Category: Free Essays

For the purpose of this essay I will write a critical analysis of a case study assessing the health needs of a child within a family. The case study is of a two parent family of a two year old girl. The family had transferred from another area. Their daughter was born prematurely at thirty one weeks. She didn’t offer eye contact and had no voluntary speech. Full permission has been obtained to use the information in the case study. I used firstly Orems nursing model to assess the family’s needs. Then a more appropriate framework Family Health Needs Assessment.

The model is a behavioural model. Behavioural models are based on the hierarchy of human needs by Maslow (1993). The hierarchy starts at the bottom of a pyramid with essential needs, when these are met the person progresses up the pyramid until full potential is achieved (Maslow, 1993). Orem’s model is based on societies need for the client to be self caring (Henderson, 1990).

Orem’s (2001) model has a continuum of self care abilities, the aim being to move along this continuum to self care or adapt to a diminishing self care in terminal or chronic ill cases.

Orem (2001) states that the family and significant others in a person’s life must be involved in their self care. It is a model which values individual responsibility, prevention and health education as key aspects of nursing intervention (Aggleton and Chalmers 2000).

Orem lists the following key factors that influence health;

1. Adequate intake of air water and food.

2, Adequate excretion of waste.

3. A balance between activity and rest both mentally and physically.

4. Social interaction and solitude should be optimised.

5. The prevention or avoidance of hazards and danger.

6. The feeling of being and behaving normally leading to stress reduction.

By being able to carry out self care in these areas the person fulfils what Orem (2001) calls their Universal Self Care Demands. If there is illness injury or disease the individual has self care demands in three extra areas (Orem, 2001). These are known as the Health Deviation Self Care Demands.

i Structure.

ii. Functioning.

iii. Behaviour.

Orem uses the Nursing Process starting with assessment of the family in order to discover their individual problems which are defined in terms of self care deficits (Orem, 2001). The first stage of Orem’s model identifies both the demands for and the ability to achieve, self care in an individual (Aggleton and Chalmers, 2000). I assessed the family the parents both worked dad is a chef and mum is a carer in a nursing home they are both supported by grandparents who lived across the street. Both were fit and well. The two year old daughter was causing her mother concern in that she was not speaking it was difficult to get her attention with very little eye contact. Using Orem’s list I asked questions about each of the six activities. The problems identified were related to the two year olds behaviour of pacing around the room not speaking no eye contact and slapping her hands one on top of the other.

After gathering information I had to decide why there was a self care deficit. This was difficult using Orem’s which states the self care deficit should be linked to a lack of knowledge or of skills to a lack of motivation to achieve self care (Aggleton and Chalmers, 2000). These don’t seem to apply to a two year old cared for by her parents. But clearly her behaviour was a cause for concern.

I had now completed a good deal of paperwork a fault recognised by Fawcett et al (2004) in many instances it has led to nursing models being a “bureaucratic chore” (Fawcett et al,2004). A checklist method and standard care plans would have allowed for a quick assessment of the Universal self care demands (Kitson, 2001).

The next stage is to plan and set goals (Salvage and Kershaw, 1990). The long term goal for each client would be the restoration of a balance between self care ability and self care needs (Salvage and Kershaw, 1990).

The implementation of the care plan may involve activities to meet self care demands (Pearson et al, 2004). In addition members of the family, or significant others, may provide some care. Orem (2001) has identified six broad ways in which assistance can be given to implement a care plan.

1.Doing for or acting for another

2.Guiding and directing another.

3.Providing physical support.

4.Providing psychological support.

5.Providing an environment which supports development.

6.Teaching another.

However each of these methods of helping requires compliance (Pearson et al 2004). Orem’s model demands that clients and their families are willing and able to adopt certain roles achieve self care (Aggleton and Chalmers 2000).

3) Evaluation

Orem (2001) has suggested that the evaluation of care given should be measured in terms of the clients or families performance of self care.

Using Orem we should set out goals in terms of what the family will achieve (Pearson et al, 2004). It was difficult to set goals babies who are born prematurely can suffer from learning difficulties and to investigate the two year olds behaviour was the goal.

Orem’s model didn’t seem to fit well with this families care.

The major problem with nursing models concerns the relationship with the clients of the service. These are of two kinds. The employer for most nurses in the UK, the employer is the Government. The Government has aims and objectives for its health care system which is to use evidence based practice which may conflict with a particular nursing model or philosophy (Mckenna et al, 2008). Orem’s model is over fifty years old and is not evidence based.

The problems mainly being centered on the daughter’s behavior the following framework was more appropriate for this family.

An evidence based framework The Family Health Needs Assessment was introduced into the health visiting service in 2003 and is based on the Framework for the Assessment of children in need and their families (Department of Health et al, 2000). The Assessment Framework was intended to help practitioners to become child-centered (Horwath, 2010). The aim being to do an assessment of the family’s health and parenting needs. A triangle is used as an illustration of the Framework the child being in the centre (Rose, 2009).

The three sides of the triangle represent the key factors that influence the Childs health; child developmental needs, parenting capacity and family health and environmental factors. Each one has sub headings specific to the main heading.

Child’s Development Needs

Health

Education

Emotional & Behavioral Development

Identity

Family & Social Relationships

Social Presentation

Self Care Skills

Parenting Capacity

Basic Care

Ensuring Safety

Emotional Warmth

Stimulation

Guidance & Boundaries

Stability

Family health

Family history & functioning

Wider family

Housing

Employment

Income

Family’s Social Integration

Community Resources

The aim of the initial Family Health Needs Assessment (FHNA) is to undertake a full

assessment of the family’s health and parenting needs. The impact of parenting

capacity, family health and environmental factors on the child’s health and well-being

is assessed to identify children and families who may require additional support to

achieve the 5 outcomes identified in Every Child Matters (2004).

Being healthy

Staying Safe

Enjoying and achieving

Making a positive Contribution

Achieving Economic well-being

There is research evidence to suggest that low birth weight and prematurity indicates a greater risk of not achieving the 5 outcomes identified in Every Child Matters (2004).

Then a family health plan can be developed to include the family’s needs as agreed in partnership with the parent/carer. How the family wishes to address these needs

An action plan which identifies specific interventions/support and who this will

be provided by as well as the date for review and a review of progress made against the action plan.

The assessment took some time I had to reword some of the questions for fear of giving offence. The assessment forms were lengthy and there was some duplication. Emotional warmth under parenting Capacity and Emotional and behavioral development under the heading Childs developmental Needs. I found it difficult to know what to include under some of the headings. In Calders study (2003) the practitioners found the heading for ‘the child’s developmental needs’ the most challenging of the three headings. A number got confused between ‘social presentation’ and ‘self-care skills’ and the majority struggled with assessing ‘identity’.

The task for practitioners is to specify what, in relation to health and development, the child is at risk of and how significant they consider this risk to be (Horwath, 2010).

The original Framework for the assessment of children in need and their Families has guidance and support materials which explain the risk of harm, reducing the Framework to ‘the Triangle’ and a set of descriptions separates the needs from the risk of harm. Which could lead to a loss of focus on the child and their needs (Platt, 2006).

Both parents in this case were happy to carry out the assessment some parents can be unco-operative or even hostile Brandon et al, (2009). This could also cause a lack of focus on the needs of children. Brandon et al, (2009) found that good parental engagement can also disguise risk of harm to a child.

It is important hear what children have to say (Archard and Skivenes, 2009). I did engage the two year old with my identity badge which she recognized the picture but in this case I wasn’t able to interview the child because of her understanding and limited speech. I was able to observe her though and record my observations. Brandon et al. (2009) describe the various ways in which professionals don’t include children in the assessment. These include young people and siblings and a failure to address the needs of children who chose not to or are unable to speak because of disability, trauma and fear (Brandon et al 2009).

Groups of children in need that are hard to assess included: disabled children; adolescents; children of different cultures and faiths; and children in asylum-seeking

and refugee families (Brandon et al, 2009). Another group of children that also

has been found to be difficult to assess are children in need from higher socioeconomic groups. These cases were found challenging by social workers because:

the parents were more aware of their rights (Brandon et al, 2009). Care must be given to recording accurately what the child says and managing that information,

especially if it is negative about the parents so not to expose the child to any more risk

Practitioners are responsible for gathering information and they also have to share the findings of the assessment with family members.

From the assessment I identified a problem under the heading Child Developmental Needs Health the two year old daughter was growing physically but was not developing speech and had limited eye contact. The family had just moved from another area. Their daughter had been born premature at 31 weeks and she had had follow up appointments at hospital now that they had moved the hospital was too far away.

The follow up at hospital was important for her developmental reviews. So the first identified need was to register at the Doctors and explain that she needs a referral to the hospital for a full pediatric review.

Speech was a problem in that she was making the occasional sound and not forming her words properly. I made the speech therapy referral and gained assurances that her parents would take her. We discussed taking her to a nursery to mix with other children. After talking it was decided so that mum could go too to join a mother and toddler group. So things moved swiftly we put a time scale on these three major things of three weeks. I arranged to visit again in two weeks.

The aim of this assignment is to show the relationship between social inequality, health and poverty. Throughout this assignment you will see how social inequality and health has a big impact and influence on poverty. Poverty is linked with many groups which interact with each other. I will go into depth about these groups and their links with poverty throughout my assignment (ie race, gender, class, sexual orientation, disability, age). I am going to show you how these insights apply to professional practice in terms of: Challenging social attitudes, working with individuals, working with groups and service provision.

Social inequality relates to how long and how well one lives their life. This is mainly shaped through a persons place in society and their stance built around occupation, education and income. (Graham h: 3) ‘Health is a healthy state of well being which is free from disease’ (wordnetweb.princeton.edu/perl/webwn).

‘Poverty is the state or condition of having little or no money, goods or means of support, condition of being poor, indigence’ (Dictionary.reference.com/browse/poverty).

There are two types of poverty relative poverty and absolute poverty. Absolute poverty is the minimum needed to sustain life. Relative poverty is lack of resources ie money, which people in poverty need to provide them with enough food, clothes, fuel and social inclusion with their friends and local communities. (Blackburn C,)

Social inequality has a big impact on health and contributes to people living in poverty. There are allot of factors which influence a persons life ie: Life expectancy ‘ how long people live and the nature of their jobs ie Professional, managerial/technical, skilled, unskilled and unemployed. Social class ‘ mortality vary by cause of death, infant mortality rate, living on a low income ‘ debt – poor nutritional health ‘ having enough to eat. Poor health ‘ unemployed and people who have never worked are one of the highest groups – also poverty in employment – disability – old age. Other forms of social inequalities are ethnicity and gender especially women through disadvantage and discrimination which are important influences on health. (http://www.Office for national statistics)

I’m going to look at the main causes of poverty:Unemployment ‘ on social security- living on a low income ‘ debt-homelessness ‘ social class ‘ having enough to eat, Poverty in employment ‘ different groups working for low pay – women ‘ poor health ‘ debt – ethnic minorities ‘ gender inequality. Cost of a Child ‘ nutritional food ‘ clothes ‘ trips ‘ toys, disability and sickness ‘ nutritional food – poor health – on social security, old age ‘ fuel poverty – low income ‘ poor health and nutritional needs. (Oppenheim C: Contents)

Unemployment, Poverty in employment, ethnic minorities and gender inequalities:

In Britain today there are around 3.9 million people seeking work, and around 13.5million people are living below the income thrush hold which is unthinkable. It is estimated that 1 in 5 people in the UK are living in poverty. In Britain around 4.5 million people are getting paid less than ‘7 per hour. (Lecture on poverty, slide 13 power point 1, poverty statistics)

Long term unemployment is divided into 3 main categories:

– Older workers who are nearly ready to reach retirement

– People who are prone to illnesses and are not up to working

– People without skills and qualifications

People who are unemployed live in poverty, they experience hardship and trauma, often some social groups who are unemployed talk about being depressed and ashamed that they are in receipt of benefits. (Oppenheim, C: 56,57)

‘The process of claiming and receiving benefits for unemployed has become increasingly stigmatizing’ (Oppenheim, C:59).

The ethnic group that is most effected by poverty is the Bangladeshis they had the highest poverty levels which appeared to be more severe and long lasting than any other groups. Also rates of sickness and disability are much higher within the Bangladeshis group. (JRF findings 2007)

New patterns are coming to light that there has been a rise in self employment and in part time and low paid work. Many of the jobs on offer however are low pay with few long term employment and statutory rights ie sick pay, holiday pay and entitlement. This creates poverty and stores it for the future. (Oppenheim, C: 59)

Within the Joseph Rowntree Foundations one of his aims is to reduce gender inequalities to create a sustainable care system. Most people at home are cared for by women however as a woman’s financial opportunities increase they will tend not to bear the costs of providing care unaided. ‘To create a sustainable care system, care and carers must be better supported and more highly valued to involve more men in caring and reduce gender inequalities.’ (Joseph Rowntree Foundations 2009)

As you can see from the statistics there is still quite a number of years of difference

between the type of work you do, your life expectancy and also gender.

Class and Food ‘ Although intakes of fat are similar across social groups, minerals and vitamins like fruit and veg are lower amongst manual classes and those receiving benefits and lone parents. (Slide 10 of power point 1 poverty lecture)

Also those groups are experiencing fuel poverty as it has doubled between 2005 and 2007. However an interesting fact has come to light that many of those moving into fuel poverty were not on low income which is a very worrying concern for all members of society, the way to try and tackle fuel poverty is to cut fuel costs or provide help with the cost. (Publications ‘ The NPI Site:2)

Children ‘ According to the JRF Report between 2006-2007 ‘in-work child poverty’ was at an all time high. This is children that live with parents where at least one of them are working and are living below poverty line incomes. (Publications ‘ The NPI site) When parents are living below the poverty line this has a knock on effect on children through cheaper and less nutritional food being provided due to lack of money. Also children miss out on trips, are bought less clothes and toys due to reduced income which their parents earn.

