contents 4 the main jobs in health, social care and early years services 47 groups of care workers...

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Acknowledgements viIntroduction vii

Unit 1 Health, Social Care and Early Years Provision

Chapter 1 Care needs of major client groups 2Client groups 2Health, developmental and social care needs 3Babies and children (aged 0–11 years) 3Adolescents (aged 11–18 years) 7Adults (aged 19–65 years) 9Older people (65+ years) 10Disabled people 12Social policy goals 12Health needs assessment 14The reasons why individuals use health, social care

and early years services 15

Chapter 2 Types of care services 16The organisation of health, social care and early

years services 16Statutory sector organisations 17The structure of the social services 24Joint work and planning 26Early years services 27Voluntary organisations 28Private health and social care organisations 29Different service providers working together to

meet client group needs 29Informal carers 29Young carers 30Care services offered to different client groups 31

Chapter 3 Ways of obtaining care services and barriers to access 33Referral 34Barriers to referral 35

Chapter 4 The main jobs in health, social care and early years services 47Groups of care workers 47The effect of changes in services and service provision

on care workers 56Interpersonal and communication skills 57Differing communication needs of client groups 62What if it is not possible to communicate with a client? 64

Chapter 5 The value bases of care work 66The aim of health and social care services 66The care value base 67Guidelines in care settings 77

Unit 1 Assessment

Contents

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164

167

Unit 2 Promoting Health and Well-Being

Chapter 6 Understanding health and well-being 87How can we define health and well-being? 87What are the health needs of different groups of people? 92How have ideas about health and well-being changed over

time? 96How do ideas about health and well-being vary between

different cultures? 99

Chapter 7 Factors positively influencing health and well-being 103A balanced diet 103A healthy lifestyle 113Supportive relationships 116Adequate financial resources 117Stimulating work, education and leisure activity 118Use of health monitoring and illness prevention services 120Use of risk management techniques to protect individuals

and promote personal safety 121

Chapter 8 Risks to health and well-being 124Genetically inherited diseases and conditions 124Substance misuse 127An unbalanced, poor-quality or inadequate diet 135Stress 136Lack of personal hygiene 137Lack of regular physical exercise 138Unprotected sex 139Social isolation 142Poverty 143Inadequate housing 143Unemployment 144Environmental pollution 144

Chapter 9 Indicators of physical health 147Indicators of good physical health 147Blood pressure 149Peak flow 150Body mass index 152Resting pulse and recovery after exercise 153Use of measures of health 154

Chapter 10 Health promotion and improvement methods 155Health promotion and the medical profession 155Physical health assessments and target-setting before

devising a health improvement plan 156Setting realistic health improvement targets 158

How different health behaviours can help people achieve their targets 161

Unit 2 Assessment

Unit 3 Understanding Personal Development and Relationships

Chapter 11 Human growth and development 168Introduction to human growth and development 168Infancy (0–3 years) 171Young children (4–10 years) 174Adolescence (11–18 years) 176Adulthood (19–65 years) 179Later adulthood (65+ years) 180

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Chapter 12 Factors that affect growth and development 182Physical factors 182Social and emotional factors 183Economic factors 191Environmental factors 192How factors interrelate to affect an individual 193Self-esteem 193Physical and mental health 195Employment prospects 197Level of education 199

Chapter 13 Effects of relationships on personal development 201Relationships in infancy (0–3 years) 201Relationships in childhood (4–10 years) 204Relationships in adolescence (11–18 years) 206Relationships in adult life 210Relationships in old age 213Abuse, neglect, lack of support and their effect on personal

development 216

Chapter 14 Self-concept 219What is self-concept? 219Influences on self-concept 221

Chapter 15 The effects of life events on personal development 230Life events 230Sources of support 237

Unit 3 Assessment

Index 245

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Health, social care and early years provision

Learning about the areas of care that are provided, the way in whichthe services are organised and the different jobs available will help toprepare you to make your own decisions about a career in health,social care and early years work.

In this unit you will learn about:

� the range of care needs of major client groups;� the types of services that exist to meet client group needs and

how these are organised;� the ways people can obtain care services and the barriers that

can prevent people from gaining access to services;� the major work roles and skills of the people who provide health,

social care and early years services; and� the values that underpin all care work with clients.

You will understand more about the work of health, social care andearly years service providers by:

� understanding how services are developed in response to socialpolicy goals and to meet the needs of individuals; and

� knowing about the different services and job roles.

This unit is assessed through portfolio work. Your overall result forthe unit will be a grade from G to A*.

Assessment

What you will learn

Introduction to Unit 1

Unit

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Unit 1Health, social care and early years provision2

Care needs of major client groupsChapter

Figure 1.1 The major client groups

Key issueWho needs to use care services and why?

By the end of this chapter you will have learnthow care services are designed to meet thehealth, development and social care needs ofmajor client groups. You should understandthat services are shaped to meet the needs ofindividual users. The major client groups are:

� babies and children� adolescents� adults� older people� disabled people.

You will learn how services are developed andprovided to meet social policy goals, such asreducing child poverty, homelessness and drugmisuse in the population as a whole. You willalso learn that health authorities and localauthorities assess the care needs of localpopulations in order to identify likely servicedemand in a local area. You should also be ableto identify and describe the reasons whyindividuals may require and seek to use health,social care and early years services.

CheckpointA client is a person who receives a service.For example, if you go to see your doctor you arethe client and the doctor is providing the service.

Different groups of people, because of their ageor physical abilities, have different healthneeds. These different groups of people arecalled client groups. The ones you need toknow about are shown in Figure 1.1. These arethe client groups who need to use care services– you need to learn them.

Client groups

Client group name Age range (years)

Babies and children 0–11

Adolescents 11–18

Adults 19–65

Older people 65+

Disabled people People of any agewho are well buthave specialneeds because ofa physical ormental disability


Care needs of major client groupsChapter 1 3

In order to understand who needs to use careservices and why, you need to know thegeneral needs of each of the client groups.These can be divided into the followingcategories:

� Health needs: Those things we need inorder to stay physically healthy (see Figure 1.2).

� Developmental needs: Those things weneed in order to develop intellectually. Forexample, as a baby develops into a childthe baby needs more advanced toys tostimulate her or his brain (see Figure 1.3).

Health, developmental andsocial care needs

Warmth

Shelter

A balanceddiet

Protectionfrom harmGood hygiene

Sleep

Exercise

Healthneeds

Figure 1.2 Health needs

Figure 1.4 Social care needs

Figure 1.3 Developmental needs

Newexperiences

Education Books

Developmentalneeds

Interestingleisure activities

Enoughmoney

Somewhereto live

Socialcare needs

Purposefuloccupation,

for example, schoolor work

Relationshipswith other

people

� Social care needs: Those things we needthroughout our lives to support us sociallyand emotionally and to keep us settled inour community (see Figure 1.4).

However, other needs vary from client group toclient group. We will look at the extra needs ofeach group so that you can understand howcare services are designed and shaped to meetthe health, development and social care needsof these groups and individual members ofthese groups.

Care services for babies and children aredesigned to help their carers to meet all their needs.

Activity� Work with a partner and write

down the needs of a newborn baby.� Discuss why the needs of a baby change as

the baby grows older.� Try to write down as many ways as you

can think of how someone caring for achild can make sure all the child’s needsare met.

Babies and children (aged 0–11 years)



The early years services are those services thatprovide health, social care and educationservices to children between the ages of 0 and8 years when they are not at school. Someexamples are shown in Figure 1.5.

Health care services for babies and childrenIn addition to the health care offered to allpeople, there are special services for children:

Early years services � Maternity services: Before a baby is bornand up to 10 weeks after the birth, themother and child are looked after by amidwife.

� Health screening: From the age of 10 weeksall children are seen in their own homes byhealth visitors, who give children regulardevelopmental tests. These tests are forgrowth and development, sight andhearing.

� Vaccination and immunisations: Childrenare given a programme of injections(starting at the age of 8 weeks) to protect

Setting Provider Description

Childminders Private; registered with A childminder looks after other people’s children in the childminder’s local authority own home. This might include looking after other children after school

as well as looking after children under 5 years of age during the day

Nannies Private; no registration A nanny looks after children in the children’s own homerequired

Day nurseries Statutory or private; A day nursery is open all year round and children under 5 years of age inspected by OFSTED can stay all day

Workplace nurseries Statutory or private; A workplace nursery is organised by an employer and the places areinspected by OFSTED often subsidised. This means the employee does not pay the full cost

Crèches Private or local Crèches look after children under 8 years of age for short periods authority run of time. For example, they are found in new shopping centres, allowing

parents to shop for a few hours

Playgroups Voluntary or private Playgroups are non-profit-making groups designed to give childrenunder 5 years of age an opportunity to play. Sessions are often two tothree hours long

Nurseries or Statutory or private; Nurseries and kindergartens offer sessions in mornings and afternoonskindergartens inspected by OFSTED that allow children under 5 years of age to learn and play

Nurseries within Run by local education Some infant or primary schools have a nursery attached. The nurseries schools authority take children from 3 to 4 years of age. No charge is made to the parents

Infant and primary Run by local education Infant and primary schools take children from the age of 5 years.schools authority; inspected by The normal school day is about six hours long

OFSTED

After-school clubs Voluntary or private After-school clubs look after children over the age of 5 years after schoolhas finished during term time. They are often used by working parents

Holiday play Run by local authorities Holiday play schemes look after children over the age of 5 years schemes and private and during school holidays. They are often used by working parents

voluntary groups

Figure 1.5 Child care settings



them from whooping cough, polio, tetanus,measles and other infectious diseases.These immunisations are given by thedoctor or at the local baby clinic.

