Leadership For Health & Social Care Services
Person centred practice (PCP) or more commonly referred to as person centred planning is based on the principles of inclusion and taking a holistic approach when planning the care service delivery.There are five key features of PCP; The individual is at the centre of the plan.The plan will identify what is important to the individual and identify the individuals’ strengths and what support they will require to achieve their potential.
The individuals support network are involved in the ongoing planning and reviewing process. The plan will promote community participation for the individual.
The plan is a live document which is reviewed by all involved minimum every 6 months or when circumstances change. The care planning, monitoring and reviewing of care plans are key aspects to working with individuals and care workers. In line with PCP key aspects must be adhered to including legislation and policy to ensure the individual is at the heart of the plan & review process. However we must remember not to get caught up in the planning and administration process its self, we must remember the true purpose of the care plan. Such example of this can be seen by a quote from a Service User; “I don’t have a care pathway.
I have a life. ” (Scottish executive, 2005:5) Care plans must be done properly and all relevant parties involved. Some people may not know what a care plan is. When people don’t feel good they need support to be involved. After all, where’re planning their care and the individual must be at the centre of the plan. A Service User who contributed to the report Developing social care: service users vision for adult support, felt strongly that social care should be based on the social model; informing policy, practice and procedures (Beresford 2005).
The Department of Health clearly states that it supports the social model of disability (DoH 2008a). This social model is underpinned by a range of legislation and policy which steers the provision of person centred care. There are several Acts that underpin PCP. The human rights act 1998 sets a firm base line for pcp. The act covers the individual’s right to liberty and security, respect for private and family life, and the right for freedom of thought conscious and religion.
This act sets a firm base line for good practice in health and social care by underlining the needs of the individual are paramount and that everyone has the right to receive quality care. Age Concern quote (2008) “the dignity needs and wants of older people must be put at the centre of their care, and Human Rights are the perfect vehicle to ensure this and deliver quality care services” Whilst drawing up a care plan there are several legislations and policies to adhere to, below I have listed a few which have an integral role in pcp.
There is a statutory duty on public authorities to ensure they eliminate unlawful discrimination and harassment and to promote equality of opportunities between men and women. This is governed by the equalities act 2006 which makes it unlawful to discriminate on the grounds of a person’s sexual orientation, religion and beliefs when providing a service and exercising a public function. This act has established a commission for equality and human rights (CEHR) which is responsible for promoting the understanding of human rights and equality, also challenging unlawful discrimination.
The disability discrimination act 1995 main function is to stop discrimination for disabled individual, giving those equal rights and access to goods, facilities and services. This act states that providers are not allowed to treat the disabled less favourably because of their disability. Most companies and organisations that provide service, facilities or goods, be it either paid or free; both private and public bodies / companies must adhere to this act.
One aspect of the NHS and community care act 1990 is that local authorities must conduct a needs-lead assessment which takes into account a person’s preference making it pcp. On the other hand a resources-lead assessment only takes into account the resources available and not the individual. In my area of work an example would be an individual would be sent to a day service where their preference would be a sit in service which would be more appropriate. This example goes against all principles of pcp.
All care service providers are regulated by an independent body as outlined in the Care standard Act 2000. In Wales we are regulated by the CSSIW. This independat body carries out regular inspections to ensure compliance with all relevant legislation and one of their key focus is Service User quality of life which is closely linked to pcp. In addition to legislation there are numerous policies in place to ensure compliance with pc care. The white paper Valuing people (DoH 2001) stipulates that person centred approach will be essential to deliver real change in the lives of people.
Whilst this white paper is aimed at individuals with learning disabilities the principles can be applied to all types of care. The national service frameworks are long term strategies for improving specific areas of social care. PCP is a theme that runs through the white paper. We as care providers have minimum expectations which are required of us by the government; national minimum standards. These standards are not legally enforceable but are guidelines for providers and commissioners to judge the quality of a care service. There are many ways consent is established with individuals.
During a PCP meeting the individual may be able to make their wishes and expectations known clearly. In which case the Service User will give consent. On the other hand the mental capacity act 2005 is in place to empower individuals who lack capacity to make their own decisions. There are five core principles; It’s assumed an individual has capacity unless an assessment has taken place that determines otherwise.Individuals must be given appropriate support prior to making decisions (prior to a judgement being made to say the individual can not do so.
Individuals have the right to make an unwise decision, by making an unwise decision it does not mean the individual lacks capacity. When an individual is assessed as lacking in capacity, any decisions made for them must be in their best interest. Any actions that are result of an individual lacking in capacity must be the least restrictive in terms of their basic rights and freedoms. By applying all these principles in a MDT meeting a decision can be reached which will be in the best interest of the individual.