‘Lack of money and other material resources shape both the routines and choices that parents make for their own health and their children’s health.’ (Blackburn, C: Poverty and health: working with families : 136) Disability ‘ People who have a disability are at least two and a half times more likely to be unemployed than someone who isn’t disabled. People who have a disability are more at risk of being in poverty as they experience higher living costs due to extra medication needs, equipment, clothing and bedding depending on their disability. (Oppenheim, C: Poverty the facts: 65)

Old Age ‘ Elderly People are at particular high risk as the government has weakened financial control for some of the poorest pensioners. People who are in well paid jobs normally have private pensions and they also receive a state pension once they reach retirement age. However people in low paid jobs, unemployed and people who have gaps in employment ie mothers are set to experience poverty as they hit retirement age due to inequalities with the labour market. (Oppenheim, C: Poverty the facts: 69)

Outline how you might apply poverty to professional practice in terms of:

Challenging social attitudes

Joseph Rowntree Foundation aims to promote public interest in poverty issues by encouraging public support for abolishing poverty in the UK. (www.jrf.org.uk/sites/files/jrf/2000-poverty-attitudes-UK.pdf)

Currently the public are a long way from supporting an anti-UK poverty agenda. Allot of people are not aware of the problem and don’t believe it is a key issue within our society. Poverty is sometimes related to and more so associated with international groups, absolute rather than relative poverty. ‘The public feel very wary of offering more help to anyone, in case they are ‘taken for a ride’ by freeloaders.’ (www.jrf.org.uk/sites/files/jrf/2000-poverty-attitudes-UK.pdf)

Within professional practice challenging social attitudes could be improved through:

Awareness ‘ built on:

Targeted messages and channels of the issue

Appropriate hooks to get attention and gain sympathy

Passionate and authoritative leadership

Trust ‘ built on:

Statistical evidence for the public to see

Real examples of people in poverty, through media channels

Transaction ‘ To tackle the issue, give the public information on:

What is going to be done about the issue?

Who will carry it out?

How can the public help with the issue?

Working with individuals and groups:

Youth Homelessness

Within the UK between 2006-2007 there were 750,000 young people that experienced homelessness. Causes of homelessness amongst young people are mainly that they come from disadvantaged and poverty stricken backgrounds. Many of them have experienced some kind of trauma or have come from troubled backgrounds while growing up, many also experience a breakdown in communication between parents and step-parents.

Once young people are homeless this impacts on almost every aspect of their lives ie education, jobs, welfare, social contact and may result in them taking drugs and getting into trouble with the law. Many young homeless people experience poor health compared to their peers who are not homeless.

Many also experience mental health problems and depression. Throughout the last decade there have been a number of policies set up to address the problem. The policies have paid particular attention to prevention, focusing more so on the 16 to 17yr old groups and care leavers aged 18-20.

Working with Service Users

Over the years there has been a great increase in the cultural shift in the way that authorities and support providers have been responding to youth homelessness.

A consensus discovered that being statutorily homeless was not always the best outcome for young people. A housing options approach developed, while there were still some concerns about gate keeping, the majority felt that new practices had increased service provision.

Over time people still found the homelessness experience stressful, intimidating and often felt like they had no control over the situation. So both young people and agencies requested a widespread provision of dedicated housing officers for young people. Particularly preventative services ie family mediation and ‘earlier per-crisis interventions’ including working with parents. In tackling the problem the JRF report suggests that there is a need for more evidence based on ‘what works’ in addressing homelessness and an ‘evaluation of supported lodgings schemes in particular’. (www.jrf.org.uk/sites/files/jrf/2000-poverty-attitudes-uk.pdf)

Conclusion

Poverty is far from being abolished if anything it is increasing rapidly and the recession has pushed many families and individuals into poverty even further according to the jrf report. (publications ‘ The NPI Site) Poverty is mainly determined by three factors ‘ access to work, and the failure of government policies to deal with them. Access to work is determined by class, gender and race. If unemployed, people getting a job is not necessarily the answer to their problems if they are going to be receiving a low wage ie lone parents and low income families with children. Social security have failed to pull people out of poverty, often leaving them to cope on minimum incomes. (Oppenheim, C: Poverty the facts: 70) According to the jrf findings on monitoring poverty and social exclusion 2008, from 2002 to now out of 56 indicators 14 improved while 15 worsened and 27 remained steady. (Publications ‘ The NPI Site) This proves that the government have allot to answer for and allot of existing policies need to be reviewed and updated in order to see a major improvement and the abolishment of poverty altogether.

In 1918, half the world’s population was infected by the Spanish flu of the 1 billion infected 50 million past away from the disease. In 2003 humanity was faced once again by a terrible pandemic, Severe acute respiratory syndrome (SARS). SARS was merely a wakeup call, calling to attention the unpreparedness of Canada. In 2005 the World Health Organization (WHO) addressed this concern by implementing an influenza pandemic preparedness plan checklist. Canada responded to this fear of unpreparedness with the “Ontario health plan for an influenza pandemic”. One of the ethical key issues that were addressed was health care workers duty to provide care during a communicable disease outbreak. That is to say do health care workers from practitioners to nurses to volunteers have an obligation to come to work during a pandemic. With a estimated absenteeism rate of 39% amongst all health care workers in Canada during the first two weeks of a pandemic and 34% of nurses who would seek other employment during a pandemic due to fear. Stricter guidelines must be set for Canada health care workers standard of care during a pandemic crisis. Engaging the public to set these guidelines is one of the best ways to reach a consensus on what the duty of health care workers should be. Although there are punishments should a health care worker breach their duty to provide care it is insufficient. Health care workers will be faced with an ethical dilemma when a pandemic arises because of the conflict between performing their duty to provide care, self preservation, and the health of their families. Health care workers need to have an array of facts towards a pandemic situation then contemplate their position on what to do when a pandemic takes place using deontological, teleological, bioethical principles and Kohlberg’s theory of moral development.

When the public was engaged 90% said that health care workers should face all risks if safety precautions are taken, 47% of the public agreed that the government has the right to conscript health care workers during a pandemic. 50% of the public agreed that health care workers should face lose of employment and licensing should they not show up to work. However, as of now health care workers are subjected to a 184050 dollar fine according to the occupational health and safety act. Due to 30% of all SARS cases being health care workers, there is an understandable level of fear. Nurses in particular seem to have a reserved fear during a pandemic with 34% of nurses primarily young nurses would quit during a pandemic. Nurses also exhibit the highest level of fear with 61% of nurses who were scared to care for SARS patients to the point where they would avoid them. This fear felt is brought on primarily from having less than two hours of infectious disease control training. The first step to preparedness, to make an ethically sound decision is to educate and raise awareness. Increased fear was due to perception of greater risk of death, lifestyle change and being treated differently because they are health care workers. Therefore, Health care workers need to understand that although they are in a high risk area there have been several steps taken in regards for their safety. Knowledge of preventive measures should not be assumed by the staff but rather educated by the employers. The knowledge of preventive measures can be learned and preserved by facts, protocol, procedures and practise. When the health care workers are informed of the precautions that they are given it lessens the fear from the pandemic. Once the proper factual presumptions are made the health care worker can then apply ethical knowledge to make their decision.

Deontology ethics stresses that a morally right action is directly brought upon by ones performing their duty. Since a deontological ethical approach emphasizes that our actions be governed by our duties, then a definition of duty must be given concisely. In the Canadian Medical Association’s Code of ethics the expected procedure for physicians during an epidemic is vague and silent to say at best. However, physicians like all health care workers have a duty to provide care. The duty to provide care is one that is given to all health care workers this assumed duty to provide care is initiated and taught in the health care system. Duty of care is the legal term for the obligation that a health care worker has to his or her patients. There is both a duty of care and a duty to provide care for both nurses and physicians. When you first accept the meeting the standard of care you recognize duty to care then the continuity of that care is the health care workers duty to provide care. When a health care worker, nurse or practitioner refuses to go to work during a pandemic they breach both their duty to care and duty to provide care. They are wrong when they violate the duty to care for any new patient and they are wrong when they have going against their duty to provide care to their current patients. Furthermore, when a health care worker does not go to work they impose on the rights of others. Residents of Ontario and citizens of Canada have a right to health care; this right is ill-treated when health care workers do not go to work. Therefore, although there are no specific duties during a pandemic crisis the regular duty to care and to provide care are still valid and should be obeyed from a deontological point of view.

A Teleological stand point evokes that in order to make a morally good decision the decision maker must weigh out rationally and objectively the outcomes of their actions. The decision maker has to consider ethical hedonism which preserves self interest, versus ethical altruism which emphasizes the benefits of others even at the price of self sacrifice. Fear and concern for self was the second largest barrier for health care workers willingness to work. If the health care workers do go to work the good consequence is that they are helping several people and the bad consequence for this action is that only one person in addition is at risk; themselves. Versus, if the health care worker does not go to work he alone is safe while many others are suffering. However, the largest barrier for health care workers willingness to work is fear and concern for their families. Now the bad consequence of going to work does not only affect only the health care worker but their entire family is at risk. Teleological Utilitarianism states that the morally good action provides the greatest good for the greatest number. In the instance where the health care worker decides to go to work they are most likely serving and helping more people then they puts at risk, even though those they puts at risk are their own family. Therefore, what is teleologicaly good is that health care workers go to work during a pandemic. Moreover, the decision not to go to work can be seen as ethically hedonistic, but at the same time could be selflessly made if it is to protect their families that may rely on them. The public seems to support the latter 64% of which agree that health care workers with young children and or elderly should not be expected to work during a pandemic.

There are four classical principles that guide health care workers on how to ethically function at work. The first is the principle of nonmaleficence as seen in the Hippocratic Oath, fundamentally states that no action taken should result in any harm unless it is necessary to prevent greater harm. The health care workers are creating harm indirectly by not going to work and helping, this negligence that is creating the harm is just as bad as directly doing the harm themselves. The second principle is that of beneficence which states that the professional has a duty to do good. In order for the health care worker to do well and be in compliance with the guiding principle of beneficence they must go to work during a pandemic and perform good; This good is performed by helping others. The third principle of Autonomy is in respect for the patient to have the liberty to choose their own course of action. Most likely a patient with SARS or similar disease will want some sort of treatment. In order to even have the option of treatment, to allow autonomy a health care worker needs to report to work especially during a pandemic when they are needed the most. The final guiding principle of justice interjects that patients need to be treated fairly without discrimination. In order for care to be non-discriminatory then health care workers need to provide care to everyone equally including people who are suffering from the pandemic disease. Also care should be consistent from before the pandemic to after the pandemic. If the health care worker should decide not to go to work during a pandemic both people suffering from the pandemic and non pandemic diseases suffer and do not receive just treatment.

Kohlberg’s theory of moral development can be applied to this ethical maxim to decide which decision would be preconventional, conventional or post conventional. A preconventional action focuses primarily on an egocentric basis. The choice for a health care worker to not go to work during a pandemic due to fear of their own lives is a hedonistic decision. Therefore, according to Kohlberg the decision for health care workers to not go to work due to selfish concerns is preconventional. A conventional decision would encompass that a decision be made that will be good for a group rather than purely yourself. The decision to not go to work for the sake of taking care of your family and children is a self less decision for a certain group. Although the decision is still to not go to work it is considered conventional because it is for the sake of the health care worker’s family. A post conventional decision holds true to the law of justice. The law of justice and individual human rights can be applied to this scenario because every citizen of Canada has a right to health care and health care is to be distributed justly. The decision for the health care worker to go to work for the sake of universal society is considered post conventional. In order to make a truly moral decision Kohlberg’s theory of moral development could be used as a guideline for health care workers to make ethically appropriate decisions.

In conclusion, the choice whether or not health care workers should go to work during a pandemic is an ethical dilemma. In order for health care workers to make an informed decision they need to be made aware of the facts. Although there is a fine set in the occupational health and safety act of 184050 dollars the penalty is not enough as the public agrees health care workers who do not go to work should face loss of employment and licensing. The decision for health care workers to not go to work during a pandemic due to selfishness and fear even thought precautions have been set is a hedonistic decision. This hedonistic decision falls under Kohlberg’s stage of preconventional or immature level of moral reasoning. Although health care workers have a duty to care and to provide care to their patients they also have a duty to take care of their families. The decision for health care workers to not go to work during a pandemic due to fear of infecting their family which needs them, falls under a conventional and mature decision. The decision for health care workers to go to work during a pandemic in compliance with the duty to care and to provide care is a post conventional decision and is most applauded. Since this decision provides the greatest good for the greatest number of people it falls under utilitarianism. Furthermore, this decision also conforms to the principles of professional ethics. A health care worker going to work prevents harm from being done i.e. nonmaleficence; this treatment being provided is beneficial and is in accordance with the principle of beneficence. Autonomy and Justice is fulfilled by the health care worker going to work because it provides patients the option of treatment and all patients receive treatment justly without discrimination. The guidelines currently set for health care workers role during a pandemic are to incoherently put and need to be clearly stated in terms of their responsibility to go to work. The guidelines should integrate a full array of ethical theories in order for health care workers to reach a sound and informed decision.

In health and social care services, quality is an essential component and a concept with many different interpretations and perspectives. It is important to both users of health and social care services and external stakeholders. While completing this unit I have gained knowledge of these differing perspectives and considered ways in which health and care service quality may he improved. I have tried to explore the requirements of external regulators and compare them with the expectations of those who use services. I have also learnt about few methods that can be used to assess different quality perspectives, and develop the ability to evaluate these methods against service objectives. I have also focussed on concepts of managing service quality with an aim of achieving continuous improvement and exceeding minimum standards. I have made a sincere attempt to understand strategies for achieving quality in health and social care services. By completing this unit, I sincerely hope that I have learnt basics of as to how to evaluate systems, policies and procedures in health and social care services. I have learnt about methodologies for evaluating health and social care service quality.

TASK 1
Stakeholders are essential in health and social care regarding quality; discuss analysing the role of external agencies in setting standards. (1.1; 1.2)

Stakeholder as one who is involved in or affected by a course of action. Patients are part of the stakeholder group that both pays for our health care system and are the end-user of it. The interests of health care organizations, medical professionals and other health care providers are represented through various government bodies, professional organizations and labour unions.

We must try and understand quality considering the perspectives of staff and also perspectives of those who use services. Quality might have the same outcome but opinions of the health and social care staff and the patients might be quite different.

In simple terms, quality is fitness for purpose. Quality is about meeting the service users’ requirements. If quality is about meeting service users’ requirements, it is important to discover what these requirements are. If we provide services with extras that service users don’t want, we will not be adding quality.

Stakeholders can be the external agencies eg Care Quality Commission; Supporting People; National Institute for Clinical Excellence; Health Service Commissioners; local authorities; users of services eg direct users of services, families, carers; professionals; managers; support workers.

There are many organisations in the UK known as health and social care regulators. Each organisation oversees one or more of the health and social care professions by regulating individual professionals across the UK. These organisations, also known as regulators, were set up to protect the public so that whenever you see a health or social care professional, whether private or in the NHS, you can be sure they meet the standards set by the relevant regulator.

To practise profession in health and social care, people must be registered with the relevant regulator. If they are not registered and still practise, then they are breaking the law and they may be prosecuted. These registers are made up of only those professionals who have demonstrated that they have met the standards set.

