Increasingly job roles in Adult Social Care settings are becoming generic. An example of this is the joint role of social work and occupational therapy is organising reablement services.

1. Generic Working Practices in
Adult Social Care
Blaine Robin – PhD
CPD - workshop
26th October 2015

2. Introduction and background
Adult Social Care in England and Wales enables people with disabilities
and chronic conditions to live with optimum independence, dignity and
wellbeing. The statutory responsibilities (e.g. Care Act 2014; Human
Rights Act 1998; Mental Capacity Act 2005; Delayed Discharge Act
2003; NHS and Community Care Act 1990; Health and Social Care Act
2012) to perform this function rests predominantly with Local
Government (or Councils or Local authorities inter alia).

3. Processing assessments and the subsequent extended care pathway
functions (e.g. arranging services, sourcing funding for services,
reviewing those services) is the main responsibility of staff employed
within adult social care (e.g. Social workers, Occupational Therapists,
semi - professionals such as social care assessors); increasingly partner
organisations with delegated responsibilities are involved in performing
assessments functions (e.g. mental health NHS trust employed social
workers; Charities such as Jewish Care; Age UK; commercial operators
such as Millbrook Healthcare; and Housing departments within local
government).

4. Referrals & Assessments
The UK central government through its Department of Health (DH),
monitor quantitative and qualitative trends experienced by the most
vulnerable people requiring health and social care. The most vulnerable
are identified through a process of either self-referral (e.g. people
requesting services such as home care or residential care) or third party
referral (e.g. hospital discharge arrangements for people living with a
chronic condition for the first time). In recent years local government
and NHS trusts are having to deal with increases in the number of
patients or customers in need of services. This in turn has placed a
strain on the workforce where additional increases posts to match
demand has been difficult to fulfil by central government.

5. What are the challenges?
In 2004, the Department of Health carried out a study into chronic
illness in the UK (DH 2004c). Their study concluded that out of a
population of 60 million people 8.8m people in England have long-term
illness that severely limits their day-to-day ability to cope. In 2012, the
Department of Health produced further findings showing an increase in
the number of people with a Long Term Condition to approximately 15
million people.

6. Ageing Population, multiple conditions and an
increasing population
The UK also has an ageing population as people are living longer into
old age than they once did over 50 to 100 years ago. In addition
migration patterns such as movement of displaced people seeking
asylum (e.g. Syria) gives rise to demands on public expenditure in areas
such Health, Social Care, Education and Housing. The combined issues
of an increasing population combined with an ageing population which
includes people living with multiple conditions (also known as multiple
morbidities) is therefore having an impact of how services are
delivered. These trends are also common with several countries in the
developed world including Australia, North America (USA) and the
majority of European Union states.

7. International Perspective: World Health
Organisation (WHO)
When issues such as population crises impact significantly on Public
Health trends the World Health Organisation (WHO) also work with
Central governments from across the globe. Some of the support
available from the WHO includes shared expertise on management and
control mechanisms around such issues is the ageing population;
international shortage of skills within health and social care workforce
and the promotion of new methods of training in medicine and allied
health professions known as Inter professional Education (IPE).
‘[I]nitial research studies reveal that IPE increases confidence in health
professionals’ identity and appreciation of the roles of other
professions, and improves communication and team-working skills’
(WHO 2013 p 23).

8. In the United Kingdom the roles of health and social care professionals increasingly
being encouraged to work in a more collaborative ways has come from children’s social
care with implications for the way in which professionals should also practice in adult
social care. In recent years, communication processes and procedures have been
improved in order to provide support to clients and carers in need.
An example of improved communication process has been disseminated through health
and local government social services departments (DCSF & CLG 2008). Processes such
as this have also arisen because of critical incidents. One such incident was the murder
of eight-year-old Victoria Climbié by her aunt in 2000. In response to this incident
several social services departments and NHS acute trusts were found wanting in their
abilities to work together and communicate effectively about the needs of the patient
(Laming 2003). The ensuing Laming report identified professional catastrophes amongst
several agencies in terms of ineffectual multidisciplinary team working which could have
prevented the death of Victoria Climbie.

9. Every Child Matters
The green paper Every Child Matters (DfES 2004) and the Children Act
2004 (OPSI 2009d) called for a commitment to systems to be organised
to help agencies (e.g. health, education, police, health trusts)
information sharing between agencies working on behalf of children.
‘[I]mproving information sharing practice is a cornerstone of the
government’s strategy to improve outcomes for all people’ (DCSF & CLG
2008 p9).

