This essay will give an overview of the structure and quality of health and social care within the United Kingdom (UK).This essay will give an overview of the structure and quality of health and social care within the United Kingdom (UK).

by miya123456789 (student)

University Degree Subjects allied to Medicine

Health care policy and quality

This essay will give an overview of the structure and quality of health and social care within the United Kingdom (UK). The integration of health and social care is one of the key influences of holistic care. This essay will also explore equity of access, quality control, assurance and improvement in regards to providing the highest care for health and social care patients. To achieve quality; legislations, policies and procedures need to be in place to guide staff and patients. These are monitored monthly and annually to maintain high standards of care (NHS Institute for Innovation and Improvement Excellence 2013).

The policy the author will focus on is the Infection Control Policy, concentrating on the assessment and implementation in health care settings. As well as how high quality standards are maintained and continued within the policy. Confidentiality will also be conserved in this essay; therefore no Trust will be mentioned if the information is not in the public domain.

In the UK there are a range of health and social care services for every individual, from health clinics to learning disability schools. They subscribe to the same goal in providing compassionate care with the best quality, standards and evidence based practice. The National Health Service (NHS) is a publicly funded agency providing healthcare to anyone who is a resident in the UK. It was first established in 1948, formulated on the idea that excellent healthcare should be available to all individuals regardless of their wealth. Since then, there have been many changes and innovations to improve the quality and standard of the NHS (NHS Trust Development Authority 2013).

The NHS is a growing system that is influenced by global epidemiology. Knowledge and skills immensely extends through global interaction. According to Filetoth (2003) international standards provide harmonisation and standardisation of health care amongst different countries. Through joining knowledge with international services, the NHS is able to fill gaps in practice. It also provides guidance when a process can be carried out in an alternative way. Infection control is one of the major health care policies that have developed throughout the years through global impact and epidemiological evidence.

Equity is the promotion of equalisation and fairness in all services; it is a huge part of the health and social care system. This ultimately allows every individual to access the facilities, without stereotyping. Equity also promotes good quality programs, policies and procedures to be taught and used effectively throughout the health and social care service not categorising private of the free sectors to have better care (Braveman and Gruskin 2003).

To continue, equity is now seen to be part of quality control. Quality is a complex notion that has many definitions. However according to Health, Social Services and Public Safety (2013) the key domains are; effectiveness, safety, patient focus, efficient, equality of access and timeliness. When all these aspects are put together they are able to provide the highest quality of care throughout the health and social care system.

Organisation governance is a system that takes part in quality control and assurance. Their role is to provide organisations with an aims to achieve. They also control the finances needed for all aspects of health care. Both roles are accomplished through correct leadership skills such as stewardship. These attributes support the organisation to apply appropriate care in the right behaviour following the exact principles (Bullivant et al 2014).

Quality assurance (QA) is measures put in place to uphold quality care. This can be achieved through a pathway of reviewing, identifying creating standards and quality improvement (QI) plans produced by the care quality commission (CQC). QI denotes a plan or a check list of any problems within the quality of care in a health and social care setting. Improvement to any form of quality is always based on knowledge and statistics. QA and improvement go hand in hand forming part of the quality cycle. In previous decades quality was about being good enough, however now with systems of organisational governance, quality assurance and improvement it is about providing the best possible care (Goldstone 1998).

There are many different regulators in health and social care, their aim is to protect the public and make sure all health and social care professionals reach the required standard of care. Each regulator monitors different areas of health and social care. For example the Nursing and midwifery council monitor the nurses and midwifes standard of care and practice. CQC are one of the regulators that assess service areas, through measuring standards and quality. According to the CQC (2014) their responsibility is to review and measures the quality of care across the board, making sure all service users are provided with effective, safe, compassionate and high-quality care. Both CQC and organisational governance value patients, clinical and carers; as they are seen to lie at the heart of the NHS. They are centre in decision making and improving healthcare therefore they need to be educate in quality in its highest forms.

Quality control is not always successful in achieving the goals set. This can be due to the practice or resources, however the CQC have an important role in making sure quality is at the right standard. If not certain, measures are taken place such as refusing more admissions. However, the CQC are not as flexible as the process itself. Many times departments and wards are informed of their visit from CQC that promote the staff to alter behaviours, attitudes and practices hiding the true situations. However through unannounced inspections real situations can be highlighted.

