Unit 2 - Principles, Values and Regulation in the Health and Social Care Sector

Unite Code: (M/618/4168)

Task 1

Assignment
Task 1
Section 1 of your guide is about current policy on health and social care in your chosen country.
You need to:

i. Identify current government policies relating to health and social care in your chosen
country.

ii. Explain the impact of policy on the health and social care sector and on the provision
of care within your chosen country.

iii. Assess how policy meets the current needs of the population in terms of health and
social care.

Qi. Identify current government policies relating to health and social care in United
Kingdom.

Answer:

The UK policy framework for health and social care research establishes 19 policies of good

practice in the management and conduct of health and social care research in the United

Kingdom. These policies are :

i. Safety
ii. Competence
iii. Scientific and Ethical Conduct
iv. Patients, Service Users and Public Involvement
v. Integrity, Quality and Transparency
vi. Protocol
vii. Legality:
viii. Benefits and Risk
ix. Approval
x. Information about the Research

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 xi. Accessible Findings
xii. Choice
xiii. Insurance and indemnity
xiv. Respect for Privacy
xv. Compliance
xvi. Justified Intervention
xvii. Ongoing Provision of Treatment
xviii. Integrity of the Care Record 
xix. Duty of Care 

Qii. Explain the impact of policy on the health and social care sector and on the
provision of care within United Kingdom.
Answer:
These policies protect and promote the interests of patients, service users and the public in health
and social care research by describing ethical conduct and proportionate, assurance-based
management of health and social care research to support and facilitate high-quality research in
the United Kingdom that has the confidence of patients, service users and the public.

i. Safety:In this case, the person's safety and well-being are more important than the
goals of science and society. 
ii. Competence:  All of the people who work on a research project are qualified to do
their jobs because of their training,education and experience, or because they can do
their jobs under the supervision of someone who is qualified.
iii. Scientific and Ethical Conduct:Research projects are done in a way that is
scientifically sound and that is guided by ethical values in every part of their work.
iv. Patients, Service Users and Public Involvement:In most cases, patients, service
users, and members of the general public are involved in the design and management
of research, unless an exception can be made in a given case.
v. Integrity, Quality and Transparency:Research is planned, reviewed, managed, and
carried out in a way that keeps integrity, quality, and transparency in mind at all
times.
vi. Protocol:When applicable, the research proposal or protocol should provide a
detailed description and justification of the research's design and procedure, which
should adhere to a standard template and/or contain specific information.
vii. Legality:The researchers and the sponsor learn about the laws and rules that apply to
the administration and conduct of the research.
viii. Benefits and Risk:Before starting a research project, any possible benefits for the
individual participant and other current and future recipients of the health or social
care in question are weighed against the possible risks and inconveniences. These

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 risks and inconveniences are then weighed against the risks and inconveniences that
have been mitigated, and so on.
ix. Approval: It is necessary to have a research project approved by a research ethics
committee and any other relevant approval body, such as the Human Research Ethics
Committee (HREC), the Administration of Radioactive Substances Advisory
Committee (ARSAC), or the Human Fertilization and Embryology Authority
(HFEA), if such approval is expected or required.
x. Information about the Research:To avoid wasting resources, information regarding
upcoming research projects is made available to the public before they are even
started (with the exception of those for educational purposes) (unless a deferral is
agreed by or on behalf of the research ethics committee).
xi. Accessible Findings:The findings, whether favorable or negative, are made public in
a timely manner, with proper permission and privacy measures, in compliance with
any applicable regulatory standards, such as legislative requirements or the
expectations of regulators. Participants who took part in the study will get the results
of the study in a timely and accurate manner, unless there is a compelling reason not
to.
xii. Choice:Participants in research are treated with dignity and autonomy, with
consideration given to their ability to comprehend. The research participants are
provided with information to help them comprehend the difference between the
research and the standard practice that they might normally encounter, unless a
research ethics committee determines that they should not be given this information.
When participants' explicit agreement is sought, it is done so on their own initiative
and with their knowledge. In the event that consent is refused or withdrawn, there will
be no retaliation.
xiii. Insurance and indemnity: Insurance or indemnity is in place to cover any liabilities
that may arise as a result of the planning, administration, or execution of the research
project.
xiv. Respect for Privacy:As much as possible, the privacy of research participants is
safeguarded by the documentation, management, and storage, in such a way and for
such a length of time, of any information obtained in connection with or as a part of
the study. The open and transparent administration of data and tissue collections
demonstrates a commitment to the responsible use of these resources for research and
the appropriate respect of individual privacy rights.
xv. Compliance:In reaction to violation with these standards, funders, employers,
applicable professional and statutory bodies, and other organizations may be
sanctioned for the use of reasonable and proportionate administrative, contractual, or
legal means.
xvi. Justified Intervention:According to the present knowledge, the suggested deviation
from regular treatment, care, or other services is adequately supported (including
evidence from previous research).
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 xvii. Ongoing Provision of Treatment:As part of the participant information sheet and
research proposal, any particular post-intervention arrangements should be included,
as well (e.g. continuing or changing the treatment, care or other services that were
introduced for the purposes of the research).
xviii. Integrity of the Care Record:Treatment, care, or other services offered as part of a
research project are documented in such a way that others involved in the participant's
care can understand and accurately report, interpret, and verify the results, while
maintaining the confidentiality of the participant's records.
xix. Duty of Care:The duty of care due by health and social care providers does not end
when patients and service users participate in research. It is important to note that a
healthcare professional (who may or may not be part of the research team) is still
responsible for the treatment, care, or other services provided to patients and service
users who are research participants as well as making decisions about their treatment
and care after they have become research participants. Research interests take
precedence over patient interests if there is an irreconcilable contradiction between
the two goals.

