How the social services fit in National Framework.
I have asked if Rainbow has any practice codes, care value base or any charters, and they gave me The Care Value Base and customer’s charter. Now I am going to describe Care value base.
Joanna told me that every social worker must have a copy of Care Value Base and Customer Charter at them, and they must know them very well.
Care Value Base
This Care Value base is about Clients and social worker’s right, and responsibilities.
Here are some of the main points contained in the Rainbow’s Care Value Base.
- Respect to clients and colleagues.
- The social workers must respect the unique value and dignity of every human being irrespective of one’s origin, ethnicity, nationality, sex, sexual orientation, age, family status, beliefs, mental and physical abilities.
- Should show respect to their colleagues or other professionals for their qualifications, point of views and obligations. For the benefit of clients social workers should work in collaboration with other social workers and other professionals.
- Confidentiality and privacy
- Confidentiality and self-determination are essential for social workers. Social work, as a profession places the highest value on treating information about people with the utmost privacy.
- No private information should be asked for unless it’s major need. Confidentiality principle should be followed after getting private information from client.
- Private information should be provided only if in the case of client’s consent or approval of legal representative of client.
- Without being sure about security, any information should not be shared. Social workers should not discuss confidential information in public or semi-public areas such as hallways, waiting rooms, elevator and restaurants, e.t.c…
- During legal procedures, client’s confidentiality should be protected if the information needed to be shared in the court or with police.
- Social worker should protect client confidentiality in the event of the social workers termination of practice, incapacitation, or death.
- Cultural Capability and Social Diversity
- Social worker should understand culture differences and its effect on human behaviour and function in society.
- Have a view on the culture of clients; accept cultural differences and be sensitive to them.
- Get some education about cultures of clients and seek to understand nature of social diversity and oppression with respect to race, colour, and ethnic or national origin, sex, age, marital status, political view, religious belief, and sexual orientation, physical or mental disability.
- Emotional/Sexual relationship & Physical contact
- Social workers should not engage in emotional or sexual relationships with current or past clients under any circumstances.
- Social workers should not engage in physical contact with clients when there is a possibility of psychological harm to the client as a result of the contact (like hugging).
- Should avoid have sexual relation with colleagues whom may have conflict of interest; or they should transfer their responsibilities to another social worker.
- Social workers should not use insulting language in their written or verbal communications; should use accurate and respectful language in all communications to and about clients.
- If the client has a difficulty in understanding spoken language, social worker should provide detailed explanations or help to get a professional interpreter or advocate.
- Continuing Education and Staff Training
- Manager and supervisor social workers should provide arrangements to perform training for all the stuff that they are responsible for.
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Social workers should not practice, facilitate, or collaborate with any form of discrimination on the basis of race, national origin, gender, colour, sexual orientation, age, marital situation, political opinion, religion related believes, physical or mental disability
Customer charter
Child/young person can make or have a choice wherever possible within the resources available.
The Child/ young person must be treated equally and fairly irrespective to their origin, sexuality, gender, religion, colour of the skin, age, physical and mental abilities.
This code states the importance of listening to the child/young person and giving examples of how this is done, providing children/young people with every opportunity to express views about what services are received and how they would like them to develop.
- To have access to information
This principle states the importance of providing the client with comprehensive, up to date and accurate information about how the services are run, how well they perform.
Every client has the right to have a professional interpreter if they don’t understand spoken language. Client can get a social worker who speaks in his/her origin language if social services have any, foreign language speaker.
Child/young person have got the right to make complains.
Social workers should provide proper professional services with possible maximum broadness to please needs of child/young person.
What is getting in the way of changing things for the better?
I have done some research what are the problems in the care sector and how they can be solved, by asking some social workers and foster parents, as at that time in Rainbow was a meeting of social workers and foster carers. I was able to get some quick answers, they are below.
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The human rights of children are often not the dominant value base of social services departments
"It feels as if our management don't understand what 'working with children and families' is about. All they're interested in is budgets, bed spaces, how many assessments you've done. You have to build up a relationship with these kids in order to have any impact. But we've got no time for that."
Social worker
When a social services department focuses more on the cost of doing an assessment than on how the assessment is done, the quality of social work will suffer. If managers have inadequate social work knowledge and skills to nurture good practice, the quality of work with children will be undermined.
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Responses to children's needs are often dominated by a service-led approach
Decisions and services are often not geared towards a particular child's needs because the way services are organised prevents flexibility, or there is a shortage of available resources such as specialist residential or foster care provision.
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Social workers are often not able to fulfil the role that children want from them
Many of the young people consulted said that social workers didn't have enough time for them, and that when they did see their social worker, they felt that they weren't being listened to. (This has been said by deputy manager)
The explanations by deputy manager are below.