� School health services: Once they startschool, children are seen by a school nurseand given health education. If any healthproblems are detected, the nurse can referthe children to their own doctor who maysend them to a specialist.

� Dental services: Dental check-ups andorthodontic treatment (straightening theteeth) are free to children up to the age of16 years.

� Community and hospital services: If childrenneed referral to specialist treatment, theymay see a paediatrician, audiologist, speechtherapist, optician or dietician.

All these services are free to children underthe age of 16 years.

Checkpoint� A paediatrician is a doctor who treats

sick children.� An audiologist is someone who specialises

in hearing problems.

Find out what a dietician does.

Education for babies and childrenLocal education authorities (LEAs for short) areresponsible for delivering nursery, primary andsecondary education in their areas. Every 4-year-old is entitled by law to receive somenursery education, either in a school, a privateday nursery or a playgroup. Any nurserywanting to be funded by the government has tobe inspected by OFSTED, the school inspectionservice.

Checkpoint� Entitled means having a right to

something.� The curriculum is what schools or

government-funded nurseries are told theyhave to teach children by the Departmentfor Education and Skills (DfES).

� OFSTED is the school inspection service.

In 1996 the government identified sixdesirable learning outcomes for children agedunder 5 years. Each of the early years servicesshould be working towards these outcomes tohelp the child grow fully in all parts of his orher development. The areas the governmentidentified for action are:

1 language and literacy;2 maths and numeracy;3 creativity;4 knowledge of the world; 5 personal and social development; 6 physical development.

These outcomes are now known as theEarly Learning Goals and nurseries must followthem as they form the basis for the curriculumfor 3 – 5-year-old children. Children areexpected to be in full-time education in theschool term following their fifth birthday butmany children start in reception a year earlier.

ActivitySophie is 18 months old. Every morning, Monday to Friday, she is taken to the Sticky Fingers nursery owned by MrsBancroft. She arrives at 7.30 am so that herparents can leave and get to work on time.Sophie has her breakfast in the nursery and herlunch and evening meal because her parentscannot collect her until 6.00 pm. Sophie’sparents pay £80.00 per week for her nursery carebut don’t mind the cost because they know thatqualified nursery nurses are caring for Sophie.

Sophie is learning so much by being withother children. She is beginning to play with theother children as well as joining in with thepainting activities organised by the nursery nurses.

Discuss with another person the following:

1 Is the nursery privately owned or not?2 What kind of service is being offered to

Sophie and her parents?3 What are the benefits to Sophie and her

parents of using the nursery provision?

How are the activities organised by thenursery contributing to the Early LearningGoals?



Social care services for babies and childrenThe Department of Social Security (now theDepartment for Work and Pensions) isresponsible for providing benefits for childrenand families, and it also runs the Child SupportAgency. A number of benefits are available forchildren and families, and the main ones are asfollows:

� Child Benefit: A fixed payment to allparents who have a child or children.

� Maternity Benefit: Money paid to workingmothers while they are on leave from workto have a baby.

� Family Credit: Payments for families with achild or children where the family’sincome is low.

The benefits system is complex and changesfrequently.

Local authorities are responsible for arange of services, particularly for registeringpeople who work with children in early yearssettings. These settings may be statutory,private or voluntary (see Figure 1.5). Look atpage 20 to find out what private, statutory andvoluntary mean.

One such service is foster care and adoption.Fostering can be divided into three kinds:

1 short term2 long term3 teenage.

A child or teenager is fostered in someoneelse’s home because the social services and,sometimes, the parents or carers believe thereis a need for help. This can be because:

� the child’s parents or carers are ill orunable to look after the child and there isno-one else to care for him or her;

� the child has been abused in some way(either physically or mentally); or

� the child has been neglected.

Foster parents are paid for looking after a childor teenager. The money is used to support thechild with clothes and other expenses. Thefoster parents take only a small amount to coverthe cost of their caring work. Very often a childis able to return home after a period of time.Occasionally, a child will never return home, for

a variety of reasons. Instead, the child may beadopted (this means living with someone elsepermanently), sometimes by the foster family.

The National Childcare StrategyThe government has made a decision to focusattention on the early years to ensure thatpreschool children are provided with good-quality care and education. There have been anumber of key developments in this area, someof which have already been mentioned:

� A national framework of qualifications forpeople who work with children to ensureeveryone understands the levels andachievements attained through the varioustraining courses currently on offer.

� The pre-school curriculum entitled EarlyLearning Goals.

� Inspection by OFSTED of all pre-schoolsettings to ensure they are following abalanced programme of learning and play.

� Early Years Development Partnerships,where all local authorities have to producea plan to show how the local health, socialcare and education services are workingtogether for children.

Early Years DevelopmentPartnerships and PlansThese partnerships and plans are seen as thekey to ensuring there is good quality localprovision for all children. Some of the key aimsof the plans are to:

� make sure every 4-year-old has threeterms of good quality pre-school education;

� include children with specials needs withinthe same care and education settings asother children;

� show how the provisions of the ChildrenAct 1989 and other laws relating tochildren are fulfilled;

� promote training for all early yearsworkers (for example, NVQs in early yearscare); and

� provide grants for training.

For example, a childminder might decide shewould like to be NVQ trained so that she is betterequipped to help the children she looks after. Shecould apply for a grant from her local authority tohelp her with training to achieve this.



Case studyMichelle and her childrenMichelle is a single mum with two children;Jade aged 41/2 years and Kai aged 2 years. She isliving with her mother at the moment but wantsto find her own home and to obtain a part-timejob to help her support the children. Both thechildren are at home at present, but Jade is dueto start school in 3 months. Michelle is anxiousthat Jade won’t find it easy to be separated fromher. Kai worries her too because he is asthmaticand has had two recent serious asthma attacks.Michelle needs to find good-quality care andhealth support for him. Then there is theproblem of finding a job. Michelle wantssomething that will fit in with her plans for thechildren and will pay enough to cover her child care costs. Her mum can help for a fewhours a week, but no more.

1 What early years services will Michelle needfor herself and her children? You could notethese down under the headings: ‘Health’,‘Education’ and ‘Social’ care.

2 How could Michelle find out about theseservices?

3 Imagine that Michelle had moved into yourlocal area. Where would she find theservices she needs?

Check your knowledgeRead through the sections on babies andchildren before answering these questions:

1 What are the early years services?2 What is health screening?3 Name the specialists children might be

referred to.4 What are the six Early Learning Goals for

children aged under 5 years?5 How old must a child be before being

entitled to receive some nursery education?6 Which government department is

responsible for providing benefits forchildren and families?

7 What does a nanny do?8 What is a crèche?9 Why do you think ‘knowledge of the world’

is included as one of the Early LearningGoals for children under 5 years of age?

10 Do you think it is right that all parentsreceive Child Benefit, regardless of theirincome? Explain your answer.

11 How do you think the inclusion of childrenwith special needs within the same careand education settings as other childrenbenefits:� children with special needs?� the other children?

Many of the services already described forchildren, such as vaccinations andimmunisations, school health services, dentalservices and community and hospital services,continue to apply in adolescence, althoughafter the age of 16 years adolescents have topay for the services if they are not in full-timeeducation. However, adolescents also havetheir own unique health needs: they are at anage when they are no longer really children butare not yet adults. Health promotion (that is,providing information about things likecontraception or the dangers of smoking,alcohol, drugs and unprotected sex, becomes

Adolescents (aged 11–18 years)

important in adolescence.Services for adolescents are not provided

because the government is trying to be nice tothem but because certain groups of people (whowere asked by the government to look intosome of the problems facing our society) haveidentified several problems that either continueinto, or start in, adolescence such as povertyand drug misuse. These groups of people havemade their findings known to the governmentand, as a result, targets are set to try to start toalleviate some of these problems. These areknown as social policy goals (which are coveredin more detail later in this chapter).

One way of trying to meet some of thesesocial policy goals is to provide servicesdesigned to help adolescents with theseproblems. Providing health promotion servicesthat highlight the dangers of habits as smoking,



it is hoped, stops some adolescents eitherstarting or continuing with these habits. Thiscuts the cost of health treatment for problemsarising as a result of these habits, both inadolescence and later in life.

ActivityThe government is very concerned about the fact that the average weeklyconsumption of alcohol among pupils aged11–15 years has increased steadily from 5.3 unitsin 1990 (equivalent to almost 3 pints of normal-strength beer) to 10.4 units in 2000.

Discuss in a group what services you thinkneed to be provided to try to reduce theconsumption of alcohol by adolescents.

Discuss what else can be done to addressthe problem of adolescent drinking. Thinkabout role models such as family members,teachers and friends, and advertising, bothin the media and in shops. Write down whatis the biggest influence on you as anadolescent to encourage you to:� drink� not to drink.

The school nurse, medical centres,doctors’ surgeries, libraries and varioussupport agencies provide a lot of healthpromotion in the form of advice or freeleaflets. Schools also provide much of this incertain areas of the curriculum, such aspersonal and social health education (PSHE),religious studies, health and social care,drama and citizenship. Services such as theyouth service, child protection and youthoffending also offer advice and help.

You will probably be an adolescentyourself and will be aware that, although your physical needs have not changed much,your emotional, social and intellectual needshave. Figure 1.6 shows some of thesedeveloping needs.

