Unit 11 - Working in Health and Social care - SECTION B - SUBSECTION 2

Unit 11 health and social care

Section A – introduction

For my unit 11 coursework in health and social care I will be producing a report which will be based on two contrasting job roles in health care. I will talk about the jobs describing what they are and evaluating them in terms of sector, role and status. The two jobs I have chosen to do a report on will be a midwife and a care assistant. I will be carrying out research when evaluating on the above areas for both of my chosen jobs and interviewing the care assistant to get a more up close idea of their job role overall. Afterwards I will be evaluating my aptitudes to see if the job roles would be suitable for me and whether I would fit into that category. The reason I chose to write about a midwife for my job is because this I what career I hope to achieve in the future and figured it would be interesting to learn and write about. The reason I chose a care assistant however, was for the opposite reason as this is the job I would least like to do. I was however interested in their job roles and how they applied each sector to this.

Job role 1 – Midwife

Here I am going to be looking into the job of a midwife and the daily routine they follow within their job role.

Sector:

There are two sectors which any job could fall into; these are the statutory sector, also known as the public sector which includes health and educational services provided by the local government, and the independent sector.

Funding from the statutory sector comes mainly from various forms of taxation; this includes income tax, national insurance and council tax (for those services provided by the local authorities). However, the income taken from council tax is not enough to fully fund those educational and social services so local authorities are provided with funding from central government like taxation. Local authority services like domiciliary care have to pay part of this service cost. Most health workers are employed by trusts within the NHS where as most social services are employed by local authorities like county councils. Also job security within this sector is a lot more secure than they would have in any other sector for e.g. redundancy rate is lower and its harder to withdraw funding from hospitals for the government and if a hospital was to be closed there would be public protest and this would reduce the governments popularity.

Salaries in this sector are usually the result of agreements made between the public sector trade unions and representatives of statutory organisations, therefore jobs in this sector are not low paid and a salary scale is used to allow people to progress up the scale, e.g. the longer the person has been in the job the further up the scale they go and the higher paid they are. Job promotions can also be made for a worker to progress up the scale as those more experienced will be paid more than those less experienced. Pension schemes are also more valued in this sector than in the private sector and may have little influence over practices and policies within the job where as those that work alone more often will have more autonomy.

A midwife usually tends to be employed under health care trusts like the NHS which means their job comes under the statutory sector meaning the service is controlled by local government through taxation, working on hospital wards, maternity units, health centres, GP surgeries and within the community e.g. patients homes. The local government for this area that a midwife would be employed under and also have a pension scheme they can progress through is South Tyneside Council and South Tyneside Primary Care Trust. A midwife comes under the statutory sector mainly because without midwives people wouldn’t be able to give birth safely and serious complications could be caused and the care for both the woman and her baby wouldn’t be provided also there are risks that can arise without the professional care of a midwife.

The independent sector, hence the name, operates independently of national or local government organisations but must comply with legislation or government guidelines. Private, profit-making providers and non profit-making providers are the two service provisions that this sector can be split into.

Private, profit-making providers can be ran like businesses by individuals working as independent complementary or alternative therapists in private hospitals, nursing agencies, residential and nursing homes, nursery schools and special schools which have become privatised because of the NHS and community care Act. Funding comes entirely from those who use the services like individual clients, insurance companies and statutory organisations e.g. NHS and domiciliary care workers (social services departments). Profit is made by charging people more than the business pays for the treatment or provision themselves, therefore the employer for those working in this sector is the individual themselves. Pay and conditions vary in this sector due to different aspects such as demand of the job, nursing in a private hospital can be less demanding than in an NHS hospital, because clients in a private hospital don’t usually tend to be critically ill emergency cases or undergoing the most difficult surgical procedures. Job security can be lower because a private provider can go out of business if expenditure exceeds income or demand for the service declines and pension schemes are often less generous. A private hospital tends to concentrate on routine procedures such as cataract operations and hip replacements. Because private hospital clients pay for their treatment they tend not to treat socially disadvantaged people. Most services in a private hospital tend to be one-to-one sessions due to less people using the service because they have to pay, Midwifes can also be employed by this sector and the client would pay for one-to-one care with the midwife.

Role:

Main duties carried out by midwifes vary depending on which pay scale they are in, The higher up the scale they are the more duties they will be required to do rather than those in the lower pay scale performing less duties. A midwifes responsibility increases due to their progression which means the outcome of their pay will be determined by their duties. Some of the main duties a midwife will perform are written below.

Midwifes are to provide information and advice, caring and supporting women, their partners and families before, during and after birth and discuss with women the care and services they access e.g. place of birth, pain relief methods to ensure the mother is comfortable with the birth. It is vital that a midwife asses the mothers health and wellbeing needs, gives advise and motivates a healthy lifestyle encouraging surrounding family members to participate in the pregnancy, and in the birth for support, providing full antenatal care including screening tests that identify high risk pregnancies. Also it is important for a midwife to maintain accurate, existing and timely care records, both written and electronic, and participate in training providing supervision, refering, if necessary the mother to other health professionals to meet the individual needs. The should gain the skills, knowledge and competence to act as a responsible, independent midwifery practitioner within a supportive team and provide information and support about events that may occur during pregnancy, offering counselling if needed for events like miscarriages, termination, still birth and neonatal abnormalities. It is important for a midwife to promote a professional and happy environment conductive to high patient and staff morale, achieved by leadership, cooperating in all aspects of child protection, reporting any concerns to the named midwife for Child Protection and appropriate agencies, contributing to case conferences when necessary.

Providing information for parental classes as well as antenatal classes is an important part of a midwifes job, also providing support with the daily care of the baby with tasks like breast feeding, bathing and how to prepare feed up to 28 days after birth and lastly to supervise and assist labour using professional knowledge of pain management and drug use which is vital within a midwives job role.