The way of solving this is to employ more social workers, as rainbow has 10 or more times more foster children than social workers, sometimes social workers do not have enough time to make visits to all their clients.
What would help to change things for the better?
- (Com) Listening to, and involving, children and young people
More attention must be paid to the needs of children and young people. Children/young people must have a chance to get together with others who have similar experiences.
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Increase the number of foster carers, pay them, train and support them in the work they do
Social services departments might look for more foster carers from which to choose when/where to place a child. Then placement decision will be more directed towards matching children needs.
- Ensuring looked after children get the most out of the education system
Deciding to do a lot about education is probably the most valuable investment social services can make for children/young people. It is something which is going to last and go with that young person."
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To Interview a person from health sector I have visited Watford Hospital. The only a person who didn’t refuse to give me an interview was Rosanna. She is working as Nurse Manager in Watford Hospital. By doing 20 minute interview I understood that she have a very good personality and open minded person. She has told me that I am welcome to visit her at any time when I need. Watford hospital belongs to NHS and it provides statutory services.
How the social services fit in National Framework
About Watford General Hospital
Watford General Hospitals NHS Trust (WHHT) was formed on April 1, 2000 following the merger of St Albans and Hemel Hempstead NHS Trust and Mount Vernon and Watford NHS Trust.
The Organisation
The clinical services provided by West Hertfordshire Hospitals NHS Trust are divided into five divisions. Each division is headed by a Divisional Director, a Divisional General Manger and a Head of Nursing. These include:
- Acute Medical Care Division
- Surgery and anaesthesia
- Clinical Support
- Women's and Acute Children's Services
- Specialist Services
The Trust's support services are divided into seven departments; Information Management and Technology; Human Resources; Facilities, Quality Assurance/Clinical Governance; Communications; Finance; Capital Planning
The role of Rosanna as a nurse in hospital
PROFESSIONAL ROLE
- She must behave in an appropriately professional manner at all times which improve patients and visitors confidence in the service being provided. Set a good example to junior nursing members of the ward team. Accepts any constructive criticism offered by senior staff with good grace.
- She may develop the necessary clinical and associated nursing skills applicable to the specialized field of nursing in which he/she is engaged
- Establish and maintain good communications with patients, relatives, ward visitors, medical and managerial staff and all other professionals who make up a multi-disciplinary health care team.
- She must have a Have knowledge of Trust Polices (e.g.; Drug Administration, Infection Control, Uniform Standards, Care of Patients Valuables, Fire Regulations, Reporting sick, etc) and keep this knowledge up-to-date applying it to relevant situations. This she should have known when she was studying nursing.
- Demonstrate a working knowledge of the Health and Safety at Work Act.
ORGANIZATION ROLE
- Understand the ward's Philosophy of Care, model of nursing and standard goals.
- Take part in ward meeting and give thoughts and opinions professionally.
- Receive appropriately delegated duties from senior nursing staff and perform it.
- Take charge of the ward for a limited number of hours per week in order that ward management experience may be increased.
- Rosanna must report to the Nurse-in-Charge (or the Nurse Manager if self in charge of the ward) any complaints received and any accidents that have occurred to patients or staff.
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She must every time ask an advice from a senior nurse before taking action on any nursing matter that he/she is unsure about
Care Value base
Here are some of the main points contained in the Watford Hospital’s Care Value Base.
- Confidentiality
Each member of the Trust's staff is responsible for ensuring the confidentiality of any information relating to patients Any breaches in confidentiality will be dealt with by the Trust's Disciplinary Procedure and may result in dismissal
- Health and Safety
Each member of the Trust's staff is responsible for ensuring that they carry out the duties of their post in accordance with all appropriate Health and Safety legislation, guidance and procedures and that they do not, by any act or omission on their part, create a threat to the Health and Safety of any other person.
- Fire Training
Each member of trust’s stuff must attend to fire lectures every year. This is the responsibility of each member of staff to ensure that they comply with this legal requirement
- Treatment
The clients must be treated as individuals and equally irrespective to their religion, cultural differences, gender, colour of skin, age e.g.
- Language
Every client has the right to have a professional interpreter if they don’t understand spoken language. If in hospital are any workers who speak the same language as client can be asked to translate what has been spoken.
Client’s rights in Hospital
- Client can have free healthcare 'on the basis of clinical need' (clinical need is a recognised medical condition that needs treatment, such as appendicitis, a broken leg or diabetes).
- Emergency care can be provided to client at any time.
- You can see a consultant (senior doctor) acceptable to you', when your family doctor thinks you need to
- A second opinion can be given to client (talk with a second consultant) if s/he and family doctor think you need to.