These registers are open to the public. So if you want to check your professional is registered, you can do this either online or by calling the relevant organisation.

In health and social care, professionals, clinicians and others, whose work is informed by traditional bodies of knowledge, are increasingly aware of the need for continuous personal development. High- quality services cannot be sustained unless health and care staff are consistently engaged in learning, individually and together.

All care services need to work to standards and have a system for measuring that they are meeting standards. The health care system has audits which check that services meet quality standards, while social services have inspection units which register and inspect services. Standards are influenced by laws, subsequent regulations, codes of conduct and values.

All organisations such as homes, day centres or community services, need a system to monitor how effectively services are being delivered and whether service users’ are having their needs met. Organisations may have their own quality monitoring systems. At a local level, quality assurance groups may seek to clarify, prioritise or set standards.

Different parts of the system and external agencies need to work together, as part of a culture of open and honest cooperation, to identify potential or actual serious quality failures and take corrective action in the interests of protecting patients.

Explain what the potential impacts of not appropriately managing quality in health and social care settings might be? (1.3)

If quality in health and social care settings is not appropriately managed, this could lead to serious consequences. It could lead to inability to improve the health and social well-being of people in the area for which they are responsible; Planning and commissioning health and social care will be unable to meet the needs of people in that area. It will cause inability to secure the delivery to people in an area of health and social care that is safe, efficient, co-ordinated and cost-effective. Also the availability and quality of health and social care in that area will deteriorate. The development of standards, guidance and strategic targets will be stagnant. This would mean that local targets will not be achieved. It would mean that patient satisfaction will diminish and targets and expectations will not be met.

Obviously, if the quality is inappropriately managed, it would have a significant impact on all three basic criteria. It would lead to poor clinical effectiveness. Safety of the patient ill not be guaranteed and this would lead to poor outcome in terms of patient experiences.

Where the regulatory bodies find that providers are not meeting the standards, they require them to improve and has a range of enforcement powers they can use. These powers include warning notices, penalties, suspension or restriction of a provider’s activities, or in extreme cases, cancellation of a provider’s registration which effectively means closure of a service.

Providers who train healthcare professionals also have a responsibility to deliver training in a safe and effective way in line with the standards set by the professional regulators. The professional regulators have an interest where the quality of training may put patients at risk.

I. What are the major quality issues that were identified in the last State of Social Care (CSCI, 2009) standards report? What might be the implications for service users? (2.1)

CSCI’s report, The State of Social Care in England 2009, concludes that services do not meet the expectations. The report is believed to highlight that social care services are struggling to meet people’s needs. Fewer people are receiving the care they need to enable them to live independent lives in their own homes. It is all so understood that the report will say there are continuing and chronic difficulties in recruitment and retention of staff throughout the whole care sector.

People, whether they pay for their care or are publicly funded, are not always getting the individualised help that they need to make decisions about their support which in the long term can be costly to individuals, family carers, councils and the NHS.

People are not always getting quality personalised support, particularly those with multiple and complex needs, some of whom may have little, if any, choice about their care. There are concerns about people who are ‘lost to the system’ because they are ineligible for publicly funded support or are ‘self-funders’.

There is an increased demand and resources are limited which is putting a lot of pressure. The report states that people who have complex needs are not getting personalised care. It notes excellent examples of people receiving the support they need but adds that too many people are not getting the right amount of personalised care.

Many people do not get the information, advice or support they need to help them make informed choices about their care.

Implications for service users:

Poor quality service can disrupt funding, damage the reputation of organisations and individuals and lead to inappropriate planning decisions.

Improving quality improves patient care and value for money.

It is important to improve quality because it will lead to preventing ill health and provide patient-centred care. It will also help to manage increasing demand across all programmes of care and to tackle health inequalities. Improved quality will lead to deliver a high-quality.

People who would be affected the most because of poor quality will be mainly the older population, people with long-term conditions, people with a physical disability, maternity and child health, family and child care people using mental health services, people with a learning disability acute care and palliative and end of life care.

There are many different approaches to understanding quality. Describe any three approaches of your choice highlight a particular strength of each approach.

Different understandings of quality:

A common quote is: “Some things are better than others; that is, they have more quality. It is a grade of goodness or excellence. Quality therefore means free from defects. In my opinion, quality means patient’s satisfaction.

After reading and learning more about quality, I have realised that quality can be understood with variour approaches. It can be measure in terms of the exceptional (highest standards) or in terms of conformity to standards. It can also be described as fitness for purpose, as effectiveness in achieving institutional goals; and as meeting patient’s needs.

Quality as exceptionality

This is the more traditional concept of quality. It is associated with the idea of providing a service that is distinctive and special, and which confers status on the owner or user.

Many institutions emphasise that health and social care must have exceptional standards. However, it is not possible for the agency to condemn all other institutions. This approach is not always possible.

Quality as conformance to standards

The word ‘standard’ is used to indicate pre-determined specifications or expectations. As long as an institution meets the pre-determined standards, it can be considered a quality institution fit for a particular status. This is the approach followed by most regulatory bodies for ensuring that institutions or programmes meet certain threshold levels.

Quality as fitness for purpose

This approach has the following questions ‘Who will determine the purpose?’ and ‘What are appropriate purposes?’. The answers to these questions depend on the context in which quality is viewed. The purposes may be determined by the institution itself, by the government, or by a group of stakeholders.

Quality as effectiveness in achieving institutional goals

In this approach, a high quality institution is one that clearly states its mission (purpose) and is efficient in achieving it. This approach may raise issues such as the way in which the institution might set its goals (high, moderate or low), and how appropriate those goals could be.

Quality as meeting customers’ stated or implied needs

This is also a variation of the fitness-for-purpose approach. This is where the purpose is customer needs and satisfaction. Quality therefore corresponds to the satisfaction of the patients.

Which approach to quality (you may choose one that isn’t above) do you feel is more often used by providers of health and social care services users and why do you think that this is the case? (2.2)
Standards-based understanding of quality

In my view, I think health and social care providers use an approach which is conformance to the standards. Many regulatory bodies set goals and aims for a particular healthcare setting and the organisation works hard to achieve these goals.

Implementing quality needs planning. There should be policies and procedures. Government should set some targets. An audit can be an excellent tool to check if appropriate quality of care is being delivered. There should be constant monitoring and review should take place at regular intervals. Good communication is the key to implement good quality. Proper information should be shared especially when shifts finish, hand over should be done adequately. We all should be open and ready for adapting to change.

Standards: minimum standards or best practice should be the goal or certain benchmarks should be set. We must have measurable performance indicators. All health and social care settings should have codes of practice. There should be legislation in place which could either be local, national or European legislation.

In the ‘standards-based’ understanding of quality, health and social care institutions must demonstrate their quality against a set of pre-determined standards. These standards will set a threshold level of quality.

However, quality assurance today has changed. While in the past quantitative criteria was enough to demonstrate that a standard had been met, more qualitative criteria is now incorporated and institutions may thus be able to more easily maintain their individuality.

IV Suggest the potential barriers to delivering quality at this scheme and other health and social care services (2.3)

There are a number of barriers to improving quality. It could be due to lack of proper implementation of documented procedures. There is a lack of incentives to change traditional ways of providing care. Also a lack of a patient-centered culture and values. One of the biggest problem is lack of relevant training and support. Also we don’t have enough expertise in interpreting survey data. Sometimes it is just the resistance to change which can be quite difficult to overcome.

We shall discuss relative impact of a range of potential barriers. The biggest constraint is the time available to focus on improving the quality of services, followed by a lack of leadership.

People need to be identified, trained and supported to provide leadership and commitment.

Lack of leadership in delivering quality is an important barrier.

Training if not received properly could lead to poor quality in health and social care. We know there could be few health and social care workers who received no training, few who were trained in all the identified areas of quality, some who had been trained in only one area (predominantly clinical governance and audit) and the remainder received an inconsistent mix of training in different areas. A consistent package of core training in all facets of quality is needed for all NHS staff.

Staff must be rewarded through the appraisal process, this could lead to a morale boost and lead to better quality of work.

How does legislation (relating to quality) impact on the delivery of quality in health and social care service(s) offered in England and Wales? (3.1)

Rules and regulations must be followed because safety depends on them. They usually come from one of two sources as they may be local and designed by the employer or they may have been designed by the government. Hospitals have their own policies and they also follow rules set by the NHS and the government. Wherever they come from, it is important that they are followed as they are put in place for the good of everyone.

One of the main sets of rules and regulations is The Health and Safety at Work Act 1974. This act provides the basis of health and safety law. It places general duties on all people at work, including employers and employees.

All places of employment are subject to health and safety law. Employers must have relevant policies in place. These must be designed for health and social care so that all of the staff can follow them and comply with the safety laws. Most care establishments have the following policies like fire policy, lifting policy and hazardous waste policy. When running or managing a care service and carrying on a regulated activity there are certain things you have to do by law. Though the legislation should be used as guidance only, and is not legal advice.

Another important act is Health and Social Care Act 2008. The Health and Social Care Act 2008 established the Care Quality Commission as the regulator of all health and adult social care services. It is important to be aware of all the up to date provisions.

We should try to describe quality and safety from the perspective of people who use services and place them at the centre of the registration system. It is important that anyone registered to provide or manage a regulated activity is aware of the guidance that has been produced. It is very important to be aware of the legal side of things so that we can ensure the safety of patients and also ourselves.

Identify other factors that might influence the achievement of quality in health and social care services (3.2)

How to deliver high-quality healthcare in the most efficient manner possible is the question that is very important. In my opinion, healthcare delivery should be clinically effective, focusing on treatment outcomes, including survival rates, symptoms, complications and patient-reported outcomes. In my view, health and social care must be safe: avoiding harm, looking after people in clean, safe environments, and reporting any medical errors or adverse events.

One main goal should be ensuring that healthcare is available to all according to need and avoiding financial barriers that prevent access to necessary care.

It is important that health and social care is efficient: paying attention to value for money, avoidance of unnecessary interventions, and careful use of limited resources. Health and social care should be responsive: providing personalized, patient-centred care, delivered with compassion, dignity and respect; measuring, analysing and improving patients’ experience and satisfaction.

How can health and social care workers ensure their knowledge base is up to date and that their work is of a quality standard and what role and responsibilities do health and social care service providers have in relation to this. (3.3)

As health care or social care workers, we must endeavour to keep our knowledge base up to date and ensure that our work is of quality standard. Ideal care workers will go out of their way for patients, they try to understand what it’s like for the service user and carer; they are happy and interested in their work and knowledgeable about their jobs and are always ready to help. Good communication is the key.

We must attend seminars, meetings, group discussions and do online studying along with regular text bok reading. Group discussions and team work will help us to realise the gaps in our knowledge.

Care workers should have knowledge of services and legislation relevant to users and carers’ needs. They must know about the benefit system and sources of funding, or who to refer to if they don’t. It is of utmost importance that they know when and whom to ask for extra help. Health and social care workers should know about the people they are caring for. They should be familiar with the roles of other people in relation to meeting service user and carer need.

Health and social care workers must understand their limitations and have up-to-date knowledge. It is recommended that care workers review their learning over the previous 12 months, and set their development objectives for the coming year. Reflecting on the past and planning for the future in this way makes your development more methodical and easier to measure. Care workers may already be doing this as part of their development review with an employer.

CPD is a personal commitment to keeping our professional knowledge up to date and improving our capabilities. It focuses on what we learn and how we develop throughout your career.

As a professional, we have a responsibility to keep our skills and knowledge up to date. CPD helps us turn that accountability into a positive opportunity to identify and achieve our own career objectives. CPD is an opportunity to do ourselves some good; the nature and scale of the benefit depends entirely on us.

I. Identify method used to assess quality, evaluate the method with two more methods of your choice (one external and internal (4.1)

Measuring the quality of health care has become a major concern for funders and providers of health services in recent decades. One of the ways in which quality of care is currently assessed is by taking routinely collected data and analysing that data. The use of routine data has many advantages but there are also some important pitfalls.

The Measurement of Quality:

Methods for assessing quality can be various. We could use questionnaires, focus groups, structured and semi-structured interviews, panels, complaints procedures, feedback forms and road shows.

Nice questionnaires should be prepared which should be given to the patients to fill in their own time. This could give us a fair and honest opinion about our services. Small focus groups and interviews can also be a good technique. To achieve good levels of quality service, we must have complaints procedures in place. Feedback forms could be an excellent measure for quality of any service provided. This could also prove beneficial in improving the quality by acting upon any suggestions made by the patients.

Scientific methods of measurement are increasingly necessary. Evaluation requires good methods in order for the resulting data to be useful. Further, data from evaluations are being used to create significant change within organizations, so faulty data based on inaccurate measurement methods carry a great risk.

Quality will not be improved simply as a result of inspection. It must be built into the people and the processes carrying out the work of the organization. In health and social care setting we must all define quality, measure its achievement, and create innovations to constantly improve. This requires active involvement of all within the organization, from the mailroom to the boardroom. Visible, supportive leadership is essential.

II. “If quality is about meeting customers’ or service users’ requirements, it is important to discover what these requirements are” (Martin and Henderson, 2001 p. 178)

Quality is most easily recognised in its absence and many public perceptions of healthcare are based upon measuring the absence of quality for example, waiting times, waiting list sizes, even illness itself are all measurements of the absence of quality.

The client/patient: the client/patient’s view of the quality of their experience will depend upon two factors: a successful outcome and a positive experience before, during and after treatment. However, some procedures which may be deemed clinically desirable to maximise the probability of a successful outcome may be highly uncomfortable and inconvenient for the patient.

Increasingly, the separation between these aspects is being questioned as it is recognised that clinical outcomes are influenced by a patient’s general state of well-being. This increases the need to take account of what has been traditionally considered as non-clinical aspects of care.

Service quality is more difficult for patients to evaluate than goods quality. A patient’s assessment of the quality of health care services is more complex and difficult for them as well.

Patients do not evaluate service quality solely on the outcome of a service; they also consider the process of service delivery. The antibiotics may have resolved the throat infection, but if discourtesy and an uncaring attitude marked the patient’s interaction with the provider, the perception may well be “poor service quality.”

The patient defines the only criteria that count in evaluating service quality. Only patients can judge service quality; all other judgments are irrelevant. Patient’s requirements, in my opinion, are:

Access: approachability and ease of contact.

Communication: keeping patient’s informed in language they can understand. Listening to them is equally important. Less use of of medical jargon.

Competence: possession of the required skills and knowledge to perform the service.

Courtesy: politeness, respect, consideration, and friendliness of health and social care worker. Credibility: trustworthiness, believability, and honesty of the service provider.