Qiii. Assess how policy meets the current needs of the population in terms of health and
social care.
Answer:
When conducting a population needs assessment, the goal is to collect the information
necessary to understand the types and distribution of services that will be required for a
population to reap the greatest possible benefit. Understanding the health and well-being
needs of the population is necessary in order to support improvement through health and
care services and other activities, such as self-care, among other things. The procedure
outlined here is divided into three stages:
i. find out how much help is needed in terms of health and social services
ii. explain the present distribution of and demand for these services.
iii. Determine how large the gap between what is needed and what is available

It is possible to use the results of a population needs assessment to guide resource allocation
decisions, as well as other strategies for meeting people's health and care needs, including things
like self-care and community assistance, when the evaluation is complete. In the overall process
of joint commissioning, the assessment of population needs is just one component.

There have traditionally been three techniques to assessing healthcare needs, all of which are
equally applicable to assessing population needs for health and social care in the same way.
These are:

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(a) Epidemiological approaches:When it comes to epidemiology, the majority of the
information is based on quantitative data. This includes information on the size and composition
of the population of interest in terms of location, time, and the composition of key subgroups. It
also includes information on the level of need (as indicated by the prevalence of disease,
disability, or adverse life circumstances) and the current provision of services to meet those
needs.

(b) Comparative approaches:Comparative approaches: The use of historical comparisons or

comparisons between different geographies or population groups to discover possible
requirements by identifying regions or populations where there is relative under-provision are
examples of comparative techniques.

(c) Corporate approaches: These approaches collect primarily qualitative information to aid in
the understanding of the perspectives of stakeholders (patients, the general public, professionals,
policymakers, and others) on current needs and priorities for future provision of services.

In general, all three approaches are required for the assessment of population needs and the
subsequent decision-making process. Examples of these approaches include the needs
assessments for older persons conducted by the Scottish Public Health Network and the NHS
Ayrshire and Arran, which are both excellent examples of what can be done.

A. Assess current and future levels of need

The first stage in assessing population requirements is to acquire information about the existing
degree of need in the population under consideration. This information, when paired with
information on prior trends, can be used to forecast the expected future levels of demand.

1. Develop a demographic profile of the population of interest

Identifying the demographics of a target audience is the first step in the process of gauging
demand. As part of this profile, you should include current and projected population sizes, as
well as the current and projected population composition in terms of demographics, such as age,
gender, geographic location, urban vs. rural location, household composition (including marital
status), and specific population subgroups such as ethnic group. Besides the demographic profile,

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additional information can be gleaned, such as the dependency ratio, from this data set (the
number of dependents).

The Census Bureau is the most important source of information for the building of a
demographic profile. The National Records of Scotland (NRS) publishes a vast amount of
specific information about the Scottish population that is based on the Census year that was
conducted (2011). As well as midyear population estimates and projections for future years, NRS
makes use of the data to produce various types of reports. In addition to these estimates, other
sources such as Scottish Neighbourhood Statistics can provide further information. Estimates of
the population are provided down to the data zone level (the data zone is the smallest
geographical unit routinely used for population estimates, and is a small area with a median
population of around 750 people). NRS also publishes population predictions by age and gender
at several geographic regions, all the way down to the level of a council. These estimates of
fertility, mortality, immigration, and emigration are used to calculate these values. These aspects
of population change are also available in the council's jurisdiction. Additionally, in addition to
the main (primary) forecasts, NRS generates variant population estimates by altering the
underlying assumptions. These variant population projections are valuable in determining the
range of uncertainty associated with the projections. Population predictions for all population
groupings are not readily available due to a lack of data. Rees, for example, used modeling tools
to develop demographic forecasts for Scotland based on ethnic groups, which he then published.

