INTER PROFESSIONAL WORKING IN THE HEALTH

SECTOR IN UK

by Reason Chivaka

Introduction

The complex nature of human beings, demand health and social care services that

cannot be provided by a single health care professional. Consequently, various health

and social care professionals work together, towards the provision of health and

social care needs of the service users. According to Barrett et al (2005), inter

professional working's emphasis is on collaboration of various professionals towards

the provision of integrated care services for the services users benefits.

Inter professional working is important within health and social care because it

provides service users with a package of services that aims to meet their health and

social care needs. Service users, whether young, old, vulnerable or not are entitled to

quality services. The coming together of various professionals working towards a

common goal is aimed at provision of high quality services. The importance of inter

professional working is emphasised by Loxley (1997), who argued that, regardless of

its inherent problems, inter professional working is vital for solving complex social

and health care needs of the service users. This means that, inter professional working

is important within health and social care.

The changes taking place within health and social care sector have resulted in the

1
emergence of inter professional working in hospitals. Patients are now more aware of

the type and quality of care they should be getting hence they are always exerting

pressure on service providers. Consequently, health and social care professionals are

always under constant pressure not only from the services users but also from the

Government to provide integrated and quality care. As a response to this demand,

health and social care professionals adopted the concept of inter professional

working. Although the concept is not without its problems, there is growing

realisation and consensus among health care professionals that, there is need to work

together if they are to meet the expectations and needs of the services users and other

stakeholders. For example in a surgical environment where I work, it is not possible

for nurses or doctors to meet all the needs of the patients. The services of other health

and social care professionals like, occupational therapist, physio-therapist, social

workers and speech and language therapists are needed.

Review of the Literature

Prior to the second world war, the provision of health and social care in UK was

highly fragmented. To deal with the problems, during the 1940s, the Government of

the day, passed various legislations focusing on provision of health and social care

and also the creation of the National Health Services (NHS). The idea was to cater for

the health and social care needs of the people with the Government playing the

leading role. Financing of the services was the onus of the central government with

2
local authorities given varying degrees of autonomy whilst control of the service

delivery was in the hands of health and social care professionals (Gladstone:1995

cited in Barrett et al :2005). Despite the efforts by the then Government, problems

still emanated from poor coordination among health and social care professionals

who were doing things their own way with little or no thought for the needs of the

service users. During that time, there was no realisation and acknowledgement of the

importance of working together to address the needs of the service users. However,

the importance of inter professional working was realised during the 1970s but not

much was done during that time (Barrett et al: 2005).

Another development that changed the whole complexion in the 1980s was the

emphasis on free market by the then Government. The free market concept raised the

awareness of health care and social care recipients. There was increased prominence

in the demand for coherence, accountability and transparency from the service users

(Martin and Rogers: 2004). Efforts to deal with the poor and fragmented working

culture among health and social care professionals, led to the publication of various

documents by the Government.

There is evidence that, the Government came up with policies that encouraged and

supported the need and importance for various health and social care professionals to

work together. The Department of Health (DoH) 1986 document challenged all health

and social care professionals to contribute to the health of the local population. The

3
DoH (1998) document, stipulated that, health authorities and other agencies should

collaborate in the the provision of comprehensive care to target users. This was

followed by the Health Act of (1999) which removed all legal barriers to joint

working whilst the DoH (2000) document focused on financing the reforms

necessary for working together of various health care professionals (Martin et al :

2004). Another DoH (2000) document challenged nurses, midwives and health

visitors to engage in inter professional practice (Barrett etal: 2005). In 2001, the

Department of Health (DoH) produced a document entitled working together,

learning together which emphasised the importance of inter professional working and

inter professional learning to promote working together of various professional and to

help reduced friction among various professionals respectively.

It interesting to note that, these various documents made it very clear that inter

professional working is the only way various health and social care professionals can

improve the quality of health and social care by working together for the benefit of

the services users. The question is what is involved in inter professional working.