Reliability: the ability to perform the promised service dependably and accurately.

Responsiveness: the willingness to help patients and to provide prompt service.

Security: freedom from danger, risk, or doubt.

Understanding of the needs of a patient: making the effort to know patients and their needs.

III. Service user involvement has become a ‘buzzword’ in policy aimed at achieving quality. Discuss strategies used to involve service users and their effectiveness. (4.2)

“Service user involvement is a two way process that involves both service users and their service provider in the sharing of ideas, where service users are able to influence decisions and take part in what is happening”

Patients, carers, parents and advocates of the sick and vulnerable should have input into the kind of health service we have. They should be consulted about changes to services, and they should be involved in the design of those services. They should help to set the standards by which services are judged, and help to assess whether a particular aspect of the service meets those standards. At every stage, the users of the health service should be offered the opportunity to play an active part in developing, delivering and evaluating their service. Involvement can be achieved by using the following methods.

Information sharing
This may include letters, posters, newsletters, videos, tapes, text messages and forums.
Listening
This may include: one to one interviews, group interviews, focus groups, and service user meetings, one off events, questionnaires and workshops
Consultation
This may include: one to one interviews, group interviews, focus groups, questionnaires, one off specific focused events, workshops, and video or drama events.
Participation
This may include: user panels focused on specific topics, resident groups, inclusion in organising events, videos and other media to give information to other service users.

Patients should be involved in making decisions about their own health care. They should be actively involved in co-designing services, redesigning services, developing services or change management. The government should be undertaking peer education and support. More patients should be taking part in research. These strategies could be used to involve service users.

Due to previous experiences of working with a range of people in the care sector I believe that throughout my time on various work placements with people who have disabilities and difficulties in communicating, along with the experiences gained throughout my studies, my wish to pursue a career in the care profession has grown.

To further my interest in working with and around people I completed a course in childcare.

Throughout this course I was able to gain valuable experience of working with special needs children. While this was very challenging I also found it an extremely rewarding and enjoyable experience. To further my knowledge and passion for working with people I took a health and social care advanced course and took a week’s experience in a day center that involves working with people who suffer from difficulties in communicating and having disabilities. This again helped to broaden my understanding of working with people and also how to deal with children and adults with disabilities.

Within my spare time I have researched the job role and requirements for health promotion to find out what is involved. To build upon these interests further, I am taking up a one week work experience within the health field. I will be spending the first week in a care home focusing on helping elderly people that suffer from dementia and my second week assisting a health promoter to experience a more professional job role in health care. I am looking forward to this valuable experience as it will further consolidate my desire to study health and social care.

I currently work as a sales assistant which has given me a valuable experience of working with people and how to assist their needs in any way possible. During this time I am developing effective communication skills and good working relationships. In addition to this it is also helping me to show how committed I am to my responsibilities as well as demonstrating good organisation skills. Having to juggle work and school as well as social activities this also shows that I am developing my time keeping skills to make myself more committed and more punctual.

During my first year of sixth form I helped to raise money for the McMillan Cancer trust charity. I also found this very rewarding as I was helping others that were in need, just like during my work placements. I often play sports after sixth form with my friends; this has helped me to develop extra skills in working well in a team. In addition I have completed voluntary work with a year six class to increase my knowledge of working with young people, another activity that I very much enjoyed and found extremely rewarding. To further my interest in working with people I have recently volunteered to do a level 3 v-volunteering in my spare time, the certificate itself is an accreditation form Newcastle University. During my spare time I mainly like to dance and sing. I find this is a good way to express myself in addition to help me keep fit. I also attend the gym often to also help keep me fit. I also like to attend various different events and take advantage of any activities that I am offered whether it is through school or outside of school. This helps to increase my confidence and also helps me to meet new people.

I feel that university is definitely the right path for me. I am always working extremely hard to achieve the best I can, a feat which I intend to carry on throughout my university years. I feel I have the necessary skills needed to enjoy university to the full and also be successful in future years. In addition I would also like to go to university to help develop my skills even further so I can gain a good job in the health and social care sector which is always my main interest.

Social Work Personal Statement

I have decided to take up the course in social work because firstly the subjects which I am doing sociology looks at people and society’s problems, I have in this subject done work on family and at the moment doing religion, this has fascinated me to help people who are facing problems such as abuse in families. Secondly I have done personal study on this subject which I have enjoyed reading around in periodicals and journals which had fuelled my interest in gaining a more depth knowledge of working with different type of people and their problems. Thirdly I would like to take up a course which fascinates me and in which I will determined me too succeed and the challenge of working to deadlines

Whilst in the sixth form I have been involved in a scheme which aimed to provide children entering school with a low reading age, with the help their required to improve their reading levels. I also at in my private time tend to go to old people house who are disabled because one of my close relative is there also this house is opposite my house so I go in and talk to different people and talk or play games with them. This is another reason why I want to do this course because I have some experience of what I will be facing in this course, it won’t be shock to me at first time round because I know in social work you get people who are hard to handle especially youngsters

My part time job which is shop assistant helped develop my understanding of responsibility and has given me increased confidence also enabled me to act initiatively with dealing with unexpected problems and has helped to develop my communication skills . Working with the children in school has improved my interpersonal skills so that I can now work with children who can be awkward sometimes without any problems

As an individual I like keeping fit which I have a gym in my house, I also like listening to music and going out with mates which provides me a different environment from college and work, this gives me an opportunity to make new friend and meet new people. I also in my part time help my younger brother and sister with their homework or I sometimes learn from my mum how to sew clothes

As an applicant, I will bring with me an enthusiasm and motivation for this subject. My ethics background and cultural awareness should allow me to become and integrated yet individual of a university member in an increasingly cosmopolitan society.

Personal Statements: the Good, the Bad and the Ugly

Personal statements with positive impact

“After I was made redundant, I decided to become a support worker. This was because I had been volunteering for several years in the Youth Service, working with young people at risk of offending. I got a job in a special needs school where I supported pupils on an individual basis. I needed to develop a good relationship with each pupil and to adapt my communication to their special needs. An example is how I worked with a boy who was afraid of the doctor ( describes her intervention and outcome). Working in this field for three years has encouraged me to tackle an Access course; I have learnt the theory of communication and can see why I was successful in my work with school students. I would like to develop my skills and knowledge further by studying for a social work degree.”

“Skills I had gained as a support worker were needed when my father was diagnosed with dementia. I had always relied on his support and found that I had to be reliable and useful for him without letting my emotions overwhelm me.”

“I am currently working as a support worker in a multi-disciplinary community mental health team. Although I work mostly with the OTs I have a good opportunity to get an overview of the other professions including social work. I have worked together with social workers in the team to support vulnerable people in the community and particularly like the wider perspective they bring to their work such as involving carers.”

“I have worked in the substance misuse field for 5 years and have undertaken NVQ3.I have been offered the post of manager in the service I work in but thinking about my own development needs , I now want to train as a social worker to gain a wider experience of working with vulnerable adults and children.”

“I am a nursery nurse and wanted to take my interest in child protection further by studying OU courses on health and social care.”

Statements with Limited Impact

“I have always been passionate about care , becoming a social worker would allow me to fulfil my ambitions”

“I have been employed as a carer for 6 years. I enjoy my job and the experience. This has been excellent for my personal skills as I have to talk to people like the elderly.”

“I believe my personal drive is a key factor in my success as manager in a care home and I would be an asset to your degree”.

“Working as a support worker means that I have learnt skills in communication and team work.” (No further discussion of these points)

Lengthy exposition of previous employment in various retail and marketing companies, paragraph ending with “The work experience linked to social work was a six week placement in day centre where I helped escort the old people home.” No further discussion of what person learnt from this, what impact it had on decision to apply to train as a social worker.

“Having gained an NVQ 3 in health and social care and with vast experience in paid and voluntary work, I want to further my career by studying for a professional social work qualification ….. (then follows list of all the service user groups applicant has worked with) … in all these my skills in prioritising my workload, meeting deadlines , time management and team working has improved enormously.” No evidence given to demonstrate this statement.

Other statements contain very general comments on social work – such as ” A social worker’s vocation is very complex and more than interpreting the problem and assisting people find a solution. It involves methods, theories and ethics.” There is a danger that these types of generalised comment are either from websites or books and articles which are not referenced – plagiarism can rear its head even before some applicants have started their academic career!

This essay will be constructed into four parts, harm reduction, abstinence based reatments, substance misuse and recovery. There will be a discussion on the history of harm reduction and what harm reduction is in the substance misuse field, for example problematic or harmful behaviour that is caused to the individual or others either socially, psychologically, physically or legally brought on by substance misuse. Secondly an explanation on abstinence based treatments, what they are and what the relationship is between them and harm reduction. Thirdly referring to recovery and what it means in the substance misuse field and what the implications are for the service users. Last but not means least a discussion about the two different approaches and how it impacts on the service user. To conclude a summary of the main points will be made. (136

Harm reduction pilot schemes started back in the 1980’s and were a response to reduce the risk associated with harm caused by alcohol problems and injecting drug use, in response to the HIV and AIDS prevention strategy. Harm reduction is a process and not a treatment and should be integrated with other forms of intervention, it reduces the negative consequences of drug use. It is about educating the individuals, carers, partners and family members about the risks involved with their drug use and helping them take responsibility and learn to accept it rather than to ignore it. Most harm reduction interventions are aimed at preventing diseases due to blood- borne viruses (BBV) as well as overdose and other drug related deaths (Tatarsky & Marlatt 2010). Harm reduction services include needle exchange services methadone and buprenorphine programmes. Needle exchange provides services where the users have the opportunity to dispose of their old needles, syringes and spoons for example. Moreover they will also receive advice and support on safer injecting, reducing injecting and prevention of overdose, they will receive a pack which contains clean injecting equipment to take away, reducing the risk of them sharing equipment with others (NTA 2006). Substitute prescribing such as methadone and buprenorphine programmes, buprenorphine and methadone are licensed for use in opioid dependence where methadone is dispensed in liquid form and buprenorphine is administered by tablet form sublingually (Connock, Juarez-Garcia & Jowett, et al 2007). (236)

Abstinence based treatment

Abstinence means refraining from an activity which is known to be harmful and addictive or reducing this activity with the ultimate goal of being abstinent (McKeganey et al 2006). Doing this involves not taking a particular substance, avoiding areas where this is likely to be on offer or adopting a healthier lifestyle. Abstaining can be difficult to do especially when the substance has been part of their life for so long, this is where the individual has to look at healthier ways to deal with their substance use. This can include a range of abstinence based treatments to help the individuals with alcohol or drug such as Non-drug interventions the twelve step programme (self help) and Psychosocial interventions such as motivational interviewing or CBT. The twelve step programme is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioural problems, it was originally proposed by Alcoholics Anonymous (AA) as a method of recovery from alcoholism. Motivational Interviewing is usually offered to achieve and maintain abstinence, it was originally used with problem drinkers but has also been applied to the treatment of illicit drug misuse (Raistrick et al 2006). There are several Pharmacological interventions available to treat alcohol dependence which are disulfiram, acamprosate and naltrexone. These all work in different ways Disulfiram is used for individuals who wish to abstain altogether, if taken with alcohol it can cause some very unpleasant effects; vomiting, headache, palpitations and breathlessness. Acamprosate and naltrexone are an anti-craving drugs used in the maintenance of abstinence (SIGN 2003). However there is an increased risk of overdose or death due to a relapse after a period of abstinence as tolerance levels will have changed to that particular substance (REF). (288)

Substance misuse

Substance misuse is defined as the use of a substance for a purpose not consistent with legal or medical guidelines (WHO, 2006).

It is a misuse of all psycho-active substances including illicit drugs, non-prescribed pharmaceutical preparations and alcohol misuse.

People use substances because it makes them feel good, feel different and makes them more sociable. Using substances only becomes misuse when a problem arises such as it having a negative impact on health or functioning and may take the form of drug dependence causing problematic or harmful behaviour to the individual or others either socially, psychologically, physically or legally. (99)

Recovery

The Recovery Model as it applies to mental health is an approach to mental disorder or substance dependence that emphasises and supports each individual’s potential for recovery. Recovery is seen within the model as a personal journey, that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning. For someone who misuses substances recovery may not be about being totally abstinent it may simply mean still using drugs but in a safe way, for instance having clean works for injecting or substitute prescribing for opioid misuse. Recovery principles bring about the change in the way a service user thinks and aims to produce a change in behaviour, however before these changes can only happen if the person is ready to change, ambivalence may be experienced by the service user and this can affect motivation on a daily basis. Motivational interviewing techniques go hand in hand with the harm reduction model as one of the key factors with motivational interviewing is dealing with ambivalence. Prochaska and DiClemente 1983 provide a framework to understand the change process it was originally created to help understand what individuals go through in changing their behavior. it uses 5 principles, precontemplation, contemplation, preparation, action and maintenance (Hansen et al 2008). Service users with little or no motivation and who are not engaging in any attempts to change are seen as being in the pre-contemplation stage as they do not see their behaviour as a problem and there is no need to change it, this could be due to an attempt to change in the past without success and may feel demoralised so may become resistant to change. It is important to engage service users at this stage and build a trusting rapport so that in the future they will be able to turn to the practitioner for help. The contemplation stage is when a person acknowledges that they may have a problem and work towards developing motivation to change but could become ambivalent, engaging with the service user in discussion about their ambivalence is the goal at this stage getting them to think about what their problem is and how it is affecting them. Individuals in the preparation stage may want to change and have a plan but need help to do so, the reason individuals may seek treatment could be that their problem is having negative effects on life for example, criminality or job loss. The action stage comes next this is where the service user is actively setting goals to change and will be developing skills to do so, supporting the service user in making these goals achievable are key here, goals need to be small and achievable to the service user. In the maintenance stage the service user sustains changes in behaviour and works towards preventing relapse by identifying the supports around them, at this stage the service user may decide to make long term goals and problem solve how to best accomplish them. Prochaska and DiClemente 1983 describe a sixth stage and it is the relapse stage the service user reverts to the behaviour they were trying to change, the practitioner should provide support for the individual in a non-judgemental way as they may be feeling ashamed and guilty for relapsing, re-evaluate the stage of change the individual is at explore the relapse episode trying to discover if the relapse was shorter or longer than previous relapses and were they able to reduce their use, this may be an opportunity for the service user and practitioner to work on other relapse prevention techniques. (Prochaska & Diclemente 1983). However service users may move back and forth between the stages. This does not represent failure, but rather the nonlinear nature of the model. Recovery is about making the best out of their life and having quality of life and as nurses we should provide support and advice to achieve their goals (Network 26 2009). (660)

Both the abstinence model and the harm reduction model have similar goals. The goal in this case is to create a better quality of life for the person receiving the service. Harm reduction approaches are often perceived to be the opposite of abstinence based approaches to drug use and sometimes even as condoning drug use. This is not the case, harm reduction complements abstinence based drug treatment approaches by providing Injecting drug users with the knowledge and tools to stay healthy and alive until they are able or willing to achieve abstinence. Abstinence remains the most effective way of reducing the negative consequences of drug use. For injecting drug users who are unable to remain abstinent, harm reduction measures such as methadone maintenance treatment and needle and syringe programs are ways to reduce negative consequences. For example the abstinence approach to caring for an individual who uses heroin and has HIV service users would find that they would be encouraged to stop using heroin completely and to abstain from sex. While with the harm reduction programme the individual may be taught how to use heroin more safely i.e. clean needles and spoons and other paraphernalia or to substitute methadone for heroin and to practice safer sex. It can be argued that because abstinence based services were not providing HIV education and preventive tools such as condoms and syringes, individuals using these services would remain unaware of the risks of HIV and how to protect themselves from it. (247)

Conclusion

In conclusion, the integration of harm reduction and abstinence based treatment is more powerful than either model separately. The abstinence goal provides more room for the more abstract harm reduction work to occur. The accepting atmosphere of harm reduction with the addition of the clarity of the goal of abstinence promote patient retention better than either separately. The implications of this integration is that harm reduction can be more accepted and powerful in the public sector. It is important to look at the wider context of why people use drugs. Taking away a coping mechanism from a drug user may do more harm than good unless the core issues that led to drug use are dealt with in the first, hence the reason the motivational interviewing approach is more empowering for the service user (134

ABSTRACT

Purpose – Greed triggers fraud and corruption which is one of the biggest problems we are facing in our country as its increasing enormously rather than decreasing. The purpose of this study is to assess the different types of fraud and corruption and because it is such a broad topic we will focus on a life situation which highlights how greed plays a huge role in the creation of fraud and corruption.