NRS provides demographic profiles for each council area, which may be found on their website.
A wide range of demographic data is included in this section, offering a comprehensive picture
of the population in each area as well as information on mortality, births, migration, fertility, and
household composition.

2. Gather information on indicators of need in the population of interest

As previously noted, it is critical to understand the distinction between demand and supply (or
utilisation). The unfortunate reality is that many indicators of need are determined by the
combination of supply, demand, and a need for services (for example numbers of attendances at
a clinic for care of the elderly, or numbers of looked after children). It is not always feasible to
identify an ideal indicator of need that is completely independent of supply and demand factors;

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yet, when utilizing indicators of need, it is vital to evaluate how they may have been influenced
by supply and demand factors in the first place.

For all of the potential indicators of need that have been discovered, it is critical to consider not
only the average degree of need, but also the extent to which inequalities exist within the
population. In most cases, expressing need in terms of the absolute number of people who are
likely to benefit is more effective than expressing it in terms of proportions. Having the ability to
state that there are 450 persons in your area who have been classed as suffering from fuel
poverty, rather than stating that 15 percent of your population suffers from fuel poverty, may be
more useful in some situations.

A person's life circumstances (such as his or her physical and social environment), measurements
of health status (such as self-reported health), or the presence of risk factors for ill health can all
be used to determine whether or not they require assistance (such as smoking).

The physical and social environments, as well as a variety of indicators, can provide information
regarding needs. Information on the physical environment could include things like the number
of individuals who reside within 500 meters of a garbage site or indicators of the condition of the
housing stock in the area.

In terms of the social environment, the Scottish Index of Multiple Deprivation (SIMD) is a
summary measure that indicates areas of material deprivation that are concentrated in a small
geographical area. Scottish datazones are ranked in order of deprivation based on data from
seven areas (income, employment, education, housing, health, crime, and geographical
accessibility). On the SIMD website, you can find detailed information about a specific local
area. Individual components of the SIMD may be able to provide valuable supplementary
information, such as identifying areas with high degrees of denial of access. When it comes to
material deprivation, SIMD does not distinguish between individuals and material deprivation
that is geographically distributed, as is often the case in rural areas. At the moment, there is no
optimal method of diagnosing such scattered deprivation.

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There is also a wealth of information on broader societal features that comes from surveys and
other sources. These may not be able to pinpoint specific requirements, but they may be useful in
gaining an understanding of the characteristics of specific populations that are in need. Some
examples of this type of data might include statistics on internet usage and community
perceptions of safety, among other things (from the Scottish Household Survey). Using the
Indicator of Relative Needs (IoRN), which is a standardised measure of functional dependency,
we can better assess the needs of older persons in terms of long-term care and support.

Indicators of social and economic deprivation are numerous in number and variety. These
include measures such as the proportion of the population who claim pension credits (available
by age, year, and council area from the Scottish Neighbourhood Statistics website); the
proportion of people over the age of 65 who receive attendance allowance; the proportion of the
population who suffer from fuel poverty (Scottish House Conditions Survey); the proportion of
people who receive disability-related benefits such as disability living allowance; and the
proportion of people who receive disability-related benefits such as the disability living
allowance. Data on community care assessments can be used to determine a person's
requirements for at-home assistance (from a quarterly Scottish Government survey). The Census
and the Scottish Household Survey both provide information on the number of different
occupations.

The Health and Social Care Data Integration and Intelligence Project (HSCDIIP) will provide
each Integration Authority with a standard routine reporting capability as well as a data
visualisation tool that will bring together a variety of relevant datasets. On the ISD Scotland
website, you can find out more about this initiative and how to become involved.

The availability of socio-economic information at the individual level is a significant data gap
that has to be addressed.

Indicators of health status give information about the current state of one's health, as well as the
presence of disease and impairment. The Scottish Public Health Observatory (ScotPHO) website
has more information about data sources for certain health issues, as well as links to other
websites. In the case of service use indicators (such as hospital admissions), it is important to

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assess if they may have been influenced by supply or demand issues rather than by the need for
the service in question.