Contemporary Literature on Inter Professional working

Inter professional working implies the approach to assessment and intervention which

is highly collaborated by health care professionals from various professions who

4
work towards the provision of health or social care (Barsky etal:2000). Similar views

are from Leathard (2001) who said that, it is the collaboration of various

professionals with the aim of providing a quality service. Inter professional working

was the result of the realisation that, no single professional possesses all the

knowledge and skills needed to meet the varying and complex needs of the service

users (Edwards et al: 2009). This realisation resulted in the passing of various

policies by the Government which facilitated and encouraged various professionals

from various backgrounds to work together, sharing common objectives and make

complimentary contributions towards service provision. The above views and ideas

make it very clear that, the needs of the users of health and social care care services

are increasingly becoming complex such that no single health care professional can

meet the needs of the service users.

In hospitals the package of care consists of doctors, nurses, occupational therapists,

physio-therapist, social workers and speech and language therapists depending on the

diagnosis of each and every patient. As much as Doctors would want to take the

centre stage they cannot do much without the input of the other health and social care

professionals. The way forward for professional to work together through information

sharing, direct collaboration, assessment, planning, implementation and evaluation.

Collaboration among various health care is central to inter professional working

(Payn:2000). However, despite the realisation and acknowledgement of the need to

work together among health and social care professional, inter professional working

5
experiences some problems. The major problem emanates from the fact that, the way

these professional work is heavily influenced by their own professions. Fear about

being deregulated and fragmented by the Government in its endeavour to weaken

sources of power and resistance to inter professional working is another major source

of problem (Loxley:1997). The other challenge that faces inter professional working

is knowledge differences and prioritise. In practice, at times it is difficult to bring the

various health and social care professionals together due to lack of consensus, time

constraints, and poor communication. Despite documented evidence of the problems

faced by inter professional working, (Leathard :2001, Barrett et al:2005), it is a

concept that can bring the desired outcomes. Martin (2003), Meads et al (2005) and

Goodman et al (2008) argued that, despite its problems inter professional working's

merits outweighs its demerits. What then should be done for inter professional

working to meet the needs of the service users.

The argument is that, inter professional working can only work if the various

professionals coordinate, communicate and cooperate (Edwards et al:2009). Proper

coordination, communication and cooperation are the main ingredients of

collaboration which is the backbone of inter professional working. Collaboration can

be done using various means which are conferring, cooperation, consulting and team

working (Barskey et al: 2000).

Conferring

This involves various professionals sharing information about what they have

6
observed, For example a physio therapist sharing information with nurses about what

he or she had observed whilst dealing with a patient.

Cooperation

With this form of collaboration, professionals start by sharing information, agree on

what to do and then develop a plan to meet the needs of the service user. This can be

nurses sharing information with the occupational therapist and then develop a care

plan for the patient.

Consulting

Consulting involves professionals consulting each other's opinion. This involves for

example, nursing staff consulting the Social worker on how care is funded in the

community before advising the patient.

Teamwork

Involves the coming together of various professionals in order to provide a service in

an integrated way. According to Barsky etal (2005), team work involves cooperation,

engagement, information gathering, information sharing, assessment, planning and

monitoring throughout the entire process.

The consensus is that, inter professional working is very important if the needs of the

services users are to be met. Health and social cares professionals need to work

together if the services users are not going to be marginalised and they should treat

7
the various services users the same. The means that, health and social care

professional should embrace the concept of diversity as the demographics of the

service users are changing.

Diversity and Social Exclusion

The composition of the health and social care users is changing thereby challenging

the way various healthcare professionals do their work. The social structure is now

more diverse than what it was some years ago. In health and social care, diversity

demands service providers to to be responsive to the ever changing demographic

composition of the service users (Baxter:2001). Service providers should embrace the

concept of diversity and provide the same level and quality of service to any one

irrespective of their sexual orientation, age, political affiliation, gender and social

status. In Scotland, the Equality and Diversity: Agenda for Change (Dimension 6

Core) (2004) document makes it very clear that, staff should embrace diversity as

failure to do so will result in discrimination. It is therefore the role of various health

and social care providers to promote the concept of diversity and work together to

ensure that service users are receiving the appropriate service. Failure to embrace

diversity can result in some people not being able to access or receive the appropriate

health or social care. The old and the vulnerable are at risk if service provider do not

look after them, people from minority groups may not be able to access services if

service providers discriminate on the basis of ethnic origin.

8
The idea behind diversity it to eliminate problems associated with social exclusion. It

is only when service providers treat all service users the same in terms of their needs

that social exclusion can be prevented.