- A clear explanation of any treatment proposed, including any risks and any alternatives must be given to client, before you decide whether you will agree to the treatment.
- Clients haves the right to see their health records.
- The client must be ensured that their health records are kept in confidential.
- If in Hospital are some students who are doing medical researches or training client can choose whether to take a part of it.
- Client have the right to make complains and s/he must receive explanations or excuses of complains.
Client’s responsibilities to Hospital
- Let to hospital management to know if you change your name, address or telephone number.
- Clients must try to keep appointments and to be punctual. Tell to hospital as soon as possible if you cannot attend, so someone else can be given your appointment. If Hospital is running late, please be patient, there might be a time when you need the extra time.
- Emergency appointments are for cases which cannot wait until the next day.
- Clients must not call out of hours unless it is an emergency which cannot wait until the next day. Please remember the doctor who is called out at night will also be working the next day.
- Keep your call brief and avoid calling during the peak morning for non-urgent matters. Please remember to use the separate number for prescription requests and the Health Visitor.
- Client must ask a home visit when the person is too ill to come to the surgery. Most children can quite safely be brought to the surgery by car/taxi
- You are responsible for your own health and the health of your children. We will give you our professional help and advice, please act upon it.
Communication skills
Communication skills are very important to social worker and a nurse. Those are two types non-verbal and verbal. In social and health settings to have good communication skills are very important for workers to understand needs of others, form relationship/friendship with clients, to show respect to them and members of staff, meet client’s social intellectual and emotional needs.
Listening skills also are very important in these settings. These are not just hearing the words of person it is to listen carefully, to understand the meanings and emotional feelings of client
Non-verbal communication is messages what we send without words using our body, eyes, tone of our voice, how we sit/stand. Using Non-Verbal communication can lead to misunderstanding, such as white middle-class people often expect other people to look them in the eye while talking. If they look down it is a sign of dishonesty, stress or depress. In black community looking down while conversation is a sign of respect a way of showing you are using listening skills.
To overcome this barrier care workers must be careful not to assume that statements and signs always mean the same thing- culture, race, class geographical location and alert meaning. Social worker must understand people’s emotional needs, by learning cultural differences, trying to speak a language or non-verbal language which is available to the clients.
Joanna told me a story about a Kosovan boy who didn’t speak any English and he was very aggressive, by using calm and slow tone of voice she calmed him down as; calm and slow tone messages mean that she is being friendly.
In these type of situations is very important to use an acceptable body language that it won’t affect child emotionally. She told me that she was using her arms and hands movement to help explaining to boy what she was trying to say. Non verbal communication social worker might use if the client can’t hear. But there are also barriers to communicate to people. Social worker must have some knowledge of cultural differences, because using non-verbal communication she may send a message which is not acceptable for client.
Nurse Manager does not use much non-verbal communication in her work. She communicate with clients if they have any complaints, or not happy with treatment. She spends her working time managing Nurses and monitoring that everyone use charters and value base, so I can’t evaluate.
Social worker and Nurse Manager may use a telephone to communicate.
Social worker may call to her client to make an appointment to visit him/her to see if everything is going good. If child do not speak any English social worker may use a telephone to contact to interpreter and by phone everything may be interpreted.
Nurse Manager may use phone for same things as social worker, but she also use telephone to contact with hospital employees, as every worker should have telephone in their offices.
Nurse Manager also may use a telephone to make calls to patients to be ensured that they are feeling good.
Telephone will keep a contact within Hospitals and Social Services in England
In this two settings fax can be used to send information from one hospital to another or to other social services.
E-mails are new type of communication skills. Not every one can use or have access to e-mail. By e-mail clients or workers of social and heath services can receive information about services provided, if any changes happen in sectors.
Written communication Nurse Manager does not use much. Social worker may use written communication if a person can’t hear or a person can not understand social worker can explain by drawing things.
Barriers that can arise and the way of overcoming them
The main barriers can be four types.
- Physical
- Financial
- Psychological
- Communication
Physical barriers
Physical barriers can arise if the building is not planned for clients. Some older Buildings are not specialized for disable people or older people, and it makes lot difficulties for old, disable people. If a person can not get into the building it means they can not access and use services in there. Once client is inside of the building they need to be able to move easily, but In Britain are some building not designed for disable persons. To overcome these barrier old buildings must be changed into a specialized for disable or older people.
This is one of the biggest problems in Hospitals as some of them do not have facilities for disable or older people.
It is not a problem for Rainbow as social workers only visit out to their clients,
Financial
Financial barriers cone arise from lack of money. These days most of private hospitals or surgeries must have to be paid. A lot people do not have any money to pay for services and they do not. If a person use NHS which gives free treatment are unable to pay for bus or trains to reach services.
To overcome these barrier social services may give to people more financial support.
