Health and Social Care - Quality assurance within the NHS investigation.

A03

Quality assurance within the NHS

The first service which I have chosen to do my investigation for is the national health service (NHS) to make my investigation reliable and the answers which I have gained to be validated I will gain both primary and secondary data, for my primary data I will speak to a member of staff at my local general practitioners, for example a doctor and conduct an interview with them. The information which I gain for him will be kept confidential, and only used for the purpose of my coursework, and no personal details including the individuals name will be released. For my secondary data I plan to use reliable text books, and also the internet, which will give me a broad spectrum of knowledge.

What is the quality assurance and how is quality care achieved?

When interviewing the GP at my local doctors surgery he explained how everybody has human rights, which includes the service users and those who provide the service to them, these human rights are fundamental legislation safeguards. This means that in order for these safeguards to work effectively professional care workers need to know what rights and responsibilities the service users have, which will then enable quality care to be achieved. To ensure that health and safety is achieve to both those who live and work in care settings following procedures and the legislations has to a main priority. He then outlined what quality care itself encompasses which are listed below:

• Following safe working practices these will effects the service users in a positive way in that they will create safe working practices, an example of this would include doctors having to

wear protective gloves when treating patients with open wounds and cuts, and then dispose

of these in a separate bin, which is disposed of differently to other waste. This will reduce

the risk of infection to between the patient and the doctor but also it will reduce the risk of

the infection spreading to others simply though a touch.

• Knowing our own attitudes, this encourages good customer service to all those who attend the GP service, those who work among the GP's within the surgeries, including the nurses,

the receptionists etc will need to have the correct manner in which they speak to everyone

who attends the service and understand that they are there for a reason which is to help

those in need. Therefore they have to be consistent in their work to enable to people to

trust and appreciate the work that people are doing.

• Not being prejudice, this is an essential and important way of promoting quality care, and if it is applied during work could have detrimental effects on service users, ensuring that an

individual's is not victimised and treated differently due to different varying factors, will

effect individuals self-esteem and also their trust in an organisation and the skills and

qualities by which it has to offer. When a person is treated with prejudice from a person in

general and especially from a professional position, it can cause them to feel that they

cannot attend services which could help them and in some cases save their lives. People will

not attend services which do not give the correct standard of service, and so for many will

have to live with anxiety of their issue, without the appropriate treatment, which could

further their problems in the long run.

• Encouraging high self-esteem, this is what the GP stated was an important factor which

needs to be highly recognised especially in people who are generally low. The GP's will offer

many different tactics to promote high self-esteem and will continue to help until they do in

fact find something that works. An example being for an individual who suffers from

depression due to stressful pressures in their home lives and their work lives, they will be

diagnosed an then offered treatment, whether it be medication, relaxation therapy,

cognitive psychology therapy etc. These will all offer different treatments to ensure that the

individual who is suffering will have the confidence and the reassurance to carry out their

day to day tasks without feeling like they have taken too much on.

• Knowing about relevant legislation according to the GP is important, this is due several

reasons, mainly because medical revelations are constantly changing and the treatments

which are seen to be the better ones are also changing, which means that in order for

doctors to treat their patients with their best interest they need to be aware of the changing

medical systems. This will affect the service user in that they will be receiving up to date

treatment which has undergone much research to ensure that it is an appropriate measure,

however this does also therefore have implications on the service provider in that they have

the responsibility to learn new and evolving procedures and have the responsibility to give

their users the correct treatment.

• Enabling fair and equal access to services, this the GP stated is a principle which should be

followed in the same way in which they need to not be prejudice to individuals as it can

have a detrimental effect on the service user. This could include a middle class individual

being denied care because they are seen to be able to afford to go privately with their need.

• Applying the care values, this principle enables individuals to have the best quality acre with services can offer without the risk of harm, and the embarrassment of their issue or problem being enclosed to others. Applying the care values within their work enable to the service providers to gain the trust from their fellow patients, which will entice them to again go to the service when they are in need of ca:e and support. However this could also affect the service providers practise of work in that they are may be put into an awkward position if they are to maintain confidentiality with the fear of the individual harming themselves or

others around them, in this case the care values may be broken for the best interests of tpe individual.

