres for older people, for people with disabilities, people with learning difficulties, people with mental health problems and for people with specific conditions such as dementia or visual impairment. The day service provision is designed to provide a friendly, stimulating and supportive environment for people who otherwise would be socially isolated. Day centres normally offer educational facilities and support, where appropriate, to help people progress into employment. Day care services may be provided by statutory, voluntary or private providers.

Hospice care aims to improve the quality of life for people who have an incurable illness. Care may be available from when the diagnosis of a terminal illness is made until the end of the individual’s life. Hospice care is holistic, providing for the physical, social, emotional, spiritual and practical needs of the individual, their family and their carers. Care may extend to support during the bereavement period.

Residential care refers to the long-term care of adults and children needing 24-hour care, which cannot be provided adequately or appropriately in their own home. Residential care units are usually specialist units providing care for specific client groups, such as people with mental health problems, people with learning difficulties or older people unable to look after their daily needs. There are two types of care home: 

• a residential care home, which provides help with personal care such as washing, dressing and taking medication 
• a nursing home, which provides personal care but also provides 24-hour nursing care by a qualified nurse, who may also contribute to the planning, supervising and monitoring of healthcare tasks.

Domiciliary care, sometimes called home care, is care provided in a client’s home, rather than in a specialist care setting. The care may be short-term, for example providing support following discharge from hospital or for a family with a new baby, or may be needed as a long-term solution for a service user with a disability or for a frail older person. The support can vary from one visit a day to 24-hour care, providing both support with domestic tasks and intimate personal care. Appropriate domiciliary care being provided can ensure that service users are able to live as independently as possible in their own home.

Occupational health services aim to keep a workforce fit and healthy so that they are able to carry out the duties for which they are employed, or to assist employees to regain fitness following an injury or illness. These services are normally provided by an employer to support the people that they employ. This can include access to nurses based in the workplace or referral to a doctor or other health professionals. Referrals may be to a counsellor, if the employee is thought to be suffering from work-related stress, or to a physiotherapist if there is a problem with the employee’s posture or a repetitive strain injury. Advice, information and treatment will vary according to the individual employee’s needs.

Access 

Is when a person contacts a care provider personally, by letter, email, phone call, making an appointment or attending a care setting or surgery and requesting help. Access to the primary healthcare services, such as doctors, dentists and opticians, is normally through self-referral. Many social care services for children and adults are accessed by self-referral.

is when a friend, neighbour or relative 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, or a relative concerned about the general health of a person with Down’s syndrome may contact the GP. These referrals are usually to services that are accessible through self-referral.

is when a health or care professional contacts another service provider to request support for a service user. For example, a GP referring a service user to a hospital consultant, or a head teacher referring a child with learning difficulties to an educational psychologist, or a social worker contacting the domiciliary care services for a client with disabilities.

Local authorities have a duty to carry out a community care assessment for anyone who appears to be finding it difficult to look after themselves without additional help. The adult social services department is usually responsible for this, and it would normally be a social worker who completes such an assessment. It may be that the service user needs: 

• reassurance and information about local or national organisations that could help 
• simple devices that can help the client to live independently, such as aids to open tins or jars, or equipment to help them use their bath 
• higher level of care, such as domiciliary care, or they may need residential care.

If a client is supported in their home by family, friends or neighbours, these carers also have a right to a carer’s assessment to see whether they need support to carry out their caring activities. These unpaid carers are often called informal carers to distinguish them from professional care staff, or representatives of charitable groups. The Care Act (2014) sets out carers’ legal rights for assessment and support. When the assessment for a service user or their carer is complete the service users must be provided with a written copy of the report outlining the needs identified and the action agreed.

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, has to consider whether these needs arise from: 

1 a physical and/or mental impairment or illness, plus 2 an inability to achieve at least two of the following daily activities (called outcomes): 

• prepare and eat food 
• wash themselves or their clothes 
• manage their toilet needs 
• dress appropriately, especially in cold weather
• move around their home easily 
• keep their house safe and clean 
• maintain family or other close relationships, in order to avoid social isolation 
•  access work, training, education or volunteering 
• use local facilities, including shops, recreational facilities and other services 
•  carry out caring responsibilities, including caring for their children 
• meet the outcomes likely to affect their health and wellbeing. 

