Unit 10 care practice and provision

Last year the WPCT was in the top national band under all three headings selected by health care commission, and was also one of the 28 PCTS across the country to join national primary care contracting collaborative.

The WPCT need to make sure that they promote quality assurance and that the services they provide and set up in Wokingham have high-quality service, not only so that it keep to the standards of the WPCT And the government, but also so that the people of Wokingham feel comfortable and able to use the service when and how they need to.

The Community Team for People with Learning Difficulties (CTPLD) that works with the WPCT or any other PCT, they also work with community teams, and mental health services. For my case study I will be looking at Ravens Wood, a community that helps and supports those with learning difficulties there are 149 adult residents and 22 children all with learning disabilities. Ravens wood works with the CTPLD and the service users at Ravens wood. Any member of the CTPLD could be a social worker, occupational therapist, community nurse, or even and community support worker, every member of the CTPLD works together as a team also known as 'The Team Link'. The CTPLD tries to make sure that services users with learning disabilities gets the same rights and choices as any other service user.

A02

How do the services and practitioners meet individual needs?

My case study

Looking at Ravens Wood where I am going to be looking at a particular case study.

Ravens Wood, a community that helps and supports those with learning difficulties there are 149 adult residents and 22 children all with learning disabilities, all funded by their local government. Residents' levels of ability vary greatly. All, however, are encouraged to live life to the full and have choices with the maximum independence with the support of 450 professional care workers.

Johnny is a resident at Ravens wood; he has lived there almost all his life, and is 52 years old. Johnny has mobility problems, he has little communication skills as he is deaf and partially blind, he does not respond well to communication aids such as computers.

Johnny's carers at Ravenswood noticed that Johnny's eyesight was worsening when they were getting Johnny to point at various objects; they also noticed that Johnny was experiencing dizziness regularly. Ravenswood took Johnny to a local GP, which the WPCT allocate 2-3 GPS within the area that can be used by Ravenswood.

Ravenswood were told that Johnny needed to have a cataract operation and referred Johnny to Royal Berkshire hospital to see a surgeon. The surgeon said that the operation was not a good idea for Johnny, because Johnny could not consent to the operation as he has little communication skills. The surgeon also said that Johnny was unable to read and had poor eyesight and came to the conclusion that there was little point.

Ravenswood always take into account 'what best for the resident/service user', and organised a multi-disciplinary meeting with the CLTPD, where there was Johnny's carer, psychologist, speech therapist, language therapist, occupational therapist and a physiotherapist. They discussed weather the operation for Johnny was necessary and came to conclude that it was. They considered if the treatment is life saving, if the treatment is a physical or mental illness and Johnny's capacity to consent.

They also discussed Johnny's best interest, weather without the operation will it deteriate his eyesight and dizziness.

As Johnny cannot consent the operation himself, there will be an advocate that will consent on Johnny's behalf, the advocate needs to be none bias.

Once the multidisciplinary meeting has come to an agreement (agreement not to treat, unanimous agreement to treat or divided opinions). In the case of a divided opinion they would seek anther opinion. In Johnny's case the multidisciplinary team meeting all came to an agreement to treat Johnny.

After to agreeing that Johnny can have the operation, the CTPLD will put Johnny on the waiting list, where they can arrange for Johnny to have the cataract operation, which could be at Royal Berkshire hospital, and then Johnny would be on anther waiting list at Royal Berkshire hospital where the surgeons can arrange the operation.

When drawing up a care plan for any service user like Johnny they will need to consider the following areas;

* Physical- concerning Johnny's body, his physical well being. As Johnny has poor mobility they ill need to provide Johnny with a wheelchair.

* Intellectual- Concerning weather Johnny is using the mind creatively, stimulating his brain i.e. education, access to book or newspapers, stimulated conversations or even looking at sensory things. They will need to consider Johnny's intellectual needs, as Johnny has little communication they may want to consider a language therapist, to make Johnny feel more comfortable when he has his operation

* Emotional- concerning Johnny's general happiness, quality of life and feeling good about him. They will need to consider Johnny's emotional needs; again as Johnny has little communication and little use of communication aids, the hospital may consider have a carer for Johnny or language therapist.