Design/ Methodology/ approach – in depth interview are conducted with a senior quantity surveyor who has been working for a contracting company for the past six years and has allowed me to be part of the investigation process that is being conducted. The reason behind the investigation is to find out how come they owe such a great amount of money for tax but money had been deducted from their salaries since they started working and reasons of being unfairly dismissed.

Findings – The employer of the contracting company seems to be deducting money from his employee’s salaries but not paying the tax company without the knowledge of his employees using it for his own private use. Additional information was found that all his workers haven’t been registered under the department of labour and the company has been running for a number of years now and unfair dismissal was practised in this company.

Originality/ Value – The final results of this paper will help us understand and beware that there are all kinds of corruption in the industry. Ms Anonyms will hand over all her payments slips to the investigation officers to prove that she has been working and paying for her tax over the past years while working and to also open a case of unfair dismissal and take it to the Commission for Conciliation Meditation and Arbitration (CCMA).

TERMS OF REFERENCE
PROPBLEM DESCRIPTION

Fraud and corruption play a big role in the construction industry which this results in the hindering of development in our country and the country not moving forward.

AIM

The Aim of the research is to bring the matter of fraud and corruption to attention of the reader. To detect risks in the industry and to provide users with relevant anti- corruption resources.

OBJECTIVES

To find out what triggers fraud and corruption

To what extent is an individual willing to scoop low to get what they want and not be caught

How corruption affects the Construction industry

How it hinders development.

PROPOSAL
Chapter one

1.1 Introduction

Greed is a critical issue affecting the construction industry and country as a whole as it leads to fraud and corruption which plays a huge part on the hindering of development in our country.

Chapter 2

2.1 Greed

The selfishness of an individual of wanting more and not being satisfied of what they already have.

2.2 Fraud

A criminal offence done intentionally because of personal motives which the individual will gain that could affect another individual.

Corruption

Chapter three

3.1 Case study

Ms Anonymous finds herself in the middle of a fraud and corruption situation that she was not aware off.

3.2 Tax invasion

CONTENT PAGE

PGE NO.

Acknwoledgements

Abstract

Terms of reference

CHAPTER 1
INTRODUCTION

Fraud and Corruption are broad and complex issues but their roots are embedded in a countries social or cultural history, Political and economic development and it includes both these committed by the government, employers, employees, management staff, individuals or a group of people who have come together with one agenda only and these committed is motivated by Greed.

Greed steers and individual into fraud and corruption which also triggers the power of the mind, when a person starts procrastinating about the benefits and what one shall gain they begin to start plotting ways in making these thoughts into reality and once these thoughts become reality and the outcome is greater than expected they start abusing the situation into their own advantage.

The construction industry sector is recognised as carrying the highest risk of corruption, the rate of corruption and fraud in the industry is increasing enormously rather than decreasing which is slowing down the economy and surprisingly it has become an ordinary and normal habit that is being practised. It is almost like a swimming pool which everybody now wants to jump in and swim in the deep end not bearing in mind that not everybody can swim.

CHAPTER 2

HISTORY

GREED

Greed is that extreme desire to attain or posses more than what one has such as material wealth which is usually more than what one needs and deserves. It also involves using being wealthy to gain power over others also denying others of wealth and power.

It is basically being selfish, thinking of one’s self while at the same-time affecting other people negative way. For example if a building inspector would accept a bribe from a contractor to approve and state that all work done is of good quality and condition while that is not true than that is an act of being greedy because looking at the situation the only people gaining here are the building inspector and the contractor while in the long it will negatively affect the community as a whole or the people who will be in use of the premises that is being built.

FRAUD

In the country we live in fraud is a criminal act that would disadvantage an individual or a group of people and it is also a civil law violation. Fraud is done intentionally which involves dishonesty for personal gain or damage to other individuals. Fraud can be categorized into many forms for example theft and embezzlement.

In a case of fraud you would have for example a person such an Alien (not belonging in the industry) who knows nothing about the construction and the whole background of it having certificates qualifying him in erecting projects in a case that he doesn’t even how foundation is done.

CORRUPTION

Corruption in any case is the act of being dishonest and abusing power or the person’s position. Corruption can happen anywhere and is usually committed by an individual or a group of people such as officials or private persons. Corruption comes in many forms such as bribery, nepotism, cheating, vote rigging and extortion.

An example of corruption would be paying off kickbacks to get multi million rand contracts for dubious reasons, having to regularly donating huge sums of money to maybe political parties or buy expensive gifts such as cars worth millions rands in-order to get something in return.

“Corruption and fraud come in with greed because they are actions stem from the lack of ethics and undermine human institution and human relations.”

CHAPTER 3

CASE STUDY

Ms Anonymous and Contracting Company.

Ms Anonymous has been working for a contracting company for the past 3 years as a senior quantity surveyor for this company. She did more than just her employed position where she also worked in the civil side of the work and any other work that needed attention she would be gladly to assist in other words she was more of an asset to the company and they had mentioned that to her as well.

The problem started when Ms Anonymous received a letter that she needed to go sort out her tax returns. When she went to pay a visit at the tax company (SARS). S he was informed that she owes a lot of money and was asked why she hasn’t been paying for her tax? She was shocked and told them that she has been paying for her tax ever since she started working for her recent company the past three years. They told her to request and RIP5 form from her employer and also to keep all her pay slips as proof of payments for tax when needed to check her account and also that her company was one of the companies that were chosen for audits in 2012 so they would be an investigation with regards to her matter of not paying tax and would take things from there.

Audits where later on done of the company and it revealed that they owe a great deal amount of money and that they have not been paying whatsoever. They told Ms Anonymous to bring all evidence as proof that money has been deducted from her account for tax and they had promised that no information regarding with her account would he linked to the owners of the company and had assured her that she did nothing wrong as they had called in her to query her about her tax number. Investigations continued as the tax investigators kept coming into the office to do Company Audits and since they had no financial and bank statements and how much is being charged from the workers it pin pointed that they have been not paying such as VAT and PAYE.

Things started to be little offish at work where they were all panicking and looking for fingers to point as they were not aware how and what had led SARS to come and audit the company with realising that SARS had chosen them themselves than rumour went out the Ms Anonymous had went to SARS. Later on they made false pay slips saying as he was paid more than she was being paid so that it will show as if she was the one who was not paying Tax but then Ms Anonymousness Payslips had proven all of that wrong.

A month later Ms Anonymous was called into the Bosses office and was told that due to financial constraints they will have let her go because they will not be able to afford and they will be giving her 3 months to look for her job and are willing to give her good recommendation.

TAXATION

The importance of paying tax

Nobody wants to pay tax which is highly understandable but that money is the only money raised through tax that the government relies on to produce public revenue to pay for public expenses that provide goods and services to the public. Without tax and people not paying it becomes difficult for the government to try meeting the basic needs of the country. Both the state and the local governments are imposed in collecting tax.

There are different types of taxes that need to be paid which are:

Income taxes

Payroll taxes

Sales taxes

Excise taxes

Wealth taxes

“Article I, Section 8, says: “The Congress shall have Power to lie
And collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the country”

Benefits and uses for tax

As mentioned above that tax pays for goods and services for the public such as:

Education

Public housing

Public welfare such as security

Unemployment benefits

Highways and public transportation

Health

Police

Fire protection

Tax also includes daily operating expenses of the government and also salaries of the government employees and also interest on debt owed by the government. It is highly important as the benefits of tax keep the country in place and running and also reaching out to the people who are unable to afford from themselves. The roads we walk and drive in everyday is because of the tax that is being paid, the public clinics and hospitals that help our people to get treatment and be attended to when they cannot afford when they are sick is because of tax and the list goes on but all in all it is beneficial for the country for tax to being paid.

Responsibilities of income tax payers

The income tax system is a voluntary act and compliance but it does not mean that tax payers can only pay tax when they want to or not pay tax when they also don’t want to. In other words everybody who is working must pay tax and in order foe people to comply with the legal responsibilities the tax law must be fair and firm.

When looking at being fair, the government must be fair enough as to the people paying tax wont resent him as the government and the leader of the country and also resent paying tax at the end of the day and making sure that everybody complies. When looking at being firm, people who don’t comply with this law and try to duck it must be punished and made seen that they are committing a criminal offence and should pay dearly for such action.

Penalties for Tax Fraud

In most cases people who don’t pay tax are due to carelessness or negligence or usually done intentionally and find ways to avoid paying tax which is seen as tax fraud and these people are faced with tax interest or tax penalties. Tax fraud is when people who avoid paying tax and are not honest to the government about their monthly/annually incomes so they can be taxed fairly with regards to how much they earn and they lie in-order to pay little tax which becomes unfair to the government and all other tax payers.

Tax fraud is a crime and people who commit such crime face high consequences close to about 75 percent financial penalties. There is no way of ducking and hiding from paying taxes because eventually everybody is caught just that it might not be now but when it comes to fraud and corruption someone always slacks up and leaves foot prints.

LABOUR RELATIONS ACT (LRA)

The labour relations act is the relationship between people who work and those who they work for. The labour relations act was reshaped and implemented to create a good and working-full environment in the workplace. To give an employer and a employee to work under good and fair principles knowing their rights and limitations and which lines not to cross. To protect the employee against the employer and to also protect the employer against the employee but in most cases employees are opening cases against their employers. it is hoped that democracy in the workplace will bring industrial stability, economic growth, and labour peace.

Dismissals of the Labour relations act

Chapter VIII of the LRA concerns unfair dismissals. Section 185 records that every employee has the right not to be unfairly dismissed. The term “dismissal” is examined in the section 186 and includes:

A termination effected by an employee with or without notice.

An employer’s failure to renew a fixed term contract when an employee has a reasonable expectation

Refusal of an employer to allow an employee to return to work after maternity leave.

Retrenchment

When retrenchment is introduced it is usually when a company is facing some financial difficulties and is done for the followings reasons, economic, structural or technical reasons and before retrenchment takes place a proper procedure needs to be taken in-order to allow for retrenctment which is as follows:

Consultation

Immediately when the employer has no other options but to apply retrenchment, he has to inform his employees buy holding up a mass meeting where everybody is present or he could hold individual meetings with the individuals who will be involved in the retrenchment.

Employees are allowed to interact with the employer and also suggest other alternative ways which could be looked into such as reducing working hours and also workings days, the appropriate method to be used for the people are to be dismissed. Minutes can be taken in this case as it would help for misunderstood situations and to protect both the employer and employees.

When consultation is taking place members of the trade unions can be present to protect their workers and all the commission for conciliation, Mediation and Arbitration (CCMA) can also be present to intervene in this matter.

Disclosing of information in writing

When complementing retrenchment the organisation or the employer should issue letters to the employees that will be affected because of retrenchment. The information should inform the employees of the pending and the dates of retrenchment, reasons why they will be intiating retrenchment, the servenrane pay that is proposed, the assistance of the employer with regards with interviews and assisting them in getting new employment if possible.

Should there be any misunderstanding or any disputes that could take place than the employer shall refer to the written information to clarify any mis-understandingand these disputes could be handled by the labour court or the Conciliation, Mediation and Arbitration (CCMA).

Opportunity for feedback

The employer should give employees the opportunity to give feedback with the proposed retrenchment that will take place, give them a chance to make presentations and whatever is said and presented must be taken inot consideration by the employer and try to negotiate as so all paryies are happy.

The last in 1st out rule should be applied when dealing with retrenchment as you can’t compare a person who has been working for a company for the past 3 years over a person who has been around the company for 2months. If the company is going through financial constraints and they wish to let go a few staff than they should consider the last recently employed staff.

CHAPTER 4
CHAPTER 5

Data collection

With the information gathered with regards to Miss Anonymouses case we can draw up the following checklist:

The company has been deducting tax from her salary

She received a monthly income

She enjoyed annual and sick leave, UIF and PAYE benefits

She has been working for the company for the past 3 years

She signed an employment contract of reinstatement in September 2009

There is no proof of her being registered by her employer under the Labour court

Data analysis

With the gathered information it shows that Miss Anonymouses was a full employee of the company which also makes her fall under the people who should be paying tax to the government every-month. Having a look at her payslip it clearly shows that money has been deducted for tax from her payslip and with her knowledge she has been paying for tax. Additional information has been found that she was has not been registered under the labour court meaning she can’t be taxed as they may not be aware of how much she gets paid which is would make it hard for the tax man to tax her properly. The company is at fault for using moneyof the employees for their own personal use and without their knowledge and this sot of behaviour does fall under fraud and corruption and is a crime.