CheckpointIf you are assertive you can argue a point or stand up for yourself without beingaggressive, and you can say no to people aboutthings you don’t want to do.

Learning aboutwork and workrelationships

Developing new skills (workand recreation)

Coping withchanges such as

puberty

Learning aboutsex andsexuality

Making lovingrelationshipsoutside the

family Adapting familyrelationships, still

loving but expresseddifferently

Learning whenand how to be

assertive

Learning tobe responsible

for him or herselfand others

Learning to beindependent and

confident

Respect frompeers (friends)

Keeping fit

Figure 1.6 The developing needs of adolescents

Developingneeds

of adolescents



Case studyJulieJulie is a 15-year-old school girl who is verybright and hard working. She has an active lifeoutside school, caring for and riding her horseand training at the local athletics club twice aweek. However, she is now in Year 11 and isbeginning to feel the strain of trying to balanceher hobbies with the increasing demands of herschoolwork. She has not told her family abouther worries. She is becoming withdrawn anddepressed and is liable to flare up at theslightest criticism made by her family. Herparents are very worried about her as she isreluctant to discuss any of her worries withthem.

1 What services can her parents call upon tohelp Julie cope with her problems?

2 What services can Julie call upon withouther parents’ knowledge?

3 Is there a service you think is, or should be,provided in school to help students likeJulie? Describe such a service and say whyyou think it could help adolescents.

The social services already described forchildren (such as foster care) can also apply toadolescents. Other social services that apply tochildren (and adolescents in particular) includethe following:

� Residential care (see below).

� Child protection: Social services have achild protection register that lists childrenand young people whose welfare and safetyare felt to be at risk. Social workersmonitor their welfare and, if the situationbecomes worse, the child or young personis moved to foster care or a residentialhome while help is offered to the familyand child to try to solve the problem.Anyone who comes to the notice of socialservices from the police, concernedneighbours, other family members orschools as suspected of being abused or

Social services for adolescents

neglected in any way, or in danger becauseof problems in the family, is visited. His orher needs are assessed and his or hername is put on the register until such timeas the situation is thought to be resolved.Such children and young people areassigned a social worker for them tocontact if the need arises. All schools havea child protection officer to whom anysuspicions of abuse are reported; thisinformation is then passed on to socialservices who visit the family and monitorthe situation closely.

� Youth offending services: These servicesare used mainly by adolescents butsometimes by children as well. They givesupport to young people who havecommitted an offence and provide themwith legal advice (as well as help) to getthem back into school or employment or toget benefits when they have been in ayouth custody centre. They also supportthe families of the youth offenders.

� Youth work: Social services employ specialworkers who work with young people.These workers might come into school oncertain days of the week to talk toteenagers about their problems or to askthem what facilities they would likeproviding to occupy them in the evenings.Alternatively, these workers might beavailable in local community centres. Theymight also run youth clubs and activitiesaimed at different age groups.

Adults are served by the health services inmuch the same way as children andadolescents, although adults will develop moreserious medical conditions as they grow older,and they may require a wider range ofspecialist care. Health care for adults includesgeneral hospital services (for example,operations such as hysterectomies,physiotherapy after accidents, strokes, etc.),and recuperation and rehabilitation adviceafter conditions such as a heart attack. Someadults may also need mental health care (as do

Adults (aged 19–65 years)



children and adolescents but less commonlythan adults), which is provided either bycommunity nursing or in residential care.Complementary therapies, such as osteopathy,aromatherapy and chiropractic, are now usedalongside more conventional medicaltreatments, and doctors often refer adults tothese services although most are run privatelyoutside the National Health Service. Familyplanning clinics and hospices are other healthcare services used by adults.

Adults’ educational (developmental) needsare provided by further educationestablishments (such as universities), localcolleges on day release, correspondencecourses or night classes at local schools orcolleges.

Social services that are provided for adultsinclude refuges for adults at risk of violence,homelessness services, support services suchas the Samaritans and advice services such asthe Citizen’s Advice Bureau. Many of thesehave to be provided because adults are havingproblems with relationships.

As people become older, they may need more help with daily living. Local authoritieshave the duty to assess the needs of olderpeople and the power to provide services in order to meet those needs. They offer arange of services to meet the needs of olderpeople.

Older people (65+ years)

� Aids for dressing, eating and carrying outeveryday tasks.

� Help with continence problems, includingpants and other aids.

� Help with speech and swallowing problemsafter an illness such as a stroke.

� Foot care and chiropody (podiatry).� Residential care.� Day care facilities.

In social care services, the term ‘residential’often means a client living in a care home withother people. This could be a residential homewhere care workers are on duty at all times.

The social services and the independentsector (private business) provide residentialservices. Residential care is also provided bycharitable groups. The following are someexamples of people who live in residential care homes:

� Older people who can no longer care forthemselves.

� People with physical disabilities who needpractical help with moving, eating anddressing.

� Children with no carers – e.g. childrenwhose parents have died or who cannotcare for them.

� People with learning disabilities who needsupport managing their own lives.

Residential care is included here becauseolder people are the main users of residentialcare services, but it is important to realise(from the bullet points you have just read) thatthese services are also for those withdisabilities and for children with no carer.

Sheltered accommodation

Another kind of residential care is calledsheltered housing. Clients live independentlyin their own homes (rented or purchased) andhelp is immediately available if they need it. Awarden is on duty at all times. Their job is tomake sure the clients are safe and well. Theclients are also encouraged to join in with arange of social activities that are planned andprovided for them, usually by the residents and

Residential care services

The help that may be offered includes thefollowing:

� Nursing care at home.� Personal care (e.g. help with bathing,

getting up, getting dressed).� Domestic help (e.g. shopping, housework,

laundry and pension collecting).� Equipment (e.g. bath seats, commodes,

wheelchairs, bed rails and hoists).

CheckpointDuty in this example means being required by law to assess the needs of older people.



dressed (usually waiting for her breakfast!). Ialways have to help George. He can’t get outof bed easily, so with the help of other staff Iuse the hoist to get him up and on to hisfavourite chair. Some of my clients eat theirbreakfast in bed if they are not feeling toowell. If this is the case then I take them theirbreakfast.

1 Identify three ways in which Cathhelps her clients.

2 Identify the differences for theclients living in residential carecompared with those living in theirown homes.

3 Why do you think somebody mightneed to go into residential care?Give reasons under the headings‘Health needs’ and ‘Social needs’.

1 Identify three different needs Cath’sclients have.

2 How can Cath help her clients withthese needs?

Case studyA residential home for older people

Hello, my name is Cath and I am a care worker ata residential home for older people. I only work15 hours a week because I am also a student atmy local college. When I go into work first thingin the morning, the night duty staff tell me aboutour residents and what sort of night they havehad. They tell me if Mrs Hall has not been able tosleep or if Mr Bancroft had a good night out withhis daughter. They make sure all the clients’records are up to date before they leave duty.

The first thing I do is awaken the clients Iwork with. Sometimes I find Mary already up and

warden of the accommodation. Clients do nothave to join in unless they want to. They arestill completely independent and make theirown choices about their lives.

Day care centres are provided by both thehealth and social services. Those provided byhealth services are discussed on page 27 inChapter 2. In the case of social services, themain purpose is to provide social supportactivities for the clients, not medical treatmentand health care. The types of activitiesprovided are shown in Figure 1.7.

Day care centres are very important in thelives of many older clients or those with specialsupport needs. Often clients are collected fromtheir own homes or residential homes and

Day care services

taken to the day care centre in minibuses runby social services or voluntary groups.

Friendship

Games

Talking groups

Fitness

Therapeuticactivities

Creativeactivities

Figure 1.7 The types of social support activitiesprovided in day care centres

Day carecentre

activities



Irrespective of the particular disability a personmay have, he or she is likely to have additionalneeds to those without a disability (for example,appropriate, suitably adapted facilities andresources, and access to services that allow thatperson to lead an independent life). In additionto the services already mentioned for otherclient groups, some disabled people needadditional specialist nursing and medicalservices, including physiotherapy, psychology,occupational therapy and rehabilitation services.

CheckpointAccess means the route that enabless a person to take advantage of a particular service.

People who have physical or learningdisabilities require the kind of care thatenables them to live as full a life as possible.We need a wide range of services for thosepeople. Primary health care teams andcommunity services, as well as hospitals, oftenprovide these services. The kinds of service youmight come across are as follows:

� Supported community living: People withspecial needs sharing a house in the localcommunity and being supported by ahealth care worker.

� Day care centres: Often based in localhospitals providing, for example assessment,treatment and occupational therapy.

� Hospital care: To treat a specific illness ordisability.

� Home care: Medical care provided in thehome to allow the client the opportunity tostay within his or her own community.

There is a range of services for people withlearning disabilities, as in the case of Stephenin the following activity.

Day centres for people withlearning disabilities

Health services for people with a disability

Disabled people Case studyStephen is 17 years of age and has Down’s syndrome. He lives at home with his parents. Every day he takes the bus to theWoodlands Centre, five kilometres from where helives. At Woodlands he is able to take part in arange of sporting and recreational activities,which he thoroughly enjoys.These include horseriding at the local riding centre. Stephen is alsopart of the horticulture group, which raises plantsfor sale at a garden fair twice a year.The moneythey raise helps to pay for the extra facilities thecentre needs.