During the PCP/ MDT/ BIM the individual may have family, friends, HCP, advocate present to enable a holistic approach to the individuals care pathway. By using person centred practice positive outcomes can be achieved; by adopting all the above legislation, regulations, policies the individual will receive the level of care and support they require, as decided by themselves and people who have the individuals best interests as paramount to the individuals care. In my role I have reviewed all documentation in relation to the primary assessment our Service Users undergo prior to our delivery of care.
The assessment takes a holistic approach to the Service Users life, from mobility to cognitive function and is undertaken in the Service Users home with their preferred family member, social worker and any other health care professionals that have input into the Service Users life. Following a management and staff meeting and consultation with Service Users families and HCP to gather their feedback and views I have implemented changes to the documentation to make the assessment and subsequent care plan / file user friendly as needed by the Service User.
By implementing this I’m ensuring compliance with regulations and legislation. I support my team to implement person centred practice in many ways. Adequate training as detailed in the care workers professional development plan and led by example, I believe being the best. PCP is discussed at management meetings which is then cascaded down to the care workers through their team meetings and supervision sessions.
We have recently introduced a new format care plan, which I’m supporting the team leaders to complete using the active support model of care. During the recruitment process, all care workers undergo a 5 day induction period, during which PCP is introduced with the support of accredited dvd’s from Mullbery House and the new care worker is given the opportunity to demonstrate how they would apply pcp. Also a small library of reference books are available for care workers to loan for their professional development.
I have recently supported one of the team leaders to review the manual handling care needs of a new Service User, no-capacity, who’s family were not familiar with manual handling techniques, by using techniques that were not prescribed the Service Users was being put at risk of injury as were the family. During the primary assessment this was discovered and immediately reported to myself. In conjunction with the team leader we contacted the social service to arrange for OT assessment, also we submitted a VA1 to inspectorate reporting our safeguarding concerns.
During the OT assessment the Service User, family, social worker and our team leader was present to enable a best interest care plan to be drawn up. Several items of equipment were agreed and ordered, and care plan agreed by all. Several weeks later, the Service User is now in receipt of appropriate approved equipment and manual handling techniques which meets his needs. I have implemented a handover sheet for care workers prior to their delivery of care to new Service Users / from new care workers to ensure the Service User receives continuity of care.
The handover takes place between the primary assessor and the care worker. The care worker and assessor discuss the care plan and risk assessments. At the Service Users first call the care worker is introduced by the assessor. All the care workers are required to notify the office of any changes to the Service Users care needs or preferences immediately, care workers are also encouraged to discuss Service Users needs/ preferences during their 6 weekly supervision session. Care workers are made aware of changes to the care plan in the handover and during the monthly team meeting where all Service User changes are discussed.
I’m in the process of reviewing policies and procedures, which will ensure we are Service User led and not service led. Service user active participation has many proven positive outcomes. Active participation may lead to increased confidence and self-esteem, the chance to acquire new skills, and improved material resources if for example it helps them to acquire paid employment. Active participation leads to greater satisfaction (Department of Health & Farrell, 2004) and improved quality of life (Wallerstein, 2006).
For instance service users who have had greater control in decisions about the support they receive, report greater satisfaction and better health than those who have not. Beyond benefits to the individual, the participation process may also help create a stronger sense of community involvement. For active participation to succeed the culture of the company must allow for regular change and want to hear what the Service User has to say, take it on board and action it. All our Care workers are required to report to the office any feedback / comments/ changes from the Service User and the care work.
Within XXXXXXXXX all new starter undergo a 5 day induction period, one element of this induction is active support. The care workers are given an insight into active support. Further training is made available periodically, training is an ongoing commitment to the care worker professional development and the quality of service we provide our Service Users with. A good example of active support I like to use is, if the Service User enjoys cooking but is unable to bear their weight etc take the veg to them. The Service User may enjoy peeling the veg at the table or in their chair.
This enables the Service User to take control of their meal preparation, giving them a sense of purpose and satisfaction. When we receive a referral the Service User may have already undergone the 6 week enablement package of care, after their discharge from hospital. In line with the care plan we encourage the Service User to remain independent and re-able the Service User to achieve their aspirations. To promote Service Users to actively participate in all aspects of daily living skills, during the primary / review assessment risk assessments must be agreed.
This is not to prohibit the Service User from participate in daily living skills but to ensure we are supporting the Service user in a safe environment where risks have been assessed and minimised or where possible removed. During this process a person centred approach is paramount involving outside agencies, eg OT, family and friends, social worker, advocate. Adaptions, equipment, tele care etc may be available for the Service User to minimise the risk whilst promoting participation in daily living skills.