Health and Safety is Important to the Health and Social Care Workplace
The UK has developed regulations and policies that oversee the quality and safety of care. Legislations such as the Health and Social Care Act 2008 give the Care Quality Commission the mandate to inspect and regulate the care given in registered care entities such as hospitals and care homes. Health and safety regulations help to improve care in the UK by providing a framework for standardizing care and holding care givers accountable to ensuring the safety and health of individuals in the health and social care workplace.
1.1. A Review of Systems, Policies, and Procedures for Communicating Health to Stakeholders
The United Kingdom has a legislative framework to guide the practice of health and social care work, including residential homes. Health and safety in the workplace is a priority in social care. British legislation that governs social care organizations includes the Health and Social Care Act and the Care Act of 2014 (Humphries, 2015). The 2012 Health and Social Care Act introduced clinical commissioning groups which provide leadership at local levels. The Care Act emphasizes the role of integration and collaboration in the provision of care. Policy initiatives to ensure coordination in the provision of care services include the Integrated Care and Support: Our Shared Commitment which facilitates the integration of local care providers through Health and Wellbeing Boards. Similarly, the Health And Safety Act Work Act 1974 allows organizations to communicate with their employees on applicable policies in order to ensure compliance with the law. The Health and Social Care Act 2008 tasks the Care Quality Commission (CQC) with protecting and improving the health and safety of consumers of health and social care services.
In the case of Fleetwood Hall residential home, the review systems in place include supervisions and appraisals. According to the 2015 CQC report, however, these review channels were underutilized. The employees reported that the management’s involvement in supervision and appraisal was not timely. Targeted communication, such as focusing on employees as a specific group of workers helps to ensure better adherence to work requirements (Bourne, 2016). Challenges in training opportunities were evident. The management did not adhere to the CQC procedures requiring a yearly update medication for nurses. The procedure for communication was hierarchical. There were unit managers, the registered manager, and staff. Although staff reported complaints such as moving floor sections, the management was yet to respond by the time of inspection.
Systems and procedures that are present in the residential home for communicating information on health and safety include care plans and organization practice protocols. Although the CQC report found that the managed care plans were not up to date or comprehensive, the facility used care plans to manage the health and safety risks of patients. Improvement is needed in ensuring that patients and families are involved in the creation of care plans. Also, the organization has various protocols in practice, such as the policy on restraint. The home’s management specified to workers that the use of physical restraint was not an acceptable practice. Despite these policies, the management trained its care workers in the use of restraint and did not adhere to the policy. The management also held staff meetings in which issues such as low staffing levels, staff behaviour, and future changes were discussed. In review, the Fleetwood Hall residential home had a wide range of systems, policies, and procedures for communication, such as direct communication to staff and clients, hospital policies, and training, but these avenues were either underutilized or misused.
1.2 Responsibilities for the Management of Health and Safety in Relation to Organizational Structure
Regardless of the structure of a care organization, all components should contribute towards protecting and improving the health and safety of all stakeholders. Within organizations, stakeholders are related to the organization by the basis of interest, rights, contributions, ownership, and knowledge (Bourne, 2016). The success of social care work is dependent on how the care organization engages its stakeholders. Worker engagement in decision making results in better care outcomes (Van Bogaert et al., 2016). Involving workers in the organization improves their attitudes and willingness to consider the safety and health of fellow individuals at the workplace. The approach of the management and owners of the organization is essential to the improvement of health and safety in the social care workplace. For instance, the management provides funds, sets the organizational climate, and may remove or introduce structural barriers to other employees. Effective social care management involves the provision of support, resources, and information to workers (Van Bogaert et al., 2016). Lastly, the responsibility of improving health and safety in the social care workplace lies with the users. When users understand what services they require, they are more likely to influence the activities of the organization (Batley and Mcloughlin, 2015). Therefore, the organizational structure of a care organization affects the health and safety of users.