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Skills:

There are a range of important skills and knowledge needed to pursue a career in midwifery. Skills needed by a midwife should vary depending on the different areas of their job. The skills can be put into categories such as the ones below:

People skills - many people will have babies so professional support is needed and reassurance to a huge diversity of women, during some of the most emotionally-intense periods in their lives.

Communication and observation – midwifes need to have good listening skills and communication skills to communicate with women their partners and families being able to speak, receive and give instructions without any misunderstandings, answering questions and recognise any needs the mother may have. They should be able to build relationships effectively via telephone as well as in person and in group discussions. Verbal and non-verbal skills are appropriate in different ethnic and socio economic group; not being judgemental.

Interest in the physical, psychological and process of pregnancy and birth – A midwife will need a professional understanding of child development. The midwife should have a genuine desire to help women and babies, also updating test and knowledge against experience

Team working skills – Working alongside other health practitioners also alongside parents and their babies as the better the communication the more easily the birth is likely to go. They should also be able to deal with the work load, using good concentration skills without being disrupted which allows the birth to follow more smoothly

Dealing with emotionally charged situations – being able to stay calm and alert in times of stress helping women to feel confident and in control and if something was to go wrong a midwife would have to be there to react quickly and effectively.

Management/supervision and co-ordination skills – Midwifes have to be able to negotiate and be extremely organised using leadership skills acting as mentors to any sort of trainee student and the mother. They need to have independent decision making skills and influence and persuade women.

Physical and written skills – Midwifes need to have good hand-eye coordination when carrying out vaginal examinations and episiotomy and being able to perform maternal and neonatal resuscitation. They also need to have good written skills to ensure communication is maintained and is understandable to be able to write reports, policies and keep patients records.

Emotional effort – A midwife should be able to cope with a distressing situation such as foetal abnormality and traumas such as still birth.

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Team work:

Team work plays a very important part in midwifery and is essential when working with other health care professionals in a multi disciplinary team to allow the best care for the mother and baby and their families who provide support also as they will have individual needs that must be met. Midwifes work with a variety of different health care professionals such as GP’s, nurses, community nurses, health visitors, social workers, physiotherapists, administration and many more. A midwife will have a named supervisor to allow them to gain new skills and knowledge to provide care a lot more effectively.

Status:

Public Approval - Public approval is thought to be highly valued by the general public, some job roles higher than others due to it being influenced over how useful the job is to them in particular. First impressions of a job can be strongly influenced by the media and how it is communicated towards the public. Those jobs that require a high level of qualifications tend to be classed as having a higher status than those with lower levels of qualifications for e.g. a care assistant in a residential home in contrast to a brain surgeon. Reports of medical errors or failures in child protection can reduce the public approval on their opinion of a doctor and social worker. A midwifes job status has a very high approval in society and is valued greatly by the general public for the care and support they give to women not only going through labour delivering their child but throughout the whole pregnancy including before and after birth. Reports have been made to show distressing situations for patients which the public may not approve of when a patient is being told:

‘British Journal of Midwifery’ states “We don’t have a bed for you at present, but there will be one available in three months”

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This statement changes public approval because if a midwife was to say this to a patient a patient may feel uncomfortable. There could also be a problem if the patient was ready to give birth and wouldn’t be able to wait three months for a bed. The public would start to refer to a different hospital that were more welcoming towards them and didn’t refuse them a bed. This would reflect badly on the hospital and more people would stop using their services.

Career progression:

Some employers may provide opportunities for in-service training which enables employees to improve their skills whilst still being paid. Working within the NHS allows people plenty of opportunities to progress their job role based on promotion as well as changing jobs altogether to gain more skills that may be needed. This can also lead to a higher paid job E.g. a qualified nurse, after a few years may train to specialise in fields such as health visiting or midwifery. A midwife has an opportunity to work in different health care settings to help gain experience and develop their knowledge on ...

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∙ A clinical specialist in an area such as home birthing, giving breast feeding advice, working on a labour ward supervising or doing ante-natal screening.

∙ Become a consultant midwife, dividing your time between midwifery itself, training and leading improvements within the practice.

∙ Higher management opportunities working towards the head of midwifery services or a supervisor of midwives with the local supervising authority.

∙ Becoming a specialist in ultrasound, foetal medicine, intensive care neonatal units, public health and teaching parenting education.

∙ A midwife could also choose to go into teaching or research within a healthcare setting or a university.

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Career progression depends partly on promotion and if the midwife is prepared to change jobs frequently (e.g. changing locations or moving countries etc.) this is where a midwife is more likely to progress further than a midwife who stays in the same place and waits for promotion.

Qualifications:

To work for the NHS ran by the local government a midwife at minimum will be required to demonstrate numeracy and literacy skills and a “pre-registration” qualification in midwifery which must be at degree level which is achieved by attending a three year full-time course. This allows them to become registered with the NHS and the nursing and midwifery council (NMC). If however, there is a qualified nurse who wants to change their job role to become a midwife, an 18 month part-time course can be carried out. These tend to be more adult nurses, which allows them to gain a degree in midwifery and to become a registered midwife.

Local and political factors:

This can affect the employment of midwifes in a number of ways. If the country has certain rural areas then unemployment will be high and there will be fewer job vacancies available. If the country was to grow economically this would ensure more job opportunities and employment would rise as sectors will expand as the government will be spending more money on them. If more money was to be spent in the statutory sector this will increase the number of midwifes employed who can therefore spend more individual time to have one-to-one sessions with their patients like a patient paying for a private midwife in the private sector. This however is not the case at this time, there is a high increase in births and there are not enough midwives within the NHS due to this.

