Generic Working Practices in Adult

Social CareBlaine Robin – PhD

CPD - workshop26th October 2015

Introduction and background

Adult Social Care in England and Wales enables people with disabilities and chronic conditions to live with optimum independence, dignity and wellbeing. The statutory responsibilities (e.g. Care Act 2014; Human Rights Act 1998; Mental Capacity Act 2005; Delayed Discharge Act 2003; NHS and Community Care Act 1990; Health and Social Care Act 2012) to perform this function rests predominantly with Local Government (or Councils or Local authorities inter alia).

Processing assessments and the subsequent extended care pathway functions (e.g. arranging services, sourcing funding for services, reviewing those services) is the main responsibility of staff employed within adult social care (e.g. Social workers, Occupational Therapists, semi - professionals such as social care assessors); increasingly partner organisations with delegated responsibilities are involved in performing assessments functions (e.g. mental health NHS trust employed social workers; Charities such as Jewish Care; Age UK; commercial operators such as Millbrook Healthcare; and Housing departments within local government).

Referrals & AssessmentsThe UK central government through its Department of Health (DH), monitor quantitative and qualitative trends experienced by the most vulnerable people requiring health and social care. The most vulnerable are identified through a process of either self-referral (e.g. people requesting services such as home care or residential care) or third party referral (e.g. hospital discharge arrangements for people living with a chronic condition for the first time). In recent years local government and NHS trusts are having to deal with increases in the number of patients or customers in need of services. This in turn has placed a strain on the workforce where additional increases posts to match demand has been difficult to fulfil by central government.

What are the challenges?

In 2004, the Department of Health carried out a study into chronic illness in the UK (DH 2004c). Their study concluded that out of a population of 60 million people 8.8m people in England have long-term illness that severely limits their day-to-day ability to cope. In 2012, the Department of Health produced further findings showing an increase in the number of people with a Long Term Condition to approximately 15 million people.

Ageing Population, multiple conditions and an increasing

populationThe UK also has an ageing population as people are living longer into old age than they once did over 50 to 100 years ago. In addition migration patterns such as movement of displaced people seeking asylum (e.g. Syria) gives rise to demands on public expenditure in areas such Health, Social Care, Education and Housing. The combined issues of an increasing population combined with an ageing population which includes people living with multiple conditions (also known as multiple morbidities) is therefore having an impact of how services are delivered. These trends are also common with several countries in the developed world including Australia, North America (USA) and the majority of European Union states.

International Perspective: World HealthOrganisation (WHO)

When issues such as population crises impact significantly on Public Health trends the World Health Organisation (WHO) also work with Central governments from across the globe. Some of the support available from the WHO includes shared expertise on management and control mechanisms around such issues is the ageing population; international shortage of skills within health and social care workforce and the promotion of new methods of training in medicine and allied health professions known as Inter professional Education (IPE).‘[I]nitial research studies reveal that IPE increases confidence in health professionals’ identity and appreciation of the roles of other professions, and improves communication and team-working skills’ (WHO 2013 p 23).

In the United Kingdom the roles of health and social care professionals increasingly being encouraged to work in a more collaborative ways has come from children’s social care with implications for the way in which professionals should also practice in adult social care. In recent years, communication processes and procedures have been improved in order to provide support to clients and carers in need.

An example of improved communication process has been disseminated through health and local government social services departments (DCSF & CLG 2008). Processes such as this have also arisen because of critical incidents. One such incident was the murder of eight-year-old Victoria Climbié by her aunt in 2000. In response to this incident several social services departments and NHS acute trusts were found wanting in their abilities to work together and communicate effectively about the needs of the patient (Laming 2003). The ensuing Laming report identified professional catastrophes amongst several agencies in terms of ineffectual multidisciplinary team working which could have prevented the death of Victoria Climbie.

Every Child Matters The green paper Every Child Matters (DfES 2004) and the Children Act 2004 (OPSI 2009d) called for a commitment to systems to be organised to help agencies (e.g. health, education, police, health trusts) information sharing between agencies working on behalf of children.

‘[I]mproving information sharing practice is a cornerstone of the government’s strategy to improve outcomes for all people’ (DCSF & CLG 2008 p9).

