In health and social care services, quality is an essential component and

a concept with many different interpretations and perspectives. It is

important to both users of health and social care services and external
stakeholders. While completing this unit I have gained knowledge of
these differing perspectives and considered ways in which health and
care service quality may he improved. I have tried to explore the
requirements of external regulators and compare them with the
expectations of those who use services. I have also learnt about few
methods that can be used to assess different quality perspectives,
and develop the ability to evaluate these methods against service
objectives. I have also focussed on concepts of managing service quality
with an aim of achieving continuous improvement and exceeding
minimum standards. I have made a sincere attempt to understand
strategies for achieving quality in health and social care services. By
completing this unit, I sincerely would say that I have learnt basics of as
to how to evaluate systems, policies and procedures in health and social
care services. I have learnt about methodologies for evaluating health
and social care service quality.

Stakeholder as one who is involved in or affected by a course of action.

Patients are part of the stakeholder group that both pays for our health
care system and are the end-user of it. The interests of health care
organizations, medical professionals and other health care providers are
represented through various government bodies, professional
organizations and labour unions.

We must try and understand quality considering the perspectives of staff

and also perspectives of those who use services. Quality might have the
same outcome but opinions of the health and social care staff and the
patients might be quite different.
In simple terms, quality is fitness for purpose. Quality is about meeting
the service users’ requirements. If quality is about meeting service users’
requirements, it is important to discover what these requirements are. If
we provide services with extras that service users don’t want, we will not
be adding quality.
Stakeholders can be the external agencies eg Care Quality Commission;
Supporting People; National Institute for Clinical Excellence; Health
Service Commissioners; local authorities; users of services eg direct
users of services, families, carers; professionals; managers; support
workers.
External agencies plays important role in order to provide good quality of
services and setting standard of care for health sector. Plenty of external
agencies work for it such as National institute for clinical excellence,
Care Quality Commission, Health Service Commissioners and local
authorities. Role of each agency is important in setting standards and
achieving quality outcome for health and social care sector.

National Institute for Clinical Excellence: This independent organization

provides guidance in terms of promoting good health which prevent and
treat ill health. In Royal United Nursing home professionals reassured
before giving prescriptions to the service users having problem of
anxiety and panic attacks and require regular sedatives for sleeping. For
this case if required professionals also ask review and advice of
government practitioner. Service providers and professionals take
training of National Institute of Clinical Excellence guidelines for treating
different medical conditions. As compare to CQC NICE guidance mostly
used to assure about quality of services and NICE also make sure that
value for money are maintained.

Care Quality Commission:

The care provided by local authorities, NHS, private companies and
voluntary organization are regulated by CQC. They always aim to
provide quality and better health care to each service user. In Royal
United Hospital CQC makes minimum three inspections yearly on the
measure of cleanliness, care quality and so on. CQC has the power to
take action on the behalf of service user if the care and quality provided
by health care is not acceptable. CQC perspective initiates measures
through putting service users on the centre of care; they were in the
favour of promoting independence and equality. Always try to improve
performance of their hospital to achieve standard.

There are many organisations in the UK known as health and social care
regulators. Each organisation oversees one or more of the health and
social care professions by regulating individual professionals across the
UK. These organisations, also known as regulators, were set up to
protect the public so that whenever you see a health or social care
professional, whether private or in the NHS, you can be sure they meet
the standards set by the relevant regulator.

To practise profession in health and social care, people must be

registered with the relevant regulator. If they are not registered and still
practise, then they are breaking the law and they may be prosecuted.
These registers are made up of only those professionals who have
demonstrated that they have met the standards set.
These registers are open to the public. So if you want to check your
professional is registered, you can do this either online or by calling the
relevant organisation.

In health and social care, professionals, clinicians and others, whose

work is informed by traditional bodies of knowledge, are increasingly
aware of the need for continuous personal development. High- quality
services cannot be sustained unless health care staff are consistently
engaged in learning, training , individually and together.