• Preventing barriers to access of services. The GP which I had spoken to from my local

surgery stated that there are many barriers for which some patients and doctors face during

the work, which include language, geographical, and psychological, all of which can be

reduced to help the patient to gain the correct quality care which they deserve. For example

If there are language barriers then the patients may be offered a translated which will

increase their chance of gaining the correct treatment which is available to them. This may

have further effects on the NHS itself in terms of the cost.

Improving information and consultation with service users

This is a preview of the whole essay

reduced to help the patient to gain the correct quality care which they deserve. For example

If there are language barriers then the patients may be offered a translated which will

increase their chance of gaining the correct treatment which is available to them. This may

have further effects on the NHS itself in terms of the cost.

Improving information and consultation with service users

When interviewing the GP at my local doctors surgery he explained how In any service clients need feel like you have an opportunity, rather than being simply given the solution, they should be given a chance to have an input in what they may possibly put themselves through due in many cases medication can have severe side effects which could affect their everyday living. All the potential options should be given to the service users, whereby they will also be given the costs and the benefits of each, and a wide range of the structure by which they may have to change their lifestyles, these factors will all influence their decision making process, the care worker will have a further input into this process in that they need to give their opinion depending on what they think will be the most beneficial to their client, and whether they believe that the individual themselves will be able to cope with the advantages and the disadvantages of the treatments.

There are occasions where the decision making process may seem quicker and less easier for both parties, especially where the service user may have difficulties in communication, therefore they may have difficulty explaining and helping the individual who is suffering, and even through these situations may appear to be difficult the service provider should give the user the opportunity to decide what they think they should do and the service provider needs to help them to gain the most information they can without forcing them into certain regimes. These all need to be put into place to maintain that the service user has their rights to be able to choose and be consulted on their decisions and how by which these will affect them. An example of this could be when an individual suffers from a disorder for example insomnia, the client would be given the advice from about different kinds of treatments, these would include both medication and other new treatments such as counselling and cognitive treatment programmes which will aim to change individuals thinking processes, they could also have take part I relaxation treatments. The clients will be given the

advantages and disadvantages, the success rates, and the opinion of the doctor who is providing the information, which will all input their decision processes. If the client knows that they are being treated by a knowledgeable professional who has dealt with many different cases, then they are likely to feel comfortable with the input of the doctor and more often than not they will go with what has been said. The will affect the service users in many ways in that they will feel in control of their lives despite of what illness or disorder has disrupted their lives, they will feel valued by those who are helping them deal with their disorder ana the information their are being informed With, they would thirdly also feel independent in that they will be the person with the final decision on the path of treatment that they will take, and they will always have the support of other throughout.

Below is a table by which the GP states is how quality assurance is maintained to clients attending a health service:

There are other ways in which and mechanisms by which quality assurance-is implemented one way as previously mentioned is by improving the information and consultation with service users the NHS plan (2000) and the health and social care act (2001) required many changes within the involvement of patients and the public in health services. The NHS organisations now has a duty to involve the patients and the public on the organisation of the different services which are offered to people, and in the development of services including the planning, operations and proposals for change, this information can be found though many different ways for example through leaflets and websites. In the past NHS trusts only notified the public when they were going to change the provision of services, which would include the closures of hospitals or other specialist units. This

therefore would affect those who attend the services on a regular basis in order for them to live a relatively normal life, and if they were only notified when closures were beginning to happen then they may be unable to attend other specialist units, which would affect their quality of life with these changes the general public will have the opportunity to have their say, with as to whether they need a unit, and what services the current departments need to improve upon, which will lead to the services being 91SIeto meet the needs of the service users better in the future.

After interviewing GP of the local doctors' surgery another mechanism of quality- assurance is that of patients' advice and liaison services. The services are available from all of the

NHS trusts, and are there to offer advice, the service plans to help solve problems on a short amount of time, for example these would include complaints about certain wards within hospitals, for example the cleanliness of the ward, or a complaint about a the quality of food being provided to the patients. The PALS service does not only apply to the patients which attend the service but also their careers and their families who are also wish to complain about the service which is being provided. The service offered by PALS also directs complaints to higher places for example the hospitals management, the ICAS which is the independent complaints and advocacy service. This service which is provider to the service users enables them to receive the correct type of treatment while they are in the care of others, and they are in a place which is easily accessible to those who require the help needed.

