Legal And Ethical Practice For Learning Disability
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The drive towards the provision of 'person-centred' services for people with learning disabilities, has acquired a vast amount of policy maker's attention in the United Kingdom (Cambridge, 2008). Valuing People (UK Department of Health, 2001) has been the most fundamental government paper that has prompted a change in the way current health and social care services operate. Collaboration can be seen as an important facilitator in delivering quality healthcare and achieving an holistic care service (Xyrichis et al., 2008). However, previous research focusing on teamwork in healthcare has been criticised for lacking a basic understanding of what this concept represents. This assignment aims to address the importance of inter-professional and multi- professional collaboration within the health and social care domain, when working with adults with learning disabilities.
The concept of working together originated under the umbrella term mutli-agency team working; this term dominated the discourse of policy and practice in the first years of the 21st Century. Mutli-agency teams were drawn together from distinct agencies for a set period of time and for a particular task whilst other groups of professionals came together as interagency teams simply for a particular project or case (Anning 2006). An example is a group of health practitioners, social workers and carers, reviewing and monitoring service provision and access to person-centred services for adults with learning disabilities. The government have advocated for Learning Disability Partnership Boards to be set up so as to make it a priority that service users don't fall 'between the gaps' and that they receive sufficient support and access to person-centred services.
Clark (1993) states that inter-professional and inter-disciplinary practice can be used interchangeably. Inter-Professional working occurs when two or more professionals collaborate together in order to provide patient-centred care and a better quality of care; for instance the interaction between a general practitioner and a nurse. Multi-professional working occurs when professionals from health related occupations and varying backgrounds come together for a particular case. For example a diabetes team, whose primary function could be to assess, monitor and inform all people with diabetes within a particular catchment population. The team would mostly comprise of a consultant endocrinologist, two diabetes specialist nurses, a dietician and podiatrist. The UK Department of Education (2003) conducted research which shows that a person with a disability is likely to be in contact with more than ten different professionals in their lifetime. Throughout this time, issues can arise which may lead to a lack of continuity and co-ordination of care services. This is the main reason why the government advocates for an integrated approach for health and social care provision. This is not limited to healthcare but also outside of the domain, as different organisations have their own role to play. For instance, disparate services such as education, training, housing and employment need to work together and have a certain level of access to information about a client, whist maintaining patient confidentiality. For example the transition from secondary care to tertiary care such as from hospital to a residential home would require varying levels of expertise. An occupational therapist to examine the environment that the patient will be moving to, a medical practitioner to identify the need for the patient to be moved, a nurse to ensure continuity of care and a social worker to ascertain the level of support required on a day to day basis.
The National Health Service (NHS) is the largest organisation in Europe, and is recognised by the World Health Organisation as one of the best healthcare services in the world (Department of Health, 2000). The Healthcare Act (1999) requires NHS organisations to work together in partnership (Glendinning et al, 2001) yet evidence such as the Lord Lamming report suggests that barriers to inter-professional and multi-professional practice still exist. Lord Lamming's findings of the Victoria Climbié inquiry highlighted that poor co-ordination and a lack of communication between agencies, was central to her untimely death.
Since the publication of Every Child Matters (Department for Education and Skills 2003) local authorities are now developing innovative solutions for information sharing known as an 'Information Hub'. Clear and effective communication between all parities is required for this to be successful, with specific reference to learning disability, care providers work and plan in different ways such as PATH (Planning Alternative Tomorrows With Hope) therefore it is even more important to clearly document and share information freely in order to foster the implementation of care plans and create value in the best interest of service users, service providers and other professionals.
Traditionally, the NHS relied on paper records such as patient files, letters and referral forms. This was subject to unauthorised access, loss, a breach in patient confidentiality and a lack of accurate and up-to-date information. However due to the National Programme for Information Technology (UK Department of Health, 2005) and advances in technology, information sharing is more accessible due to the use of electronic databases which has security mechanisms to prevent malpractice and unauthorised access as well as upholding clinical governance. As outlined in the Nursing and Midwifery Code of Conduct (2008) quality record-keeping and evidence based policies are necessary for effective communication. However, this can in turn result in 'inactive collaboration' (Daly 2004) with each professional group having a 'singular input into patient care'. Purtilo and Haddad (1996) state that verbal communication is important in sustaining the relationship between patients and healthcare professionals. Regular meetings of a multi-professional team with a common care pathway can aid the teams' collaboration.
Professional identity and patient power, is another factor which must be considered. Leathard (1994) points out that the rivalry between professional groups can inhibit collaborative working. Power struggles within society for example between, experienced colleagues and inexperienced colleagues are barriers towards successful inter-professional working. However, new approaches in care provision such as skill-mixing and a drive towards person-centred services utilises the authority of the patient to govern the priorities of an inter-professional team as well as valuing each member of a team and their contribution. A difference in philosophies of care is also a key factor, as different professional groups have different moral and ethical philosophies in care provision. Such as, the paternalistic approach of a medical practitioner versus the approach of a public health advocate (Daly 2004).Recent research suggests that inter-professional working can lead to verbal abuse; professional autonomy is challenged when professionals work together in groups. A study conducted by (Joubert, Du Rand, VanWyk.., 2005) reported that 'nurses experienced high levels of verbal abuse by physicians'. A tense environment can lead to poor working conditions and a higher risk of errors (Celik et al 2007).
Professionals have different pay brackets, which is defined according to their professional group and then their role within the group. Issues that may arise include resource allocation and funding for staff. At present the UK is involved in global crisis and the economy is central to restoration as jobs are at risk and services are being cut which is a hindrance to mutli-professional working. There staff shortages within the NHS, which can damage interaction between groups and see a decline in collaboration. However, Leathard (1994) states that that advantage of inter-professional lies in the more efficient use of staff.
Integrated care lies at the heart of health and social care provision and is at the future management of people with learning disabilities. The Care Programme Approach (CPA) was introduced in 1991 as a framework for people who require support from a range of different care service providers. The aim of the approach was to promote personalisation by consolidating services into a single service known as a 'care co-ordination model' (Goodwin, 2010). The concepts of inter-professional and mutli-professional teamwork can promote effective and efficient patient care. A patient is able to receive expertise specific to the individuals' problem, and a team can provide co-ordination which can prevent any aspect of the patients' care being overlooked. Professionals are able to share knowledge and skills however it is important to understand how professions can work together amicably as ethical dilemmas can arise. Core values such as altruism, advocacy and integrity are important in health and social practice and all staff should adhere to professional codes of conduct.
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