INTER PROFESSIONAL WORKING IN THE HEALTH SECTOR IN UK by Reason Chivaka

Introduction The complex nature of human beings, demand health and social care services that cannot be provided by a single health care professional. Consequently, various health and social care professionals work together, towards the provision of health and social care needs of the service users. According to Barrett et al (2005), inter professional working's emphasis is on collaboration of various professionals towards the provision of integrated care services for the services users benefits.

Inter professional working is important within health and social care because it provides service users with a package of services that aims to meet their health and social care needs. Service users, whether young, old, vulnerable or not are entitled to quality services. The coming together of various professionals working towards a common goal is aimed at provision of high quality services. The importance of inter professional working is emphasised by Loxley (1997), who argued that, regardless of its inherent problems, inter professional working is vital for solving complex social and health care needs of the service users. This means that, inter professional working is important within health and social care. The changes taking place within health and social care sector have resulted in the 1

emergence of inter professional working in hospitals. Patients are now more aware of the type and quality of care they should be getting hence they are always exerting pressure on service providers. Consequently, health and social care professionals are always under constant pressure not only from the services users but also from the Government to provide integrated and quality care. As a response to this demand, health and social care professionals adopted the concept of inter professional working. Although the concept is not without its problems, there is growing realisation and consensus among health care professionals that, there is need to work together if they are to meet the expectations and needs of the services users and other stakeholders. For example in a surgical environment where I work, it is not possible for nurses or doctors to meet all the needs of the patients. The services of other health and social care professionals like, occupational therapist, physio-therapist, social workers and speech and language therapists are needed.

Review of the Literature

Prior to the second world war, the provision of health and social care in UK was highly fragmented. To deal with the problems, during the 1940s, the Government of the day, passed various legislations focusing on provision of health and social care and also the creation of the National Health Services (NHS). The idea was to cater for the health and social care needs of the people with the Government playing the leading role. Financing of the services was the onus of the central government with 2

local authorities given varying degrees of autonomy whilst control of the service delivery was in the hands of health and social care professionals (Gladstone:1995 cited in Barrett et al :2005). Despite the efforts by the then Government, problems still emanated from poor coordination among health and social care professionals who were doing things their own way with little or no thought for the needs of the service users. During that time, there was no realisation and acknowledgement of the importance of working together to address the needs of the service users. However, the importance of inter professional working was realised during the 1970s but not much was done during that time (Barrett et al: 2005).

Another development that changed the whole complexion in the 1980s was the emphasis on free market by the then Government. The free market concept raised the awareness of health care and social care recipients. There was increased prominence in the demand for coherence, accountability and transparency from the service users (Martin and Rogers: 2004). Efforts to deal with the poor and fragmented working culture among health and social care professionals, led to the publication of various documents by the Government.

There is evidence that, the Government came up with policies that encouraged and supported the need and importance for various health and social care professionals to work together. The Department of Health (DoH) 1986 document challenged all health and social care professionals to contribute to the health of the local population. The 3

DoH (1998) document, stipulated that, health authorities and other agencies should collaborate in the the provision of comprehensive care to target users. This was followed by the Health Act of (1999) which removed all legal barriers to joint working whilst the DoH (2000) document focused on financing the reforms

necessary for working together of various health care professionals (Martin et al : 2004). Another DoH (2000) document challenged nurses, midwives and health visitors to engage in inter professional practice (Barrett etal: 2005). In 2001, the Department of Health (DoH) produced a document entitled working together, learning together which emphasised the importance of inter professional working and inter professional learning to promote working together of various professional and to help reduced friction among various professionals respectively.

It interesting to note that, these various documents made it very clear that inter professional working is the only way various health and social care professionals can improve the quality of health and social care by working together for the benefit of the services users. The question is what is involved in inter professional working.