* Social needs- Johnny lives in a community; Johnny has the enjoyment of friends or enjoying the company of others, having a sense of caring and love feeling. As Johnny is used to living in Ravenswood in a community, with the enjoyment of his friends and carers, the hospital will need to consider how they will continue making Johnny feel cared and loved for, by having a carer.

We can refer to this as PIES. PIES is very important to any person as well as Johnny, to have a good all rounded health you would complete state of physical ,intellectual emotional, social well being. Any one of the PIES could a number of illnesses that could affect anther one of the PIES; this is why services and practitioners also need to consider care plans with the PIES in mind. Care plans or assessments are put in place for service users to help services and practitioners meet the needs of the service users like Johnny. In a care plan you would have detailed information about the service user what there needs are, medication, and plan of care for that service user. Anther good reason why the care plan is good idea is so that if anther cares worker or practitioner takes over in caring for the service user they all fully aware of what the needs are for the service user.

After and before Johnny's operation the practitioners of Royal Berkshire hospital will consider the different approaches that will help and reduce bad health, they will take into account these different approaches set up by services and practitioners to help and reduce health these would be known as:

* Preventative and treatment approach

* The Holistic approach

* The empowerment approach

* The Behavioural approach

The preventative and treatment approach trying to avoid disease by having a healthy lifestyle for example Johnny at ravens wood would be given choice of various different healthy meals. There is a primary prevention and a secondary prevention, primary being changing a person's way of life like regular excise or stopping smoking. At ravens wood they would make sure that all residents like Johnny try to get some regular exercise, weather it is walking, swimming or even horse riding. The secondary prevention is identifying a disease at the early stages where it can be treated for example screening, or going to see your GP about any early worries or concerns like Johnny did.

'Prevention is better than cure'

The holistic approach

This approach considers the whole person and not just their disease or illness. For example because Johnny needs a cataract operation, it can at anytime be made worse with other related issues or factors such as stress. Using the holistic approach takes in to account Johnny's illness but any factors that could make the illness much worse.

The empowerment approach

Empowerment mean giving Johnny the power, the chance to make his own decisions, making him involved in what treatment or procedures Johnny is undertaking. The whole point of the empowerment approach is so that Johnny can make his own informed choice. It's not just the Johnny that benefits from this approach, Johnny's careers and service providers benefit to.

The behavioural approach

This approach looks at trying to change a Johnny's behaviour or attitude towards their health. This approach could contain Campaigns, posters, leaflets, television adds to support Johnny to change their attitude towards their health.

Examples could include stop smoking, drinking, drug abuse campaigns, or even health eating campaigns.

Services and practitioners use the different approaches as shown above to enable prevention of which could reduce illness from the service users like Johnny. Care plans are anther important factors within health care, it enables the service providers i.e. a doctor to assess the service users physical, intellectual, and emotional and social needs. By finding the needs of service user the services and practitioners would identify whether there needs are emotional, physical, intellectual, or emotional, then these needs will be met through the different health preventions (prevention and treatment, holistic, empowerment, pr behavioural) then finally this would develop into care assessment or care plans for the service user.

I think the practitioners are more likely to use the empowerment and preventative treatment approach. Johnny will feel much happier and at ease if he feels he has the power, by giving Johnny the power he will feel as if he has choices and is not forced against his will. Also by using the preventive and treatment approach, which will include giving Johnny a controlled healthy diet, which he will have choice over by providing Johnny with a variety of different meals , also Johnny could do some physiotherapy to make Johnny have some more mobility.

How do practitioners work in a multi -disciplinary teams?

Multi-disciplinary teams would suggest that practitioners working in care with different specialist professions who provide care for service users like Johnny. Multi-disciplinary could work in hospitals, the community, care centres and could with any age group like children or older people or they could specialise in working with people with mental health problems.

Multi-disciplinary teams are important in any community as they work as a team to provide for the community, Multi-disciplinary teams consist of specialists that work in a particular area. They work in teams so that they can discuss a service user's needs user as well more quickly and get them referred more quickly, this makes it better for the service.

The single assessment process could be where a practitioner assesses a service user which could be done in a session depending on the health and state of the service user, and assesses all the needs of the service user

When Johnny goes into Royal Berkshire hospital, he will be visited by many different practitioners working in multidisciplinary teams such as, surgeons, nurses, physiotherapists and language therapists. This will ensure that all of Johnny's needs are met.