Each day a group of the clients at the centreworks out a menu for lunch and then walks tothe supermarket to buy the ingredients. Thenwith the support of one of their carers they cooklunch for everyone. Stephen is also learningcomputer skills. This is very useful as he has hisown computer at home.

Discuss with a partner the services that areavailable to Stephen at the centre. How doeseach service help Stephen achieve a betterstandard of life? Make notes of yourdiscussion.

Domiciliary care is care that is provided in theclient’s own home. This can include:

� help with personal hygiene (e.g. bathing,dressing and using the toilet);

� household care and cleaning;� transport; and� shopping.

The availability of these services usually variesfrom one place to another. It often depends onthe amount of money the social care serviceshas to spend on client care. In some placesclients are asked to contribute a small amountto the cost of the service provided.

When the government commissions a group ofpeople to look into one of the problems facing

Social policy goals

Domiciliary care



our society (such as homelessness, childpoverty and drug misuse), that group of peoplewill report back on the particular area theyhave been asked to investigate. Based on theirreport a policy will be written to help tacklethe problem and targets will be set toimplement the policy – that is, to put it intoaction. These targets are known as social policy goals.

Checkpoint� Commission means to instruct or give

authority to a group of people to do aparticular task.

� Implement means to put into action.� A policy is a general plan of action.

An example of such a group of people isthe Policy Action Team (PAT) on YoungPeople. The team was made up of expertsfrom the voluntary sector and business andpeople with a research background, as well assenior Whitehall officials. PAT was puttogether in 1998 to look at how thegovernment can improve the way policies andservices work for young people following areport published in September 1998 aboutsocial exclusion.

Checkpoint� Whitehall is a street in London where

there are many government offices. We usethe phrase ‘Whitehall officials’ to meanpeople who work for the government.

� Social exclusion refers to people who areexcluded from opportunities to have ahealthy and economically comfortable life.Some factors that create social exclusion arepoverty, family conflict, poor educationalopportunities and poor services.

� Initiatives are new ideas for, or first stepstaken towards, solving a problem.

Exclusion among young people emerged asa particular issue in the September 1998 report.The Policy Action Team therefore investigatedand, in their report (published in March 2000),said that the most important task facing society

is to ensure that every young person, no matterwho he or she is, has the best possible start inlife and the opportunity to develop and achievehis or her full potential. However for a minorityof young people, achieving this ambition willnot be easy, with too many of them appearing tobe destined for a life of underachievement andsocial exclusion.

The PAT used a case study about a youngman called Matthew to illustrate the problemsfacing young people. Matthew was abused byhis stepfather and older half-brother at homeand was bullied at school. He began takingdrugs and getting involved in crime and, at theage of 16, he was kicked out of home. When hewas 17 he spent six months in jail.

The PAT suggested that the governmentshould support young people such as Matthewmore effectively through their adolescence andshould act earlier to stop them developingproblems in the first place. This meansdeveloping and providing services to do this.

The report states that a large minority ofyoung people experience a range of acuteproblems, including homelessness, poverty,drug addiction, illiteracy (an inability to read orwrite), mental illness and serial offending. Ithighlighted facts such as the following:

� One in five children are growing up inhouseholds where no-one has a job, whichmeans these children are experiencingpoverty.

� The UK has more 15 – 16-year-old drugusers than any other European Unioncountry.

� In England and Wales half of all 16 – 19-year-olds have tried drugs.

� There are approximately 32, 000 homeless16–21-year-olds in Britain.

� There are more homeless 16 – 17-year-olds,in the UK than in other European Unioncountries.

CheckpointAcute in this context means serious. Serialmeans at regular intervals.

Some of these problems are partly due to thefollowing:



� Not enough work has been done to preventthem.

� The services designed to meet the needs ofthe poorest young people have been badlydesigned and have been providedhaphazardly rather than where they areneeded.

� The services are restricted rather thanbeing available to all who need them.

� The services have not been adapted to newproblems experienced by young people,such as poor mental health, drug abuseand family conflict.

� The money has not always gone to theright places, which has meant that some ofthe most deprived areas have had lessmoney spent on them.

� When the policies and services weredesigned, the young people they weresupposed to help were not consulted abouttheir needs.

� The services often work in isolation fromeach other.

The Policy Action Team therefore made thefollowing recommendations:

� Shifting the balance of effort and resourcesinto preventing young people experiencingproblems, rather than coping with youngpeople when they have encountered theproblems and are in serious trouble.

� Improving individual services for youngpeople.

� Designing policies around the needs andpriorities of young people, by involvingthem in the policy-making process.

A report such as that produced by thePolicy Action Team for Young People thereforeprovides facts and examples and it makesrecommendations to which service providerscan respond in order to develop and provideservices that contribute towards meeting socialpolicy goals, such as reducing child poverty,homelessness and drug misuse in thepopulation as a whole.

In addition to policy decisions made centrally bythe government, there are also regional groups.

Health needs assessment

Strategic health authorities and primary caretrusts (explained in more detail in Chapter 2),along with the local authority, need to assess thecare needs of the local population so they canplan and develop the health and care servicesthat are needed in their local area. Each areadevelops its own Health ImprovementProgramme, and this, along with the PrimaryCare Investment Plan, is an important localdocument that helps in this process. Public andservice users, local authorities and health serviceproviders pool their ideas, efforts and resourcesto improve health and to reduce the gap betweenthose who are disadvantaged and those who arenot. They outline the current position of many ofthe important health areas within their districtswhich allows them to identify any likely servicedemand in the area. These documents are thebasis on which all the organisations involveddevelop plans to make significant healthimprovements within the local population by:

� promoting healthy living;� preventing ill-health;� providing health and social care when

needed; and� reducing the problems of the poor and

disabled.

Checkpoint� Primary care trusts are regional

organisations that involve all the healthcare services in the area. They identifywhich services are needed in their area andthen arrange for various organisations todeliver those services.

� Strategic health authorities are bodiesthat monitor (watch over) the primary caretrusts and the National Health Service trust(hospitals).

� Local authorities provide such services associal services and schools in a particular area.

The government publishes its national healthpriorities in reports, and these priorities areincorporated into local documents. One suchreport is the NHS Plan, which was published inJuly 2000. This report set targets for the NHSon such issues as:

� heart disease and stroke;� cancer;



� accidents;� mental health;� children’s health; and� improving waiting times.

It also set targets for the NHS to work withsocial services on the rehabilitation of olderpeople to help them live independently and onincreasing the participation of drug users indrug treatment programmes (as well as targetsfor social services on education and adoption).

Individuals use health, social care and earlyyears services because they may need thefollowing:

� Care: To be looked after in some way.� Support: To be given help of some kind

(e.g. encouragement or money).� Advice: To be given an opinion or

information as to what to do.� Medical treatment: To have a medical

problem dealt with.

The reasons why individualsuse health, social care andearly years services

At various stages in an individual’s life, he orshe may require help to meet his or her health,development and social care needs. Careservices are designed to meet these needs andare shaped to meet the needs of individualusers – so an individual will seek to use thoseservices as and when it becomes necessary.

Check your knowledgeRead through the whole chapter and then try to answer the following questions:

1 Name the five major client groups.2 What age range is covered by each of the

client groups?3 What do we mean by development needs?4 Give three reasons why an individual might

seek the help of the early years services.5 Name three health needs an adult has.6 Name three social needs an older person has.7 Name one social poverty goal.8 How can health and social care services

help to reduce drug misuse?9 Why do health authorities and local

authorities assess the care needs of localpopulations?

10 What are the four general reasons whyindividuals need to seek the use of health,social care and early years services?Describe these reasons.

room to invite her to live with them. They decide they need to talk to someone aboutwhether their mother’s situation might beimproved by having some help in her own homeor by moving into some sort of residential care.Gertrude agrees she cannot go on as she is butis reluctant to leave the home where shebrought up her family. She is happy for Charlesand Mary to talk to someone on her behalf.

1 Identify the health and social careservices Charles and Mary mightcontact to help with Gertrude’s needs(for example, the local authority abouthome care help).

2 List the reasons why they would seek touse those particular services.

Case studyGertrudeGertrude Evans is 76 years old and a widow.She has recently been finding it harder to getabout because her arthritis has been gettingworse and she is distressed because she can nolonger keep her house as spotlessly clean as shealways has done. Her son, Charles, and daughter,Mary, are married, have children of their own andhave moved to other parts of the country.Although they visit her regularly she is quitelonely because she cannot get out and about asmuch as she used to. To make matters worse, shehas recently suffered a slight heart attack and haslost a lot of confidence because she is worriedthat any exertion will bring on another attack.

Charles and Mary are becoming increasinglyworried about her but neither of them has the



Key issueWhat types of care services are provided to meet client group needs?

By the end of this chapter you will have foundout about organisations and private sectorpractitioners that deliver health care, socialcare and early years services. You will be ableto identify the main types of care services thatare offered to different client groups.

You will learn who provides the servicesand where they are made available. You shouldunderstand that there may be national andregional variations. You should be able toidentify local and national examples of serviceproviders who operate in the following caresectors:

� Statutory (including NHS trusts and localauthority services).

� Private (including private companies andself-employed practitioners).

� Voluntary (including charities, localsupport groups who use volunteers andnot-for-profit organisations with paidemployees).

You will learn how the different serviceproviders work together to meet client groupneeds. You will also understand how informalcarers (family, friends and neighbours) providea large amount of care in the community.