All care services need to work to standards and have a system for
measuring that they are meeting standards. The health care system has
audits which check that services meet quality standards, while social
services have inspection units which register and inspect services.
Standards are influenced by laws, subsequent regulations, codes of
conduct and values.
All organisations such as homes, day centres or community services,
need a system to monitor how effectively services are being delivered
and whether service users’ are having their needs met.

Organisations may have their own quality monitoring systems. At a local

level, quality assurance groups may seek to clarify, prioritise or set
standards.
Different parts of the system and external agencies need to work
together, as part of a culture of open and honest cooperation, to identify
potential or actual serious quality failures and take corrective action in
the interests of protecting patients.

If quality in health and social care settings is not appropriately managed,

this could lead to serious consequences. It could lead to inability to
improve the health and social well-being of people in the area for which
they are responsible; Planning and commissioning health and social
care will be unable to meet the needs of people in that area. It will cause
inability to secure the delivery to people in an area of health and social
care that is safe, efficient, co-ordinated and cost-effective. Also the
availability and quality of health and social care in that area will
deteriorate. The development of standards, guidance and strategic
targets will be stagnant. This would mean that local targets will not be
achieved. It would mean that patient satisfaction will diminish and targets
and expectations will not be met.
Obviously, if the quality is inappropriately managed, it would have a
significant impact on all three basic criteria. It would lead to poor clinical
effectiveness. Safety of the patient ill not be guaranteed and this would
lead to poor outcome in terms of patient experiences.

If health care sector not providing sufficient and effective

service quality it leaves negative impact on its stakeholders. Stakeholder
temperament seems to be changed in some cases due to the poor
quality of services provided by health care. Service users complaining
about getting poor service continuously and more over that no one is
taking accountability that means change is needed. Solution over , every
service user should get consultant in charge for the sake of services
they are receiving.

In order to maintain stability in stakeholders perspective quality

measuring is required in Home care , in hospital industry. Every
stakeholder has their opinion about quality standard which no one can
change, but coordination and same indicator of quality among
stakeholder is essential. The case study about Royal United Hospital
shows that lack of coordination and lack of similar opinion is main
among stakeholders is main reason of poor quality services
(BENZEVAL, & JUDGE, 2001). Level of poor quality will be reduced with
the help of monitoring and measuring quality because health care
service is very complex. For instance take an example from case study
which determine that service users is affected due to the poor quality of
care, as the record shows dehydration complaint is found in many
patients due to lack of fluid intake (The Royal United Hospital CQC
report 2013).
Level of poor quality will be reduced with the help of monitoring and
measuring quality because health care service is very complex.
For instance take an example from case study which determine that
service users is affected due to the poor quality of care, as the record
shows dehydration complaint is found in many patients due to lack of
fluid intake (The Royal United Hospital CQC report 2013).
Where the regulatory bodies find that providers are not meeting the
standards, they require them to improve and has a range of enforcement
powers they can use. These powers include warning notices, penalties,
suspension or restriction of a provider’s activities, or in extreme cases,
cancellation of a provider’s registration which effectively means closure
of a service.
Providers who train healthcare professionals also have a responsibility
to deliver training in a safe and effective way in line with the standards
set by the professional regulators. The professional regulators have an
interest where the quality of training may put patients at risk.
CSCI’s report, The State of Social Care in England 2009, concludes that
services do not meet the expectations. The report is believed to highlight
that social care services are struggling to meet people’s needs. Fewer
people are receiving the care they need to enable them to live
independent lives in their own homes. It is all so understood that the
report will say there are continuing and chronic difficulties in recruitment
and retention of staff throughout the whole care sector.
People, whether they pay for their care or are publicly funded, are not
always getting the individualised help that they need to make decisions
about their support which in the long term can be costly to individuals,
family carers, councils and the NHS.
People are not always getting quality personalised support, particularly
those with multiple and complex needs, some of whom may have little, if
any, choice about their care. There are concerns about people who are
‘lost to the system’ because they are ineligible for publicly funded
support or are ‘self-funders’.
There is an increased demand and resources are limited which is putting
a lot of pressure. The report states that people who have complex needs
are not getting personalised care. It notes excellent examples of people
receiving the support they need but adds that too many people are not
getting the right amount of personalised care.
Many people do not get the information, advice or support they need to
help them make informed choices about their care.
Poor quality service can disrupt funding, operation or damage the
reputation of organisations and individuals and lead to inappropriate
planning decisions.
Improving quality improves patient care and value for money.
It is important to improve quality because it will lead to preventing ill
health and provide patient-centred care. It will also help to manage
increasing demand across all programmes of care and to tackle health
inequalities. Improved quality will lead to deliver a high-quality.
People who would be affected the most because of poor quality will be
mainly the older population, people with long-term conditions, people
with a physical disability, maternity and child health, family and child
care people using mental health services, people with a learning
disability acute care and palliative and end of life care.