Many would be recipients of health and social care services do not get the services

either due to lack of information or inability to access them. It is therefore the role of

health and social care service providers to help services users with information and

access to these services. Fail to do so will worsen the problems associated with

social exclusion. Social exclusion is the ''marginalisation of individuals and groups

within a society from education, jobs or health care'' (Abrams et al: 2007). A review

of the literature shows that there is no general consensus as to what constitute social

exclusion and how it should be determined. Room (1995) argued that, ''a

multidimensional approach is the best way to establish its causes and determine

appropriate solutions''.

A multidimensional approach, means that the services of various professionals are

required to find out why one has been socially excluded. In healthcare, when a patient

is admitted, it is important to collect a lot of information to determine whether a

patient, especially the elderly and the vulnerable ones are accessing and getting all

the services they need to live a better life. It is therefore important that, various

healthcare professionals should work together to prevent situations that leads to social

exclusion. Proper needs analysis, risk assessment and implementation is vital.

9
Needs analysis

Provision of health and social care needs of users can only be met if their needs are

properly identified. Needs analysis is vital as it informs the service providers and

guides them in planning of care (Malone and Bucknall:2010). In my place of work,

needs analysis is done by collecting information from the patient and from other

health care professionals such as care managers, social workers, community nurses

and General Practices. The information collected helps to give a holistic view of the

patient and the problem. Guided by the health and social model as well as the Roper

etal (2000) model of care which emphasises on activities of daily living, staff are able

to identify the needs of the patient. For example, social circumstances of a patient

may indicate that, after discharge the patient may not cope at home, hence under such

circumstances, it is important to plan how to deal with the identified problems. Whilst

the needs analysis is vital, it is beset with problems as at times it very difficult to

gather vital information due to poor communication among health care professionals.

Consequently at times the information gathered my not address all the needs of the

patient (Gulanick and Myers:2007). However, despite these shortcomings, needs

analysis is important as it gives a clear picture of the patient, the problems and helps

to plan and do a risk assessment.

Risk assessment

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

10
patient and what are the associated risks. Risk assessment is part and parcel of the

process of assisting patients to meet their activities of daily living. The importance of

risk assessment is highlighted by Sud and Gorman (2008) who argued that, risk

assessment is vital because provision of health care services is risky to both services

providers and service users. Given this argument, the assumption is that, whatever

care is planned, the interventions should be free from risks or the level of risk should

be low as this has an impact on the quality of patient care. In my place of work, risk

assessment is part of our culture as it is something that is done everyday. The

cooperation of the patient and other health care professionals is vital if risk

assessment is to be of benefit to the service users. The patient should be furnished

with full information as to why and how the assessment is being done.

However, in practice there is always conflict among health care professionals on how

to carry out the risks assessments. For example, physio-therapists usually complain

that, nursing staff are fond of using moving and handling equipments instead of

helping and encouraging patients to mobilise, especially post operative and elderly

patients. Since nurses are with the patients most of the time, they argue that, they

know the patient's needs very well hence, they can do a better risk assessment and

plan better that other health care professionals. However, risk assessment should be a

joint endeavour by all health care professionals (Gulanick and Myers:2007). Risks

assessment is linked to inter professional working as various health care professionals

should work together, share information and agree on the plan of care. The

11
information gathered during needs analysis and risk assessment is vital for planning

patient care and how it should be implemented.

Care Implementation

The purpose of a patient care plan is to guide the service users when implementing

the interventions necessary to address the needs of the patients. It is important that,

the interventions should been agreed by the various health professionals who are

involved in the patient's care. Usually the implementation of the care is left to nurses

but inter professional working literature stresses the fact that, there should be

collaboration among the various health care professionals from assessment to

evaluation (Martin and Rogers : 2004).

The focus of implementing care is on moving the patient from dependence to

independence depending on their problems, hence it is important that, the patient

should be fully informed and supported. Various health and social care service

providers should play their part as much as they can and there should be constant

engagement and evaluation. If the implementation is done properly and various

health care professionals are collaborating, then the quality of care that service users

receive will improve and patients will recover quickly.