Although this chapter describes in general whoprovides services and where these are madeavailable, there may be national and regionalvariations. You need to be able to identify localexamples of service providers in the threesectors named above, so a number of theactivities in this chapter require you to find outdetails of such services in your own area. Be onthe lookout for leaflets about services when you

Be prepared

go to see the doctor, dentist or any other healthand social care services.

Care services may be provided in one of threeways (see Figure 2.1):

� Statutory services have been set up becauseParliament has passed a law that requiresthe services to be provided (e.g. accidentand emergency departments in hospitals).

� Private organisations are run on a profit-making basis and are businesses (e.g.private residential homes).

� Voluntary organisations are run on a non-profit making basis (e.g. Barnardo’s, anorganisation that provides care forchildren and young people).

The organisation of health,social care and early yearsservices

Types of care servicesChapter

INFORMAL CARE

STATUTORY

PRIVATE VOLU

NTA

RY

Social services and education

(residential and nursing homes,

day centres, home care,

early years centres,

nurseries, schools,

child protection)

Hospita

ls an

d clini

cs

commun

ity se

rvice

s

(GPs

and d

istric

t nurs

es,

healt

h visit

ors,

dentis

ts, optic

ians,

occup

ationa

l

therap

ists,

etc)

Hosp

ices

Day c

entre

s

Befri

endi

ng se

rvice

s

Lunc

heon

club

s

Child

pro

tect

ion

agen

cies

Child

car

e ag

encie

s (e.

g. N

SPCC

)

Help

in th

e co

mm

unity

(e.g

. WRV

S)

FamilyFriends

NeighboursChurchgroups

Hospitals

Clinics

Residential and nursing homes

Nursing and home care agencies

Domestic help agencies

HEAL

TH

AUTHORITY

LOCAL AUTHORITY

Figure 2.1 An overview of health and social care provision


Types of care servicesChapter 2 17

People outside these formal agencies andorganisations also provide health and socialcare. Informal care may be provided by familymembers, friends and neighbours (see Figure 2.2).

The two main providers of statutory servicesare the National Health Service (NHS) andlocal authority services. Statutory services areorganised at government (national), regionaland local levels (see Figure 2.3):

� National levels of the organisation includekey government departments. Thegovernment is divided into variousdepartments that have a responsibility forspecific areas (e.g. the Department ofHealth deals with national issuesconcerning the NHS).

� Regional levels include regional services inthe NHS, social services boards and thestrategic health authorities.

� Local levels include local authority socialservices departments, hospital andprimary care trusts and GPs.

The Secretary of State for Health in Englandand the Secretaries of State in NorthernIreland, Scotland and Wales are responsible forall aspects of health and social care provision.The Department of Health (DOH) in Englandhas responsibility for:

Statutory sector organisations

� making policies in relation to health andsocial care and issuing guidelines;

� monitoring the performance of healthauthorities and social service departments,ensuring the quality of care; and

� allocating resources for the provision ofhealth and social care.

Private healthcare

Voluntary healthcare services

National HealthService

Voluntary socialcare services

Private socialcare

Social servicesdepartments

Informal carers

Figure 2.2 The providers of health and social care

National

ParliamentSecretary of State for HealthDepartment of HealthNational voluntary organisations’ headquarters

Regional

NHS strategic health authoritiesVoluntary organisations’ regional officesRegional offices of private health andsocial care agencies

Local

NHS trustsLocal voluntary organisationsLocal authorities social services departmentsPrimary care trustsVoluntary organisations’ local officesPrivate health and social care agenciesInformal carers

Figure 2.3 National, regional and local levelsof health and social care provision

Health andsocial care

CheckpointThe DOH is responsible for:� deciding what needs to be done and how

it will be put into practice;� providing safe, quality services; and� deciding which part of the service gets

what amount of money.

In Northern Ireland, health services andsocial services are organised as a singleagency. This is called a unified structure and is provided outside political control. Althoughthe organisation of health services in Scotland, Wales and Northern Ireland may bedifferent from that in England, the range andprovision of services are much the same (seeFigure 2.4).



Before 1948, health services were provided invarious ways: some by voluntary organisations,some by local authorities, some by employers,some by private care. There was no co-ordinationof services. Generally people had to pay for theirhealth care. Many poor people could not affordhealth care if they needed it.

Did you know?Before 1948, if people needed to see a doctor for coughs, colds or more serious illnesses,they often were not able to because they didn’thave enough money. Many more people becamevery ill and sometimes died because theycouldn’t afford the medical care they needed.

The structure of health servicesIn July 1948, Nye Bevan, a government minister,founded the National Health Service (NHS). He wanted free health care for all at the time of use.

ActivityFind out who the present Secretary of State for Health is.You can do this by using the Internet or the library.

Find out what the current Secretary of Statefor Health has as his or her targets andgoals. How are you made aware of thesetargets and goals?

The National Health Service (NHS)

Figure 2.4 The health care structures of England, Wales, Scotland and Northern Ireland

Secondaryhealthcare

Primarycare

trusts

Secondaryhealthcare

Primarycare

trusts

Secondaryhealthcare

Primarycare

trusts

Secondaryhealthcare

Primarycare

trusts

Strategichealth

authorities

Departmentof Health

(for Englandand Wales)

ScottishHome and

HealthDepartment

Departmentof

Health

Departmentof

Health

Localhealthboards

Strategic health

authorities

Local health boardsUnified health and

social services

WALESSecretary

ofState

SCOTLANDSecretary

ofState

ENGLANDSecretary

ofState

NORTHERNIRELANDSecretaryof State

PARLIAMENT



There were, and still are, three main parts tothe National Health Service.

1 Primary care services: These are familyhealth services and they are provided byfamily doctors (GPs), practice nurses,district nurses, health visitors, dentists,opticians and pharmacists and aregenerally the first contact a person haswith the health service. There is also a lotof preventative work in primary care (e.g.routine dental check-ups and eye tests).

2 Secondary and tertiary care services:Secondary care services include generalhospitals; tertiary care services includesuch things as specialist hospital centres(e.g. specialist cancer care hospitals). Thecare is often provided following referralfrom a primary care or community healthprofessional. For example, a GP may refera patient to hospital for tests and specialinvestigations. Secondary care is about thecare that is given in hospitals, day casesurgeries and outpatient clinics.

3 Public health services: This area is mainlyconcerned with health promotion andpreventative work and includes healtheducation programmes aimed atpreventing illness and disease. Childhoodimmunisation programmes againstillnesses such as smallpox and whoopingcough and dental health care educationprogrammes are good examples of publichealth services. Both the health servicesand local authorities have various roles inthe promotion of better health.

CheckpointOpticians look at people’s eyes and are able to prescribe glasses and contact lenses tocorrect vision problems.Pharmacists (or chemists) dispense medicinesthat are prescribed by doctors or other healthprofessionals.

Until recently there were onlycomparatively minor changes in the way theNHS was structured and, indeed, providedhealth care. However the NHS has nowundergone major reforms that have been more

far-reaching than any other changesundertaken since it was set up in 1948.

These reforms are set out in a number ofgovernment White Papers. The most radicaland, indeed, important of these White Papersare as follows:

� The New NHS: Modern Dependable(December 1997): This document set outthe ways in which the NHS would changeto provide new and better services for thepublic.

� A First Class Service: Quality in the NewNHS (June 1998): This document describesthe quality, standards and efficiency thepublic should expect from the NHS andhow the NHS will be monitored to makesure it is performing well.

� The Health of the Nation (June 1991):This document sets health targets forhealth care practitioners to achieve in thekey areas of coronary heart disease andstroke, cancers, mental illness, HIV/AIDSand accidents.

� Saving Lives – Our Healthier Nation (July1999): This document is about saving livesby promoting healthier living and lookingat how inequalities in health can bereduced. Its main aims are to improve thehealth of:

– the nation as a whole by increasing thelength of people’s lives and the number ofyears people spend free from illness; and

– the worst-off in society and to narrow thehealth gap that exists between differentgroups in society.

It sets national targets for improving health bythe year 2010:

– Heart disease and stroke: To reduce thedeath rate from heart disease and strokeand related illnesses amongst people of65 years by at least a further third than inthe The Health of the Nation document.

– Cancers: To reduce the death rate fromcancer amongst people aged under 65years by at least a further fifth.

– Mental health: To reduce the death ratefrom suicide and undetermined injury byat least a further sixth.

– Accidents: To reduce accidents by at leasta further fifth.



As a result of this document, healthpromotion is being aimed at healthy schools(children), healthy workplaces (adults) andhealthy neighbourhoods (older people).

ActivityRead the main aims of Our Healthier Nation and then answer the following questions:

1 List at least five factors that affect healthbut that people have little control overpersonally (for example, pollution).

2 Write down your ideas as to how eachof these factors could be tackled bythe government.

3 Why do you think the governmentpicked the four areas it did for itsnational targets?

4 Produce a health promotion leaflet toencourage healthy schools.You need toidentify the main factors involved, suchas what children eat at school, the sortof accidents children could have atschool, etc., before you start to design it.

Poorer people and those living in deprived areas are more likely to suffer from cancer, heartdiseases and other related illnesses. People frombetter-off areas are more likely to recover fromcancer.

1 Why do you think there is a health gapbetween different groups in society?Think of at least five different factorsthat are likely to affect poorer peopleand those who live in deprived areasmore than those in better-off areas.

2 Based on the factors you identified inquestion 1, produce a healthpromotion leaflet as part of the healthyneighbourhoods campaign.