In my view, I think health and social care providers use an approach

which is conformance to the standards. Many regulatory bodies set
goals and aims for a particular healthcare setting and the organisation
works hard to achieve these goals.
Standards That Already Exist In Health And Social Care For
Measuring Quality:
Standard is level of quality against which performance of health care can
be measured. Having standard is essential and requires ensuring and
measuring safe and effective practice. It designed in order to encourage
and support a better practice environment in health care. Due to
implementing standard individual would be able to receive right care
within health and social care. Person-centered approach can be
facilitated through quality standards. Due to implementing specific
standards in health care sector error will be reduced and quality will be
increased (Department of Health, Social Services and Public Safety
2006).
Care Quality Commission introduces many quality and safety standards
and record keeping is one of them. Record keeping standard ensures
that patients do not get unsafe and incorrect treatment and care
standard in any manner (Care Quality Commission, 2010). In record
keeping it is initiated that patient’s treatment, medical condition and
other important information related to care should be recorded by
service provider on regular basis. The maintained records have been
assessable whenever it will be required. Service users experience and
trust improve due to keeping such relevant record. Level of health
professional’s practice can raised. As far as our case concern it is found
that record keeping system was not implemented by the RUH bath and
hence the fail to meet CQC standard of record keeping. Though RUH
Bath maintained some records but when CQC requested to look those
records they were not easily assessed (The Royal United Hospital CQC
report 2013).
Another standard incorporated by CQC to maintain high quality of care is
respecting dignity and rights of individual’s (Care Quality Commission,
2014). It is important to increase satisfaction level of service user’s and
their experience that their dignity should be maintained. Dignity is related
with individual’s feeling and behaviour. But contrast is experienced in
RUH Bath as per the case study which evidenced that some of the times
patient’s dignity was not respected.
Safeguarding people who use services from abuse is also the essential
standard quality and safety of CQC. It simply required that people should
be protected from abuse and staff should respect their human rights.

Implementing quality needs planning. There should be policies and

procedures. Government should set some targets. An audit can be an
excellent tool to check if appropriate quality of care is being delivered.
There should be constant monitoring and review should take place at
regular intervals. Good communication is the key to implement good
quality. Proper information should be shared especially when shifts
finish, hand over should be done adequately. We all should be open and
ready for adapting to change.
Standards: minimum standards or best practice should be the goal or
certain benchmarks should be set. We must have measurable
performance indicators. All health and social care settings should have
codes of practice. There should be legislation in place which could either
be local, national or European legislation.
In the ‘standards-based’ understanding of quality, health and social care
institutions must demonstrate their quality against a set of pre-
determined standards. These standards will set a threshold level of
quality.
However, quality assurance today has changed. While in the past
quantitative criteria was enough to demonstrate that a standard had
been met, more qualitative criteria is now incorporated and institutions
may thus be able to more easily maintain their individuality.