She has been working for the company for over the past three years so if the company was going through any sort of financial problems and they saw using the retrenchment system as part of covering costs than they did not follow the proper procedures of dismissal, she was not even consulted properly or given a chance to discuss the matter and negotiate or think of other alternative ways to avoid such dismissal.

Re-solutions, suggestions

When referring to the case study, the best possible steps that could be taken here is that Ms Anonymous keeps all proof of her payments that she can represent to SARS, write each and every single thing said to her and if they is anything asked or told to ask for it in writing and signed for because in the country we live in anything is possible and to make life easy is having all proof and evidence just to be on the safe side.

With regards to unfair dismissal, she should take the matter to the CCMA and report the act of unfair dismissal because no proper procedures where taken so it is either they will have to compensate her even more or giver her, her job back if she is willing to take it back. Each and every employee has a right to be treated fairly in the working environment and legal action can be taken in situations like this.

CHAPTER 6
CONCLUSIONS

Fraud and corruption is everywhere and is triggered by greed of an individual and it reduces economic growth, quality of life and undermines government creditability and reduces effectiveness. The fight against them should be presented in a short period of time in order to fight corruption. Every federal department and agency should work together continuously. Audit and investigation s could find any corruption or fraud cases, but the most important thing is to define how to prevent and detect them at the earliest stage possible.

With reference to changes in government policy and ideologies of welfare, debate the significance of the shift from victorian ‘pauper’ to 21st century ‘service user’ and its impact on social work practice and values.

By charting changes in government policy and welfare ideologies, this essay will discuss the significance of the move from the Victorian ‘Pauper’ towards the 21st century ‘Service User’ and examine how this has influenced social work values and practice. But first, brief consideration must be given to offering a definition of these terms. The Oxford English Dictionary (2009: online) defines a pauper as somebody with no property or means of livelihood; who is dependent upon charity from others; and a beggar. Terminology has changed dramatically and the term ‘service user’ emerged in the 1990s as the generic name for people social workers work with (Pierson & Thomas, 2006: 560). In contrast to ‘pauper’, the Collins Internet-Linked Dictionary of Social Work by Pierson and Thomas (2006: 560) states:

“its popularity has spread among practitioners, managers and social work educators alike as it seems to convey the more contemporary emphasis on those who receive the service having some rights and influence over that service” (Ibid.).

All societies have methods of assisting those in financial difficulties (Payne, 2005: 13) and the 1601 English Poor Law was the first national welfare provision that lasted in one form or another for 350 years (Spicker, 2008: 78). However, in the 18th century, the Poor Law Report demonstrated the current allowance system was demoralising and promoted idleness (Fraser, 2009: 53). This, coupled with a proliferation of paupers and escalating relief costs, led to the Poor Law Amendment Act 1834 which heralded the introduction of workhouses, designed to deter everyone but the destitute from applying for support (Thane, 1996: 31). It was hoped by replacing outdoor relief with the workhouse, the faults of the current system would be corrected (Fraser, 2009: 55). Ultimately, it provided a harsh alternative to self-help that the pauper would only accept when destitute; and fearing the workhouse, they would hopefully find employment (Ibid.: 55-56). This was in keeping with the general social philosophy of the time that supposed “men were masters of their own fate and that the individual had within his grasp the power to find his own salvation” (Ibid.: 56). Those requiring assistance were blamed for their position and expected to find solutions to their own self-imposed misery (Sullivan, 1996: xiv). Therefore, the Victorian Poor Law divided the needy into the deserving and undeserving poor; with the deserving worthy of philanthropic assistance whilst the undeserving was punished for their feckless behaviour (Ibid.). In essence, the Amendment Act successfully forced able-bodied men to take responsibility for themselves (Thane, 1996: 33).

Throughout the 1880s charitable responses to suffering grew (Payne, 2005: 36) and the Charitable Organisation Society was established in 1869, aiming to persuade charities to organise resources so they were distributed to those best able to use them (Thane, 1996: 21). The COS was not an alternative to the Poor Law, but the flip side of the same coin (Payne, 2005: 36) and its principles encouraged people to become self-dependent and only helped those with potential to support themselves (Thane, 1996: 21). It provided charity for the ‘deserving’ and hence, left those without potential to become self-dependent to destitution or the Poor Law (Ibid.: 21-34). Furthermore, COS endeavoured to find lasting solutions to people’s problems, without removing them from their environment and pioneered the practice of case-work whereby investigations were conducted into clients’ backgrounds who were then helped if deemed worthy (Ibid.). Much had to be said for this case-work approach, which provided a real attempt to investigate the nature of the people’s problems (Ibid.) and essentially, through the development of this method, created social work (Payne, 2005: 38).

Many people following COS principles in theory found it challenging to abandon those in desperate need in practice (Thane, 1996: 23). Hence, dissatisfaction generated new voluntary approaches, including the Settlement Movement, which initiated modern community work (Ibid.). Residential settlement Toynbee Hall was established in 1884 where graduates would live and work among the poor; a model replicated throughout the country by the end of the century (Ibid.). It aimed for them to utilise their moral example and education to foster social development (Payne, 2005: 37) and its warden Samuel Barnett believed class harmony and material improvement would only improve when the rich regarded the poor as equally worthy individuals (Thane, 1996: 21).

Moving to the twentieth century, following the Second World War, fundamental welfare changes were introduced under the Labour government in accordance with a blueprint proposed in the 1942 Beveridge Report (Bochel, 2008: 192). Subsequently, the period from 1945 until the 1970s is considered:

“One of political consensus on key issues, stemming from a combination of the economic philosophy of Keynes, and the social policy of Beveridge, enshrining the ideas of the mixed economy and the welfare state” (Ibid.).

During this period it was assumed societies had progressed, rendering the state responsible for providing universal welfare provision for citizens (Payne, 2005: 50). Subsequently, the state established a range of social services in the new era of welfare capitalism and this social security was regarded as the instrument that would eradicate poverty (Sullivan, 1996: xiii-3). The welfare state was created to put welfare on a new footing (Briggs, 1961 cited in Spicker, 2008: 121) where everyone, not just the poor, had the right to access services (Spicker, 2008: 121). This contrasted starkly to when support was confined to the destitute and deliberately made unpleasant under the Poor Law (Checkland & Checkland, 1974 cited in Spicker, 2008: 121) and this commitment to universalism provided an obvious change from the past (Sullivan, 1996: 54). Moreover, social work was becoming accepted as part of universal welfare provision alongside health, housing and social security (Payne, 2005: 50) and in the 25 years following the war, a gradual professionalizing shift occurred (Lymberry, 2001: 371). Subsequently, following the 1968 Seebohm Report and the 1970 Local Authority Social Services Act, the three existing personal social services were reorganised into unified local authority departments (Sullivan, 1996: 195-196). It was hoped this would “provide a more co-ordinated and comprehensive approach to the problems of individuals, families and communities” (Seebohm Report, 1968 quoted in Lymberry, 2001: 371). Fundamentally, this was a period of proliferation and consolidation for social work with the hope it would contribute towards creating a more equal society (Lymberry, 2001: 371).

This movement to the welfare state from the Poor Law is referred to as the progression to ‘institutional’ welfare from ‘residual’ provision (Wilensky & Lebeaux, 1965 cited in Spicker, 2008: 92). Residual welfare catered for a limited number of people, was provided under sufferance and regarded as a public burden (Spicker, 2008: 92). Furthermore, the Poor Law was punitive in nature, limited liabilities through deterrence and deprived paupers of their rights (Ibid.). Contrastingly, institutional welfare covered the general population’s needs, regardless of their financial circumstances, and offered protection to everyone (Ibid.). It was built on accepting mutual responsibility, considered dependency to be normal, and was based on the premise of a right to welfare and citizenship, (Ibid.). Theoretically, this universalism provided the only way to guarantee high quality of services were available for all and removed the stigma associated with state services (Sullivan, 1996: 54).

During the two decades after the war, governments believed in Keynesian demand management techniques and Beveridges social ideas (Ibid.: 90). However, from the late 1960s these economic policies failed and the UK faced a fiscal crisis of the state (Ibid.). Subsequently, when the Conservatives were elected in 1979, the ideology of the New Right dominated and heralded a change from the post-war welfare consensus (Lymberry, 2001: 372). This period was characterised by Neo-liberal thinking, which fundamentally questioned the state-delivered institutions forming the welfare state, and these beliefs have affected policy-making and the welfare system during recent decades (Ellison, 2008: 61-67). For example, Thatcher’s government was dedicated to rolling back the state and denying mutual commitments among citizens because allegedly society did not exist but comprised of competing individuals instead (Lowe, 1999: 307). They aspired for those dependent on the state to become independent because:

“If those in need were encouraged to look passively to the state for help, they would be denied the invigorating experience of self-help and of family or community care” (Ibid.).

Therefore, the New Right were committed to re-moralising society, just as Poor Law reformers of the 1830s had before them, with a return to Victorian values (Ibid.). This generated a reduction in benefits and conditions stipulated for accessing these were toughened (Clarke et al., 2000: 3). Furthermore, an increasing stigma was attached to publicly provided welfare and it was, in some respects, criminalised by linking US notions of ‘welfare dependency’ and ‘demoralisation’ to UK ideas of ‘scrounging’ and ‘undeserving’ (Ibid.). Fundamentally, welfare had come full circle when:

“Individualism as the motor of economic and social policy in the nineteenth and early twentieth century’s gave way to the collectivism of that classic welfare state only to re-emerge in the late twentieth century” (Sullivan, 1996: xv).

New Right emphasis on the sanctity of marriage and family, the demonization of those who threatened these and their promotion of a social order based on ‘Victorian values’ impacted on social work (Lymberry, 2001: 372). It was forced to abandon its pretensions to providing a universalist service and focus on statutory duties, omitting the preventative remit laid out in the Seebohm Report (Ibid.). Furthermore, it underlined individuals looking after themselves and their families (Bochel, 2008: 194). Subsequently, social work changed after the Barclay Report of the 1980s, which introduced community social work strategies and encouraged local authority social services departments to develop alternative ways of meeting social need (Sullivan, 1996: 196). This approach envisaged moving from the traditional one-to-one focus towards facilitating self-help by communities, social networks, and individuals (Ibid.). Moreover, it heralded the movement of social workers from therapists to enablers, supporting informal carers instead of providing the care themselves (Ibid.).

When looking at New Labour and their ‘Third Way’ approach, a decisive shift has occurred in the role of the recipients of social work services. For example, Blair (2000 cited in Jordan, 2001: 529) intended to change the welfare state from delivering passive support towards active support, promoting citizens independence instead. Taking the middle ground between free-market principles of the Conservative years and old style socialism it meant services would demand more from citizens, requiring people to contribute to a responsible community (Jordan, 2001: 529-530). This tougher approach to welfare is evident in expecting many single parents, the disabled, and those receiving employment benefits to actively seek employment (Ellison, 2008: 67). Additionally, benefits are now less generous and more strictly means-tested than in the height of Keynesian welfare (Ibid.).

Furthermore, the development of anti-oppressive practice signals a change in the attitudes towards the role of users of social work services. Anti-oppressive practice has emerged over the last decade, forms part of the critical social work tradition, and is concerned with transforming power relations at every level in practice (Healy, 2005: 172-178). Theorists believe the social work role is political with social workers holding a privileged status in comparison to service users (Ibid). Therefore, social workers must be critical and reflective in order to not replicate oppressive social relations in practice (Ibid.). Furthermore, it promotes working in partnership with service users with power genuinely shared at both an interpersonal and institutional level (Dalrymple and Burke, 1995: 65 cited in Healy, 2005: 187). Thus, service users opportunities for participation in decision-making should be maximised (Healy, 2005: 187).

Social work has been affected by the unabated advancement of consumer capitalism and service users are expected to be more involved in arranging and managing services (Harris, 2009: 67). The New Right ideas emphasised that citizens had a right to freedom and choice (Ibid.: 68) and recent Conservative and Labour administrations have encouraged citizens to participate in welfare services; utilising market-like approaches to consultation and increased empowerment in decision-making (Bochel, 2008: 194). Efforts have been made to promote service user participation in planning and development with the view that their active role improves health and social care services (Carr, 2004: 2). Furthermore, the importance of individual choice in improving provider effectiveness, the notion of citizens rights and responsibilities and a belief that individuals involvement in decision-making results in solutions that better meet their needs have been underlined (Bochel, 2008: 194-195). This is evident in the Direct Payments scheme, endorsed on the basis of choice and independence, and demonstrates that the state increasingly expects citizens to be competent enterprising, managerial and autonomous individuals (Scourfield, 2007: 108). However, as Scourfield (Ibid.) asserts this raises concerns about dependent citizens and emphasises:

“a danger of using independence and choice as central organizing principles is to forget how and why the public sector emerged in the first place—to ensure that those who are necessarily dependent are treated with respect and dignity, to ensure a collectivized approach to risk, and to ensure that secure and reliable forms of support outside of the market or the family are available”.

Additionally, as Carr (2004: 2) found, the extent to which service user participation leads to improvements in services varies and there is little monitoring and evaluation of the difference user participation is making. Furthermore, despite citizenship, choice, community, social inclusion and autonomy being key to New Labours programme, (Blair, 1998 cited in Humphries, 2004: 95) Humphries (2004: 95) contends Labour’s pursuing of neo-liberal economic and morally repressive policies has degraded public services; punishing and excluding those “regarded as having been ‘given a chance’ but having ‘failed’”. She proposes it is social workers who are expected to implement the surveillance systems that operate these policies and under New Labour a shift has occurred towards social work having an increasingly negative and narrow practice focussed on restriction, surveillance, control and exclusion (Ibid.: 93-95). Thus, social work is concerned with the moralistic side of Labours policies rather than with empowering people instead (Jordan, 2001 cited in Humphries, 2004: 94). Moreover, since 1993, increasingly punitive and repressive measures have been introduced to deter asylum seekers from coming to Britain and if they are granted access they enter an inhumane and inferior ‘welfare’ system (Humphries, 2004: 100). Acts such as the 1993 Asylum and Immigration Appeals Act and the 1996 Asylum and Immigration Act removed those subject to immigration controls from the welfare state (Ibid.: 101) and Cohen (2003 cited in Humphries, 2004: 101) describes the asylum support system as the creation of a modern day poor law based on coercion and lack of choice.