Mental Health domainsAnother example of services focussed on the needs of good communication between services and patients and their carers is service for patients with a diagnosed mental health problem where their needs can be assessed through the Mental Capacity Act 2005 (OPSI 2009c, DH 2007d). Under this legislation, patients have the right to an assessment to determine whether they have the mental capacity to make decisions about their own well-being and needs at a particular moment in time.

If patients are unable to show capacity because of a particular illness (e.g. end stage dementia) then the deprivation of liberty safeguards assessment (DOLS) applies whereby the professionals and relatives of the patient assess what is in the person’s best interest to determine what services are available. Under the Mental Capacity Act 2005 patients are allowed to make declarations known as advanced decisions about health professionals that they do not want to be involved in their care (Turner-Stokes et al 2008).

Shared learning culture

‘[E]stablishing a shared learning culture between professionals is vital for ensuring practitioners understood each other enough to work collaboratively’ (Trodd and Chivers 2011 p 15).

The Occupational Therapy profession has debated IPE in the same way

‘ [I]PE aims to encourage collaborative practice, but suggested that the objectives vary, including modifying attitudes and perceptions, enhancing motivation, securing common knowledge bases, reinforcing collaborative competencies and effective change or improvement in practice’ (Brown and William 2009).

Craik et al (2008) have debated this issue of generic working and its potential impact in the area of mental health often guarding against the OT profession moving away from its core specialist areas of practice to a more generic job description as care coordinator.

‘ In multidisciplinary teams they have to respond flexibly to a client centre approach in which a number of general skills are needed. Gaining clarity about the balancing of generic and specialist, core acquired and retained role of OT is essential’ (Craik et al 2008 p 23).

References

Brown, T and Williams, B (2009) The use of DVD simulation as an interprofessional education tool with undergraduate occupational therapy students. British Journal of Occupational Therapy. 72(6), 266-274.

Criaik, C McKay, E, Lim K.H, Richards, G (2008) Advancing Occupational Therapy in Mental Health Practice. Oxford. Blackwell.

DCSF & CLG (2008) Information sharing: guidance for practitioners and managers. Available online at www.everychildmatters.gov.uk/information sharing (accessed January 2009).

DfES (2004) Every Child Matters: Change for Children. London. Department for Education and Schools Available online via www.everychildmatters.gov.uk (accessed January 2009).

(DH (2004c) Chronic disease management: A compendium of information. London, Department of Health)

Department of Health (2012). Report. Long-term conditions compendium of Information: 3rd edition.

Laming, H. (2003) The Victoria Climbie Inquiry report of an inquiry by Lord Laming. Available online file:///H:/General%20stuff/The%20Laming%20report%20into%20the%20death%20of%20Victoria%20Climbie.pdf. (accessed October 2015).

OPSI (2009b) The Children Act 2004. Available online via http://www.opsi.gov.uk/acts/acts2004/ukpga_20040031_en_1 (accessed January 2009).

OPSI (2009c) The Mental Capacity Act 2005. Available online via http://www.opsi.gov.uk/acts/acts2005/ukpga_20050009_en_1(accessed January 2009).

Trodd, L & Chivers, L (2011) Interprofessional working in practice. England. McGraw Hill.

Turner-Stokes, L and Higgins, B.(eds.)(2008) Long –term neurological conditions: management at the interface between neurology, rehabilitation and palliative care. Concise guidance to good practice series, No.10. London: RCP.

WHO (2013) Transforming and scaling up health professionals’ education and training. Geneva.

Exercise 1 - What does generic working mean to you ? Working in pairs describe what it means to you based on your experiences - What do the following terms mean? - Multi disciplinary working - Collaborative working - Partnership working - Integrated working - Interdisciplinary working - Inter - professional working

Exercise 2Mrs. Smith is 82 years old. She was admitted to hospital after suffering a stroke in June 2015. She is widowed and lives alone in a 3 bedroom house in Northern Luton. In October 2015 she was transferred from Luton and Dunstable Hospital to Morlands care home for rehabilitation. A referral has come into your cluster team for a “reablement referral”. You have been asked by your Advanced Practitioner to complete a Reablement Assessment to include a “generic support plan” (i.e. OT and SW). Using the checklist provided please list some the factor that can support or inhibit generic working.