Multi-disciplinary therapy teams within the community such as physiotherapy, occupational therapy, speech therapy or language therapy, could visit the Johnny at Ravens wood. Therapists work in teams as this is well-organized, in each team of therapists they will be assigned to a particular service user group such as children rehabilitation or in Johnny's case would be learning disabilities. The different therapy teams will asses the needs of Johnny and make an individual care plan assessing all the needs for Johnny.

Referring back to the CTPLD 'team link', they also work in teams of different professions to enable the best for Johnny and to ensure all his needs are meet.

One of the services I will be looking into is the CTPLD how they help they service users like Johnny, and how it helps the practitioners themselves to receive or deliver services. The organisation of the CTPLD is the flat structure shown below;

Team management

Service care managers service care managers

Practitioners

There is range of different practitioners which could include a nurse, psychologist, psychiatrist, speech and language therapist, adult placement and respite care, community care support worker, dietician, physiotherapist, care manager, and occupational therapist. With the organisation of the flat structure it benefits service users as the CTPLD is organised in a team that they all work together giving the Johnny the best care they can and with the range of different practitioners they can be accessible to receive the care for their individual needs. It would also benefit the practitioners as working in a team is beneficial than working individually, they can refer Johnny on so to suite his needs.

The health services within the CTPLD they also work along with the social services in Berkshire west, they work together in meetings, discussions, referrals, and they work as a team.

The nurses that work within the CTPLD have different levels of qualification of high racy nurses being at different levels to newly qualified nurses. All the nurses get supervision from nurses that are at a higher level than themselves, they would have meetings on how the individual nurse is getting on with her job, what they have been doing since they last meet what case studies they are involved with. Depending on how what level the nurses are at will depend on how many times a week or month they would meet, the more higher the level of nurse you are the less times you will need to meet. This way of supervision would benefit the practitioners because they would be able to ask questions or queries when they meet for their meetings, they would be able to discuss how they are where they would need any help. Supervision would also benefit the services users like Johnny, as practitioners would feel more comfortable and confident in what they are doing, so that they can provide the best quality care for Johnny.

Practitioners also need to be able to work around Johnny to meet his need. 'Flexible working'. Being adaptable to their work load around Johnny his needs are met and the practitioners are organised and up to date with the Johnny so that they can resume the care or referral they need.

The referral system of Johnny where, Johnny can be referred where the practitioners see fit to refer, the service users i.e. to residential homes, GP's or psychiatrist. Johnny could self refer himself (self referral) where they feel they want to see a GP for example; Johnny makes the choice to go and see the GP. With the CTPLD there is a case load with any referral system where they have waiting lists which may leave some service users like Johnny waiting weeks, or months. CTPLD have some service users with more extreme cases and therefore would be put near the front of the case load or waiting list, the more the extreme the case the higher the service user goes up in the waiting list, they are prioritised. The referral system benefits the services user as they see a more experienced practitioner who specialises in a particular area and therefore gets specialised care. The practitioners benefit as they can refer service users as and when they need to enable the service users to get the best care possible.

In order to keep the CTPLD on track with there service users like Johnny, they deal with have assessment process Johnny, the practitioners may have interviews with Johnny or interventions where they intervene find what the needs of Johnny are and try and find ways of dealing or helping with it. In any assessment process of Johnny the practitioners would use assessment tools these are known as 'the paper work', the health action plan for example.

In any health care setting confidentiality can be a big issue, the CTPLD work in a confidentiality based setting, the practitioners keep any records, paper work, health assessment or care plans locked in filed cabinets. How ever discussing service users in meetings or in an office can be a problem as I found that their offices when cramped, small, and closed in, where any other practitioners or staff members could potentially over hear a services users details. What the CTPLD could do is have a more confided office area, or only discuss service users or Johnny in a room with only the practitioners concerned with the Johnny in that room. Confidentiality benefits any service user like Johnny as keeping their notes confidential will make him feel at ease and more comfortable about returning to any health care based setting. For practitioners it benefits them as discussing service users is un professional and would cold result in service users being upset or angry and not using the services anymore.