10. Mental Health domains
Another example of services focussed on the needs of good
communication between services and patients and their carers is
service for patients with a diagnosed mental health problem where
their needs can be assessed through the Mental Capacity Act 2005
(OPSI 2009c, DH 2007d). Under this legislation, patients have the right
to an assessment to determine whether they have the mental capacity
to make decisions about their own well-being and needs at a particular
moment in time.

11. If patients are unable to show capacity because of a particular illness
(e.g. end stage dementia) then the deprivation of liberty safeguards
assessment (DOLS) applies whereby the professionals and relatives of
the patient assess what is in the person’s best interest to determine
what services are available. Under the Mental Capacity Act 2005
patients are allowed to make declarations known as advanced
decisions about health professionals that they do not want to be
involved in their care (Turner-Stokes et al 2008).

12. Shared learning culture
‘[E]stablishing a shared learning culture between professionals is vital
for ensuring practitioners understood each other enough to work
collaboratively’ (Trodd and Chivers 2011 p 15).

13. The Occupational Therapy profession has debated
IPE in the same way
‘ [I]PE aims to encourage collaborative practice, but suggested that the objectives vary,
including modifying attitudes and perceptions, enhancing motivation, securing common
knowledge bases, reinforcing collaborative competencies and effective change or
improvement in practice’ (Brown and William 2009).
Craik et al (2008) have debated this issue of generic working and its potential impact in the
area of mental health often guarding against the OT profession moving away from its core
specialist areas of practice to a more generic job description as care coordinator.
‘ In multidisciplinary teams they have to respond flexibly to a client centre approach in
which a number of general skills are needed. Gaining clarity about the balancing of generic
and specialist, core acquired and retained role of OT is essential’ (Craik et al 2008 p 23).

14. References

15. Brown, T and Williams, B (2009) The use of DVD simulation as an interprofessional education tool with undergraduate occupational therapy students.
British Journal of Occupational Therapy. 72(6), 266-274.
Criaik, C McKay, E, Lim K.H, Richards, G (2008) Advancing Occupational Therapy in Mental Health Practice. Oxford. Blackwell.
DCSF & CLG (2008) Information sharing: guidance for practitioners and managers. Available online at www.everychildmatters.gov.uk/information sharing
(accessed January 2009).
DfES (2004) Every Child Matters: Change for Children. London. Department for Education and Schools Available online via www.everychildmatters.gov.uk
(accessed January 2009).
(DH (2004c) Chronic disease management: A compendium of information. London, Department of Health)
Department of Health (2012). Report. Long-term conditions compendium of Information: 3rd edition.
Laming, H. (2003) The Victoria Climbie Inquiry report of an inquiry by Lord Laming. Available online
file:///H:/General%20stuff/The%20Laming%20report%20into%20the%20death%20of%20Victoria%20Climbie.pdf. (accessed October 2015).
OPSI (2009b) The Children Act 2004. Available online via http://www.opsi.gov.uk/acts/acts2004/ukpga_20040031_en_1 (accessed January 2009).
OPSI (2009c) The Mental Capacity Act 2005. Available online via http://www.opsi.gov.uk/acts/acts2005/ukpga_20050009_en_1(accessed January 2009).
Trodd, L & Chivers, L (2011) Interprofessional working in practice. England. McGraw Hill.
Turner-Stokes, L and Higgins, B.(eds.)(2008) Long –term neurological conditions: management at the interface between neurology, rehabilitation and
palliative care. Concise guidance to good practice series, No.10. London: RCP.
WHO (2013) Transforming and scaling up health professionals’ education and training. Geneva.

16. Exercise 1
- What does generic working mean to you ? Working in pairs describe what
it means to you based on your experiences
- What do the following terms mean?
- Multi disciplinary working
- Collaborative working
- Partnership working
- Integrated working
- Interdisciplinary working
- Inter - professional working

17. Exercise 2
Mrs. Smith is 82 years old. She was admitted to hospital after suffering
a stroke in June 2015. She is widowed and lives alone in a 3 bedroom
house in Northern Luton. In October 2015 she was transferred from
Luton and Dunstable Hospital to Morlands care home for rehabilitation.
A referral has come into your cluster team for a “reablement referral”.
You have been asked by your Advanced Practitioner to complete a
Reablement Assessment to include a “generic support plan” (i.e. OT
and SW). Using the checklist provided please list some the factor that
can support or inhibit generic working.