Here are some examples of articles from newspapers stating a shortage in midwives and raising a concern:

‘Times online’ stating this, “UK: Shortage of midwives puts mothers and babies at risk”, “Research shows that many baby units are failing to meet targets for the number of midwives and that Labour’s promise is far from being achieved”

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‘Mail online’ stating this, “Shortage of midwives putting lives at risk”

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‘The independent’ stating this “A chronic shortage of midwives is putting the lives of women and their unborn children at risk, the Government was told today”

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‘The daily gazette’ stating this “Shortage of midwives sparks threat to maternity services”

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The level of affluence in an area can have a strong influence on the type of client a midwife will meet, in areas of greatest poverty and deprivation a midwife is likely to meet clients with multiple problems within the pregnancy than a normal pregnancy would have.

Also the increase in areas they want to work will depend on whether the worker is prepared to move homes as they would have more choice in a larger city, however living in a large city would involve much more travelling time than similar jobs in urban areas and this would make it more difficult when travelling to work than it would for to get to a job in a small town. Living in a large city e.g. London tends to be more expensive than in most other areas and to compensate for this expense workers in the public service job roles are higher paid. This could therefore effect the cost of living for a midwife as they have lower levels of pay compared housing prices and may not be able to afford to buy homes of those working in the business sector as they are not paid enough to move around and work at the hospital they wish to because of house prices rising rapidly.

An article from the ‘times online’ states:

“The price of a typical house increased by 0.9 per cent to £150,946 in March in contrast to February when month-on-month house prices fell by 1.9 per cent”

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This has effected where a midwife chooses to move to and be able to work in the hospital of their choice wherever in the UK.

“The average salary for a Midwife in the UK is: £22,839”

An article taken from ‘my salary online’ states: “In 2008, the average salary for a midwife was 17,500. The 2009 figure, as recorded above, is 22,839. This is a difference of 31% from 2008 to 2009. Figure based on 20 respondents in the 2009 UK data survey.”

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Another factor that can affect the availability of jobs for a midwife is the age of the midwife and training. Young midwifes who are just entering their career don’t tend to be as qualified as an older midwife with ‘more experience’ may not get the job straight away until one of the older midwifes have retired and there is an available space.

One other factor that can affect the availability of jobs for a midwife is the number births increasing in the UK the ‘guardian’ newspaper shows an article which states:

“The birth rate has climbed to its highest point in 13 years to an average of 1.8 children for every woman in England and Wales, the Office for National Statistics said yesterday.”

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A graph taken from the ‘telegraph’ shows the population increase in the UK due to immigration increasing by five million. The number of immigrants giving birth in the UK has increased a great deal and has had an impact on midwifes as there is more pressure on the service and demands for midwifes are higher.

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“Abortion rates among under-18s have risen steeply since 1998, when the Government introduced a target to cut teenage pregnancies.”

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Here is some graph figures showing the years and the age of the mother at conception and the rates going up taken from a sexual health website.

The figures on the graphs showing the births increasing at a younger age can have an impact upon midwifes because not only due to the shortage of midwifes but mothers giving birth at a younger age can be a lot more complicated and this puts a lot of stress of the midwives. Also the work load will go up with more people giving birth so this will add to the stress for a midwife.

Working conditions:

Pay:

For many health and social care workers salaries are paid on the number of hours they work in a week. A midwife pay is based in ‘bands’, a pay system where different staff within the NHS are paid. Below are some of the pay scales for a midwife:

The minimum salary for a newly qualified midwife working within the NHS starts at - £19,683. (Band 5).

However a midwife can progress up to band 6 which starts at £23, 458 after a minimum of 12 months working at band 5 and a maximum of 24.

A midwife can then progress up to senior level at band 7 e.g. those managing a team, having specialist knowledge, teaching midwifery or carrying out research, which starts at £28, 313 and can rise up to £37-326.

Salaries for those midwives who progress up to a midwife consultant may vary, starting at £43,335 in band 8A but can occasionally receive as much as £75,114 at band 8D.

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Hours:

Full-time employees typically work around 40 hours per week where part-time workers will only work around 20 hours per week including any job-share arrangements. Working hours for a midwife is likely to include unsocial hours. An average working week is usually 37.5 hours and is likely to include day and night shifts varying between the two. Community and independent midwifes are regularly on call 24 hours and they will also be on an on-call rota at some point in the working week.

Working patterns:

Some jobs follow traditional working patterns; most jobs being from 9am to 5pm. For example a school teacher would work these times. Many health care jobs involve shift work because staff are always needed at all times. In terms of working patterns, midwifery can be incredibly flexible. Shift work within a hospital ward setting can be on a full-time or part-time basis, and may be worked out around the hours most convenient for the individual, such as working nights only or an ‘on-call’ rota to make them available to be contacted in emergencies. Being a midwife involves day and night shift to make them available for patients and they normally work a mixture of shifts including:

Early shifts – from (7.15am to 3.15pm)

Late shifts - from (1.15pm to 9.15pm)

Night shifts – from (9pm to 7.30am)

Overtime:

Some workers welcome overtime as an opportunity to earn more money as sometimes it can be paid at a higher rate than normal working hours, the need for overtime occurs when there are subject to changes in the level of demand. Overtime is normally paid on an hourly basis, even for those receiving salaries. Midwifes work a lot of overtime due to the work load and not being able to complete their work within shift hours. An alternative to overtime is time off in lieu which is a whole day off when available but they cannot finish a shift early. Most midwives fine they, themselves will not take any time off due to shortage of midwives, and therefore are only paid for they contracted shift hours they work (37.5-40 hours per week). Some midwives will not be paid for the extra hours they are needed if demand is high.

Pension:

When a worker retires, if he/she is healthy, they can live up to at least 40 years and their quality of life from then on is determined by their income. An occupational pension makes a significant contribution to retirement income. A midwife working in the public sector will have access to a good pension scheme as contribution to the scheme are made by the employer and the worker and this makes it a little easier for the worker. A midwife working in the private sector usually buys into the scheme and pays into a pension provided by a profit-making financial institution. Some jobs don’t have a pension scheme where the employee has to arrange this individually. Midwives are entitled to a pension where the employer contributes and can be accessed when they retire, and most midwives would be covered by this when working in the public sector.