Royal Berkshire hospital is anther service provider that would work in multi disciplinary teams; the organisation of the service is quite similar to the CTPLD's as shown below;

Consultants

Ward sisters ward sisters

Divisional nurse divisional nurse

Other staff including physiotherapists, pharmacists, dieticians, nurse specialists and

Healthcare assistants.

This organisational structure which is very similar to the WCTPLD where they have a flat panel of practitioners, then they have more qualified nurses and doctors at the top. This is a good organisational structure for the practitioners within royal Berkshire hospital as it is clear organisation for the hospital they have more qualified at the top taking charge of the other practitioners making sure they are doing what they should be, also putting power in place , having authority and charge over the practitioners. The organisational structure also benefits Johnny as he is receiving the best possible care from the consultants and nurses working together in a multi disciplinary team.

Also similar to the WCTPLD is the how the nurses with higher levels of nursing, gained through training, supervise the nurses that are at lower levels. They may supervise nurses when they are treating Johnny making sure they are doing the right procedures, talking and meeting the nurses regularly to see how they nurse is getting on what she finds a struggle what she may need help and advise on.

Anther similar aspect of organisation is the flexible working where the practitioners need to be adaptable to the different shifts they work, they may need to do morning, afternoon or evening shifts and therefore need to be flexible to regular change, in order to meet the needs of their service users like Johnny.

Referral with Royal Berkshire hospitals works when a practitioner or doctor even you're local GP feels that you best interest is to be referred to a different departments or specialist within the area of need Johnny may be referred after his operation to an eye specialist. Any service user could be referred due to physiological issues, issues with pain, difficult social issues, carers or service users that need additional help. Referral systems help the practitioners by passing on the service users to a more specialised help and where they can achieve the best quality of life. It benefits the services users to as they are referred on they will see anther specialised practitioner who would know more about the problems the service user may have and more knowledge of how to help the service user.

Confidentiality in Royal Berkshire hospital is an important factor; the trust has a complete duty to the service user's personal information. To ensure that no one gets hold of one of the service users records they themselves have to pick up the records in person and supply further information like date of birth or house hold address. With regards to practitioners having access to service users records they will have to declare a confidentiality agreement where by they must not discuss service users outside of work or to any other practitioner who is not involved with the service users heath and well being. This benefits the service users as they can have complete trust in the practitioner's care, of confidentiality and no that they won't discuss your personal information with anybody that is not concerned. It is also a benefit to the practitioner as they are working in a confidential hospital where they can provide the services users with the best health care they can without breaking the service users trust. Royal Berkshire will also have to abide by Johnny's confidentiality as they would with any other service user being treated at royal Berkshire hospital. The different practitioners will need to be aware of Johnny's history as will Johnny's carers, but they are restricted to discussing Johnny's history with any other practitioner that is not involved with the care of Johnny. Johnny's notes will also be kept locked away where no one has access to Johnny's or any other patient/service user notes and history.

Royal Berkshire hospital has an equal opportunities policy which ensures that all job applicants or employees are not discriminated on the grounds of race, colour, religion, sex, disability or learning difficulty or social background. This also applies to the service users as they will not be treated differently on the grounds of race, colour, religion, sex, disability or learning difficulty or social background. This benefits the service user like Johnny as they will not be discriminated against and will be treated as an individual. It is also a benefit to the practitioners of job applicants as they will not be discriminated against and will be working in a multicultural work place.

As well as equal rights for patients at the Royal Berkshire hospital they also provide qualified interpreter in many languages as well a sign language which service users like Johnny to feel more comfortable when coming to the hospital, if they did not have this service then Johnny may chose not to go to hospital as they may feel scared about not being able to communicate that well with the practitioners. This also benefits the practitioners as they will feel they can communicate with the service users better and understand there needs.

Anther service that Royal Berkshire hospital provides is the rapid assessment clinic for older people (RACOP). This is an elderly care assessment and treatment ward. One of the main purposes of this ward is to offer multidisciplinary specialist assessment for older people. An example could be an elderly service user with sudden deterioration in physical functioning. This is a benefit to the service users and practitioner as they can provide/ receive improved health care for the elderly.

A03

How quality assurance is promoted by Ravenswood

Quality assurance is a system for evaluating the performance, the quality if the services they provide i.e. what Ravenswood provide to their service users. Many of the quality assurance procedures would be set by the central government. Standards, governance, and quality control are all essential in any care setting like Ravenswood or any health service.