An adult is eligible for support only if they meet both criteria. If a person meets these criteria for support, called national eligibility criteria , the local authority has a duty to make sure the identified needs are met.

As you have seen, the health and care services available in the UK are many and various and accessing these services can be very confusing for service users, particularly when, people are unwell or have complex personal difficulties. These difficulties may lead to service users and their families not receiving the care they need and have a right to. Some of the barriers to accessing services may be: 

• language, for example if English is not a service user’s first language and there is no interpreter available, or the service user is hearing-impaired and there is no signer available to support communication 
• inconvenient location of the service, particularly if the service user has to rely on public transport, additionally, the cost of travelling may be a barrier as financial help for travel is not always available 

• financial, such as the cost and difficulty in providing care for children or other dependants while a service user attends a care setting, or the potential loss of wages scarce resources, for example long waiting times for hospital appointments or treatment, lack of beds available in hospitals or appropriate residential care settings, restricted opening times or specialist resources not easily available 
• communication, such as service users feeling unable to communicate easily with care providers and other service users, because they feel discriminated against or that there is prejudice against them, or that there are negative stereotypes associated with their community. For example, some groups in society, such as travellers, may not feel comfortable at care settings where they may feel that they are discriminated against.

Organisation 

Many voluntary organisations or charities represent their service users when they need to contact and liaise with other official agencies. For example, MENCAP will represent their service users and support them if they are liaising with other organisations such as their local council housing department, social services or other health and care professionals. Shelter 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 or negotiating with landlords. These organisations also provide support if service users need to make a complaint. Patient groups in hospitals represent the needs of patients and also support individuals making complaints. Many charitable groups act as pressure groups and campaign on behalf of the individual members that they represent. For example, they may write to the papers, use social media, organise demonstrations and contact Members of Parliament or local councils to raise awareness of their service users’ needs and to request improvements to the services offered. For example, the NSPCC campaigns to encourage the government to introduce policies and laws that support the protection of children. 

If a client has a serious communication problem, an advocate may speak on their behalf. For example, clients may have a learning difficulty, a speech impediment, poor literary skills, a limited grasp of English or lack confidence when talking with professional health and care workers. In health and care settings, advocates are usually volunteers. They work with individual service users, getting to know them well and building a trusting relationship so that they can accurately represent the needs, wishes and preferences of their client to the professional workers and to official organisations when needed. This may be through attending care meetings with the service user or completing forms, writing letters or Emails 

All care settings must have formal complaints procedures. The settings have a responsibility to ensure that their service users and, where appropriate, their families and other informal carers, understand how to access and use complaints procedures if they are unhappy with the quality of care provided. The procedures and the 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 a timely way 
• have their complaint formally investigated 
• be told the outcome of their complaint.

Care organisations are required to have whistleblowing policies, as discussed earlier in this chapter. Whistleblowing policies provide protection for staff who tell the press or another organisation outside the setting in which they work that the quality of care at their workplace is dangerously poor. For example, if they report the situation to the media, the police or to a professional body in order to heighten awareness of the problem and to bring about change.

Regulators 

The CQC is responsible for monitoring and inspecting health services and adult social care services in England. Its aims to ensure that health and social care services are of a high quality and that they are delivered safely, effectively and compassionately. The CQC monitors and inspects: 

• NHS Trust hospitals and independent hospitals 
• GP provision, including GP practices, walk-in services and out-of-hours provision 
• clinics, including family planning clinics, slimming clinics and clinics run by GPs and hospitals dentists residential care homes and nursing homes domiciliary or home care services
• community care provision, including day centres and other community support for people with physical, social or mental health problems, or people who have a learning disability 
• mental health provision, including provision for people who are detained, for people whose rights are restricted under the Mental Health Act (2007) and for those who voluntarily receive care, either in hospital or in the community 
•  accommodation for people requiring treatment for substance misuse. 
• All providers of these services must register with the CQC. A service provider can be an individual, a partnership or an organisation – for example a company, a charity, an NHS Trust, or a local authority.