The organizational structure of the Fleetwood Hall Home affects the health and quality in that workplace. The home’s organizational structure is hierarchical, with the registered manager being superior, followed by unit nurses, and other staff. Within this structure, the CQC holds the registered manager responsible for enforcing all health and social care legal requirements set in legislation such as the Health and Social Care Act of 2008. In other words, any compromise of health or safety in the home reflects negatively on the manager. The new manager was responding to challenges such as resistance to change among the staff members and working on issues in their audit reports of health and safety. The management roles in safety and health include ensuring that medical and care records are up to date, training staff, and responding to the changing needs of its population. Nurses were in charge of administering the medications to patients and developing care plans. The structure of the organization requires modification in order to engage patients and their families as important stakeholders.
1.3 Health and Safety Priorities
Managers of the health and social care organization must set priorities for health and safety. For example, there is a need for continuous monitoring of the quality of services they deliver. Within organizations, some tasks are easier to monitor than others (Batley and Mcloughlin, 2015). Measurable outcomes and processes help organizations to improve the quality of care they provide. Some of the important standardized processes and outcomes that social care workplaces should consider include the levels of cleanliness, management of waste, safety protocols, and emergency services. In addition to monitoring, the organizations must ensure that there are adequate communication channels for effective stakeholder engagement with regard to health and safety. Engaging stakeholders helps to ensure that the organization has a direction and reduces dissident behaviour (Bourne, 2016). When serving the mentally ill people, the priorities for health and safety should involve training in proper communication strategies (Atkinson et al., 2015). Communication, adherence to policy, compassionate care, and accuracy in medication is important for ensuring that mentally ill patients stay in a safe and healthy state.
The mental health unit of the Fleetwood Hill home has a capacity of 33 people. The facility covers persons with chronic mental health needs. The need for proper communication mechanisms in the mental health unit is apparent from the CQC report. For instance, some patients were not involved in the making of the care plans, and the personal information of the patients was not systematically recorded or considered in making care plans. The failure to understand patient preferences affects their health directly because it sidelines their holistic needs. Another priority includes the training of the staff in handling mental health patient needs. For example, the staff had received no training in mental capacity. As a consequence, mental health capacity assessments at the unit were generic and did not have real importance or application to the safety and health of the individual patients. Prioritization of health and safety also requires an understanding of regulations and legislation covering mental healthcare services. The CQC found evidence that the home adhered to the Mental Capacity Act of 2005 and did not force the residents to take medication through covert forms. Allowing patients to make decisions about their medications is important for their health.
Concerns for safety, such as emergency facilities and fire safety remain a priority for the home. The CQC (2016) reported that there were sections of the floor that moved in the mental health unit, and this was risky to patients. The CQC found that the fire doors in the unit were open. Concerns for female safety due to sharing of lounge facilities with men are a priority safety concern. Although the management erected signs to direct each gender to the respectful facilities, there is a need to restructure and separate these facilities into gender-specific units. The mental health unit also urgently needed to update its protocol for incident reporting. Presently, the structure has loopholes that result in many safety concerns remaining uninvestigated or reported to the management. For example, concerns over bruises or one mental health unit resident trying to light the jacket of a fellow resident were not brought to the attention of the Local Authority. The management of the home must take immediate measures to prioritize health and safety at the mental health units by addressing multiple aspects such as separation of genders, staffing, and training of communication and mental capacity.
2.1 Using Information from Risk Assessment to Inform Care Planning and Organizational Decision Making
Risk assessment is essential for addressing safety concerns and improving the quality of care an individual receives. Health and social care workers must assess the risks that patients are exposed to and develop response plans. Atkinson and colleagues support person-centred risk assessment which includes components such as proportionality, the involvement of the service users and their families, contextualizing behaviour, and learning culture (2015, p.170). Proper risk assessments provide important information for integrating into care plans and for incorporating into handovers. For example, fall risk assessments must consider the risks in the environment, the vulnerable individuals, the effected changes, and continuous evaluation of hazards (Atkinson et al., 2015, p. 203). Hence, if an individual is determined to be at high risk for falls, the care plan should indicate this and involve measures to improve mobility. A person who is mentally unstable or with a high dependency need and a risk to other patients will require more personal attention. Information from in-depth and person-centred risk assessments are of great value to the creation of care plans. In Fleetwood, there are challenges in collecting accurate risk assessments due to a skills mismatch in the mental health unit, poor integration of risk assessments into care plans, and little evidence of personalized care. For instance, the staff did not adhere to the care plan requiring repositioning within two hours and thus exposed a patient to a high risk of developing pressure ulcers.