Holiday:

Depending on the job role, holidays will tend to vary. A midwife is entitled to a minimum of 27 days holiday per year but New Years Day, Good Friday, Easter Monday, Early May Bank, Late may Bank, Late Summer Bank, Christmas day and boxing day may also be split between midwives and classed as days off which can bring this up to 33 days holiday per year. If a midwife became pregnant themselves however, they are entitled to 27 weeks maternity leave which will be paid as if they are on normal working shifts. If they wish for any more time after the birth of their child they are entitled to an extra 26 weeks but this now becomes unpaid.

Job security:

Depending on the contract given in a job role, job security can vary. Jobs that are offered as permanent contracts are more secure than those offered as temporary contracts as a permanent job can only be ended if the worker decides to leave the job, retires, is made redundant because the need for the job is no longer there, or is dismissed for seriously breaching the employers or the work places rules and regulations, e.g. bullying clients or co-workers or racism. A temporary contract is often offered for around 6 months of a year for period where more staff is needed e.g. a Christmas period is a busy time of year, or in circumstances where they are a cover for an employee e.g. someone on maternity or paternity leave. A midwife has a high job security because the demand for midwives is high which means they are unlikely to be made redundant and they usually tend to have a permanent contract.

Anti discriminatory practice:

This is a practice that requires employers not to discriminate on the basis of gender, colour, creed, religion, learning ability, race, sexual orientation, disability (physical or mental) for any reason when recruiting workers or in working conditions for e.g. pay and pension, unless it would cause a danger to another person, e.g. the person could not for fill a task or meet requirements. Workers are usually treated equitably on the basis of gender to allow males and females doing the same or a similar job to be paid on comparable scales with equivalent opportunities for promotion. When a midwife applies to be a midwife there will be both male and female on the form to show that employers are not discriminating on the basis of gender. Research has shown that currently, “around 0.4% of midwives in the UK are male” and these should have the same opportunities as any female midwife

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Some of the anti discriminatory acts are listed below:

The Race Relations Act 1976 – This is an act put in order to prevent any discrimination, directly or indirectly on racial grounds in: employment, education, and housing, in the provision of goods, facilities and services. If a midwife was to use racial abuse towards a patient or a staff member, not only would this lower the public approval but it also puts their job at risk. A midwife needs to be polite when caring for a patient and make them feel as comfortable as possible to ensure the birth follows correctly and prevent any complications from occurring.

The Sex Discrimination Act – This is an act to render unlawful sexual discrimination on the grounds of marriage, sex, or gender reassignment. This provides protection for both genders in employment, training or education. A midwife should not discriminate any patient or worker for their sexuality under any circumstances. This would also reduce public approval rapidly and less people will feel like they want to use their service; they can also loose their job for discriminating against sexuality as with any discrimination. It is important that a midwife is polite to a patient no matter what and make them feel comfortable for the birth to run smoothly as it can be a complicated procedure and very stressful if the patient and midwife don’t work together.

The Gender Recognition Act - The purpose of the Gender Recognition Act is to provide transsexual people with legal recognition in their acquired gender. Legal recognition will follow from the issue of a full gender recognition certificate by a Gender Recognition Panel. If a midwife was to discriminate a patient or other worker for their genders this may make them feel uncomfortable and upset, it could also put their job at risk like any other discrimination and affect the way the birth turns out. Public approval again would be reduced and people would not wish to use their service.

The Employment Equality Regulations – this prohibits employers unreasonably discriminating against employees on the grounds of and of the acts above: sexual orientation, age, religion, and belief. A midwife should not discriminate against any patient or other member of staff in any way or form for any reason. If this was to happen a midwife would loose their job and reduce public approval a great deal which would prevent people from wanting to use their service.

These acts come into place when recruiting and when deciding what terms and conditions should be offered to an employee as well as when decisions are made about who should be promoted, transferred or receive training as well as to any decisions about terminating someone's employment.

There are also nursing and midwifery legislations that are in place for any midwife to follow when doing their job effectively.

The Nursing and Midwifery Order 2001 - This Order provides for the regulation of nurses and midwives and creates a regulatory body, the Nursing and Midwifery Council, which is required to set standards of education, training, conduct and performance and to put in place arrangements to ensure that they are met. It provides for the Council to keep a register of qualified nurses and midwives and creates four statutory committees: the Investigating Committee, Conduct and Competence Committee, Health Committee and Midwifery Committee. If a midwife’s performance was not to be monitored then their performance could drop and this could cause serious problems, it is vital that a midwife keeps up their performance at all times to ensure a smooth birth, making sure there are no health issues.

Criminal Records Bureau (CRB) - The Criminal Records Bureau (CRB) was set up to allow employers in the public, private and voluntary sectors to run a background check on all job applicants who they might be considering offering work to. Anybody intending to work in the healthcare profession is also subject to a CRB check. For example, GPs, nurses, midwives, surgeons, dentists, psychologists, osteopaths, vets, chemists etc, this is to provide a statement to show they have no criminal convictions to ensure the patients they work with are safe with the midwife and any other staff that may be present. It is vitally important that a midwife has a clear CRB to prevent any complications. One of the main qualities a midwife needs is patience and some mother giving birth can be abusive and even become violent so it is important for a midwife to be able to control a situation like this.

Midwifery Legislation - For any midwife this will be based on their ability to demonstrate that she/he has the required skills and abilities to practise the profession safely according to the national requirements. Midwifery legislation is the part of a nation's laws that relate to the profession and practice of midwifery. Midwifery regulation is the set of criteria and processes arising from the legislation that identifies who is a qualified midwife and who is not, and describes the scope of midwifery practice. Registration, sometimes called licensure, is the legal right to practise and to use the title of midwife. If an individual was to be employed by the NHS as a midwife who was not qualified to be a midwife this could cause serious complications as they do not have the skills they need to carry out the duties safely.