Following the Health and Social Care Act (2012) the National Institute for Health and Clinical Excellence (NICE), was renamed as the National Institute for Health and Care Excellence (which is still abbreviated to NICE). This name change reflects its new responsibilities for social care. NICE is responsible for providing guidance on current best practice in health and social care. It publishes guidance and advice that aims to control and improve health and social care provision. For example, NICE provides: 

• guidance on the most appropriate treatments for people with specific conditions and diseases, such as cancer or diabetes
• evaluation of whether procedures are sufficiently safe and effective to be used within the health and care services 
• guidance about the use of specific health technologies and procedures, including the use of new and existing medicines, treatments and procedures 
• assessment of the cost and the effectiveness of treatments 
•  recommendations about best practice, based on the most recent research 
• support for health promotion campaigns and healthy living advice. 

NICE recommendations are for the use of NHS practitioners, local authorities, charities and any organisations financed by the government who provide health and social care services. As part of NICE’s new responsibilities for social care it aims to provide a smoother transition for service users moving from health services to social care services, and from children’s services to adult social services. NICE has jurisdiction in England and Wales and its recommendations are national, providing consistent approaches for service users wherever they live.

PHE is an executive agency sponsored by the Department of Health that was set up on 1 April 2013, following the implementation of the Health and Social Care Act (2012). It aims to protect and improve the public health and wellbeing of people in England, and to reduce health inequalities. The focus of all public health organisations is on the protection and improvement of the health of a community or population, in contrast to the individual support of a service user discussed earlier. 

• setting up health promotion programmes to improve the nation’s health, for example PHE ran a high-profile campaign ‘Be Clear on Cancer’, with a particular focus on the prevention of lung, bowel, kidney and liver cancer 
• research projects to improve our knowledge of public health issues and generate strategies to address problems, for example in 2015 PHE published a report on the prevalence of breastfeeding at 6– 8 weeks after birth 
• taking measures to protect the nation’s health when there is a public health concern, such as when an epidemic is threatened or a new virus is circulating. Examples of campaigns supported by PHE include, in 2013, helpful advice for people who may be affected by flooding, and in the autumn of 2015 PHE launched their largest flu vaccination programme, ‘Stay well this winter’.

The Office for Standards in Education, Children’s Services and Skills (Ofsted) regulates and inspects services that educate children, young people and adults or care for children through the inspection of: ▸▸ state funded schools and colleges, and some independent providers ▸▸ adult education providers ▸▸ initial teacher education ▸▸ many private agencies who provide training in the workplace, particularly those that educate and train apprentices ▸▸ education provision in prisons and the armed forces. Ofsted also regulates and inspects care provision for children and young people, for example by inspecting:

• nurseries, pre-schools and child minders 
• fostering and adoption agencies
• settings providing residential care for children. Inspectors make a judgement about the overall effectiveness of the provider based on their judgements relating to the:
• effectiveness of leadership and management
• quality of teaching, learning and assessment
• personal development, behaviour and welfare 
• outcomes for children and learners. Following inspection,
• Ofsted publishes a report and the provision is graded: Grade 1 – Outstanding, Grade 2 – Good, Grade 3 – Requires Improvement or Grade 4 – Inadequate.

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The NMC is a statutory authority set up by parliament in 2002. It is responsible for regulating the standard of professional practice of all nurses and midwives in the United Kingdom (England, Scotland, Wales and Northern Ireland) wherever they are working. This applies whether they are in paid employment or working as a volunteer. The NMC exists to protect the public and it sets high standards for:

•  initial education and training of nurses and midwives
• continuing professional development
• standards of professional practice
• standards of personal conduct, both at work and in leisure time.

The NMC sets the standards and formal code of practice required of all nurses and midwives. Nurses and midwives have to provide evidence of continuing learning and training in order to remain on the register. All practising nurses and midwives are required to register with the NMC, who investigate any allegations that their members are not meeting the standards set. The NMC has the power to restrict a nurse’s practice, for example to require that they work under supervision, take specific training or are restricted to working in a limited number of areas, or to remove them from the register. If a nurse or midwife is removed from the register they are no longer

The HCPC (formerly the Health Professions Council) was set up in 2012 under the Health and Social Care Act (2012). The HCPC promotes good practice and also exists to protect the public, throughout the United Kingdom, from poor standards of care. The HCPC regulates a wide range of health and care related professionals, sixteen different professions in all, including physiotherapists, occupational therapists, speech therapists, social workers and paramedics. Members of these professions must register with the HCPC. To register as an HCPC approved practitioner, individuals must: 

• have achieved the relevant qualifications 
• meet the standards of professional practice and personal behaviour required by the council. 