Risk assessment results influence the organizational decision making with the aim of preventing further adverse occurrences. Care centres perform assessments for individual susceptibility to pressure ulcers in order to reduce incidences of pressure ulcers and the associated costs (Atkinson et al., 2015). Therefore, risks that are due to procedural causes prompt the management to enforce safety protocols and hence improving patient health outcomes. Similarly, organizations may make decisions about resource allocation on the basis of risk assessment findings. For instance, staffing requirements vary in units because of the levels of care individual patients require. More patients with a higher dependency will require an increase in the levels of staffing for that unit. Besides, the care organizations use up to date risk assessments to make financial plans that closely reflect the true needs of the population it is serving. The Fleetwood Hall management increased the staffing levels in response to the risk assessments at the mental health unit which showed that understaffing exposed patients and staff to risk.
2.2 Analysis of the Impact of One Aspect of Practice to Individuals
A concerning aspect of practice that has an impact on individuals and their families is poor reporting and responses to safeguarding concerns. In the case study, there were complaints by a family member about a relative with bruises and no information on the bruise in the handover book. The CQC also found that many instances of abuse, whether verbal, physical or intimidation, were not reported to the Sefton Local Authority as safeguarding protocol demands. According to the Care Quality Commission, the requirement to respond to safeguarding concerns and discuss it with the relevant local authority complies with the Mental Capacity Act (2005) which protects individuals from unlawful restraint and Regulation 13 of the Health and Social care Act 2008 which requires care organizations to safeguard its clients from abuse and improper treatment. In Fleetwood Hall residential home, there were multiple instances of abuse and improper care for residents in the mental and dementia units. Most of the care home’s employees and management were not familiar with the Sefton local safeguarding policies. Thus, the organization’s safeguarding practice was in violation of external policies and its own requirement of annual employee training on safeguarding.
The impacts of poor safeguarding practices on the residents of the home were obvious. For instance, residents in the mental health and dementia units had unexplained bruises. The causes of the bruises were not explained to the relatives of the persons in the homes. In addition, there is an indication that the top-down organizational structure of the home worsens the impacts to individuals. The management was not aware of the safeguarding procedures of the Local Authority and did not have the safeguard procedures at the facility. The effect of this lack of knowledge trickled to the staff for which a majority had no training in safeguarding and were not aware of what practices constituted improper treatment or abuse. As a result of poor understanding of safeguarding procedures, the residential home exposes its residents to potential abuse and improper treatment (Kupeli et al., 2018). For instance, the use of physical restraint violates the Mental Capacity Act provisions and harms the health and wellbeing of residents. Limited understanding and implementation of safeguarding procedures at Fleetwood has significant negative impacts on the care given to the residents and their families.
2.3 How to Address Dilemma in the Implementation of Policies and Systems for Health, Safety, and Security
The dilemma in this case scenario may be addressed by reviewing existing policies on patient autonomy and dignity, the Fleetwood residential home policies, individual needs, and the perspectives of the patient and her family. To start with the case specifics, Mrs Y is unable to speak about her specific concerns but can communicate refusal or distress. Given the nature of the wheelchair, we may assume that the home assesses Mrs Y as a person with a high risk for falling and recommends the use of straps when moving her in the wheelchair. Policies such as the Mental Capacity Act requires for the dignity and autonomy of the patient to be upheld but gives allowances for making decisions on behalf of mentally incapable persons.
The first step to addressing this dilemma is to make a mental health assessment by a skilled professional such as a mental healthcare nurse. If she has the capacity to make the decision, she should be involved in creating her plan of care. Consideration of the CQC (2016) report of the Fleetwood Hall residential home shows that the care plans of the persons in the mental health and dementia units barely incorporate personal preference or involvement. To an extent, the failure to involve patients in their care plans may explain the resistance of Mrs Y to straps. If upon the assessment it is determined that Mrs Y lacks the capacity to make her own decisions, the staff should refer to her records for her preferences and values and apply for the Deprivation of Liberty Safeguards. If these interests, as relating to being confined by straps on a wheelchair, were not explicitly mentioned, the opinion of her family and concerned parties should be solicited. Involving the individual or her legal representatives to make the decision of her care is recommended but these decisions must be made in the best interest of Mrs Y. The dilemma thus calls for an integrated approach that involves the caregiver, the home, her family and friends, and Mrs Y. The solution should base on Mrs Y’s best interest, as she would have determined if she had the capacity to make the decision herself.