Rules and regulations must be followed because safety depends on

them. They usually come from one of two sources as they may be local
and designed by the employer or they may have been designed by the
government. Hospitals have their own policies and they also follow rules
set by the NHS and the government. Wherever they come from, it is
important that they are followed as they are put in place for the good of
everyone.
One of the main sets of rules and regulations is The Health and Safety
at Work Act 1974. This act provides the basis of health and safety law. It
places general duties on all people at work, including employers and
employees.
All places of employment are subject to health and safety law.
Employers must have relevant policies in place. These must be
designed for health and social care so that all of the staff can follow
them and comply with the safety laws.
Most care establishments have the following policies like fire policy,
lifting policy and hazardous waste policy. When running or managing a
care service and carrying on a regulated activity there are certain things
you have to do by law. Though the legislation should be used as
guidance only, and is not legal advice.
Another important act is Health and Social Care Act 2008. The Health
and Social Care Act 2008 established the Care Quality Commission as
the regulator of all health and adult social care services. It is important to
be aware of all the up to date provisions.
We should try to describe quality and safety from the perspective of
people who use services and place them at the centre of the registration
system. It is important that anyone registered to provide or manage a
regulated activity is aware of the guidance that has been produced. It is
very important to be aware of the legal side of things so that we can
ensure the safety of patients and also ourselves.

How to deliver high-quality healthcare in the most efficient manner

possible is the question that is very important. In my opinion, healthcare
delivery should be clinically effective, focusing on treatment outcomes,
including survival rates, symptoms, complications and patient-reported
outcomes. In my view, health and social care must be safe: avoiding
harm, looking after people in clean, safe environments, and reporting
any medical errors or adverse events.

One main goal should be ensuring that healthcare is available to all

according to need and avoiding financial barriers that prevent access to
necessary care.
It is important that health and social care is efficient: paying attention to
value for money, avoidance of unnecessary interventions, and careful
use of limited resources. Health and social care should be responsive:
providing personalized, patient-centred care, delivered with compassion,
dignity and respect; measuring, analysing and improving patients’
experience and satisfaction.

Methods for assessing quality can be various. We could use

questionnaires, focus groups, structured and semi-structured interviews,
panels, complaints procedures, feedback forms and road shows.
Nice questionnaires should be prepared which should be given to the
patients to fill in their own time. This could give us a fair and honest
opinion about our services. Small focus groups and interviews can also
be a good technique. To achieve good levels of quality service, we must
have complaints procedures in place. Feedback forms could be an
excellent measure for quality of any service provided. This could also
prove beneficial in improving the quality by acting upon any suggestions
made by the patients.
Scientific methods of measurement are increasingly necessary.
Evaluation requires good methods in order for the resulting data to be
useful. Further, data from evaluations are being used to create
significant change within organizations, so faulty data based on
inaccurate measurement methods carry a great risk.
Quality will not be improved simply as a result of inspection. It must be
built into the people and in the processes carrying out the work of the
organization. In health and social care setting we must all define quality,
measure its achievement, and create innovations to constantly improve.
This requires active involvement of all within the organization, from the
mailroom to the boardroom. Visible, supportive leadership is essential.
As health care or social care workers, we must endeavour to keep our
knowledge base up to date and ensure that our work is of quality
standard. Ideal care workers will go out of their way for patients, they try
to understand what it’s like for the service user and carer; they are
happy and interested in their work and knowledgeable about their jobs
and are always ready to help. Good communication is the key.
We must attend seminars, meetings, group discussions and do online
studying along with regular text book reading. Group discussions and
team work will help us to realise the gaps in our knowledge.
Care workers should have knowledge of services and legislation
relevant to users and carers’ needs. They must know about the benefit
system and sources of funding, or who to refer to if they don’t. It is of
utmost importance that they know when and whom to ask for extra help.
Health and social care workers should know about the people they are
caring for. They should be familiar with the roles of other people in
relation to meeting service user and carer need.
Health and social care workers must understand their limitations and
have up-to-date knowledge. It is recommended that care workers review
their learning over the previous 12 months, and set their development
objectives for the coming year. Reflecting on the past and planning for
the future in this way you make your development more methodical and
easier to measure. Care workers may already be doing this as part of
their development review with an employer.
CPD is a personal commitment to keeping our professional knowledge
up to date and improving our capabilities. It focuses on what we learn
and how we develop throughout your career.
As a professional, we have a responsibility to keep our skills and
knowledge up to date. CPD helps us turn that accountability into a
positive opportunity to identify and achieve our own career objectives.
CPD is an opportunity to do ourselves some good; the nature and scale
of the benefit depends entirely on us.
Measuring the quality of health care has become a major concern for
funders and providers of health services in recent decades. One of the
ways in which quality of care is currently assessed is by taking routinely
collected data and analysing that data. The use of routine data has
many advantages but there are also some important pitfalls.
The Measurement of Quality:
Like I said previously there are various methods of assessing quality.
We could use questionnaires, focus groups, structured and semi-
structured interviews, panels, complaints procedures, feedback forms
and road shows.
Nice questionnaires should be prepared which should be given to the
patients to fill in their own time. This could give us a fair and honest
opinion about our services. Small focus groups and interviews can also
be a good technique. To achieve good levels of quality service, we must
have complaints procedures in place. Feedback forms could be an
excellent measure for quality of any service provided. This could also
prove beneficial in improving the quality by acting upon any suggestions
made by the patients.
Scientific methods of measurement are increasingly necessary.
Evaluation requires good methods in order for the resulting data to be
useful. Further, data from evaluations are being used to create
significant change within organizations, so faulty data based on
inaccurate measurement methods carry a great risk.
Quality will not be improved simply as a result of inspection. It must be
built into the people and the processes carrying out the work of the
organization. In health and social care setting we must all define quality,
measure its achievement, and create innovations to constantly improve.
This requires active involvement of all within the organization, from the
mailroom to the boardroom. Visible, supportive leadership is essential.