Among the general measures of health status are measures of average life expectancy (LE, which
is the amount of time someone can anticipate to live) and measures of healthy life expectancy
(HLE) (HLE, the length of time someone can expect to live in good health). These can be
obtained from the National Records of Scotland (NRS) for LE and from the Scottish Public
Health Observatory (for HLE) at the council level, as well as from other sources. The National
Vital Statistics System (NRS) publishes data on overall mortality as well as death due to specific
causes such as Coronary Heart Disease, stroke, and cancer. The National Research Service
(NRS) also publishes statistics on excess winter mortality. Health status as reported by
individuals is a good overall indicator of health status, and data from the Scottish Health Survey
is available at the local government level.

The Scottish Health Survey includes information on the prevalence of long-term diseases (such
as diabetes), however the data is sparse and reliant on self-reporting, making it difficult to draw
meaningful conclusions. Practice Team Information Program data on consultation rates in
general practice for specific long-term conditions is accessible through ISD's Practice Team
Information Program, although only at the Scottish level. A limited number of long-term
diseases are covered by the Quality and Outcomes Framework (QOF), however there is no
breakdown of the numbers of persons in each general practice based on age, gender or any other
feature. Detailed information on diabetes is collected by the Scottish Diabetes Survey, which is
then made available at the health board level. In order to estimate how many people in each
Scottish Health Board may have undiagnosed diabetes, modelled data on diabetes uses accurate
estimates of diabetes prevalence from detailed research studies elsewhere in the UK to estimate
how many people in each Scottish Health Board may have undiagnosed diabetes.

Data extraction procedures with general practices have been established by some Scottish NHS
Boards, allowing them to obtain more extensive information from practices about practice
activity, including the number of people who consult for specific long-term conditions. In the
medium term, these types of data extracts could be made available to all NHS Boards through
the SPIRE program, which is now being developed.

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The amount of information available about cancer patients is relatively extensive and accurate.
ISD is responsible for maintaining the Scottish cancer registry data, which is derived from a
variety of data sources (not just hospital admissions).

It is also possible to obtain information on the number of patients who have numerous long-term
conditions by extracting data from general practice records (so called multi-morbidity). On the
basis of primary care data extraction, a research study has been released that estimates the degree
of multimorbidity at the national level in Scotland. Scottish Public Health Network's needs
assessment for older people, which was published in 2012, includes estimates of the prevalence
of long-term diseases such as diabetes.

Data on the prevalence of disability in the population is less prevalent, while data on the number
of people who claim sickness-related benefits is accessible at the local level in some areas. A
little amount of information on self-reported disability is included in the Scottish Household
Survey. There is very little information available about sensory impairment. There may be data
on deafness and visual impairment available in areas where local primary care data extraction is
available, albeit this information may be incomplete in some cases. Although data on the number
of persons who are officially blind or partially sighted is available, it is limited to the most
severely affected and hence significantly underestimates the total number of people who are
visually impaired. Routine data does not provide any estimates of the number of people who are
deaf or hard of hearing. Estimates from a relevant charity are based on surveys conducted in
other parts of the United Kingdom that are now a little out of date. The Scottish Household
Survey provides information on households in which someone requires regular care for a
medical condition. The Scottish Health Survey has information on dental health, which you may
find here.

ISD is in charge of maintaining national data on hospital admissions and discharges. It should be
emphasized that this is also a metric of service provision, and as such, it may be affected by the
availability of certain local services in the area. It is possible to obtain hospital discharge
information in the council region. This information is available for both all-cause and specific
diagnosis admissions. Both the overall number of admissions as well as the number of people
who have received at least one admission are available for public use. In some cases, hospital

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discharge data can be utilized to generate specialized indications, such as those linked to falls in
the elderly and those connected to alcohol-associated hospitalizations.

The availability of information on mental health and well-being is limited. According to the
Warwick Edinburgh Mental Wellbeing Scale (WEMWEBS) score, information on mental
wellbeing is available at the local level from the Scottish Health Survey at the council level.
There is also information available about bad mental health (GHQ). At the national level,
information on consultations for mental health problems in primary care is available from the
ISD's PTI program, but the availability of local data is dependent on whether or not there are
local initiatives to extract primary care data. The Quality of Life Foundation (QOF) has data on
the prevalence of dementia and depression, but these are aggregate figures that are not broken
down by age or gender. Hospitalization is reserved for the most severe forms of mental illness,
and statistics on hospital admissions do not provide a comprehensive picture of the range of
mental illnesses that can be treated in the community. According to estimates from a UK charity,
the prevalence of dementia is estimated based on expert consensus and research studies
conducted in a variety of locations.