2.4 Effects of Non-Compliance with Health and Safety Legislation in Health and Social Care
Non-compliance with legislation on health and safety in the workplace has dire consequences for all stakeholders. The care entity’s owners and management are at high risk of suffering financial losses and poor reputation. Poor ratings from acknowledged bodies such as the CQC negatively affect the brand image of health and social care centres. The reputation of Fleetwood Hall suffered due to negative reviews by the CQC. Financial losses are likely due to underutilization of the capacity of the residential facility. Fleetwood had an unutilized capacity of 20 persons during the initial CQC visit which means that the management loses revenue. Besides, the organization exposes itself to the risk of closure. The CQC report indicates that action to revoke Fleetwood hall’s license may be necessary if the CQC determines the lack of improvement in the quality of care.
Non-compliance adversely affects the staff. Financial strain due to underutilization of services may trickle to the reduction of salaries or benefits of employees. The culture of non-compliance affects the exposure the staff has, levels of work satisfaction, and motivation. In Fleetwood Hall, employees do not receive the necessary training and thus have little prospects of professional growth. A low skill level among caregivers affects their capacity to participate in an integrated care system (Kupeli et al., 2018). Furthermore, the risk of closure of the care institution threatens the job security of the workers. Job satisfaction in the workplace is likely to diminish due to the lack of supervision and oversight, perceived inadequate measures to ensure worker safety, and understaffing. The residential home management has been forced to resort to agency staffing because of high turnover rates.
Arguably, the patients and their families incur the greatest burden of all stakeholders in non-compliant care homes. Non-compliance to regulations encourages a low-skill level and low motivation among care home staff. The result is a compromise of the health and safety of the patients and people utilizing these services (Kupeli et al., 2018). For instance, the CQC found that people in the residential home were often subjected to restriction without up to date records of authorizations or mental capacity assessments. Such instances of policy violations reduce the trust the patients have in the care home staff. Low trust levels affect the health and safety of the people in social care facilities.
3.1 How Health and Safety Practices are Reviewed
The agency in charge of reviewing best practices in UK health and social care facilities is Care Quality Control. The CQC monitors the quality, safety, and effectiveness of care and ensures that safeguarding procedures are in place (Kupeli et al., 2018). The CQC report of the Fleetwood Hall residential home demonstrates the process of reviewing health and safety practices in social and healthcare institutions. The CQC visits care institutions, sometimes unannounced, for inspection. In the case study, the CQC found the registered manager on duty. The inspection process includes interviews, the examination of documents, and observation of the day-to-day activities of the facility. The CQC review addresses the safety, responsiveness, efficacy, caring, and leadership of the service a facility provides and gives an overall rating of the service.
The interview session includes an examination of diverse stakeholders. In the case study, the CQC held conversations with the home manager, nurses, patients, visitors, and other staff to address the aspects of service under review. The interview establishes the present condition of the services and facilities. These conversations help to get the context of current practices, gaps in service delivery, and improvement plans or ongoing efforts. Furthermore, the CQC examines documents such as care plans and care home procedures for safeguarding in order to examine for compliance with safety and health policies in health and social care workplaces. Evidence from the documents is contextualized to understand the overall state of service delivery in the institution. CQC officials observe the activities and service delivery of an institution to grasp how the staff complies with regulations and how the management responds to any concerns.
Findings of the review are presented within categories that the CQC predetermines. Boyd et al. (2017) recommend that group inspections may be more reliable than assessments made by individuals. For instance, the CQC determined that the safe service rating of the residential home was “inadequate”. Some of the reasons given are unsafe management of medicines, suboptimal environmental concerns such as moving floor sections, and inadequate staffing levels. Where necessary, alerts of non-compliance were issued to relevant authorities such as the Sefton local authority for safeguarding. The CQC then sets a timeframe for which service delivery should be improved before taking more drastic measures.