Another way in which quality assurance is regained in the health and social care services according to the GP and other sources is that since 2003 all NHS trusts have a PPI forum which is a patients' forum (patient and public involvement forum). These are run by a number of voluntary patients and people who live within the community. Who were appointed by the commission for patient and public involvement in health. These services have many functions including having the right to inspect all NHS service, also that of private services, they are also able, they go in a monitor the

quality of service which is given and this is from a patients point of view, and the contribute this evidence to other examining bodies which will lead to further action if consistent issues arise. The representatives from the forums are able to join NHS committees and represent the interests of patients which enable them to get their point across to those who may be able to influence it.

There is also the patients' choice initiative which is another mechanism for quality assurance. There were several reasons why this initiative was put in place including that there were long waiting times for some operations, also there were high amounts of patients which were not attending outpatient clinics and also even cancelling their admission to hospitals. The idea behind this initiative is that patients can choose a hospital of their chose to have their operation in, as in some hospitals there are shorter waiting list than in others. This initiative is still not in completion as there is a need for a national IT system which allows a wide range of use. There is however a worry that some patients

will be unable to make an informed choice due to difficulty, and that waiting lists have been reduced for some operations because of the NHS's use of the private hospitals, and new specialist hospitals and not through patients choice. This will hopefully in the future effect the patients who need a common operation which generally have longer waiting lists, and will also not cause the individuals problems to increase due to waiting for their operation.

Finally in 2001 the patients charter was replaced by the new NHS charter this is there to give

patients a clear guide to what they should expect from the NHS services, including the standards they should and expect and also their rights and responsibilities. The NHS charter also gives patients the correct information about where to get the treatment which they require. The key point of which include:

• Responsible use of the NHS - patients should try to keep all of their appointments when

possible, patients should return, NHS equipment when they do not require anymore, paying

any charges promptly and also treating NHS staff with respect.

• Easier access to information- people who use the NHS charter are encouraged to access the most appropriate health services, which include NHS direct, local pharmacies, a walk in

centre etc. In the past people were more likely to attend A+E for problems due to there not

being any or they were unaware of the services which are available to them, which obviously led to delays in areas which could have been prevented.

• Targets for hospital treatments - the targets which hospitals aim to uphold is that people

who are suspected of having cancer should be seen within 2 weeks of being referred to a

specialist, patients should not wait any more that 17 weeks before they have outpatient

appointment, and also no more than 9 months for in-patient care.

• Cancelled operations - the hospitals aim that if an operation is cancelled on the day of

surgery a new surgery date should be set within the next 28 days, and if this does not

happen then the hospital will pay for the patients to have the operation at another hospital of their choice.

• A+E waiting times - 'no one who attends an A+E should be there for longer than 4 hours

which included arrival, to admission, transfer or discharge.

• Right to complain - when complaints are being dealt with they need to be dealt with

sensitively, effectively which could prevent further problems.

Implementing quality service standards

After carrying out my primary and secondary data collection I have found that one way in which quality service is implemented is through the 'national service framework' or the NSFs, Which was put into place as a way of improving long-term care. Their purpose of which was to the specific areas of care. This was managed by different areas having certain goals which were to be achieved in certain time scales. The aims of the national service framework include:

• Set national standards and to identify main interventions for a specific service group

• To put in place strategies to support implementation

• To establish ways to make sure progress is within an agreed time scale

• Raise quality and decrease variations in services in 'a new and first class service' that are

being provided.

The NSF was established in 1998 and they consider a large amount of people including the health care professionals, the service users, the health service managers, partner agencies etc. Support is give n from the department of health they also monitor the progress of different kinds of services. Some example of services ,which the NSF covers includes:

• Coronary heart disease- over a 10- year period standards will be implemented to improve

the prevention, diagnosis and treatment of those who are in need of the services. These

standards will obviously affect the users in a positive way in that services will be aim to

educate those who are more likely to be more susceptible to the disease, and help to

recognise what foods they should be eating to maybe reduce the likelihood of it occurring.

The health care professionals should with the help of reducing waiting list should be able to

diagnose early enough and intervene with prevention before the disease becomes further

life threatening, which will again reduce the likelihood of death, and also should reduce the

pressure upon families who may believe that a member could potentially die due to action

not being taken sooner. Treatment before and after an incident should be monitored further so that after for example a heart attack the individual is not release from hospital too soon before they have had time to recuperate and relax after such an epic and fatally bad occurrence in someone life has occurred.