Standards

National service frame works (NSFs) are national standards in certain settings that have been set by the government to improve standards of any health care service or care setting like Ravenswood. Standards relating to the level of service necessary in any health service or care setting like Ravenswood are always improving with the help from the NSFs. Targets will be set in agreement with the NSFs, PCT's (WPCT), social services and national health services, any agreements made will have set time limits. WPCT will look to see what targets to tackle or any issues and concerns within Wokingham.

Aspects of Quality assurance

Quality assurance mechanisms used by services take many forms;

Improving information and consultation with service users

Changes in the involvement of patients and health services took place because of the NHS plan (2000) and the health and social care act. The acts look at how they can and should involve patients and the public with ho services are run. NHS as well as local councils and social services departments now involve the service users and public and they also provide information about services offered in various was such as leaflets and websites. At ravens wood they provide information for the residents like Johnny in the form of leaflets, carers. Ravens wood feel it is essential to have consultations with the residents like Johnny and Johnny family so that they are updated and informed.

Involving service users in the NHS and social care

Health and social care act implements the NHS must involve and consult with the service users and the public with any service planning and proposals for change. Examples of consultation include questionnaires being sent to households in the area or asking them to comment on the services available. Residents like Johnny may have the chance to get involved with meetings about how services should be run and what is needed or to be changed, this way it gives Johnny a voice and makes him feel that he is important and that he can give his opinion.

Patient choice

This initiative is how service users like Johnny or patients be involved in making decisions about their own care. At Ravenswood they feel that choice is important for the residents like Johnny to give them that empowerment and give them choice rather than choices made for them as if they are not important. Johnny will get choice with what meals he would like to eat for example Ravenswood will offer Johnny three choices of dishes and he would get the choice of what dish he would like. Johnny will get choice of how to decorate his room to make him feel more comfortable and to make his room his own. Johnny will get choice with regards to health weather he would prefer to see a male doctor rather than a female, maybe Johnny would prefer to have a certain doctor or would like a speech therapist present.

Service standards in social care

Numerous polices and legislation standards in social care are being developed in a range of areas. NFs are one way of developing standards, which would be monitored by trusts and social services working in partnership. In the NFs for older people, which raven wood, hold residents of all ages. In the Nfs there is local councils, hospital trusts, PCT's, voluntary sector, and older people. There is meetings that take place and they will set up actions plans and targets set by the government, which will be monitored. They have come up with immunisations for elderly over 65 and exercise programmes for the elderly. Ravens wood would need to be a part of these standards as they have residents that could be elderly, and this would benefit those residents giving them the service standards they need.

Using performance measures in social care

The commission for social care inspection is responsible for;

* Inspections of all social care organisations like ravens wood, against nationals standards, and publishing reports.

* Registering services that are meet national minimum standards.

* Inspections of local services authorities.

* Publishing an annual report to parliament on progress in social care and analysing expenditure.

* Publishing star ratings for local authorities.

The CSCI sets out regulations, standards and on information about specific social care standards. These would apply to Ravenswood; these are a way of promoting a good practice and identifying areas for improvement. Ravenswood will have inspections to make sure that they are carrying out the right standards for the residents like Johnny, to make sure that the residents are happy with the care they receive from Ravenswood and for point out areas of weakness which can be improved upon.

Residents at Ravenswood that are under ages of 16 and 17 of ages that are moving into adult hood would need to be supported in this process. Education, training and employment are very important and should be present in the residents care plans at Ravenswood and should be reviewed frequently. This will ensure that the residents have a successful as possible transition to adult hood and make sure that residents are ready for the transition to adult hood, making them feel more at ease. The residents care plan would include;

* Education, training and employment.

* Securing safe and secure accommodation at Ravenswood for the residents.

* Support for the residents that have more severe disabilities.

* Financial support and assistance, in which case the county that they lived in would fund the residents at Ravenswood.

* General and specialised health education and health care and other specialist services such as counselling to the residents.