Contemporary Literature on Inter Professional working

Inter professional working implies the approach to assessment and intervention which is highly collaborated by health care professionals from various professions who 4

work towards the provision of health or social care (Barsky etal:2000). Similar views are from Leathard (2001) who said that, it is the collaboration of various professionals with the aim of providing a quality service. Inter professional working was the result of the realisation that, no single professional possesses all the knowledge and skills needed to meet the varying and complex needs of the service users (Edwards et al: 2009). This realisation resulted in the passing of various policies by the Government which facilitated and encouraged various professionals from various backgrounds to work together, sharing common objectives and make complimentary contributions towards service provision. The above views and ideas make it very clear that, the needs of the users of health and social care care services are increasingly becoming complex such that no single health care professional can meet the needs of the service users.

In hospitals the package of care consists of doctors, nurses, occupational therapists, physio-therapist, social workers and speech and language therapists depending on the diagnosis of each and every patient. As much as Doctors would want to take the centre stage they cannot do much without the input of the other health and social care professionals. The way forward for professional to work together through information sharing, direct collaboration, assessment, planning, implementation and evaluation. Collaboration among various health care is central to inter professional working (Payn:2000). However, despite the realisation and acknowledgement of the need to work together among health and social care professional, inter professional working 5

experiences some problems. The major problem emanates from the fact that, the way these professional work is heavily influenced by their own professions. Fear about being deregulated and fragmented by the Government in its endeavour to weaken sources of power and resistance to inter professional working is another major source of problem (Loxley:1997). The other challenge that faces inter professional working is knowledge differences and prioritise. In practice, at times it is difficult to bring the various health and social care professionals together due to lack of consensus, time constraints, and poor communication. Despite documented evidence of the problems faced by inter professional working, (Leathard :2001, Barrett et al:2005), it is a concept that can bring the desired outcomes. Martin (2003), Meads et al (2005) and Goodman et al (2008) argued that, despite its problems inter professional working's merits outweighs its demerits. What then should be done for inter professional working to meet the needs of the service users.

The argument is that, inter professional working can only work if the various professionals coordinate, communicate and cooperate (Edwards et al:2009). Proper coordination, communication and cooperation are the main ingredients of collaboration which is the backbone of inter professional working. Collaboration can be done using various means which are conferring, cooperation, consulting and team working (Barskey et al: 2000). Conferring This involves various professionals sharing information about what they have 6

observed, For example a physio therapist sharing information with nurses about what he or she had observed whilst dealing with a patient.

Cooperation With this form of collaboration, professionals start by sharing information, agree on what to do and then develop a plan to meet the needs of the service user. This can be nurses sharing information with the occupational therapist and then develop a care plan for the patient. Consulting Consulting involves professionals consulting each other's opinion. This involves for example, nursing staff consulting the Social worker on how care is funded in the community before advising the patient.

Teamwork Involves the coming together of various professionals in order to provide a service in an integrated way. According to Barsky etal (2005), team work involves cooperation, engagement, information gathering, information sharing, assessment, planning and monitoring throughout the entire process.

The consensus is that, inter professional working is very important if the needs of the services users are to be met. Health and social cares professionals need to work together if the services users are not going to be marginalised and they should treat 7

the various services users the same. The means that, health and social care professional should embrace the concept of diversity as the demographics of the service users are changing.

Diversity and Social Exclusion

The composition of the health and social care users is changing thereby challenging the way various healthcare professionals do their work. The social structure is now more diverse than what it was some years ago. In health and social care, diversity demands service providers to to be responsive to the ever changing demographic composition of the service users (Baxter:2001). Service providers should embrace the concept of diversity and provide the same level and quality of service to any one irrespective of their sexual orientation, age, political affiliation, gender and social status. In Scotland, the Equality and Diversity: Agenda for Change (Dimension 6 Core) (2004) document makes it very clear that, staff should embrace diversity as failure to do so will result in discrimination. It is therefore the role of various health and social care providers to promote the concept of diversity and work together to ensure that service users are receiving the appropriate service. Failure to embrace diversity can result in some people not being able to access or receive the appropriate health or social care. The old and the vulnerable are at risk if service provider do not look after them, people from minority groups may not be able to access services if service providers discriminate on the basis of ethnic origin. 8

The idea behind diversity it to eliminate problems associated with social exclusion. It is only when service providers treat all service users the same in terms of their needs that social exclusion can be prevented.