The Midwifes’ Act – this act regulates the profession of midwifery, requiring certification for midwives and providing a penalty for any woman practicing midwifery without certification, with the exception of legally qualified medical practitioners or those giving assistance in emergencies by the central midwives board which governs and trains midwives.

Data Protection Act (1998) – This act defines UK law on the processing of data on identifiable living people. It is a legislation that governs the protection of personal data in the UK. There should be a paper record and a computer record of the information which should be accurate and up to date according to the person’s right and kept secure. It should not however, be transferred to any other country without appropriate protection and allows the individual to access their personal data.

The Medicine Order (1980) – This order states that medicine is not to be prescribed or sold or supplied by a certificated midwife unless a prescription is given before hand by a qualified practitioner. If a midwife was to prescribe drugs to a patient before they were qualified this could result in serious problems as the patient may be allergic to the medication or subjected not to take it for health reasons. A midwife could not only loose their job due to this but they could put others at risk also.

Births and Deaths Registration Act (1953) – states the death of every person dying in England or Wales and the cause of the death should be registered by the registrar of births:

Births should be notified within 36 hours which is usually carried out by the midwife with forms gained for the health authority
Registration of birth should be completed by a midwife if a parent hasn’t done this within 42 days
If a baby is still born a certification of burial should be signed by a midwife as they were present when the baby was still born and examined the body to be buried and certified.

It is vitally important that a midwife notifies births and deaths. If a midwife didn’t register a birth or a death this could mean that nobody will know of the birth or death and who they are. It is also illegal for a birth/death not to be registered and can lead to problems in the future.

Job satisfaction:

Some jobs will be seen as more satisfying than others e.g. a midwife may get a great deal of satisfaction after delivering a healthy baby where as a cytology screener who repeatedly looks at tissue sample slides might seem to have less satisfaction. Job satisfaction is very important for various reasons and employers benefit if their workers are satisfied as this makes them well motivated and less likely to leave. A midwife may find job satisfaction from a various range of activities within their job such as the birth itself or helping the mother through her pregnancy or completing a task like their work load. However work load, or pressure from other professionals can be unsatisfying and this may cause them to leave their job which results in a stressor.

Information about cytology screener:

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Presence of stressors:

This is an aspect of a person’s situation that increases the probability of them themselves experiencing stress. Stressors for midwives can be serious and cause high stress such as complications when delivering the baby or still birth. Midwives are trained to recognise the signs of trouble in pregnancy and labour so if a situation went wrong in the delivery suite they would be responsible so this could cause high stress. Also the work load a midwife has to deal with can be heavy for them if they are not organised with work colleagues or if they are ‘on-call’ this can disrupt them during the night, also with them working long days (shifts). Due to the shortage of midwives this may result in more patients being assigned to one midwife.

Some clients within health care are very enjoyable to work with e.g. someone who cooperates well and is sensible etc. where as some can be very difficult to work with e.g. not communicating because of the nature of their health or social care problems. They can even become aggressive. If the mother who is pregnant or the mother’s family is not co-operating with the midwife, this could set the midwife back as they may find it difficult to get any important information across to them.

Client outcomes:

Some health and social care jobs will involve a positive outcome for the client e.g. a midwife delivering a baby with breathing problems and they over come this problem and bring out positive feelings, where as other job role may see little or no change in a client because they are only seen for a short time. A midwife may find that bringing a new life to the world is pleasing for both, the midwife and the mother knowing that they have brought a close bond and helped each other throughout the pregnancy. A midwife knows that they play an important part in a mother’s pregnancy by giving advice and important information. Some outcomes for a midwife may not be positive however, for example a baby dying before or during delivery which may bring a negative impact on the client’s outcome as this may be upsetting for both the midwife and the mother. Complications can arise during a birth which could result in harm to the child which also causes negative outcomes for everyone.

Level of responsibility and task significance:

Some jobs carry a lot of responsibility. In a highly responsible job role, one worker’s actions may have an effect on many other workers when decision making as it may bring out consequences for clients and co-workers, particularly those involving team leaders/supervisors etc. a midwife carries a large amount of responsibility as they are team leaders to the individual patients. A midwives job consists of a variety of duties and they may find this challenging as each day brings new challenges.

Autonomy:

This refers to how much the action of the worker has. People who mainly work alone e.g. health workers will have more autonomy than those who work in a large organisation under close supervision e.g. a nurse. A midwife has a lot of autonomy as they work alone a lot of the time which gives them autonomy over their work unless they have a problem that must be taken up with another practitioner or supervisor. Legislation of the NHS however, must be followed by a midwife and they do not have autonomy over their patients.

Social factors:

Social factors can be influenced by job satisfaction because some workers may find it satisfying to have a good social environment because it gives opportunities for social contact with other workers, patients and clients. Jobs which have the same group of workers frequently can bring rewarding friendships between people. A midwife comes into social contact with many people during the working day which allows them to gain friendships or general social contact with their patients.

Section A – introduction

For my second job I am going to focus on a care assistant and will be talking about their jobs describing what they are and evaluating them in terms of sector, role and status. A brief description about these sectors has already been mentioned in my first job section, midwifery which will allow me to avoid repeating myself when writing in this section.

Sector:

As mentioned in my first job, there are two sectors in which a job can fall into; these are the statutory sector and the independent sector. A care assistant is mainly based:

· In a care home

· A residential care home

· A nursing home

All of these types of services are all run by social services.

Because social services are run by county councils this means a care assistant can come under the private sector but if the care assistant is employed under the NHS their job would come under the statutory sector meaning the service is controlled through local taxation.

Private, profit-making providers

A care assistant working in a care home is employed by private individuals and funding comes from those who purchase the service (e.g. residents staying at the care home) and insurance companies or even private individuals. Some can be funded by the NHS for those whose need for being in a care home is health based but residents will be charged for provision.