It is proposed that there will be around 30strategic health authorities in England by 2002.The primary function of these authorities willbe to monitor the primary care trusts and the

Strategic health authorities

NHS trusts to ensure they are providing good-quality and efficient services that meet theneeds of the populations they serve.

CheckpointMonitoring providers of services meanswatching over the providers of those services tocheck that standards are as high as they shouldbe and that everything which should be done isdone so in the way it is meant to be.

Primary care trusts have replaced the primarycare groups that first came into being in 1999.Primary care trusts are larger organisations,serving a population of (usually) 100,000–300,000people. These are free-standing bodies thatcommission services and that provide a widerange of health services within the localcommunity. Their work involves many of theduties the old health authorities previouslycarried out, including the following:

� Planning services within the PCT’s area.� Assessing primary health care needs in

order to contribute to and to implementthe government’s Health ImprovementProgramme.

� Developing services within the area.� Commissioning.� Arranging service contracts (e.g. with

hospitals).� Managing services provided by GPs,

dentists, opticians and pharmacists andmonitoring the quality of services.

� Providing public information aboutservices.

� Registering and dealing with complaintsabout the provision of services.

They are also able to:

� employ staff under their own terms andconditions; and

� buy, own and sell assets, such as land orbuildings.

Most of a PCT’s income is money directly fromcentral government, which is, of course, publicmoney (money that is paid in taxes by everyoneto the government).

Primary care trusts (PCTs)



CheckpointCommissioning involves identifying whatservices are needed in any one particular areaand asking another organisation to provide theservice that meets these requirements. This is abit like designing an outfit you would like for anevening out.You decide what you would like it tolook like and then pay someone with the rightskills to make it for you so you have exactly whatyou want rather than a shop-bought outfit thatmight be nice but not just what you had in mind.

ActivityFind out what the primary care trust in your area is called and where it is based.You can find this out on the Internet, at thelibrary or by contacting your local medical centre.

National Health Service trusts are self-governing units within the health service.Trusts are managed by a board of directors andare accountable to central government. A trustcan be either a hospital or a group of hospitals,or an ambulance service for a particular area.

CheckpointAccountable means responsible to.Therefore the government has the right tomonitor a trust and challenge the running of it ifthings are not as they should be.

A trust is able to:

� decide its own management structure;� employ staff under its own terms and

conditions of employment;� buy, own and sell assets, such as land or

buildings;� carry out research; and� provide facilities for medical, nursing and

other forms of education/training.

Self-governing trusts receive most of theirincome from NHS contracts for providingcommissioned services to PCTs.

NHS trusts

All trusts, both primary care and NHS,must produce annual reports and maintainannual accounts, which must be published. Thismeans the public can see how its money isbeing spent!

This is a new national organisation thatcommenced work in April 2002. Itsresponsibilities are to inspect, regulate andenforce standards where necessary in a rangeof caring environments. These include:

� private nursing homes;� residential care homes;� home care provider agencies;� nurse agencies;� private hospitals;� adoption agencies;� children’s homes; and� boarding schools.

The National Care Standards Commission isdirectly responsible to government and isdivided into eight regions across England.These areas are again broken down intosmaller area groups.

NHS Direct is a telephone helpline that canprovide information about health, illness andhealth services. Specially trained nurses canadvise whether you should treat yourself athome, speak to a pharmacist, visit a GPpractice, dentist, optician or walk-in-centre orgo to hospital.

NHS walk-in centres are available in a numberof towns and cities across England. Theycomplement general practice by providingtreatments for minor illnesses and injuries (e.g.strains and sprains), health promotion and self-care advice. They are run by nurses and anappointment isn’t necessary. Most walk-incentres are open from 7 am to 10 pm, sevendays a week.

NHS walk-in centres

NHS Direct

National Care StandardsCommission (NCSC)



ActivityFind out if there is a walk-in centre near you and the types of services it provides. You can find this outfrom the Internet, the library or bycontacting your local medical centre.

Find out what services are not provided bythe walk-in-centre and why they are notprovided.

A surgery provides a wide range of services(see Figure 2.5).

Doctors’ surgeries

A health centre provides medical and healthcare as well as support and personal welfareservices. The range of services provideddepends on the kind of care required in yourlocal area, how many people live there, how oldthey are and the amount of money available tospend. By building health centres, healthservice planners can organise most of therequired services under one roof. The firsthealth centres were started in the 1930s.

Dentists are part of primary care servicesbecause they are usually the first people anyonewith a mouth problem goes to. They are based ineither a health centre or a dental surgery andoffer a wide range of services, such as:

� treatments;� check-ups;� oral health education;� hygienist treatment;� orthodontics (making teeth straight); and� minor oral surgery.

As you will know from earlier in this section, ahospital is an example of a trust – that is, it ismanaged by a board of directors and isaccountable to the government. Hospitalsprovide secondary care: clients usually go to ahospital because a health professional hasreferred them there. Clients use hospitals for:

� operations and consultations;� treatment for infections, accidents or illness;� health education; and� rehabilitation after an operation or illness.

Sometimes a client who needs specialtreatment or help will have to go to a specialisthospital, which are often called ‘centres ofexcellence’. These specialise in such care as:

� heart transplants;� terminal illness (care of people who are

dying);� paediatric care (children’s specialists);� mental health care; and� maternity and women’s health.

Hospitals

Dentists

Health centres

Prescriptions

VaccinationsBlood tests

Antenatal care(for pregnant

women)

Consultations(asking your doctor

questions aboutyour health)

Health check-up

Nursing careHealth

education

Minoroperations (e.g.

wart removal)

Figure 2.5 Some of the servicesprovided by a doctor’s surgery

Doctor’ssurgeryservices

A walk-in centre



Clients can have health care in their ownhomes as well as in hospitals, health centresand doctors’ surgeries. The services providedin the community are often based at a healthcentre or a surgery and are carried out byprimary health care teams. Services can also be provided by a community health caretrust attached to a hospital. Examples ofcommunity health care services are shown inFigure 2.6.

Community health care

Case study

NellNell is 79 years old.She lives by herselfwith her two cats.She has very badarthritis and legulcers that will notheal up. She cannotget around muchby herself. Once aday she is visited bya district nurse who

treats her leg ulcers and gives her a weeklyvitamin injection.

Every evening a care worker comes at about7 o’ clock to help her wash and get changed forbed. She also makes sure that Nell hasremembered to take her tablets. On WednesdaysNell is taken by hospital transport to the daycare centre at the local hospital. A physio-therapist helps her with exercises to keep herjoints mobile. She has lunch with her friends andreally looks forward to the day.

The nurse at the day hospital always has achat with Nell to make sure everything is goingwell at home.

1 List the various services Nell receives.2 What are the benefits to Nell of receiving

the services mentioned?3 What would happen to Nell if these services

were not available to her?

Communitymidwife

Generalpractitioner

Healthvisitor

Dentist

Districtnurse

Communitypsychiatric

nurse

Specialistnurses

Figure 2.6 Community health care services

Check your knowledge1 What is meant by the term ‘statutory

services’?

2 What is the difference between a privateorganisation and a voluntary organisation?

3 Which are the main two providers ofstatutory services?

4 What do we mean by a ‘unified structure’?

5 What is the difference between primary andsecondary care?

6 Write down one example of a tertiaryservice.

7 Name two examples of public healthservices.

8 Which government White Paper aims tosreduce inequalities in health care?

9 How many strategic health authorities wereset up in England during 2002?

10 Name three areas of work covered byprimary care trusts.

11 What is an NHS trust?

12 What is the name of the new nationalorganisation set up to inspect, regulate andenforce standards in a range of careestablishments?

13 What is NHS Direct?

14 What is the purpose of walk-in centres?

15 Why are some hospitals called centres ofexcellence?

Communityhealth care

services



The introduction of the National Health Servicein 1948 also meant a range of health and socialcare services came under the direct control ofthe Minister of Health. It was hoped this directcontrol would result in a more unified and co-ordinated range of services. The responsibilityfor providing for old and disabled people, andchildren by the local authorities was extendedfurther. Also, services for people with mentalhealth problems were strengthened throughthe setting up of the Provisional Council forMental Health. However, until the 1960s thesethree areas of care were operated quiteseparately from one another. The publication ofthe Seebohm Report in 1968 resulted in theamalgamation of the children’s departmentsand the welfare services. Then, in 1970, theLocal Authority Social Services Act set out anew framework for social care provision, whichrequires the local authorities in England to setup Social Services Committees (see Figure 2.7).

The structure of the social services

services. In England and Wales, county councils,metropolitan councils and the London boroughsrun the local authorities. In Northern Ireland,there are four boards that administer thecombined health and social services. In Scotland,regional local authorities control social servicesdepartments. However, the powers andresponsibilities of local authorities are definedby Parliament, which passes legislationoutlining the local authorities’ duties.

Local authorities have the responsibility forthe co-ordination of many aspects of social carein their communities, including services forchildren, for people with learning disabilitiesand for people with mental health problems, aswell as responsibilities for housing, education,leisure facilities, refuse collection andhighways.

Each local authority must appoint aDirector of Social Services and must have aSocial Services Committee. Some localauthorities have separate directorates for eachof their responsibilities (e.g. social services,housing, education, etc.). Others combine thesedepartments at senior management level; forexample, one director might oversee housingand community care services which couldinclude services for older people and servicesfor adults with disabilities (see Figure 2.8).