If a member of the public feels that a professional registered with the HCPC is not meeting the standards set, they have a right to complain. The HCPC will investigate complaints and take the appropriate action. In cases of serious misconduct, this can include suspension or permanent removal from the register.

The GMC 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 
• takes action to address shortfalls in the standards of treatment that may put patients’ safety at risk, or brings the medical professions into disrepute. 

When a serious concern is raised about a doctor’s behaviour or professional practice, the GMC investigates. If the concern is upheld, the GMC may restrict the doctor’s right to practice. The doctor may be required to work under supervision or to undertake further training or in extreme circumstances they may be removed temporarily or permanently from the register.

Organisation     Responsibility 

The Health and Social Care Act (2008), and the linked regulations of 2014, require that registered providers of care services must ensure that they have sufficient numbers of appropriately qualified staff to meet the needs of their service users at all times. They must also provide or support training and professional development to ensure that their staff can carry out their caring role. In social care settings, new staff are required to complete an induction programme and to meet the requirements of the Common Induction Standards (2010) within 12 weeks of commencing their new job. This requires the manager to ensure that all new employees understand how to implement the codes of practice in their workplace and how to meet the current National Occupational Standards (NOS) for their role.

National Occupational Standards (NOS) describe best practice. They are the standards of professional practice that should be met in the workplace. The NOS for people working in the health and social care sector are applicable throughout the UK and were updated in 2012. The NOS underpin the codes of practice in care settings and the curriculum for the training of practitioners and cover the standards that are also included in the codes of practice for professional bodies, for example the Nursing & Midwifery Council (NMC).

In order for health and care practitioners to maintain the high standards required in the sector, they need to continually update their skills. This will ensure that they are following the best practice and most up-to-date procedures, based on recent research. As discussed earlier in this unit all members of the GMC, the NMC and the HCPC are required to complete regular professional training to remain on their registers. It is the responsibility of care managers to ensure that support staff who are not members of professional organisations also regularly update and extend their skills.

All care organisations are required by their regulators, which include the professional organisations and the inspection agencies, to have formal procedures to address complaints. Where allegations of poor practice are made against staff, this will normally initially be addressed through the organisation’s internal disciplinary systems. However, in more serious instances the regulatory body, for example the GMC, the NMC or the HCPC may be involved. In extreme circumstances, for example in cases of assault or death thought to be caused by negligence or active abuse, the police may also deal with the complaints.

Many practitioners will be members of trade unions or professional associations, which support them if they are accused of professional misconduct or are in conflict in other ways with their employer. For example, many doctors belong to the British Medical Association (BMA), nurses may belong to the Royal College of Nursing (RCN), midwives to the Royal College of Midwives (RCM) and social workers are often member of the trade union UNISON.

Protocols are accepted codes of practice and behaviour required of professionals by their regulatory bodies. The regulatory bodies, such as the GMC, the NMC and the HCPC, also provide protection for employees by ensuring that the standards expected of them are clear and transparent. As part of their induction and ongoing training, health and care practitioners must fully understand their professional responsibilities and the protocols by which they must practice.

Specific Needs 

When supporting people with physical and mental illnesses, a multi-disciplinary approach is usual and normally essential. When people are supported by health and care professionals, it is not at all unusual that the service user has a range of concerns in addition to the one first presented. As discussed earlier in this unit, care professionals, whatever their speciality, aim to take a holistic approach to meet the needs of the whole person. People with mental health problems often have associated physical ill health. Poor physical health can lead to serious anxiety and depression. It is the care professional’s role to judge when it is necessary to work professionally with other specialists to ensure that the service user’s needs are fully met. Mental illness is difficult to define and, therefore, difficult to monitor. What is regarded as normal and acceptable behaviour varies from one society to another, and at different times in history. In addition, the evidence available is derived largely from medical statistics, recording the number of people who present themselves for treatment. Mind, the charity that works with and supports people with mental health problems, estimates that one in four people experience a mental health problem each year.