Quality is most easily recognised in its absence and many public

perceptions of healthcare are based upon measuring the absence of
quality for example, waiting times, waiting list sizes, even illness itself
are all measurements of the absence of quality.
The client/patient: the client/patient’s view of the quality of their
experience will depend upon two factors: a successful outcome and a
positive experience before, during and after treatment. However, some
procedures which may be deemed clinically desirable to maximise the
probability of a successful outcome may be highly uncomfortable and
inconvenient for the patient.
Increasingly, the separation between these aspects is being questioned
as it is recognised that clinical outcomes are influenced by a patient’s
general state of well-being. This increases the need to take account of
what has been traditionally considered as non-clinical aspects of care.
Service quality is more difficult for patients to evaluate than goods
quality. A patient’s assessment of the quality of health care services is
more complex and difficult for them as well.
Patients do not evaluate service quality solely on the outcome of a
service; they also consider the process of service delivery. The
antibiotics may have resolved the throat infection, but if discourtesy and
an uncaring attitude marked the patient’s interaction with the provider,
the perception may well be “poor service quality.”
The patient defines the only criteria that count in evaluating service
quality. Only patients can judge service quality; all other judgments are
irrelevant. Patient’s requirements, in my opinion, are:

OTHER POTENCIAL BARRIERS THAT COULD HINDER QUALITY

CARE AND ANALYSIS OF RUH’S POTENTIAL BARRIERS IN
DELIVERING QUALITY HEALTH AND SOCIAL CARE SERVICES:
External Barrier:
Barrier created due to external factors in front of the RUH prevent the
hospital from achieving quality standards and are given as below:
Legislation: In certain cases it is found that RUH has to face certain legal
issue. This type of controversies effect on hospital’s image and quality of
care was affected. Warning notice from the CQC standard had also
been issued after the inspection of their team.
Social policy: In terms of ensuring the experience of service user at the
highest quality level, safety has to be promoted and value for money in
place of health is required. In lack of social setting staff do not able to
empower with the right skills and training in quality improvement and
measuring techniques.
Internal Barrier:
Interaction between people: Having right staff and correct attitude
towards quality is basic criteria for maintaining good practice in
healthcare. But it is not being practices in RUH identified in case study.
This attitude and less interaction create potential barrier in front of
hospital.
Organizational structure: RUH need to make changes in structure of its
organization in order to gain quality standard. Value, ethics and believes
of staff should be improves and for this proper training is required to be
arranged.
Impact of the barriers are quite obvious, as staff does not feel motivated
and satisfied while working in the hospital and providing services to
the patient’s. As it is known less satisfied and motivated staff cannot be
committed towards their organization which will impact through their
services provided. If service user get less quality service they got
dissatisfied and such dissatisfaction chain lead RUH towards less quality
and service provider organizations category.