Non profit-making providers

In this kind of organization, care assistants can work in a housing association which is ran by the local government, South Tyneside Council and employed by social services so that the care for the individual is at their own home. Taxation such as national insurance and council tax etc is where the funding comes from for this. Some of the care homes within South Tyneside where a care assistant will work could be:

Harton Grange Care Home , (Barchester Healthcare Ltd),

Harton Grange Care Home is a combined residential and dementia care service, offering personally tailored care plans, through collaboration with health professionals and key workers, to ensure residents' period of care is stress-free and effective.

Bedewell Grange Care Home , (Barchester Healthcare Ltd),

Bedewell Grange Care Home is a residential care facility based in Hebburn that is particularly suited to looking after people with dementia or Alzheimer’s disease, for whom they are able to offer a regular activities programme and sound healthcare.

- Chichester Court Care Home, (Four Seasons Health Care),

This purpose built care home provides accommodation in single occupancy rooms, all of which have private toilet facilities. Some rooms are suitable for sharing.

Role:

Care assistants (which can also be called care workers or social care workers) work with a wide range of people including:

-Children (and families)

-Disabled people (both mentally and physically)

-The elderly

They carry out a range of daily activities for these people depending on their personal needs.

Main duties:

A care assistant will carry out a range of different duties to ensure the best care possible for their residents ensuring health and safety is assessed on both the patient and the environment around them. The Duties a care assistant will carry out are:

A care assistant will ensure that resident’s nursing, personal and psychological needs are met on a daily basis, helping to encourage independence to the residents, giving them as much choice as possible, in the activities of daily living which the residents within the Nursing Home participate in. A care assistant should promote and maintain a stimulating and attractive environment for the residents and assist them when washing, dressing and undressing, using the toilet, including continence promotion when needed carrying out frequent check-ups. It is vital that a care assistant participates in the basic nursing care of the residents, under the supervision of trained staff, e.g. bed-bathing, pressure area care, mouth care, eye care and any other needs a resident may have.

A care assistant should undertake any other duties as required in order to keep the Nursing Home running smoothly, as it should; Beds should be frequently changed and resident’s rooms kept tidy cleaning a little every day, also helping when serving meals and drinks, feeding those residents who are unable to feed themselves and ensuring that each resident receives the meal or diet that he/she has requested and is suitable for his/her needs. The care assistant should assist in activities within the Home and keep all patients’ information confidential regarding their needs. It is important for the care assistant to observe and monitor a resident’s behaviour and any changes should be questioned keeping regular checks advised by a senior member of staff, also helping families adjust to the new care setting and make the resident feel as comfortable as possible.

All staff and residential meetings should be attended, including mandatory training courses to achieve required qualifications, to help meet the needs of the individuals care and develop plans with other health and social care professionals, also guiding the residents to and from the residential home e.g. hospital appointments etc.

All residents within the care home should be allowed full privacy for anything that may be bereaving or that may be unwell or even dying and ensure all equipment is clean such as wheel chairs, Zimmer frames, hearing aids, glasses etc.

Skills:

At a minimum a care assistant is required to have a basic knowledge of health, safety and hygiene.

The skills needed by a care assistant vary when carrying out their job effectively. It is vitally important that a care assistant speaks good English to be able to communicate as effectively as possible, speaking with enthusiasm and be good at working as part of a team, having a genuine interest when working in the care setting. A care assistant should enjoy helping and caring for residents, ensuring friendliness at all times using a good sense of humour. A care assistant will be expected to willingly participate in vocational training programme and be respectful when approaching both staff and residents, having the ability to create a bond with those from a different background who may have sensitivity. One of the most important qualities to have when working as a care assistant is to be reliable and trustworthy using flexibility so they can work on their own initiative as part of a team as well as individually.

Team work:

Well coordinated teamwork within the healthcare professions can provide an effective and cost-effective patient care. Team work for a care assistant is important especially when needing to communicate with other health care professionals to meet the needs of each resident. This involves them working as a multi-disciplinary team, involving GP’s, nurses, dentists, opticians, dieticians, physiotherapists, pharmacists and chiropodists etc. To communicate with these professionals effectively a good working relationship is needed in order to ensure the best care possible for the residents. Team work is important in how the staff interacts with each other and which functions they perform. Professionals with different backgrounds, different education, different responsibilities and different interests all work together the appropriate quality care.

Status:

Public Approval for a care assistant can be both highly valued and undervalued depending on the public’s views. When they are highly valued this is because people see this as helping those most vulnerable in society to get the appropriate care and support they need. The public can change their views easily once the care home has been negatively shown in the media. A wide range of articles and reports have been made about how care assistants have negatively treated the residents in the care home. E.g. abuse or abandoning them shown in these articles below:

The guardian - “Whistleblower accuses staff of 'appalling' abuse at care home”

“One of Britain's leading charities for people with severe learning disabilities has been accused of abusing some of the most vulnerable people under its care”

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The independent – “Physical and sex abuse exposed in care homes”

“One woman was raped by a member of staff, others were sexually assaulted and there were repeated incidents of violence between residents of the homes run by Sutton and Merton Primary Care Trust. One male staff member was observed to have slapped, kicked and punched residents over a period of at least four years”.

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The times online – “Exposed: filth and abuse in care home”

“Within hours of starting work as a carer the undercover reporter saw a resident being manhandled. Then came the cold food and poor hygiene”

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The times online - “Couple arrested over five care home murders”

“A couple were arrested today on suspicion of murdering five elderly residents at a village care home which they ran”.

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These articles are all negative media reports of care assistants abusing their residents telling us how it occurs leaving a negative impact behind on how people perceive those who work in homes. This will reduce public approval significantly as people wouldn’t want their families/friends to be abused like this and putting them at risk which would lower the number of people who use this service. Also people would not want to work for the service due to concerns of what people would think.