Ravenswood will be responsible to ensure that residents have access to and chose from a range of appropriate leisure activities, Ravenswood have their own stables with horses for the residents that enjoy horse riding will have access to. Ravenswood have a farm for those who have interests in animals. They have grounds and fields where residents can use to play such activities, if a resident at Ravenswood has a special interest in an activity Ravenswood does their best to see that they can provide it or can get access somewhere for the residents.

Ravenswood and their many staff and carers are responsible that birthdays, name days, cultural and religious festivals are celebrated and service users participate in planning these events. Ravenswood give the residents like Johnny to chose how to decorate their own rooms, what colour paint they would like, if they want certain posters, weather they want a TV or a radio, this makes the residents feel that they have a choice and feel more comfortable in their rooms. Although Ravenswood is traditionally known to be a Jewish community, they accept residents from all cultures, religions and backgrounds. If residents such as Johnny wanted to celebrate Christmas he would be allowed to have a Christmas tree in his room if he wished to.

Ravenswood would be responsible for residents under the age of 18 do not have access to, or watch videos certified as suitable for over 18's, and systems and polices are in place to safe guard users when using computers and using the internet. The law enforces this and Ravenswood must abide by it.

Residents at Ravenswood, leisure interests and areas which a service user has a talent or ability are encouraged and financially supported, this is to make residents like Johnny have an enjoyable life and use their talents to the most and be supported by there abilities, which could make them more confident and feel happy that they are talented.

Quality assurance is provided by Ravenswood by;

* Managing complaints

* Staff training issues

* Resident surveys

* Start rating systems

* Registration and inspection procedures

* National frameworks

* Government guild lines

* Consultation with residents

* Rewarding good practice

A04

I will now be looking at a piece of government legislation, with the effects of the legislation on care practice and provision. The legislation is will be looking is the white paper- valuing people.

The white paper sets out government commitment to improving the life of those with learning disabilities. The white paper works closely with local councils, health services, voluntary organisations and people with learning disabilities and their families to provide new opportunities for those with learning disabilities to lead full and active lives.

The white paper defines a learning disability must have the presence of;

* A significantly reduced ability to understand new or complex information.

* A reduced ability to cope independently.

* Which lasted before adult hood and will have a lasting affect.

White paper feels that a low intelligence quote for example an IQ below 70, is not itself a sufficient reason for deciding weather an individual should be provided with additional health and social care support. White paper would do an assessment of social functioning and communication skills should be taken into account when determining needs.

People with learning disabilities like Johnny, are often more vulnerable and socially excluded within society, as a result of this white paper have come to recognise areas which need to be tackled in order for people with learning difficulties to live fuller and more independent lives in their communities. The major problems white paper has recognised are;

* Poorly coordinated services with families that have disabled children.

* Poor planning for young disabled people at the point of transition into adult hood.

* Insufficient support for carers, particularly those caring for people with complex needs.

* People with learning disabilities often have little or no choice or control over many aspects in their lives.

* Substantial health care needs of people with learning disabilities are often unmet.

* Housing choice is unlimited

* Day services are not tailored to the needs and abilities of the individual.

* Limited opportunities for employment.

* The needs of people from minority ethnic communities are often over looked.

* Inconsistency in expenditure and service delivery and;

* Few examples of real partnership between health and social care or involving people with learning disabilities and carers.

This has affected Johnny at Ravenswood because he can now get the care and support he needs that Ravenswood has to offer to all of its residents.

The white paper sets out to achieve these major problems by a long term implementation programme at national level, supporting the implementations;

* Learning disability task force that will advise the government on implementation.

* Implementation support team that will promote changes at regional and local levels.

* Learning disability partnership boards, they will have responsibility for ensuring implementation and will also develop local action plans.

* Social services that will carry out inspections in care homes and learning disability services.

This affects Johnny, because Ravenswood and services are being inspected and monitored and evaluated that he can get the best care he possibly care proved by Ravenswood and supported by government's implementations.

Many people with learning disabilities were involved in consultation processes, which were put in to place to suggest ideas for improving services. There are six groups bring together theses consultation meetings these included people with learning disabilities, carers, local authority, NHS, and voluntary sector representatives and researchers, this benefits Johnny because he can have a say in how services need to be bettered changed, this would make Johnny feel that he has a voice and can make his opinions and it will be counted for. . There were many clear messages from the consultation meetings;

* Children with learning disabilities wanted to be treated like other children and not be seen as special.