Many would be recipients of health and social care services do not get the services either due to lack of information or inability to access them. It is therefore the role of health and social care service providers to help services users with information and access to these services. Fail to do so will worsen the problems associated with social exclusion. Social exclusion is the ''marginalisation of individuals and groups within a society from education, jobs or health care'' (Abrams et al: 2007). A review of the literature shows that there is no general consensus as to what constitute social exclusion and how it should be determined. Room (1995) argued that, ''a multidimensional approach is the best way to establish its causes and determine appropriate solutions''.

A multidimensional approach, means that the services of various professionals are required to find out why one has been socially excluded. In healthcare, when a patient is admitted, it is important to collect a lot of information to determine whether a patient, especially the elderly and the vulnerable ones are accessing and getting all the services they need to live a better life. It is therefore important that, various healthcare professionals should work together to prevent situations that leads to social exclusion. Proper needs analysis, risk assessment and implementation is vital. 9

Needs analysis Provision of health and social care needs of users can only be met if their needs are properly identified. Needs analysis is vital as it informs the service providers and guides them in planning of care (Malone and Bucknall:2010). In my place of work, needs analysis is done by collecting information from the patient and from other health care professionals such as care managers, social workers, community nurses and General Practices. The information collected helps to give a holistic view of the patient and the problem. Guided by the health and social model as well as the Roper etal (2000) model of care which emphasises on activities of daily living, staff are able to identify the needs of the patient. For example, social circumstances of a patient may indicate that, after discharge the patient may not cope at home, hence under such circumstances, it is important to plan how to deal with the identified problems. Whilst the needs analysis is vital, it is beset with problems as at times it very difficult to gather vital information due to poor communication among health care professionals. Consequently at times the information gathered my not address all the needs of the patient (Gulanick and Myers:2007). However, despite these shortcomings, needs analysis is important as it gives a clear picture of the patient, the problems and helps to plan and do a risk assessment.

Risk assessment Having identified the needs of the patient, the next challenge is, how best to help the 10

patient and what are the associated risks. Risk assessment is part and parcel of the process of assisting patients to meet their activities of daily living. The importance of risk assessment is highlighted by Sud and Gorman (2008) who argued that, risk assessment is vital because provision of health care services is risky to both services providers and service users. Given this argument, the assumption is that, whatever care is planned, the interventions should be free from risks or the level of risk should be low as this has an impact on the quality of patient care. In my place of work, risk assessment is part of our culture as it is something that is done everyday. The cooperation of the patient and other health care professionals is vital if risk assessment is to be of benefit to the service users. The patient should be furnished with full information as to why and how the assessment is being done.

However, in practice there is always conflict among health care professionals on how to carry out the risks assessments. For example, physio-therapists usually complain that, nursing staff are fond of using moving and handling equipments instead of helping and encouraging patients to mobilise, especially post operative and elderly patients. Since nurses are with the patients most of the time, they argue that, they know the patient's needs very well hence, they can do a better risk assessment and plan better that other health care professionals. However, risk assessment should be a joint endeavour by all health care professionals (Gulanick and Myers:2007). Risks assessment is linked to inter professional working as various health care professionals should work together, share information and agree on the plan of care. The 11

information gathered during needs analysis and risk assessment is vital for planning patient care and how it should be implemented.

Care Implementation

The purpose of a patient care plan is to guide the service users when implementing the interventions necessary to address the needs of the patients. It is important that, the interventions should been agreed by the various health professionals who are involved in the patient's care. Usually the implementation of the care is left to nurses but inter professional working literature stresses the fact that, there should be collaboration among the various health care professionals from assessment to evaluation (Martin and Rogers : 2004).