The organised structures of social servicesdepartments have changed considerably in thelast few years. This has happened so they cancarry out their new roles and responsibilitiesas required by new legislation, particularly theNHS and Community Care Act 1990. Asmentioned earlier, this Act made localauthorities the purchasers of care, rather thanthe providers of care. Many social servicesdepartments reorganised their staffingstructures to reflect these changes inresponsibilities (see Figure 2.9).

Activity1 Why do you think the govern-

ment wanted to change the role of local authorities from providers topurchasers?

2 What might be the advantages anddisadvantages?

Parliament

Secretary of State for Health

Department of Health

Local authorities

Social services committees

Social services departments

Figure 2.7 The structure of socialcare in England

Although the Secretary of State isresponsible for the provision of social care, it isthe local authorities who administer those



Local Authority Chief Executive(Social Services Committee)

Director of Housing andCommunity Services

HousingDepartment

Services forolder people

Areateams

Homecare

Residentialand day care

Residentialand day care

Adultservices

Childrenand familysupport

Physicaldisabilities

team

Learningdisabilities

team

Mentalhealthteam

Residentialand day

care

Childprotection

Family placements(including adoption

andfostering)

Community CareServices

Children andFamilies Services

EducationServices

Director of Educationand Children and Families Services

Figure 2.8 Combining different social care functions: an example

Before 1990 Since 1990Local authorities were providers Local authorities were purchasers of care. This meant they had to: of care. This meant they had to:

Own and run care homes and Pay private care homes to look after residential homes clients

Employ all the staff Provide money to the owners to payand train their staff

Train all their staff Provide money to the owners to payand train their staff

Provide services such as cleaning Find private cleaning companies tocome in and clean the institutions

Run a catering department Bring in ‘contract caterers’ to providefood

Figure 2.9 Changes in local authority responsibilities since the NHS andCommunity Care Act 1990



The role of the social services departments haschanged as their function as direct providers ofservices has decreased and their role asassessors of need and purchasers of serviceshas increased. Their main role now is to offeradvice and to provide access to services – suchas residential care – for all client groups (e.g.children, people with physical or learningdisabilities, people with mental healthproblems or older people). Previously, localauthorities owned and managed a number ofresidential homes themselves. Today they aremore likely to purchase residential care forindividuals in private or non-profit-makingresidential homes.

Social workers are employed within thesocial services departments and their role is toassess the needs of people requiring socialcare services. Social workers are oftenorganised into teams that deal with a specificclient group (e.g. children and family teams).Teams consist of health and social careworkers (e.g. teams dealing with people withmental health problems may work side by sidewith social workers and community psychiatricnurses).

With their increased role in the purchasingof services, many social services departmentshave created special commissioning andcontracting sections. These new sectionsoperate alongside the divisions created as aresult of the 1990 Act (e.g. complaints,inspection and registration units, qualitymonitoring and planning and development).Planning and development has become evenmore important as social services departmentsare required to work closely with healthservice colleagues as well as with the privateand voluntary sectors.

CheckpointContracting means employing someone who does not regularly work for yourorganisation to do a specific job for you – for example, employing cleaners through an agency.

The role of social servicesdepartments

Health and social services must now worktogether to modernise the front-line care theyprovide for people. In September 1998, thetargets set for achieving this were outlined inModernising Health and Social Services:National Priorities Guidance 1999–2002. Thepriorities contained in this document includedthe following:

� Cutting waiting lists and waiting times.� Modernising mental health and primary

care services.� Reducing deaths from cancer and coronary

heart disease and improving the health ofthe most disadvantaged in society.

� Improving the quality and safety ofchildren’s services and providing betterrehabilitation services for older people.

Previous governments tried to encourage jointplanning between the health and localauthorities. However, this was difficult toachieve because of the different ways theauthorities were structured. For example, interms of health, the care of older people whowere mentally ill was the responsibility of themental health services whereas, in terms ofsocial care, the same people came under theremit of services for older people.

Other problems have arisen because healthauthorities (now primary care trusts) and localauthorities do not share the same geographicalboundaries. For example, one primary caretrust may cover all or part of a local authority’sarea (see Figure 2.10), or one local authority’sarea may come under the responsibility of anumber of primary care trusts.

Joint work and planning

HEALTHAUTHORITY

Primary caretrust

2

Primary caretrust

3

Primary caretrust

1

Figure 2.10 A primary care trust that covers morethan one local authority area



Check your knowledge1 How has the role of the social services

changed over the years?

2 Name three services offered by socialservices.

3 What does the word ‘residential’ mean?

4 Why are social workers often organised intoteams?

5 What does contracting mean?

6 What is the function of a general Social CareCouncil?

7 What were the targets set in September1998 for the modernisation of care?

8 Why do you think it is important to cutwaiting lists and waiting times? What effectwill achieving this have on health and well-being?

9 Why was it hard to modernise mentalhealth services for older people when olderpeople come under the responsibility ofboth mental health services for health careand services for older people for socialcare? List some difficulties you couldimagine arising.

10 Suggest a way these difficulties could beovercome.

11 Give some examples of when an olderperson might need a rehabilitation service.

The early years services are those services thatprovide health, care and education services tochildren between the ages of 0 and 8 yearswhen not at school. As with the health andsocial services, the early years services involve both the statutory sector and privategroups.

Statutory servicesThe government’s role is to provide statutoryservices directly, or to supervise services

Structure

Early years services

through government departments. The fourmain government departments concernedwith children are shown in Figure 2.11.Funding from these central governmentdepartments is passed on to local authoritiesin the form of grants. The authorities then usethese grants to provide services for childrenand families in their areas. The three mainservices are health, education and socialservices.

Other services for childrenAs we saw in Chapter 1, there are specialservices for children (in addition to the healthcare for all), such as health screening,vaccinations and immunisations. These are all free to children under the age of 16 years.The local education authorities areresponsible for providing nursery, primaryand secondary education, while theDepartment for Work and Pensions isresponsible for providing benefits for childrenand families. Details of these, plus notes onthe National Childcare Strategy and the EarlyYears Development Partnership and Plans,can be found in Chapter 1. It would be a goodidea to read those sections of Chapter 1 againto make sure you are fully aware of what isdelivered by the early years services.

Department

1 Department of Health (DOH)

2 Department forEducation and Skills(DfES)

3 Department for Work and Pensions

4 Office of the DeputyPrime Minister(ODPM)

Responsible for

Health services,including hospitalsand local health care

All aspects ofeducation and skills,including standards inschools and daynurseries

Providing benefits for children andfamilies

Local government,Housing, planning andthe countryside

Figure 2.11 Government departmentsconcerned with children



The UK has a long tradition of voluntaryservices and this sector has always beeninvolved in the provision of health and socialcare. Today, the National Council for VoluntaryOrganisations (NCVO) is the central co-ordinatingagency in England. Its main function is toprovide links between voluntary organisations,official bodies and the private sector. Councilsin Scotland, Wales and Northern Ireland havesimilar roles. There are over 20,000 voluntaryorganisations in the UK and more than 170,000of these are registered as charities. Throughoutthe UK, the Home Office is the governmentdepartment responsible for co-ordinatinggovernment interests in the voluntary sector(see Figure 2.12).

Voluntary organisations

The Home Office

The National Council forVoluntary Organisations

Localgroups

Nationalgroups

Self-helpgroups

Figure 2.12 The structure of voluntaryorganisations in England

There are thousands of voluntaryorganisations involved in health and socialcare, ranging from national agencies such asAge Concern to small local groups. In recentyears self-help groups have greatly increased innumber. These are usually set up by peoplewho share a particular concern and who wantto help other people in similar situations.

Funding for voluntary organisations comesfrom various sources, such as contracts withhealth authorities or local authorities, fund-raising events, charitable donations fromindividuals, groups of people or businesses andthrough grants from grant-awarding bodies.Voluntary organisations tend to focus onspecific issues (see Figures 2.13 and 2.14).

Organisation

Family Welfare Association;Child Poverty Action Group;Relate (formerly MarriageGuidance); Barnardo’s; ChildLine;National Council for One-ParentFamilies; National Society forthe Prevention of Cruelty toChildren; Claimants’ Union(advice on social securitybenefits); Samaritans (for lonely,depressed and suicidal people);Women’s Aid

WRVS (Women’s Royal VoluntaryService); MIND (NationalAssociation for Mental Health);Gamanon (for people withgambling problems); Help theAged; Brook Advisory Centres;Royal Institute for the Blind;Royal National Institute for DeafPeople; Alcoholics Anonymous;British Red Cross Society;Haemophilia Society

Salvation Army; Church Army;TocH; Church’s religious UrbanFund; Church of EnglandChildren’s Society; Young Men’sChristian Association (YMCA);Catholic Marriage AdvisoryCouncil; Jewish Welfare Board

Figure 2.13 Voluntary organisations and theirprincipal areas of concern

Area of concern

Personal andfamily problems

Health anddisability

Nationalorganisationswhose work isreligious in inspiration

Figure 2.14 Age Concern



ActivityRonnie is 68 years old and has just had a liver transplant. He is in hospital in aspecialist centre in Leeds. His wife, Hilda, livesover 60 kilometres away and cannot drive.

The Wheels for Support group have beenorganising voluntary drivers to take Hilda toLeeds every day so that she can visit Ronnie inhospital. She is very grateful to them.

1 What would have been the effects onRonnie and Hilda if this voluntary grouphad not existed?

2 What voluntary groups have you got inyour area? Use the Internet, library or YellowPages to find out. Note down the servicesthey provide.