Career progression:

There are many opportunities which will allow a care assistant to gain more skills to result in a better paid job, dependent on a committed, responsible and enthusiastic approach. Employers usually offer care assistants the opportunity to take on professional development courses in hygiene, health and safety and other related topics but they may also be encouraged to work towards an NVQ level 2 or 3 in Health and Social Care. The NVQ will allow care assistants to progress (with enough experience) to a managerial or supervisory role, such as a senior care assistant, which involves being responsible for members of staff as well as clients and their families. Being a care assistant provides a range of transferable skills and equips care assistants with the knowledge and experience to work in various roles within a health and social care capacity. Direct experience is not necessarily required for the job but it will be useful to have some experience of working with people, preferably in a caring capacity. This could be personal experience of working with a family member or voluntary experience, such as visiting elderly people in residential homes or helping in a school for pupils with learning disabilities.

Qualifications:

Depending on the job role qualifications will vary. To be a care assistant first of all they have to be 18 years old or over. There are no formal qualifications that are required to be a care assistant however any relevant work experience with looking after venerable people such as: the elderly, people with learning difficulties or other disabilities can be looked upon as ‘more experience’ relevant to the job. Training tends to be completed on the job and NVQ/SVQ’s can be gained during this to move up to a care worker with more responsibilities. A care home would prefer to have someone more experienced as they will be working with a variety of different people e.g. disabled people, those with an illness and frail people.

Local and political factors:

This can affect the availability of a care assistant’s job in a variety of ways. Research has shown an increase in elderly people in the UK and this will continue to rise over the years in the future.

“The population of the UK is ageing. Over the last 25 years the percentage of the population aged 65 and over increased from 15 per cent in 1983 to 16 per cent in 2008, an increase of 1.5 million people in this age group”.

The graph below shows this:

Quote and Graph taken from:

The graph above shows the increase of the elderly and that the fastest population increase has been in the number of those aged 85 and over, the ’oldest old which means that there may be more people wishing to go into a care home where care is provided for them and this also takes pressure from families and friends as they know that the resident will be safe within the care home. Those in demographic areas may also be increasing, which also means that services like care homes will be looked upon.

There is however a shortage of people working as care assistants within care homes so the government is in demand for care workers for those vulnerable, this will ensure more jobs available for people to gain more experience and qualifications within care and also they will be needed due to the increase in the elderly in the future. NVQ/SVQ’s can be gained due to the government offering this so those who have no or little qualifications will take interest in the career enabling to gain more knowledge and experience.

Working conditions:

Hours:

Care assistants usually work shifts which mean their hours and days of work vary from week to week. Typically care assistants work between 37 and 40 hours a week which may include night shifts or weekend work. Some may have to stay overnight to observe residents usually based on a rota. Shifts can be long and demanding so care assistants need to have good stamina and both physical and emotional endurance.

Pay:

Pay for those working within social work, providing care for others (care assistant) can be based on the number of hours they work in that week while others can be paid on the hourly rate. Care assistants usually start on a salary of around £11,000 which can increase to between £14,000 and £17, 000 once experience is gained. Senior care assistants typically earn up to £24,000 a year. Pay varies for a care assistant depending on what role they do as shown above.

Working patterns:

Both full-time and part-time hours can be based day and night shifts for care assistants who can be required at different times of the day such as working in the morning, afternoon and evening.

Full-time shifts can be:

Morning 8am to 5pm

Afternoon 1pm to 9pm

Night shift 8pm to 8am

Part-time shifts can be:

Morning 8am to 2pm

Afternoon 2pm to 8pm

Night shift 8pm to 2am

Overtime:

Care assistants can be required to do overtime by management due to shortage of staff but they can also choose to do this by choice if they are any available shifts, the overtime will be paid for and is usually set at a scheme called time and a half which means the normal hourly rate will be paid plus half of the hourly rate on top of that hour. To ensure the care assistants health is not affected overtime may not be allowed or only a short number of hours may be allocated.

Pension schemes:

Care assistants are not entitled to pension schemes when going through the residential care home itself because of it being based in the independent sector, a stakeholder pension (A type of personal pension that has to meet certain standards set by government), is however available which the care assistant themselves can privately arrange it. The care assistant can take one out themselves or it may be available through their employer, but is not classified as occupational. Those employed by social services will automatically be advised to the government pension scheme.

“In the new scheme, instead of most people paying a standard contribution rate of 6%, there are different contribution rates for different pay bands”

Quote taken from:

Holiday:

As mentioned in the first job, holiday entitlement varies from job to job. A care assistant is entitled to 4 weeks (28 days) holiday per year providing they have completed a 3 month service within their residential care home. If a care assistant was to require a day off, notice has to be given e.g. (1 day = 2 days notice, 1 week = 2 weeks notice) the care home manager so that another care assistant can be asked to work that shirt, meaning the amount of time wanted to be taken off double that period of time needs to be given as notice.

14 continuous days annual leave can be given providing one month notice is given, with holiday pay. New years eve/day and Christmas eve/day may also be required to work to ensure residents are cared for however extra pay might be given for these. Sick pay can be given also if a care assistant has a sick note signed by a GP to state their illness to the care home manager.

Job security:

Depending on which sector the care assistant is working in, job security may vary also depending on the contract they are working (temporary or permanent). Normally a care assistants job security is secure and tend to be a permanent position that is given due to the shortage of staff within care homes and the increase of the elderly shown in the research in local and political factors to ensure that full effective care is given to residents in that care home.

Anti discriminatory practice:

This is when a job requires employers not to discriminate on the basis of gender, colour, creed, religion, learning ability, race, sexual orientation, disability (physical or mental) for any reason when recruiting workers or in working conditions such as pay, hours and pension. There are policies and procedures put in place for a worker to follow within the workplace ensuring no work colleague is discriminated against. (Under midwife - job role are the policies that have to be followed).