Within the NHS excellence is ...

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Within the NHS excellence is attained through a scope of departments providing vigilance, with specialists who are trained in that area to be fully competent in caring for individuals. A surgical unit (SU) is a department within an acute hospital, they closely monitor, given pain control and overall attention. Referrals are also a role of the health practitioner this could include district care or they may involve informal carers such as family and friends to support the patient. Infection control is a core part of care within the SU. There are higher risks of patients acquiring infections because of invasive treatment and medications that cause individual’s immune system to weaken making them more vulnerable to infections. Furthermore acute hospitals have bad reputations for controlling infections, since the environment is susceptible for the rapid growth and spread of contagious microorganisms (Wilson 2006).

Infection control was unclear in history due to a lack of research. Unfortunately this led to many lives being lost to now treatable infectious diseases. However in 1858 infection control, formulated and became a priority across the health and social services in the UK and globally. Florence Nightingale proposed a change in hospitals to prevent infections from occurring and spreading (DMM 2007). Throughout the years infection control has become a significant part of healthcare policies.

The SU needs to control and prevent infections, through correct use of equipment, keeping the environment hygienic and also making sure patients are clearly recorded if they do have infections. The Infection Control Policy (ICP) is a vast document that incorporates all the different areas of infection control; hand washing, hygiene of the environment down to the process of isolating a patient to enclose and diminish infections.

Isolation is where a patient is in a single room specially ventilated so that the air inside is either negative or positive pressure. Negative pressures is used for individuals with airborne infections, (tuberculosis or chickenpox) air flows into the isolated room but does not escape from the area, as air will naturally drifts from areas with higher pressure to areas of lower pressure, thereby preventing contaminated air from escaping the room. Whereas positive pressure is used for patients with compromised immune systems. Air will flow out of the room instead of in, so that any airborne microorganisms are kept away, this usually includes condition such as leukaemia and neutropenic patients (Seshadri and Baumann 2008).

The isolation policy broken down from the ICP is implemented on the SU. Hand hygiene is the pinnacle of the policy. High standards for hand cleanliness have proven to reduce and prevent the spread of infections from isolated rooms to the rest of the ward. Evidence based practice proved that washing hands between every patient is crucial in reducing infection (Centre for Control Disease and Prevention 2013). To meet high quality standards for hand washing there is a set protocol in place that covers the main areas of the hand that are left out, for example cuticle areas. The use of alcohol sanitizers have also been put in place to provide quality assurance and make sure even if there is minimal contact with patients, hands are still decontaminated (Lashley and Durham 2002).

Wearing protective clothing (PC) such as gloves, aprons and masks is another tool in perverting infections and is continually used on the SU, this minimises the contact between staff and patients preventing microorganism transmitting on clothing and skin. The Isolation Policy is instigated through wearing PC outside the isolated rooms. Quality assurance of PC regulations is to make sure that there is enough supply of all the protective clothing and are appropriately placed outside the isolated rooms. Training is another form of quality assurance; staff should be up to date on their knowledge of different forms of PC, when and how to use them. Training should highlight the importance of all PC being single use. Several studies show the need to change gloves between patients is usually overlooked (WHO 2009). This can cause infectious outbreak and cross contamination: therefore the isolation policy confidently states the importance of changing PC between patients and sometimes even during different procedures with one patient (Wilson 2006).

Additionally using and cleaning equipment in the correct form can reduce the risk of contamination with microorganisms. All instruments within the SU should be categorised to be high, medium or low risk, for example high risk equipment such as forceps and scalps need to be fully sterilised before and after use. Whereas bed pans and commodes are medium risk; they do not need to be sterilised at the point of use, but must be sterilised between each patient. In some cases the SU provide the commode solely for the isolated patient and then the process of sterilisation takes place after it is not needed. On the SU sometimes thermal sterilization is also used. This is a great form of high quality assurance in essence to when it’s time and temperature is measured (Hoffman, Bradley and Ayliffe 2004).

Low risk equipment, walking frames, tables and chairs, only require a thorough clean and to be disinfected (RCN 2005). Correct use of equipment on a surgical ward is another form of QA. While there may be low microorganism risk of on certain equipment such as sphygmomanometers and cuffs, there is still a need for cleaning adequately as normal skin contact was present.