* Parents of disabled children wanted better advice and information.

* People with learning disabilities often felt excluded and unheard, they wanted to be part of society to marginalised or forgotten.

* Carers felt strongly that they had a life time responsibility, they needed more support.

By people with learning disabilities being able to have their say like Johnny, their needs can be addressed and made aware, many issues that would not have been considered by local authorities or organisations, will possibly be suggested by people like Johnny to have their say and get their thoughts and opinions across. People with learning disabilities will now best what they want, so I think that it is a good idea to have the included in meetings.

The eleven government objectives are;

o Maximising opportunities for disabled children like residents at Ravenswood, this would include ensuring children with disability gain maxim life chances from educational opportunities to health and social care, whilst they live at home with parents or in a care setting like Ravenswood.

o Transition in adult life, as young people move into adulthood, the government could ensure that continuity or care and support for those and their families and to provide equality of opportunity in order to enable as many people as possible to participate in education and employment.

o To enable Johnny at Ravenswood to have more control and choice over their lives as possible. This could be done through advocacy in Johnny's case and a person centred approach to planning the services that Johnny needs; this could include physiotherapy, language therapist, and dietician.

o Supporting Johnny's carers to support from local agencies in order to fulfil their own families and caring roles efficiently.

o Good health, to enable that Johnny has a good health he will to have a health service designed around his needs, with fast and convenient care delivered by Ravenswood staff and with additional support where necessary like GP surgeries and health acre in the community.

o Housing, to enable Johnny and his family to be able have more say about where and how Johnny lives his life.

o Fulfilling lives, enabling Johnny to lead full and purposeful life in his community, to ensure that Johnny develops friendships at Ravenswood with other residents, and to get involved with activities and relationships.

o Moving into employment, to try and get Johnny to take part in some forms of employment, wherever possible in paid work to make a valued contribution to the world of work.

o Quality, ensuring agencies commission and provide high quality, evidence based and continually improving services, which will help towards the health and wealth fare of Johnny's and other residents lives.

o Work force and training, ensuring that Johnny's carers are appropriately skilled trained and qualified. To be able to promote a better understanding of Johnny's needs and with other residents needs.

o Partnership working, promoting holistic services for Johnny for effective partnership working between all relevant local agencies in the commissioning and delivery of services.

The white paper work with four different acts that help and support those with disabilities like Johnny, these make sure that Johnny has right, is not mistreated or discriminated against. They are there so that Johnny feels that his voice can be heard if it needs to be, the four acts are;

* Human rights act

* Disability discrimination act

* Race relations act

* Sex discrimination act

The disability act ensures that if Johnny is discriminated in any way through education or employment then Johnny will be able to gain full legal rights. Ensuring that all the needs and views of Johnny are integral to all the commission work.

It also ensures s that Johnny who is vulnerable to abuse or discrimination are protected in law.

The purpose of the white paper legislation affects Johnny and any other person that has a disability because, it sets out targets to help and improve Johnny's life, it makes sure that Johnny has right and consultations set in place to find out what Johnny options thoughts and suggestions are. Consultation would be done by Johnny's carers in Ravenswood which would be enforced by the governments polices.

The white paper enforces that Ravenswood and other health care services and care practitioners are joint working together to promote the best possible health care for Johnny and other residents. White paper also enforces that Ravenswood and health and social care practitioners are responding to Johnny's needs, suggestions, complaints and opinions and those they are not just ignored but are dealt with and taken further.

The white paper is also responsible for national and local care practice and provision abiding with national targets, joint working with other health acre services to ensure that residents like Johnny can receive the best possible care possible weather he needs to go out to the visit a physiotherapist or a physiotherapist comes to see Johnny at Ravenswood.

Through monitoring Ravenswood and other health care settings through a range of approached has also helped to improve the quality of service provision both nationally and locally.

The white paper in particular looks at the roles that both commissioners of learning disability services and the new Learning Disability Partnership Boards must play in developing and implementing local plans. It states that effective strategic planning at national and local levels is required in order to create individualized service for johnny and other people woth learning disablities, which will promote rights, independence, choice and inclusion.

Johnny must be empowered to decide what changes he wants in his life. The pressure to improve services must not overtake the Johnny's needs and Johnny's carers.