MENCAP, the organisation that supports people with learning disabilities, defines a learning disability as ‘a reduced intellectual ability and difficulty with everyday activities… which affects someone for their whole life’. This may include difficulties with regular household tasks, shopping, using public transport or managing their money. Many people with learning difficulties also have other health needs, for example people with Down’s syndrome, a common condition that leads to learning difficulties, often have heart problems and sight and hearing impairments. Research by The Foundation for People with Learning Difficulties has found that between 25 per cent and 40 per cent of people with learning difficulties also suffer from mental health problems. The prevalence of dementia is much higher amongst older adults with learning difficulties compared to the general population. Until relatively recently, many people with learning disabilities were cared for in large institutions or hospitals and were almost invisible to the rest of society. However, the Community Care Act (1990) increased the number of people with learning disabilities who were cared for and supported in the community rather than in large institutions. Importantly, the Disability Discrimination Act (1995) provided legal protection from discrimination in employment, access to public buildings and in renting of accommodation. However, MENCAP (2015) reports that despite recent progress, just 7% of adults with a learning disability are in paid employment, yet 65% want to work and, more importantly, have the capability to work. (This compares with one in two people with a physical disability being in work.) Of those people with a learning disability that do work, most only work part-time and are in low paid employment. Additionally, only a third of people with a learning disability take part in some form of education or training.

Prior to the Community Care Act (1990), many people with physical and sensory disabilities and impairments also lived in hospitals and other large institutions in which the focus was predominantly concerned with their physical care. There was less awareness of the need for a holistic approach. People with disabilities tended to be segregated from the community rather than included in the wider life of our society. A sensory impairment refers to a condition where a person’s sensory organs, for example their eyesight or hearing, function abnormally poorly, which limits their ability to perform day-to-day activities. However, a person with an impairment may only be disabled if adaptions and services are not in place to ensure they are able to perform their daily routines and other activities of daily life independently. A disabling environment describes a situation where appropriate adaptions and services are not in place to support people with impairments. For example, a person with a hearing impairment is only disabled if they do not have access to a hearing aid. Or a person with a visual impairment does not have access to information in Braille, if this is the system of communication they prefer.

The poverty rate for adults with disabilities is twice that for adults without a disability. The main reason for this, despite the Disability Discrimination Act (1995), is the high rate of unemployment among people with disabilities. According to the Poverty Site (a website containing statistics on poverty and social exclusion), approximately one in five adults with any type of disability who wants to work is unable to find employment. This compares with one in 15 adults without a disability. Furthermore, people with disabilities face extra costs related to managing their impairment, such as the extra expense of paying for to their homes, social care support and other mobility and communication aids.

    Specific Age Groups 

Human growth and development is usually described in terms of life stages, which begin with conception and range through infancy, childhood and adolescence to the final stages of adult life. The development of infants and young children can be regarded as a journey, influenced both by their physiological changes and social environment. The care and education services supporting children in early childhood are required to follow a curriculum, the Early Years Foundation Stage (EYFS) curriculum. The EYFS, which was updated in 2014, sets standards and measures progress from birth to 5 years of age. All schools and Ofsted-registered early-years providers must follow the EYFS. This includes childminders, pre-schools, nurseries and school reception classes. The EYFS covers seven key areas of learning and development, which together form a holistic model that addresses the development of the ‘whole child’. The EYFS areas of learning and development are: 

• 1 communication and language 
• 2 physical development 
• 3 personal, social and emotional development 
• 4 literacy 
• 5 mathematics 
• 6 understanding the world 
• 7 expressive arts and design.

Adulthood is the stage in human development associated with reaching physical and emotional maturity. Early adulthood, the period between the age of 18 and about 40 years of age, is associated with the cessation of physical maturation and is when the ageing process gradually begins. In the middle adult period, approximately between the ages of 40 and 65 years, people begin to notice a decline in their physical stamina. People begin to move and run more slowly than in previous years and their eyesight often deteriorates. There is a loss of skin elasticity, with an increase in wrinkles. Women will also experience the onset of the menopause . However, the effects of the ageing process for most people are most acute in later adulthood. At this stage, there are changes in the brain structure that result in noticeably slower intellectual and physical reactions, poorer memory and less effective problem-solving skills. Physical changes include poorer hearing and eyesight, a loss of muscle tissue leading to less strength and generally less stamina. Older people often experience changes in sleep patterns and their immune system is less efficient, making them prone to infections that take longer to clear. Many older people, however, live active and busy lives. They may contribute to community activities, extend their education, online or through attending courses, for example, and provide essential family support for their children and grandchildren. 