This essay has documented the move from the use of the Victorian term ‘pauper’ to the 21st century term ‘service user’ by looking at shifts in government policy and welfare ideologies and its impact on social work. Looking back, one would hope we have progressed from the Victorian Poor Law that blamed the pauper for their need of assistance and deterred them from accessing support by rendering it as unpleasant as possible. However, when observing the stringent means-tested benefit system and New Labour’s tough approach welfare, ascertaining whether we have moved forward becomes questionable. Zarb (2006: 2), referring to how older couples can be separated due to housing and care allocation, questions whether citizens are still treated like the paupers in the Poor Law era who were regularly split up for not meeting the parishes criteria for support. Furthermore, to finish, Wynne-Jones (2007: online), writing on the Joseph Rowntree Foundation website, highlights that today the media still assigns different types of morality to types of poverty:

“The ‘undeserving poor’ are the Asbo kids and the hoodies, the drug-addicted and long-term unemployed. On the other hand, the ‘deserving poor’ look a lot like middle Englanders fallen on hard times”.

Having spent time with a group of troubled young people on a Peckham estate, following the death of Damilola Taylor in 2000, she believes that it is through the stereotyped comedy characters such as Little Britain’s ‘Vicky Pollard’ that Middle England reveals how threatened it feels about the ‘undeserving poor’; utilising comedy as a means of criticising our societies ‘underclass’ (Ibid.). She maintains that as Middle England laughs from the unease that people like this exist on our poorest estates, years on from Damilola’s death, we are still failing those, like the group in Peckham, who are “damaged so badly by life that their only empowerment is to attack others” (Ibid.). Therefore, to conclude, whilst a change in terminology has occurred moving from ‘pauper’ to ‘service user’, it is problematic determining how far attitudes towards those in need of assistance have genuinely changed for the better.

Reference List

Bochel, C. (2008) “State Welfare” in Alcock, P. et al., (2008) The Student’s Companion to Social Policy, 3rd Ed, Oxford: Blackwell.

Carr, S. (2004) “SCIE Position paper 3 Summary: Has service user participation made a difference to social care services?” available at http://www.scie.org.uk/publications/positionpapers/pp03-summary.pdf accessed on 17th December 2009.

Clarke, J. et al. (2000) “Reinventing the Welfare State” in Clarke, J. et al. (2000) New Managerialism: New Welfare? London: Sage.

Ellison, N. (2008) “Neo-Liberalism” in Alcock, P. et al., (2008) The Student’s Companion to Social Policy,3rd Ed, Oxford: Blackwell.

Fraser, D. (2009) The Evolution of the British Welfare State, 4th Ed, Basingstoke: Palgrave Macmillan.

Harris, J. (2009) “Customer-citizenship in modernised social work” in Modernising Social Work: Critical Considerations, Bristol: Policy

Healy, K (2005) Social Work Theories in Context: Creating Frameworks for Practice, Basingstoke: Palgrave Macmillan.

Humphries, B. (2004) “An Unacceptable Role for Social Work: Implementing Immigration Policy” British Journal of Social Work 34: 93-107 available at http://bjsw.oxfordjournals.org/cgi/content/abstract/34/1/93 accessed on 17th December 2009.

Jordan, B. (2001) “Tough Love: Social Work, Social Exclusion and the Third Way”, British Journal of Social Work 31: 527- 546.

Lowe, R. (1999) The Welfare State in Britain Since 1945, 2nd Ed, Houndmills, Basingstoke : Palgrave Macmillan

Lymberry, M. (2001) “Social Work at the Crossroads”, British Journal of Social Work 31: 369-384 available at http://bjsw.oxfordjournals.org/cgi/content/abstract/31/3/369 accessed on 22nd December 2009.

Oxford English Dictionary (2009) available at www.oed.com accessed on 23rd November 2009.

Payne, M. (2005) The Origins of Social Work: Continuity and Change, Basingstoke: Palgrave Macmillan.

Pierson, J. & Thomas, M. (2006) Collins Internet-Linked Dictionary of Social Work, Glasgow: Harper Collins.

Scourfield, P. (2007) “Social Care and the Modern Citizen: Client, Consumer, Service User, Manager and Entrepreneur” British Journal of Social Work 37: 107-122 available at http://bjsw.oxfordjournals.org.ezproxy.lib.le.ac.uk/cgi/reprint/37/1/107?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&title=Social+Care+and+the+Modern+Citizen%3A+Client%2C+Consumer&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT accessed on 24th November 2009.

Spicker, P. (2008) Social Policy: Themes and Approaches,2nd Ed, Bristol: Policy.

Sullivan, M. (1996) The Development of the British Welfare State, London: Prentice Hall

Thane, P. (1996) Foundations of the Welfare State, 2nd Ed, London ; New York : Longman.

Wynne-Jones, R. (2007) “Deserving vs Undeserving” available at http://www.jrf.org.uk/reporting-poverty/journalists-experiences/deserving-undeserving accessed on 16th December 2009.

Zarb, G. (2006) “From Paupers to Citizens: Independent Living and Human Rights” available at http://www.scie.org.uk/news/events/humanrights06/gerryzarb.pdf accessed on 17th December 2009.

Good Practice: Adults

This assignment will focus on a case from practice, demonstrating the challenges in promoting independence specifically in vulnerable elderly adults while balancing risk and autonomy. Furthermore, this work will demonstrate problem solving skills, drawing on legislation, research and principles of good practice in the context of Adult Services from an inter-professional perspective.

The Department Of Health defines a vulnerable person as:

“Someone who is or may be in need of community care services by reason of mental or other disability, age or illness and who is or may be unable to take care of him or herself against significant harm or exploitation.” (DOH 1999).

Background of case:

Mrs A is eighty two years old, has mild learning difficulties and lives alone in her own home since the death of her husband one year ago. She has a daughter who visits occasionally due to their difficult relationship. Mrs A was referred by her GP as she had been feeling unwell for some time; she has diabetes and sometimes forgets to take her medication. Mrs A has refused help in the past by various care services due to lack of trust and sees their involvement as an intrusion in her private life.

Working within the field of the elderly in adult social services is described as Gerontological Social Work (Nathanson and Tirrito 1998). There are specifics needs that older people experience, the more informed a social worker is about the elderly and their requirements the better chances are that the social worker will provide the right services.It is essential to gain a clear understanding of economic, social and cultural factors and life perspective followed by an understanding of the need for service.

The Valuing People policy is the first White Paper in almost forty years since Better Services for the Mentally Handicapped (1971).The aim then was to close large institutions and to integrate people into the community (www.mind.org.uk). Valuing People aimed to transform the lives of adults and children with learning disabilities through a person-centred approach and to enable people to become empowered in order for them to be included in society. This policy is one in a series of policies that are an example of the political driver of change such as the White Paper, ‘Our Health, Our Care, Our Say: A New Direction for Community Services (2006) that are aiming to transform social care and to give service users more choice and to make the system more personalised (Johnson & Williams, 2007).

The 1989 White Paper, ‘Caring for People’ states the duties of local health authorities to assess people needing social care and/or support. It is based on the assumption that community care is the ‘best’ form of care available. The White Paper states that the proposed changes are intended to, first of all, enable people to live as normal a life as possible in their own homes or in a homely environment within the community. This is especially important in the long-term needs of the elderly, whom have long expressed their wish to be able to stay in their homes. Furthermore, local authorities must provide the right amount of care and support to enable people to achieve maximum independence and provide people with a greater say in their lives and the services they need. This is particularly significant with elderly people. Many older people are not in need of 24-hour care that a nursing home would provide they may just need a small amount of help, maybe for a couple of hours a day.

Although the majority of people over the age of 65 live independently and have no major care needs, a significant minority do have some problems with physical and mental health. 1 in 10 elderly people suffer from forms of senile dementia. It can be seen that it is simple day-to-day things that most elderly people require assistance with. Their main wish is clear; they simply want to stay in their own homes or in the homes of their family. (HMSO 1989).

The Social Worker requires Mrs A’s consent to an assessment and if eligible, a care plan, while making it clear that she has the right to refuse. When working in partnership with a service user and their family, the worker needs to take account of Trevthick’s (2002) fifteen points to effective partnership working. These include explaining to the family their role and power to intervene. A clear mandate is the basis of a partnership-based intervention and sensitivity given to power imbalances involving family consultation and participation in decision-making and problem solving (Bray 2001). The whole team working with Mrs A have a duty to be aware of her individual rights to confidentiality, choice, dignity, respect, autonomy, cultural, and equity.

“Elderly people need to be active participants rather than active recipients. The task is not to look after, but to motivate, empower and promote self-esteem.” (Hughes et al 1995).

A number of vulnerable adults are oblivious to the fact that they need any help; therefore it is essential that when a concern is highlighted, it is acted upon instantly to prevent the situation deteriorating. Many adults are also too proud to ask for help and as a result recognition of their vulnerability is only identified as shown in Mrs A’s case by a GP. Detection of vulnerability may also be triggered by an admission to hospital or a concernedfriend or family member contacting the social services department. During a visit by the social worker, it is clear that Mrs A had been seriously neglecting her needs; she is underweight and neglecting her hygiene. The misuse of medication is in itself a risk of covert self abuse, and could have resulted in her death.

Abuse can take place in many different contexts and it is important not to exploit a vulnerable persons civil rights. Mrs A has mistrust with other people becoming involved in her life. Therefore when and how to intervene builds on the concept of significant harm introduced in the Children’s Act. When making an assessment of an individual, many factors need to be considered, for example, the extent of vulnerability and risk of repeated acts that meet the criteria of the Community Care Act 1990. To ignore the assessment of older people can be an example of ageism in its own right, contributing to an elderly person feeling disempowered.

Assumptions about older people include older people are poor, lonely, are ill, no longer contributing to the economy and seen as a burden. When working with older people it is important not to make these stereotypical assumptions and generalise. Not all the elderly have the same characteristics; a sixty five and a ninety year old are classed as one group. “Although aging is inevitable, and people experience similar patterns and problems of aging, there are also wide-spread differences in aging patterns” (Applewhite 1998:5). Acknowledging that each individual will be at a different stage in his or her life, needs and circumstances will vary, including different ethnic minority groups to avoid making ageist assumptions and avoiding all stereotypes and stigmas. To work effectively with older people, one must develop anti ageist practice. Midwinter (1993) says that old age is like having returned to a second childhood where others will make decisions for you.

Working in partnership, the Social Worker and the GP/nurse may encourage Mrs A to engage respite care (enablement) for up to six weeks to avoid being admitted to hospital. During respite care an assessment of her needs will evaluate the level of support that will be required (if any) when Mrs A returns to her home. Mrs A’s daughter may request that her mother be put into a care home, while Mrs A is adamant that she can care for herself at home with some support. Within the risk assessment process family members may worry about the social worker’s ability to recognize potential risk for their relatives, therefore a balance between extending barriers in some areas of risk and minimizing risk in others areas needs to be made. Using a utilitarian approach, it is the social workers job to assess the whole situation and work for a solution in the best interests of all concerned. (Banks 2001:28). The Social Workers ultimate aim is to support Mrs A’s rights to control her life and make informed choices about the services that she receives (GSCC 1.1).

Good practice dictates working in partnership with service users to encourage greater trust and empowerment of clients. In turn, they are likely to feel more confident in talking about their fears, and worries and possible abuse. Health and Social care agencies working together is only a part of an overall strategy to protect vulnerable adults from abuse. Enabling service users to recognise abuse and knowing how to alert others to this is another strategy. It also ensures an agreed approach that all involved are aware of and can monitor. Protection is provided by the clarity of the situation. It is important that health and care social workers act as good role models in terms of worker-user relationships as this helps the service user to recognise when the relationship is abusive. In addition, it is important for professionals to enable service users to know how to protect themselves, such as building positive self-esteem through knowing their rights and knowing how to complain. (Public Interest Disclosure Act 1998).

An Adult Protection policy will identify and help support Mrs A’s decisions for her care and help her to understand risks and the services available to her. The social worker has to constantly question their own judgement and ensure they listen to the service user’s view while assessing if Mrs A is capable of making an informed choice taking into account her rights and the needs of her family. It is a requirement to assess if Mrs A has the capacity to make her own decisions and if she is incapable by reason, for instance, of mental illness under the Mental Capacity Act 2005, the decision will be made for her. If it is deemed that Mrs A has capacity she has the right to live in whatever way she chooses; should her choice includes staying at home without help from services her health could be at risk and she may enter a ‘revolving door’ policy in and out of health care provision.

Providing support to Mrs A does not eliminate her susceptibility. If an individual is living alone and receiving services to support their needs, they still have a level of vulnerability. Elderly people at home are more at risk from abuse by strangers than if they were living in supported accommodation. They are at risk from people calling and gaining access through force or intimidation, who either steal from them or charge very expensive rates for minor repairs. They are also at risk from physical and sexual abuse as there is no one there to stop the perpetrator. Mrs A has health and social care needs and is seen to be at risk from self-neglect and possibly neglect by others, including services if insufficient or inappropriate support is provided to adequately support her well being. (Pritchard, J 2008).

Home may be Mrs A’s choice, however the assessment will consider balancing risk and autonomy. The social worker can identify Mrs A’s strengths and skills and identify ways in which these can be improved upon. There are services available that can supply security systems to protect from theft, and physical abuse, and other environmental variables, these are implemented with clear guidelines and the coordination of multi agency workers, working together to deliver a programme of care in the best interest of Mrs A’s needs and individual choices. Parsloe (1999) stresses that there is a strong presumption that older people should exercise choice and be given opportunities to take risks towards maintaining their independence and self-determination unless or until their capacity to do so is seriously impaired. This notion is acceptable, but as seen with Mrs A there is also a high risk of illness due to poor self medication; this is sometimes overlooked as the risk-taking model is more promoted than risk minimisation. People are allowed to take a well-informed risk so long as they do not endanger themselves or others GSCC (2002). A presumption in this case is that Mrs A has capacity: the challenge here is to recognise that service users ‘have the right to take risks and helping them to identify and manage potential and actual risks to themselves and others; (GSCC 4.1).

The provision of the practice setting is governed by law which consists of primary and secondary legislation together with government guidance which must be followed by all local authorities. Section 46 of the National Health Service and Community Care Act (1990) sets out community care plans and lists the available services which include laundry services, meals on wheels, social work support and residential care. This act places a duty under section 47 on social workers to conduct a needs-led assessment if it is apparent that a person might need community care service.

Once a community care assessment is carried out, the care manager will make a decision about whether to provide support or not to the service user. Fair Access to Care Services (FACS) provides an eligibility framework for adult social care to identify whether or not the duty to provide services is triggered. Should the criteria be met, a multi disciplinary team approach working together to ensure Mrs A’s choice to stay at home is paramount with regard to her rehabilitation and care plan. The team have a duty to provide a network of support that promotes independence and to monitor Mrs A’s ability to care for herself in the community. Multi-agency working of care planning and the single assessment process has encouraged greater inter-agency working together, with the client’s needs being central to the process. Rather than working separately, and each agency providing their own service without reference to the others, joint working encourages a sharing of approach and less replication of services.