3.2 Effectiveness of Health and Safety Policies in Promoting Safe, Healthy, and Positive Culture
The case study reveals that policies and practices are instrumental in improving the culture and service delivery in health and social care institutions in the UK. When the agencies in charge of enforcing health and safety policies work effectively, significant improvements in the health and social care service delivery can be achieved. The consistency of the CQC in inspection, for example, has led to the implementation of changes in the Fleetwood Hall Home. In January 2015, the CQC found the home as inadequate but later assessed it as requiring improvement in July 2015. The policies in place that guide the CQC such as the Mental Capacity Act 2005 and the Health and Social Care Act (HSCA) 2008 play an instrumental role in ensuring that care providers are held to a standardized account. The HSCA enshrines the mandate of the CQC and gives it the authority to regulate and monitor the services provided within registered health and social care institutions.
The CQC recommendations and reviews often refer to the legislation covering the particular practice aspect. For instance, the 2016 review of the facility shows that while the overall status of the facility was inadequate, the management had sought to improve some aspects from previous inspections. For instance, the CQC (2016) found that poor staffing levels significantly affected the safety of persons at the Fleetwood Hall home and violated Regulation 13(2) of HSCA 2008. The CQC reports that the home increased the number of staff in response to safety concerns of understaffing the mental health unit. In addition, the CQC continues to use the HSCA 2008 to demand improvement of services in the home. For instance, the care home management was asked to ensure that its staff was trained on important practices such as mental capacity assessments and safeguarding. In addition to giving the CQC a mandate for inspecting care services and being a framework upon which care is standardized, the health and safety policies give the CQC the authority to take action on non-compliant providers. For instance, the Fleetwood Hall care home management was required to publicly display the latest CQC ratings of the safety of their services. Such measures increase accountability of the provider to stakeholders or risk closure by the CQC. However, little improvement in the case of Fleetwood Hall in most previous recommendations may reflect the need to review CQC responses to non-compliant cases.
3.3 Personal Contribution to Placing Health and Safety Needs
As a caregiver within a care home, my responsibilities for the health and safety of the workplace include having knowledge of all the regulatory policies governing my area of practice, adhering to professional standards in the provision of care, and participation in CQC inspections. Given the role of that health and safety policies play in improving the quality and safety of care in health and social care workplaces, understanding the requirements of these regulations helps me as a provider of care to meet the health and safety needs of my clients at work. For instance, a better understanding of safeguarding provisions reduces the likelihood of perpetrating improper practice or allowing an abusive environment at the workplace.
Improving my professional standards through training and learning from experience informs my contribution to individuals at my workplace. Low professional skills among caregivers in care homes are a problem for safe care and health outcomes (Kupeli et al., 2018). For instance, poor documenting practices may result in clients missing medications at the right time during handovers. Such habits are detrimental to the health of affected individuals. My contribution to placing the health and safety needs of individuals at the centre of my practice requires that I continuously update my knowledge of care practices. For instance, as new evidence emerges, I should improve my know-how of dealing and communicating with special populations like geriatric patients or persons with mental health issues. A focus on person-centred care that involves shared-decision making places the health and safety needs of individuals at the centre of my practice.
An additional contribution to centring my practise on health and safety needs of individuals includes participation in quality assessment and improvement. As an employee, participation in quality assessment programs at the workplace and with the CQC helps to provide information on the strengths and weaknesses of the service delivery system. Evaluations from these assessments provide guidance on further practice. Keeping an open mind is important to ensure that I benefit from the recommendations on how I can improve the service delivery at my place of work.
Health and safety policies, such as the Mental Capacity Act 2005, promote the quality of care at the social and health care workplace. The case study of Fleetwood Hall Home shows that legislations give the CQC mandate to inspect homes and monitor the quality of care. Review processes ensure that care organizations are held accountable to all stakeholders, including patients and their families. Placing the safety and health of individuals at the centre of my practice necessitates an understanding of existing policies, participation in quality review processes, and keeping an open attitude for professional and skills development.