Other ways to improvement or implement Quality in my opinion,

are:
Access: approachability and ease of contact.
Communication: keeping patient’s informed in language they can
understand. Listening to them is equally important. Less use of medical
jargon.
Competence: possession of the required skills and knowledge to
perform the service.
Courtesy: politeness, respect, consideration, and friendliness of health
and social care worker. Credibility: trustworthiness, believability, and
honesty of the service provider.
Reliability: the ability to perform the promised service dependably and
accurately.
Responsiveness: the willingness to help patients and to provide prompt
service.
Security: freedom from danger, risk, or doubt.
Understanding of the needs of a patient: making the effort to know
patients and their needs.

More way’s to Evaluate approaches to implementing quality

systems and more ways in which these methods are themselves
evaluated.
In above section the important of providing quality care to the service
users is discussed. Now it is also essential to understand and evaluate
the approaches that are very crucial for implementation of quality
system. The quality management systems are important and focused
towards patient’s satisfaction and derive value for their money.
First quality management system we discuss here is Total Quality
Management (TQM) system. The application of quality management
processes throughout the organization. This includes working on
problems and strengthening areas that cross departmental lines. This
quality management system is person focused and it aims to increase
satisfaction and care standard of service users and provide value for
their money.
Another quality system is benchmarking which work on compare and
implement basis. It is required to compare your organization quality and
care with other competitive organization. Through this comparison best
and different trends are discovered and projected into our organization
practices. It will help to improve and meet the expectation of people
working in and getting served through the organization. It adopt the
process which compares current data of the health care organization
with its old records and compare the performance which helps to
determine difference between current and past performance. The
variation determined alert the manager to implement changes.
Approaches To Implement Quality System:
Policies and procedures: These are outlines in various government
document and these guidelines can also set things informed through
regulations. Different policies and procedures are implemented for
different situations in health care such as in accidental case hospital first
file a report of resident accident, after that their family members are
being informed about accident (BOYNE, 2002). The patient is treated
and then precautions are put to avoid future consequences. Policy of
infection control helps to prevent spread of infection within health care.
All the protective measures have to be followed while handling the
infectious wastes and treated residents.
Resources: Adequate and efficient amount of staff help to provide
highest quality of services and most importantly services are provided on
time and quality of those services maintained. If hospital have
appropriate resources then total quality management will be easy to
manage.
Benefits Of Applying Resources:
• Due to applying policies and procedures hospital cannot have to face
any legal consequences.

• If procedures are followed properly it will create positive image of

the Organisation or hospital

• obeying the policies like infection control will help to prevent people
from infection and maintain and therefore give quality standard to the
Organisation or hospital

• Availability of proper resources helps to serve the service users on time

and hence people would not have to wait longer for getting treated.

• Availability of proper equipment and machines and tools will help to

treat any kind of disease without wasting time.
Consequences:
• Lack of adequate resources and late in treatment lead to dissatisfaction
of service users because they are unable to get adequate services as
well as service provider are over worked so that they unable to do
anything
•
Best Approach for RUH is increasing the resources. Because it is found
at various situation that patients had to wait more for surgery and
elective surgical procedures were also being cancelled. Such incidents
tend to create negative perspective of service users. Another instance
we can take which shows that the Royal Hospital have not been able
to met personal needs of service users. Lack of facilities like shortage of
beds and availability of staff create discomfort among service users.