As well as midwives, care assistants have legislation to follow to carry out their job correctly like:

Criminal Records Bureau (CRB) - Care assistants will also have to have a Criminal background check as well as all other workers within social care. The employer will require a statement to show they have no criminal convictions e.g. assault that could put a resident at risk, to ensure residents in the care home will be safe with this care assistant. It is a way to help protect the vulnerable within society by providing a system whereby those deemed unsuitable to work with, or be in a position of responsibility and trust over, either children or vulnerable adults e.g. the elderly who a care assistant would be working with, are identified. Having a disclosure would help the residential care home to make more thorough recruitment decisions when employing a care assistant.

Care assessment:

National Health Service (NHS) and Community Care Act 1990’s

This places a duty on the local councils (South Tyneside council) to carry out a needs assessment for anyone who might require to be in a care home and to decide whether their needs call for the provision of any services like the care home for example. It also places a duty on local councils to notify health and housing authorities and invite them to take part in the assessment where it appears there may be a need for the provision of their services.

The care management system

This places a duty on the care manager to follow a sequence of care planning when concerning each resident by planning cycle to ensure the highest standard of care is provided that residents may need. It is important that a care assistant reports back to the care manager about the care of the resident and how they are doing not only so they can inform the residents family about the care but if a problem was to arise they can look back on this and use this to show how they have carried out the care for the resident.

Disabled Persons (Services, Consultation and Representation) Act 1986’

This places a duty on local councils (South Tyneside council) to consider the needs of a disabled person if they or their carer request this. It is vitally important that a resident, if disabled, has the correct facilities within the care home and also that the care assistant provides this. If a disabled resident within the care home didn’t have the correct facilities and background this could lead to injury and they may feel insecure within the care home.

Carers (Equal Opportunities) Act 2004

This places a duty on the local councils (South Tyneside Council) to inform carers of their right to an assessment; and to take into account, in the assessment, the carer’s involvement in (or wish to do) work, training, or a leisure activity.

National Assistance Act 1948’s.

This places a duty on local councils (South Tyneside Council) to provide residential accommodation for people in need of care and attention ‘otherwise not available to them’; and obliges local councils to charge for this accommodation. If a care home didn’t charge for the service the local authority would loose money and therefore would not be able to pay the care assistants working within the care home and therefore there wouldn’t be any residential care homes to suit the needs of those in need of carer and attention.

Guidance on National Assistance Act 1948

Guidance on what individuals should be able to expect from the local council responsible for funding their care when arranging a care home place for them, describing the minimum of choice that councils should offer individuals. It is important that a resident is offered a choice of care homes to suit them because it could cause a lot of complications, if one set care home was offered and that was the only choice, it may not be within a suitable distance for family members wishing to visit and it may be away from the recognisable background which may make the resident feel uncomfortable and insecure.

Health and Safety (First-Aid) Regulations 1981

The Health and Safety (First-Aid) Regulations 1981 requires all employers to provide adequate and appropriate equipment, facilities and personnel to ensure their employees receive immediate attention if they are injured or taken ill at work. These Regulations apply to all workplaces including those with less than five employees and to the self-employed. A workplace should have many first aid kits within the care home in order to prevent any staff become injured. If a care home was not to have any first aid kits in place this could lead to further injury and may then need hospital treatment.

Stressors:

A care assistant can experience a lot of stress within their job. A care assistant can find their job emotional and distressing at times for various reasons. Some stressors that may occur for the care assistant may be:

Overtime

Work load

Unsuitable shifts

Being monitored or observed

A resident causing distress for the care assistant

The death of a resident

The leave of a resident to another care home or permanently in hospital

Job satisfaction:

A care assistant may find their job satisfying at times but it can be both positive and negative for various reasons. This type of work can have numerous challenges, but can be highly rewarding as a care assistant’s support is allowing a person to live to their fullest helping them to communicate and carry out their daily living tasks making them feel comfortable and secure. They may get a great deal of job satisfaction out of this however there can be language challenges due to neurological damage and speech impairments from a person's health condition and a care assistant may find this hard and struggle to understand the resident which makes their job a lot harder for them and they may not get any satisfaction from this. Shifts can also be quite lengthy at times which can also decrease job satisfaction as it can make a care assistant feel tired.

Level of responsibility:

A care assistant doesn’t tend to have a huge amount of responsibility as they are only assisting in caring for individuals not directly caring for them as a nurse would. Some care assistants may get satisfaction out of this because they don’t have a great deal of responsibility which cant cause them major stress and they may be happy to stick to the duties and tasks they carry out throughout the working day, however a care assistant may find their job less satisfying if a resident causes them distress or they have to be assessed etc.

Client outcome:

If a resident dies or becomes severely ill which will result in death this can be a negative outcome for the care assistant as they may feel there was nothing they could do to prevent this from happening but there are however, positive outcomes for a care assistant by helping those who are vulnerable or frail with daily activities such as bathing, getting dressed/undressed etc and just generally making them feel happy and comfortable. This can make them feel that their job can be very rewarding at times.

Autonomy:

Care assistants may find that this is limited within their job as they are very much always working in a team or around other staff who may have higher status and power such as the supervisor or care manager, or even a nurse or practitioner. This may make a care assistant feel they have less job satisfaction because they don’t have the choice to carry out activities on their own without gaining consent first from the manager/supervisor. They could however get a great deal of satisfaction out of this as they won’t feel they are responsible for any serious problem that arises as they are only doing what they have been told such as:

Mixing up medication

Accidents

Injuries

Food and hygiene problems

When out on day trips etc.

If a resident does not wish to get dressed or receive any help from the care assistant, then the care assistant must obey this even if they do not agree because each resident has their own personal right within the care setting.

Social factors:

Social factors can bring out job satisfaction for some workers. Care assistants mix with many people within their job which can bring about new friendships or just general social contact for example not only will they be in contact with the residents they provide care for, but their family members also and this could bring about a close bond and a rewarding friendship. They may also come into contact with other health care practitioners like:

GP’s

Nurses

Physiotherapists

Other managers from different care settings

Pharmacists

Chiropodists and many more.