The focus of implementing care is on moving the patient from dependence to independence depending on their problems, hence it is important that, the patient should be fully informed and supported. Various health and social care service providers should play their part as much as they can and there should be constant engagement and evaluation. If the implementation is done properly and various health care professionals are collaborating, then the quality of care that service users receive will improve and patients will recover quickly.

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Comparison and Contrasting the Models of Care.

A model is a collection of interrelated concepts that guide the direction in practice (www.nursingtheory.net/model.html). Models help to turn theories into real situations. Various models are used in health and social care to aid the assessment, planning, implementation and evaluation of health and social care needs (Mayer et al :1990). For example, the medical model is based on scientific theory whilst the health and social model has its roots in social rather than life sciences (www.uws.ac.uk/interprofessional working /module). In my area of work, the health and social model is used. The model entails, the holistic approach to provision of health and social care.

Unlike the medical model whose focus is on the medical needs of the patients only, the health and socials model considers the patient's environment as well as social circumstances. For example, when a patient is admitted, a thorough assessment is done to get as much information as possible about the patient. Information gathering will not only focus on the medical problems but on the social circumstance as well (Mayer et al :1990). The information gathered will lead to comprehensive care plans. From the care plans, the services of the various health and social care professionals will be enlisted to provide not only appropriate but quality patient care.

Whilst the medical model of care's focus is on dealing with the diagnosis, the health 13

and social model of care deals with all the aspects. For example, treating an elderly patient after a fall and discharging them without looking at and addressing the causes of the fall will not help at all. Unlike the medical model, the health and social model informs that, the reasons for the falls should be investigated with a view to coming up with solutions. Vital questions during the assessment will focus on what the patient is able to do and not able to do, does the patient need the services of the occupational or physio-therapists or the social worker. It is also important to find out the what the views of the family members are.

There is a link between the health and social model and inter professional working as its holistic approach to health and social care demands the contribution of various health care professionals. The belief is that through working together, it is not only possible that the services users medical or social problem is addressed but is being prevented from recurring ( Martin et al : 2004). This is the major difference between the medical and health and social care model as the former ignores the prevention of the problem. The argument is that, unless preventative measures are taken, resources are wasted due to constant recurrences of the problems.

Conclusion The needs of the various health and social care users are changing and becoming complex each and every day. The hospital patient of 20 years ago is different from the 14

patient of today. Services users have access to information from various sources such as the internet, libraries, family and friends. As a result they are more knowledgable and aware of the type and quality of care they should be receiving. Health and social care providers need to move with the pace of change in order to meet the increasingly demanding needs of service users. Working together of the various health and social care professionals which is the main idea behind inter professional working is the only solution to the challenges that these professionals are facing in their endeavours to meet the needs of the service users. Whilst inter professional working is vital, it has its problems which these professionals have to overcome if they are to work together and realise the desired outcomes.

Failure to work together can cause some problems such as social exclusion and lack of appreciation of the concept of diversity. Hospital based professionals should constantly collaborate with their counterparts in the community to quickly deal with problems being faced by service users. It is also important that people should be treated the same and healthcare and social care professionals should not allow their on values and beliefs to affect the way they deal with service users.

To effectively help the service user be it in hospitals or in the community, thorough needs analysis, risk assessment and proper implementation of care should be done. If various health and social care professionals collaborate during the whole process then the level of care delivery will not only meet the needs of the users but will be of good 15

quality. The concept of inter professional working is vital in delivering health and social care needs.

References

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19. Room, G. (1995) Beyond the Threshold. The Measurement of and Analysis of Social Exclusion. Bristol: Policy Press. 20. Roper, N. Logan, W. and Tierney, A. (2000) The Roper-Logan-Tierney Model of Nursing. New York: Churchill Livingstone 21. Sud, H. and Gorman, J. (2008) Developing a Risk Assessment Tool to Improve Patient Safety. Nursing Times, 104: 36, 26-27. 22. www.show.scot.nhs.uk/diversity_inclusion.index.aspx

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