Care - Care is our core business and that of our organisations, and the care we deliver helps the individual person and improves the health of the whole community. Caring defines us and our work. People receiving care expect it to be right for them, consistently, throughout every stage of their life.

Compassion - Compassion is how care is given through relationships based on empathy, respect and dignity - it can also be described as intelligent kindness, and is central to how people perceive their care.

Competence - Competence means all those in caring roles must have the ability to understand an individual’s health and social needs and the expertise, clinical and technical knowledge to deliver effective care and treatments based on research and evidence.

Communication - Communication is central to successful caring relationships and to effective team working. Listening is as important as what we say and do and essential for "no decision about me without me". Communication is the key to a good workplace with benefits for those in our care and staff alike.

Courage - Courage enables us to do the right thing for the people we care for, to speak up when we have concerns and to have the personal strength and vision to innovate and to embrace new ways of working.

Commitment - A commitment to our patients and populations is a cornerstone of what we do. We need to build on our commitment to improve the care and experience of our patients, to take action to make this vision and strategy a reality for all and meet the health, care and support challenges ahead.

Victoria Climbié was abused, and finally died, while living with her guardians in the Borough of Haringey, London, in February 2000. Victoria was born in the Ivory Coast, West Africa, and came to live in London with her great aunt and her great aunt’s boyfriend. They claimed to be able to offer her a better life. In January 2001, the great aunt and her boyfriend were convicted of Victoria’s murder. While Victoria was living in London, and during the period she suffered horrific abuse, several organisations. had contact with the ‘family’ and had noted signs of abuse. These included the police, social workers from four different local authorities, two housing authorities, the National Health Service, the National Society for the Prevention of Cruelty to Children (NSPCC) and local churches. Following Victoria’s death, an enquiry was set up under the direction of Lord Laming to investigate how and why, despite being known to the authorities, this tragedy was allowed to happen. Lord Laming identified countless examples of poor practice within these services and organisations; and very poor levels of communication between them. The report by Lord Laming led to the government taking the following steps. ▸▸ Every Child Matters (ECM), this initiative was launched in 2003. ECM was to ensure that all children, regardless of their background, should have the chance to reach their full potential by reducing levels of ill health, eradicating abuse and neglect and improving educational success for all children. 

The five outcomes to achieve for all children are for them to:  stay safe  be healthy  enjoy and achieve make a positive contribution  achieve economic wellbeing.  ▸ The Children Act (2004), which led to the:   • appointment of a Director of Children’s Services in every local authority, who has responsibility for the care and education of children in their area  • ‘duty to cooperate’ for all services concerned with the care and safeguarding of children   • setting up of local Safeguarding Boards, which are responsible for monitoring the professional practice of agencies in the safeguarding of children in their area   • creation of a Children’s Commissioner, with responsibility for representing and promoting the interests of children and young people, particularly the disadvantaged and children whose voices are rarely heard.

In August 2002 two primary school children, Jessica Chapman and Holly Wells, were reported missing from their home. Less than two weeks later, their bodies were found. The girls had been sexually abused and murdered by their school caretaker. It emerged during the investigations that the caretaker had been investigated in the past for sexual offences and burglary, but he had still been appointed to work in a school. An enquiry, led by Sir Michael Bichard, was set up to investigate this tragedy. One of the key recommendations of the Bichard Report was that there should be a statutory agency with responsibility for vetting all individuals wanting to work with children or vulnerable adults, whether as a paid member of staff or as a volunteer. This was initially the responsibility of the Criminal Records Bureau (CRB) set up in 2002. In 2012, the responsibility for vetting staff and volunteers was given to the newly created Disclosure and Barring Service (DBS).

In 2008, seventeen-month old Peter Connelly, still often referred to as Baby P, died after suffering serious physical and psychological abuse over a nine-month period. Just as in the case of Victoria Climbié, he had been seen by numerous health and care professionals during this period, but they failed to intervene and avert the tragedy. Further, just like Victoria Climbié, Baby P was also living in the Borough of Haringey. Lord Laming conducted a review to establish why, despite the changes in legislation, the tragedy had occurred. He found that yet again communication had been poor,

practice unprofessional and the standards of care inadequate. As part of his review, Lord Laming recommended that there should be: 

▸ a review of the recruitment, training and supervision of social workers to ensure that they received better child protection training  ▸ improved safeguarding training for staff with a responsibility for the care of children.