• Cancer - the NHS cancer plan was formed in order reform the cancer services, and was

brought about in 2000. An example of this would include that of people who are suspected

to have cancer should have an appointment with a health professional within two weeks of

noticing the symptoms, so that a diagnosis can be made and action can be taken as with the

route at which the patient would like to take and the treatment they wish to take,

depending on how extreme their case is and what the likelihood of success would be. Having such advance diagnosis would affect both the patient and those who are treating them in that the patient will have a reliable, informed and quick response, which will reduce the wait at which they may be in doubt therefore the distress they would also be feeling. The short time at which the diagnosis should be made would also affect he health professional in that they will be able to treat the individual quickly which could also again reduce the rate at which the cancer will be growing and harming the individual, therefore they are giving the individual a chance to live, which previously may not have been readily available. Another aspect of the cancer plan would also include that of when a family appears to have a likelihood of hereditary cancer, in these cases for example when breast cancer run through the generations of the family then all member will have yearly mammograms, to catch any early signs of breast cancer which may arise. This is a positive technique which is required as those who use the service will have no need to be anxious in waiting that they may acquire breast cancer, because if it does occur then it will be caught in its early stages and therefore the treatment no matter how distressing it may be would have a higher ratio of success.

• Paediatric intensive care - The aim is here to ensure that there is a high quality of service

for children who require intensive care. High standards of care is required in all levels of

health care, however within the 'children's wards, the service providers are dealing with not

simply the child but also their parent and guardian, therefore there is a further need for

[I;" delicacy from the service providers in terms of supporting the parents while their child is

within an unstable state and while they are recovering from the illness at which they are at'

bay from, and also to give the child which they are treating the best opportunity they can

offer in order for them to live an adequate lifestyle in the future. This therefore means the

rights at which every individual has including having the food which they require,

maintaining dignity so they should be able to remain clean throughout their stay at the

hospital. This will obviously benefit the children and their parents or guardians in that they

although they may be suffering from an illness they are aware that they are being cared for

in every way that they can be, and they are not overlooked by other patients, and are

suffering as a results. The staff should be fully equipped in terms of the amount of stay

required and the supplies including fresh bedding and medication should always be are

reach.

• Mental health - this area is concerned with how services users who have mental health

needs will be planned, therefore for each individuals who is admitted or who is being

treated for mental needs should be have a personalised care ~that they are at risk to

themselves or to other who are around them, this therefore affects those who are in need in

that they are being given the correct treatment, relating to the disorders which they are

suffering from, as an individual who is suffering from an eating disorder such as anorexia,

will need a variety of different treatments than a person who is suffering from

schizophrenia, they will be monitored in different ways and treatments will be delivered in

different ways.

• Older people - new national standards have been set and service models across health and social care settings for older people whether they are living in a residential care and or being cared for within the hospital. This means that they will receive the correct treatments and will maintain their human rights in that they will be able to stay warm and eat adequately, which should help maintain their health. They will be monitored on a regular basis, as in many cases with the elderly often their stability in terms of health can change quite rapidly will increase the possibility of death. Therefore this will affect the service users in that they know they will b getting the appropriate help in a time where they may be very dependent of others, because of their lack of mobility and increase dependency on much medication the help gained from the NHS is a necessity within their lives.

• Diabetes - those who work with the care of those who suffer fro-m diabetes aim to make

sure that the 1.3 million people who suffer from diabetes receive an excellent standard of

Which will reduce the impact at which it has on their lives, if they are treated by those

who are fully qualified arid have the ability to come up with different ways to help those

who are newly adapting to living with diabetes, in terms of the medication they needs to

take, at what times and also the signs at which they will need to consider, for example when

they need to eat due to low sugar levels and when they need to take their medication. Those who are suffering from diabetes will also have to change their diet and restrict the amount of sugary foods that they eat, which could potentially hurt them fatally.

Implementing performance indicators

Performance indicators are a technique which will help to maintain quality assurance in that they help to monitor how well services are doing within the NHS organisation. An example of which is that of 'star ratings which give an overview of:

• How good the trust services were to their patients.

• How well it is run.

• How good it was on reducing treatment waiting times.