The hospitals can not pay to clients for attending their services or pay for train, bus e.g.
Emotional barriers
Some people are scared to visit health or social services as they think they won’t be treated fairly or they can be discriminated. My neighbor is 80 years old has been discriminated by a Hospital nurse of his age and now he feels fear and is scared to go to any care sectors as he think he will be treated in same way. Before NHS the hospitals, surgeries were shameful place where only poor people went to, this is one more barrier for old people who still think hospitals, surgeries are shameful place.
Can be that some people are frightened to find out what’s wrong with them.
This may overcome only if a care worker help clients to get over their fears, and be careful what they speak.
Pride is very important to some people. Not asking for a help is a part of their pride. Some of them may see it as a personal failure if they ask for help.
This may overcome only if a people put their pride in one side and ask for a help.
Effectiveness of customer charters and care value base
Every Foster Carer or carer worker must have their own copy of customer charters and care value base.
Care value base and customer charter help to make care much easier.
Every foster child or foster carer must be trained to know how and whom to complain or contact to, if they have any problems. The problem will be solved as soon as possible. This is a proof of how effective charters and care value base work.
If a new worker or foster family joins Rainbow they must be given a copy of charter’s and care value base. Everything must be clearly explained to worker and foster family.
In Watford General hospital every worker must have a copy of charters and care value base.
One of the aims of Rosanna is to monitor the use of charters of every worker. By monitoring using of charters or care value base will be much effective. The weakness is that Rosanna is one person and in Hospital work nearly 100 people and she can’t monitor all of them, sometimes happen that workers do not follow the laid, terms and conditions and it can be a result of complains from clients.
The company reserves the right to invite worker to leave, if s/he does not fully comply with the laid, terms and conditions of organisations.
In customer charter of both settings is written that carer workers must provide professional services and services with maximum broadness.
Rainbow fostering service pays a lot attention to children’s and young people’s needs. Paying attention to patient is the biggest weakness of Watford General Hospital as there is not enough stuff to satisfy patient’s needs. To solve this problem they must employ more stuff.
In Hospital and in Rainbow everyone are treated fairly irrespective to their origin, sexuality, age, gender e.g.
In this setting if a person speak different language a translator must be provided. In the wall of Rainbow and Watford Hospital I saw small notices saying; ‘do you need a translator please ask’. They provide translator in any language, but if a translator is not available services make an appointment for another day and they invite translator.
The clients must be kept informed about services, how well they run e.g.
Every week the information about how the services are run, how well they perform is being sent to foster families. When you fill up the form of Hospital is a small section saying if client wants to receive Information in their services.
In section Cultural Capabilities is written that every worker must understand the cultural differences, have a view on the culture of clients get some education about cultures. Every year Rainbow sends their worker to training to get information and renew them about cultural differences.
When I asked about this section from Rosanna the answer was simple and short.
Any employee who joins our team must already have education on cultures and their differences.
In section Emotional/ Sexual and Physical relationship is written that carers must not engage in emotional/sexual relationship with current or past clients under any circumstances. If this happens the employee may be dismissed.
- Respect to clients and colleagues.
In both setting the respect to client must be same and must be backwards from clients to care workers
The respect must be illustrated at any aspect.
If a worker doesn’t illustrate the respect to client, s/he may be disappointed of the services and may never attend to same service. This may cause several problems.
For example if a person is diabetic and regularly attend to GP to get a treatment, and has been disappointed from service and do not attend to service any more. The sugar pressure may get high and s/he may lose consciousness.
- Confidentiality and privacy
Any information given by client must be kept in high confidence.
Every workplace must have a storeroom where information must be kept, this must be high secured. The information may be given to law enforcements or may be shared with other workers in workplace only.
If the information is not kept in high confidence, the client has the right to take legal actions.
- Emotional/Sexual relationship & Physical contact
The care worker hasn’t got the right to get into Emotional/ Sexual relationship or Physical contact with clients. If the person had any contact or relationship may be taken to court.
In 1999 the social worker went into the physical contact with a 15 years old Girl in Manchester. He has been sued for child abuse----??????
- Continuing Education and Staff Training
The staff must be trained, educated in specialized and qualified courses.
If the care worker is not qualified s/he may cause several problems.
For example:
Nurse has been sent to old lady who needs an injection every day before night, and nurse is not qualified in injections. The lady will not get an injection. The Physical health of lady may get worse.
She may be afraid of using the same services again.
Britain is a multi cultural country, where not everyone speaks English.
In every hospitals or social services are notes that tell they can provide with interpreters. I think this is the biggest support what the care services could do for people who do not any speak English.
If person is not understood or did not understand s/he may feel depressed.
This can affect on physical or emotionally health of client.