B. Assess current levels of supply of services

A community's level of need for health and social care services was assessed in the first
paragraphs of this document, describing the methodology. To help planners better understand the
amount to which current services are satisfying the demand, this section provides examples of
ways to define current service levels in order to clarify the gap between current provision and the
need.

Describe the existing health and social care service offering, concentrating on infrastructure,
service organization, and workforce composition and skills.

The next step is to identify suitable measures of current provision. For social services this might
include levels of activity, such as:

- the percentage of elderly adults who require intensive or low-level care at home and are
receiving it, respectively.

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- percentage of elderly individuals receiving free home care; (from the Scottish Home Care
Census or NHS continuing care census).

- Caring for unpaid responsibilities.

- The provision of subsidized or sheltered housing by the local government Includes data from
the yearly Care Home Census on care homes.

As a proxy for activity, indications may include current expenditures on housing assistance and
adaptations such as showers or lifts, as well as free personal and nursing care.

For health services measures of current provision might include data on:

1. primary care consultations (either through data extraction from local primary care
practices or through the use of national estimates from ISD's PTI program).
2. the number of outpatient visits (information by diagnosis is not available for outpatients).
3. A&E attendances (generally, information by diagnosis is not trustworthy or
comprehensive); • emergency hospital admissions and multiple emergency hospital
admissions (generally, information by diagnosis is not reliable or complete).
4. Statistics on unscheduled care, including newly developed analyses based on the linking
of hospital admissions, NHS, and Scottish Ambulance Service data.
5. duration of hospital stay;
6. the number of surgical procedures performed.
7. Delayed discharge at the Health Board and Local Authority level, based on the quarterly
census of delayed discharge.
8. non-acute inpatient care census data from the yearly Balance of Care/NHS Continuing
Health Care census.
9. data on end-of-life care, including the proportion of time spent at home or in a
community setting during the final six months of life.

ISD provides all of these measurements at the relatively small area level. In terms of risk factor
reduction services, data are available on smoking cessation, breast screening, and vaccines such
as influenza.

The Integrated Resource Framework (IRF) team at ISD releases resource mapping assessments
that detail the pattern of health and social care spending in Scotland and at the partnership level.

Access to current services is a critical part of service offering. The Health and Care Experience
Survey collects data on patients' experiences with GP practices and out-of-hours services.

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 Additionally, ISD publishes data on the volume and type of prescribing. With the addition of
the Community Health Index (CHI) number to prescriptions, assessments of patient safety
and polypharmacy are now possible (the inappropriate prescription of multiple medicines,
particularly to older people).

There are some significant data gaps regarding health service supply. These include (as
mentioned previously) information on the reasons for visits to A&E departments and minor
injury units; information on services provided by community pharmacies, optometry, district
nurses, primary care mental health teams, and other allied health professionals, as well as
voluntary and community groups. The Community Health Activity Data Project at ISD is
tasked with the goal of enhancing and expanding data on district nursing and community
mental health.

Performance statistics are critical for a variety of reasons, but their relevance to needs
assessment is that they may assist in identifying ineffective or wasteful services. For
example, the Health and Care Experience Survey collects data on patients' opinions of
service quality and contains a set of relevant metrics. Performance data may provide
opportunities to reallocate resources more effectively to fulfill needs.

C. Assess the gap between need and provision of services

A description of how to estimate the level and nature of population need in a community was
provided in the first section of this document. Part two described the procedure for determining
whether or not present service provision fits the need described in the first part. The final step in
the needs assessment process is to characterize and comprehend the magnitude and nature of the
gap between need and availability, in order to inform the process of prioritization and allocation
of resources.

Integrating and making sense of information

A critical last stage of needs assessment is integrating disparate sources of information to create
a picture of (health and social care) needs. This involves a grasp of the data sources' strengths
and weaknesses, as well as analytic abilities when dealing with quantitative data. Local public
health agencies may be a valuable source of information and assistance.

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Setting priorities
In order to make decisions about priorities, one piece of information that will be used is the
outcome of a needs assessment. They should be able to provide an estimate of the size and scope
of an issue in terms of health and social consequences.. Additionally, information about the
effectiveness and cost-effectiveness of various interventions must be included.. Decisions about
priorities will need to take into consideration local priorities and circumstances, as well as
available resources and what is believed to be achievable in practice in the local community at
the time.

Finding resources
Responding to the findings of a needs assessment may necessitate the development of new
resources in the form of increased investment. This, however, is not the only choice available. A
review process may uncover services that are ineffective or that may be delivered in a more
efficient manner, which may present chances to discontinue ineffective services and redirect
resources elsewhere, or to restructure services so that they are more efficient.

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