A pilot of Individual Budgets was introduced for two years in 2005 to 13 local authorities. Individual Budgets is a system that brings resources together from different funding streams into a single sum that can be spent flexibly in accordance with a service user’s needs and preferences. Service users are free to choose the money as a direct payment or request the local authority to provide services, or even use a mixture of both A care worker can be sought from the LA or a personal assistant (PA) appointed by Mrs A , paid for with direct payments ensure that her autonomy and choice is maintained. In practice, an agreement can be made to review Mrs A’s care and remove the care if it not required or increase the care package should additional need be identified at a future review.

Direct payment stems from the four principles of Valuing People that are rights, inclusion, choice and independence. The Government’s vision was that the uptake of direct payments would give people more choice in how they choose to live their lives. However, the uptake of direct payments since the introduction of the Community Care (Direct Payments) Act (1997) had been slow, mainly due to a lack of awareness and people, including professionals, can be very wary of change and taking on the unknown.The government therefore introduced new legislation in 2003 to make it a duty for local authorities to offer direct payments (www.dh.gov.uk), but figures (2006) reveal that out of a possible million people only around 46,000 had taken up direct payments (www.eastern.csip.org.uk). It raised issues that service users experienced and set out eleven objectives which included people facing lack of choice and control, social isolation, housing, health, and poor partnership between professional agencies, voluntary groups and families.

The main stakeholders from the implementation of Valuing People are people with learning disabilities themselves and their families/carers, as they were instrumental in pushing the government to push through the policy.The government is clearly one of the main stakeholders and it could be argued that this was an economic driver of change. Latest figures from the Individual Budgets Pilot study reveal that the costs of people using budgets compared to commissioned services is not much different, but long-term, costs will be reduced as people become more independent and their support hours are reduced (www.dh.gov.uk).

The introduction of ‘Putting People First’, published by the DH in December 2007is a shared vision and commitment to the transformation of adult social care over a period of three years. Key elements are: prevention, early intervention and re-enablement, personalisation, information, advice and advocacy. This presents change for people who receive services and importantly for social care workers that will need to implement these changes in their work. The changes in social care that have been taking place since the policy have meant that the role of the social worker is changing and the publication of the Local Authority Circular “Transforming Social Care” (2008:4) described the role of the social worker as being “focused on advocacy and brokerage, rather than assessment and gate keeping”. This involves improved skills in listening, working in partnership with service users, families and other professionals and empowering people to take control of their lives. The changes are proving challenging because it means a shift in the balance of power and allowing people to take more risks. A person-centred approach to supporting Mrs A is the method used within this case study, before direct payments this had been more about supporting people in the community.

The principles ofrights, inclusion, choice and independence set out as the vision in Valuing People have clearly been achieved in some people’s lives, and is effective for service users such as Mrs A who prefer to maintain their privacy at home and choice of care through direct payment. It can be seen to transform service user’s lives in that they are living independently and feel included in society.There are many people living in residential care; they spend most of their hours in centres and lead very oppressive lives.McCabe,M. (2006:12) describes the failings of institutional care as having “inflexible routine, lack of choice, dependence on others and lack of privacy” and community care creating maximum dependency.However, care needs to be taken so that people are still supported when they do live independently, specifically service users who have spent years in residential care and not prepared them to live in their own homes; adequate risk assessments are needed to address any areas that could leave them vulnerable.

References

Applewhite, S. (1998) Elders and the Twenty-First Century. Issues andChallenges for Culturally Competent Research and Practice.New York: Haworth.

Banks, S. (2001). Ethics and Values in Social Work 2nd ed. Basingstoke, Hampshire: Palgrave Publishers.

Department of Health (2001) Valuing People. London: Department of Health.

Department of Health (2001) National service framework for older people. London: Department of Health

General Social Care Council (2002) Codes of Practice General Social Care Council

HMSO (1989) Caring for People: Community Care in the Next Decade and Beyond. London, HMSO

Johnson, K. Williams, I. (2007). Managing Change and Uncertainty in Social Work and social care. Lyme Regis: Russell House Publishing Ltd.

Jones. R. (2005) Mental Capacity Act. Manual, Sweet & Maxwell cited in Pritchard, J (2008) Good Practice in the Law and Safeguarding Adults: London, Jessica Kingsley.

McCabe,M.(2006) Depression among older people: prevalence and detection. International Journal of Geriatric Psychiatry 21(7)

Thomas, A. (2008) Leadership and Management in Health and Social Care Heinemann

Midwinter, E (1993) Encore: Guide to Planning a Celebration of Your Life: Southampton, Third Age Press

Nathanson, I. Tirrito, T. (1998) Theory into Practice. Gerontological Social Work. New York: Springer.

National Assistance Act 1948 London, HMSO.

National Health Service and Community Care Act 1990 London, HMSO.

Parsloe P. (1999) Risk Assessment in Social Care and Social Work. London, Jessica Kingsley.

Public Interest Disclosure Act 1998 London, HMSO

Shakespeare, T. (2000). Help. Birmingham: Venture Press

Trevithick, P (2002) Social Work Skills – a practice handbook, Buckingham, Open University Press

Introduction

Food is a necessity for life, yet millions of people every day go without it, due to a lack of global food security. Food has been used for millenniums to bring people together, yet there are people in poverty every day that don’t know where their next meal is coming from. With the population steadily growing, now is a more important time than ever to eradicate hunger around the world.

Description of the issue

With the population set to have increased by more than 35% (Foley, 2014) in 2050, we will be faced with the reality of having to feed nine billion people. For this to be achievable, crop production would need to double, as it would have to significantly outpace population growth. With millions currently starving around the world, global food security doesn’t seem achievable. However, if we work together and are guided by the principles of human flourishing, the agriculture industry should be able to grow alongside our population, eventually resulting in food security for all.

Reasons why this issue is one associated with social justice

The United Nations (un.org, n.d.) defines social justice as “an underlying principle for peaceful and prosperous coexistence within and among nations. We uphold the principles of social justice when we promote gender equality or the rights of indigenous peoples and migrants. We advance social justice when we remove barriers that people face because of gender, age, race, ethnicity, religion, culture or disability”.

Food stability is an issue associated with social justice due to the millions of people starving around the world every day because of a lack of access to food, or an inability to purchase it. Food is a necessity to live, and therefore should be available to all, regardless of geographic location, economic status, or any other disability.

Stakeholders involved in this issue and analysis of their perspectives

Scientific research and development bodies play a vital role in the issue of food security going forward. Global partnerships such as CGIAR work towards research for agricultural production in the developing world. Their aim is to “identify significant global development problems that science can help solve; collect and organize knowledge related to these development problems; develop research programs to fill the knowledge gaps to solve these development problems; catalyze and lead putting research into practice, and policies and institutions into place, to solve these development problems; lead monitoring and evaluation, share the lessons we learn and best practices we discover; conserve, evaluate and share genetic diversity; and strengthen skills and knowledge in agricultural research for development around the world” (CGIAR, n.d.). Through their aims, they hope to achieve four main goals: reduce rural poverty, improve food security, improve nutrition and health, and have sustainably managed natural resources. CGIAR believe that science can make radical changes to the current issue of food security, and it has been cited that “one dollar invested in CGIAR research results in about nine dollars in increased productivity in developing nations” (CGIAR, n.d.). Partnerships and bodies such as CGIAR want the current situation in regards to food security to change, as they realized that the present condition is neither sustainable, nor fair, and while it may not be easily fixed, scientific breakthroughs make the issue of food security appear to be one that can be solved.

Farmers make up for 60% of the worlds population (apcentral.collegeboard.com, n.d.), yet they are constantly under threat from large corporations buying up their land. Many countries also face the issue of how to ensure increased efficiency in farming the land we already have, as Foley (2014) states “most of the land cleared for agriculture in the tropics does not contribute much to the world’s food security but is instead used to produce cattle, soybeans for livestock, timber, and palm oil. Avoiding further deforestation must be a top priority.”

There are currently “yield gaps” between existing production levels and those possible in areas such as Africa, Latin America, and Eastern Europe. “Using high-tech, precision farming systems, as well as approaches borrowed from organic farming, we could boost yields in these places several times over” (Foley, 2014), which is important in providing more food to the world, while not increasing the size of the agricultural footprint. If farmers were able to invest in these technologies, such as subsurface drip irrigation, cover crops, and mulches, there may be a high upfront cost, but they would be producing more, which would lead to them increasing their profit once the produce is sold. With a higher profit, these small farmers may be able to better stand their ground against large corporations. These methods of organic farming are also more environmentally friendly, which is important as issues such as climate change have a large impact on agriculture.

While it is often believed that small farmers are better, putting more heart and soul into what they do, there is still a role for multinational agribusinesses in the road towards food security. Many of these businesses, such as Monsanto, have been working to develop products, and methods to help farmers grow more on the land they have.

Agribusinesses work closely with the scientific research and development bodies, as they are often the largest investors. Companies, like Monsanto, have spent millions on developing agricultural innovations in key areas, such as breeding, where they select the more desirable traits from existing plants; biotechnology, where they add these beneficial traits into the DNA of another plant; integrated farming systems (IFS), which helps farmers utilise the resources they have for maximum yield, while reducing the amount of wasted resources; and chemistry, where studies are done to minimise environmental impact of herbicides, while still protecting crops from pests (Monsanto.com, n.d.).

Companies like Monsanto recognise that they need to invest further in agriculture, as the lack of food security means that they are being badly perceived, and largely blamed, due to their for-profit nature, and their use of terminator genes in their seeds, leaving a heavy financial burden on farmers, as they are unable to use the seeds again for next year. Many foods are already genetically modified, but Monsanto’s lack of ethical boundaries in doing so (such as the terminator gene to boost their profits, and crops that will only work in conjunction with their other products to gain and to capture a captive market), has resulted in public outcry against the corporation worldwide. Protest against the company has come from all corners of the globe, not just the United States, and Australia, as it is the farmers in the developing world that are most effected. These sort of issues need to be addressed if we are to produce enough food for the growing population, as all farmland needs to be utilised efficiently, not just those farmers who can afford it.

Analysis of the issue in relation to the common good and the principles of human flourishing

The common good can be defined as benefiting everybody in the world. Human flourishing comes from the Greek word eudemonia, which is a core idea to Aristotelian philosophy. It promotes the idea that by working together, and finding meaning in our lives, we will flourish as a whole. The principles of human flourishing guide us in ways we can work together and find the meaning we need to achieve this.

Global food security is an issue affecting the word, where the current injustice of the many people left malnourished needs to be responded to at a global level. The common good urges us to work together in collaboration to take responsibility for those around us, and pursue conditions in which we can achieve a life that is good for all, not just a majority. In order to achieve this, we must fight against injustices, such as Monsanto’s mistreatment of small farmers, at both local and global levels. Charity organizations can only do so much to help, and promoting the common good often challenges many current social values, and social structures that allow these injustices to take place without government interference.

The main principles of human flourishing relating to the issue of food security is: the dignity of the human person, preferential option for the poor, stewardship of creation, and solidarity.

The dignity of the human person is an important principle in food security, as it promotes the rights of those who may not be able to bring attention to their needs themselves. Avocation is important, as it is often those who need the most help that are unable to ask for it. Many small farmers in Africa, Latin America, and Eastern Europe are struggling to produce enough food, not just for global consumption, but also for themselves. Due to their nature as small farmers and not multination businesses, their voice isn’t often heard when speaking out against the problems in the agriculture industry worldwide, such as Monsanto’s use of terminator genes in their seeds, which further disadvantages the poor.

The poor cannot afford to keep buying new seeds every season, often relying on the seeds gathered from last season to replant. This keeps costs low for small farmers, and allows them to increase their profit margin. Monsanto’s use of the terminator gene means that the seeds can only be used once, and often only used when combined with other Monsanto products. Monsanto has been suffering public backlash over these issues for years as a result. A preferential option for the poor would see governments and not-for-profit organizations providing resources, such as non-genetically modified seed, or fertilizer, to these smaller farmers, allowing them to kick start their production. This would utilize the land already cleared for farming, and reduce environmental impact as well.

Stewardship of creation is the principle of looking after the planet. Agriculture has already lead to “an area roughly the size of South America” (Foley, 2014) being cleared for crops, and even more land “roughly the size of Africa” (Foley, 2014) has been cleared as pastureland for livestock. This has resulted in the loss of whole ecosystems, and is not sustainable. Particularly with the rise of global warming, deforestation is not an option. In order for us to maintain the planet for future generations, we must use the land we have available more efficiently so we can still produce enough to provide food security. It is our responsibility to care for the planet, so it can care for us in return.

Solidarity is the principle that it is our responsibility to care for each other across racial, economic, cultural, national, and ideological differences, while promoting rights for every person. In order to accommodate their needs, we must first recognize that everybody is different; while there are people starving in developing nations around the world, there are also many homeless and hungry people right here in Sydney that require our help. Their needs may differ greatly, despite their common problem of a shortage of food. Solidarity is recognizing those abroad, as well as those at home, and working towards global food security together.

A proposed resolution for realising the common good

In order to reach global food security by 2050, we must take steps now to be able to achieve the common good. With scientific developments, we are able to better develop the land we already have available, allowing us to produce more without further damaging the environment. By utilising high-tech farming systems, we can work towards reducing the yield gaps we currently have, boosting the output from these areas, as well as providing a much more reliable source of income to these small farmers.

With the scientific research and developments that have taken, and are currently taking place, small farmers are able to better understand the best ways to work their land, not only to create a higher yield, but also to save and use resources more efficiently. This helps the environment, as up to 70% of water is used in agriculture, and also saves the small farmers money.

A big part of realising the common good is understanding our part in it on an individual scale as well. We may not be scientists or farmers, but by participating in actively changing our diet, we, too, can help global food security be achievable by 2050. As Foley (2014) states, “for every 100 calories of grain we feed animals, we get only about 40 new calories of milk, 22 calories of eggs, 12 of chicken, 10 of pork, or 3 of beef. Finding more efficient ways to grow meat and shifting to less meat-intensive diets—even just switching from grain-fed beef to meats like chicken, pork, or pasture-raised beef—could free up substantial amounts of food across the world”.

Conclusion

Global food security is an issue that affects us all. Agriculture is one of the oldest and largest industries in the world, but it still has a long way to go before it is able to cater for the growing population. However, the issue has been recognised, and together, we are working towards eliminating hunger, and providing food security by 2050.