The work of private organisations in theprovision of health and social care has alwaysbeen important. These organisations charge fortheir services with the intention of making aprofit. Some of the services provided by theprivate sector are shown in Figure 2.15.

Private health and socialcare organisations

The range and extent of services availablefrom private organisations have increasedconsiderably in recent years. In particular,there was a rapid growth in private health carein the 1970s and 1980s when centralgovernment introduced the idea of a mixedeconomy of care. It is now government policythat NHS and private and voluntary health careprovision should co-operate in meeting thenation’s health needs. Private health care maybe provided by NHS hospital trusts or in totallyseparate health care facilities. Similarly, thegovernment expects local authorities to useprivate and voluntary agencies to provide themwith social care rather than own and managethose services themselves. Consequently, anumber of small businesses have emerged inrecent years, such as home-help services.

Primary care trusts and local authorities have,as a result of government reforms, agreed towork together more in areas of care thatoverlap. Examples have already beenmentioned in this chapter.

Good examples of this are often seen in thecare of older people. Instead of a number ofdifferent professionals assessing the needs of anolder person, one professional will assess andpass on the relevant information to the relevantperson in the other organisation. For example,an older person may need assistance in gettingup and washed each morning but this ‘homecare’ service may be provided either by peopleemployed directly by the authority or by peopleemployed by a private agency. In the latter case,the local authority may have a contract with theagency to provide home care for such people.

In recent years the term carer has been used todescribe anyone (other than a paid worker)who is looking after someone who cannotmanage without help because of age, illness or

Informal carers

Different service providersworking together to meetclient group needs

Residentialhomes

Home carenursing

Nurseryday care

Hospitaltreatment

Dentaltreatment

Nursinghomes

Domestic help

Childminding

Figure 2.15 Health and social care services providedby the private sector

Private health and social care

services



disability. The carer may be a family member,friend or neighbour. Many carers are childrenor young people, or are elderly themselves andin poor health (e.g. a wife looking after adisabled partner, a parent looking after a childwith learning difficulties, an adult looking aftera parent who has dementia – memory lossusually associated with old age – or a child whois looking after a sick or disabled parent).

The work of a carer can be very difficultand demanding and typically involves:

� helping people to get into and out of bed;� helping with washing and dressing, and

eating and drinking;� helping people with bathing or showering;� housework and shopping; and� helping people take medication.

Informal carers often belong to a local group,such as a church, or a group set up to adviseand help others.

The Carers Recognition and Services Act 1995says that: ‘A Young Carer is a child or youngperson under the age of eighteen who iscarrying out significant tasks and assuming alevel of responsibility for another person, whichwould normally be taken by an adult.’ Acrossthe UK there are about 32,000 young carers whoare caring for someone in the family who is ill,disabled, elderly or with a drug or alcoholproblem. Caring tasks range from generalhousehold chores (such as doing the housework,getting the shopping and doing the washing) tofull personal care (such as helping them to washand dress, keeping them company and stoppingthem having an accident).

Associations exist to support these youngcarers (such as the National Carers Association),which give advice on how to get help from thesocial services. These associations can arrangefor someone to sit with the family member orcan organise Meals on Wheels, or they canarrange for help around the house to give theyoung carer some time off. Other associationsprovide someone to talk to who will listen to and believe what the carer says, informationabout the relative’s problem and help withschool work.

Young carers

Case studyJennyJenny is 15 years old and very bright. Her mother is single and an alcoholic. She has madeJenny promise not to tell anyone else about herdrink problem, which was brought on by thetrauma of getting divorced and of which she isvery ashamed. Jenny often comes home fromschool and finds her mother lying on the sofadrunk. This means that, before Jenny can settleto her homework (she is in her final GCSE year),she has first of all to tidy the house, make some-thing to eat for herself and her mother, persuadeher mother to eat and do any other jobs thatneed doing, such as ironing a school shirt for thenext day. She often has to help her mother cleanherself up after she has been sick while semi-conscious and get her into fresh clothes.

When she eventually gets to do herschoolwork she is often interrupted by hermother singing or shouting or, if her mother isfeeling guilty (which she often does),apologising repeatedly for being a nuisance. Atthe weekend Jenny does tasks such as washingbut won’t go out much other than to get someshopping because she is worried her mothermight drink even more and hurt herself.

1 What effect is Jenny’s situation likely tohave on her health, development andsocial needs?

2 What can she do to get some help?3 What sort of help would be of benefit

to Jenny?4 What kind of help would be of benefit

to her mother?

1 Write down all the ways each of yoursuggestions in question 3 above will helpJenny’s health, development and socialneeds and explain why you think this.

2 Write down all the ways each of yoursuggestions in question 4 above willhelp her mother’s health, developmentand social needs.

3 What do you think will happen toJenny if she doesn’t get any help soon?

4 What do you think will happen toJenny’s mother if she doesn’t get somehelp soon?



Care services offered to different client groups

Many different care services have already been mentioned in this chapter. Figure 2.16 lists someexamples.

Client group Health care services Social care services Early years services

Children (Including maternity services, Residential care, child Playgroups and nursery health health visitors), general education, family centres, crèches, after-school care, toy hospital services, mental health support group services libraries, child guidance, parentcare, speech therapy, dentistry and toddler support groups

Adolescents School medical services, Foster care, residential care,primary health care, general youth offending services,hospital services, dental services, child protection, youth mental health care, health work, support group servicespromotion (smoking, sexual health, drugs, alcohol)

Adults Primary health care (including Housing/homelessnesscommunity provision of district services, residential care,and community mental health refuges, day centres,nursing), general hospital counselling support (e.g.services, mental health care, Samaritans), information family planning clinics, health and advice services, social promotion (smoking, sexual work, support groups,health, drugs, alcohol), service user organisationscomplementary therapies,hospices

Older people Primary health care (including Sheltered/supported housingdistrict and community mental residential care, home helps,health nursing), occupational day centres, lunch clubs,therapy, complementary information and advice therapies, dentistry, services, social work, supportchiropody/podiatry,specialist group services, service userhospital services (general and organisationsmental health), nursing homes,hospices

Disabled Any of the above according Any of the above according Any of the above according people to individual and local needs. to individual and local needs. to individual and local (additional Additionally, specialist medical Additionally specialist support needs. Separate specialistservices) and nursing services, and provision through service education provision and

physiotherapy, psychology, user organisations, direct support services are occupational therapy, payment personal assistance, provided in addition tocomplementary therapies, social education (life skills integration withinspecialist education and education and supported work mainstream provisiontraining services (work-related schemes, for example)and rehabilitative training schemes, for example)

Figure 2.16 Some examples of care services offered to different client groups


5 Day care is provided at a local centre oneday a week (Age Concern run the centreand arrange the transport for Mrs Stringer).

The primary care trust1 A district nurse attends to dress Mrs

Stringer’s surgical wound and to monitorher medication.

2 The podiatrist attends to cut Mrs Stringer’stoenails as she can no longer manage to dothis herself.

3 The occupational therapist has arranged forMrs Stringer to have a Zimmer frame tohelp her walk and to have a bath seat, grabrails and raised toilet seat fitted.

Informal carerMrs Stringer’s niece visits each Sunday andprovides a meal that day. She also does all heraunt’s laundry for her.

1 List all the tasks Mrs Stringer gets helpwith.

2 Does Mrs Stringer receive a ‘mixedeconomy of care’ package?

3 What is meant by a ‘mixed economy ofcare’?

4 Is Mrs Stringer receiving primary care,secondary care or both? Give examplesto illustrate your answers.

What other care needs might Mrs Stringerhave in the future and who might providethese?


Case studyMrs StringerMrs Stringer is an 80-year-old woman. She waswidowed seven years ago and lives alone in atwo-bedroomed house. None of her family livesnearby and Mrs Stringer is very isolated. Twomonths ago Mrs Stringer fell and broke her lefthip. She has now been discharged from hospitalbut her mobility is greatly reduced and she isunable to manage the stairs properly. She alsohas angina and problems with arthritis in manyof her joints. Following an assessment by thesocial worker, the following services wereprovided and recommendations made.

Local authority1 A recommendation was made for Mrs

Stringer to be moved into shelteredaccommodation as soon as possible.

2 A home carer has been provided (the localauthority has a contract with a privateagency for home care services) to help herwith washing and dressing. In the eveningshe can still manage to get herself into bed.

3 Once a week the local authority providesher with help for her shopping, forcollecting her pension and for generalhousehold tasks (also provided through theprivate home care agency).

4 Meals on Wheels are provided five days aweek as she has difficulty preparingsubstantial meals (the WRVS prepare anddeliver meals on behalf of the local authority).

CheckpointSheltered accommodation is housing (usually ground-floor flats or small bungalows)where people live independently, (either rentedor bought) that is available for people over theage of 55 years and that is warden controlled.Warden controlled means a person is on site 24hours a day in case an older person needs help.

Residential care usually means that a personlives in a ‘care home’ with other people. Thiscould be a residential home where care workersare on duty at all times. The social services and

the independent sector (private business)provide residential services. Charitable groupsalso provide residential care. Different types ofpeople may live in residential care homes. Forexample:

� Older people who can no longer care forthemselves.

� People with physical or mental disabilities.� Children with no carers (e.g. children whose

parents have died or who cannot care fortheir children).


contents 4 the main jobs in health, social care and early years services 47 groups of care workers...

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