Risk assessment is essential part of the Isolation Policy. It provides a template for the potential risks that could occur and also creates actions plans for concerns that are raised through the assessment (Damani 2003). Through past annual reports on infection control there was a clear idea on the improvements needed to be made. Risk assessments are integral in quality assurance and should be accessible for all staff for further improvements. Patients also have a role in risk assessment; any risks or issues they may feel should be challenged by the staff. The risk assessment also includes effective commutation between the clinical team and the infection control and domestic staff making sure can be provided in an emergency situation.

The NHS provides patients with holistic care, assessing individuals as a whole rather than just taking their physical domains in to account. However the Isolation Policy is sometimes ignored in understanding the isolated patient’s psychological health. Patients experience a range of emotions that are detrimental to their psychological well-being. Feelings of frustration, loneliness and neglect. There has been some evidence that shows patients’ needs are not always met. Time, physical environment and the fear of infection all the reason healthcare staff are unable to fulfil their role (Perry 2007).

However according to Nevill and Head (2012) patients have a huge role in quality assurance. Informing, educating and reassuring patients and their family on the Isolation Policy prevents them from feeling unsure and reduces the psychological effects of depression anger and anxiety. Also educating patients and family members on aspect of general infection control is useful.

Standard precautions keep everything in the correct balance and provide clear instructions to the correct practice within health and social care. Programs are created to stress the importance of keeping all practices to the highest quality. These programs incorporate the need for staff training and environmental management such as temperature control in isolated rooms (WHO 2004). Quality assurance is key within the isolation policy as it signifies the importance to provide protection, safety, efficiently and equity. The main aspect of quality assurance in relation to the Isolation Policy is making sure every stage or caring for the patient is attained in the correct way (DH 2010).

Some aspects of the Isolation Policy do not meet high quality standards. One of the major issues with the Isolation Policy in regards to quality assurance in the local trust is the regularity of the healthcare staff recording the use and disuse of the isolated rooms. Therefore monthly audits were carried out to make sure the correct records where being filled in to maintain clear documents on what beds were free for patients who have been risk assessed for having an infectious disease or are susceptible to getting an infection (Local Trust 2012).

Another problem on SU is that some patient are not isolated quick enough. Again, measures would need to be assessed and reviewed. Therefore CQC have been assessing patients and staff in providing isolated rooms for patients at the point of admission rather than later. However better risk assessments in place monitoring and auditing allows staff to be aware of the patient having an infectious disease prior to the patient admission allows the correct equipment and facilities ready for the individuals. Through the audits there has been an improvement. Not only has hospitals acquired infections decreased but also isolated rooms are used a lot more effectively for patients with infectious decease (local Trust 2013).

For best Quality care multidisciplinary team also need to be involved; this is where health and social care professionals that work closely together. This is conducive to best overall care for patients; a range of professionals combine their skills, practice and knowledge, they can; deliver best possible standard of treatment, diagnosis and overall care (Melissa et al 2013). In regards to infection control MDT members all need to work collaboratively to provide the highest quality of care and reduce infectious transmissions. This can be approached through MDT meetings but also through interpersonal learning and development. All the health and social care workers within the MDT have different roles and responsibility that all closely link to patient safety and excellent care. Inter-professional working is fundamental in a multidisciplinary team. It allows all the healthcare workers to improve quality of their work and understanding of other professional’s roles, this is hugely beneficial to patients. The key values needed in inter-professional working is communication skills, appreciation of importance of personalities and open to gaining experiences with other team members.

The quality within health and social care is upheld by many forms of monitoring, assessing and auditing; this is obtained through professionals working closely together and regulators keeping them on track. The author of this essay implemented the infection control policy; through adhering to the policies and standards of the ward. This was done through using personal protective equipment, keeping the environment clean and effectively washing my hands at the time needed. However through the SU being the author first clinical placement, there was a lack of evidence based practice. Therefore in the future better knowledge on the infection control and Isolation Policy will benefit the writer in better quality practice. To conclude this essay has provided an in depth understanding of how the Isolation Policy is implemented on a surgical ward and how quality control, assurance is the forefront of all practice. This practice is clearly stated by the NMC to be the most effective, while promoting continuous quality of care (NMC 2013).

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