12
Comparison and Contrasting the Models of Care.

A model is a collection of interrelated concepts that guide the direction in practice

(www.nursingtheory.net/model.html). Models help to turn theories into real

situations. Various models are used in health and social care to aid the assessment,

planning, implementation and evaluation of health and social care needs (Mayer et al

:1990). For example, the medical model is based on scientific theory whilst the

health and social model has its roots in social rather than life sciences

(www.uws.ac.uk/interprofessional working /module). In my area of work, the health

and social model is used. The model entails, the holistic approach to provision of

health and social care.

Unlike the medical model whose focus is on the medical needs of the patients only,

the health and socials model considers the patient's environment as well as social

circumstances. For example, when a patient is admitted, a thorough assessment is

done to get as much information as possible about the patient. Information gathering

will not only focus on the medical problems but on the social circumstance as well

(Mayer et al :1990). The information gathered will lead to comprehensive care plans.

From the care plans, the services of the various health and social care professionals

will be enlisted to provide not only appropriate but quality patient care.

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

13
and social model of care deals with all the aspects. For example, treating an elderly

patient after a fall and discharging them without looking at and addressing the causes

of the fall will not help at all. Unlike the medical model, the health and social model

informs that, the reasons for the falls should be investigated with a view to coming up

with solutions. Vital questions during the assessment will focus on what the patient is

able to do and not able to do, does the patient need the services of the occupational or

physio-therapists or the social worker. It is also important to find out the what the

views of the family members are.

There is a link between the health and social model and inter professional working as

its holistic approach to health and social care demands the contribution of various

health care professionals. The belief is that through working together, it is not only

possible that the services users medical or social problem is addressed but is being

prevented from recurring ( Martin et al : 2004). This is the major difference between

the medical and health and social care model as the former ignores the prevention of

the problem. The argument is that, unless preventative measures are taken, resources

are wasted due to constant recurrences of the problems.

Conclusion

The needs of the various health and social care users are changing and becoming

complex each and every day. The hospital patient of 20 years ago is different from the

14
patient of today. Services users have access to information from various sources such

as the internet, libraries, family and friends. As a result they are more knowledgable

and aware of the type and quality of care they should be receiving. Health and social

care providers need to move with the pace of change in order to meet the increasingly

demanding needs of service users. Working together of the various health and social

care professionals which is the main idea behind inter professional working is the

only solution to the challenges that these professionals are facing in their endeavours

to meet the needs of the service users. Whilst inter professional working is vital, it

has its problems which these professionals have to overcome if they are to work

together and realise the desired outcomes.

Failure to work together can cause some problems such as social exclusion and lack

of appreciation of the concept of diversity. Hospital based professionals should

constantly collaborate with their counterparts in the community to quickly deal with

problems being faced by service users. It is also important that people should be

treated the same and healthcare and social care professionals should not allow their

on values and beliefs to affect the way they deal with service users.

To effectively help the service user be it in hospitals or in the community, thorough

needs analysis, risk assessment and proper implementation of care should be done. If

various health and social care professionals collaborate during the whole process then

the level of care delivery will not only meet the needs of the users but will be of good

15
quality. The concept of inter professional working is vital in delivering health and

social care needs.

References

1. Alligood, M.A and Tomey A.M (1994) Nursing Theorists and their Work 4th

Edition. Morsby Publications.

2. Barrett, G. Sellman, D. and Thomas J (2005) Inter Professional Working.

Basingstoke: Palgrave MacMillan.

3. Barsky, A. Geva, E. and Westernoff F (2000) Inter Professional Practice with

Diverse Population. West Port: Greenwood Publishers.

4. Baxter, C. (2001) Managing Diversity and Inequality in Healthcare. Six Steps to

effective Management Series. Edniburgh: Harcourt Publishers.

5. Department of Health (1999) The Health Act. .www.doh.gov.uk

6. Department of Health (2000) The NHS Plan.www.doh.gov.uk

7. Department of Health (2001) Working Together. Learning Together, a Framework

for Life Long Learning for the NHS. .www.doh.gov.uk/lifelinglearning/index/htm.

8. Edwards, A. Daniel, H. Gallagher, T. Leadbetter J and Warmington P (2009)

Improving Inter-Professional Collaborations. Learning to do Multi-Agency Work.

Oxon: Routledge Publishers.

16
9. Goodman, B.and Clemon, R. (2008) Nursing and Working with other People.

Cornwall: T J International Ltd.

10. Gulanick, M. and Myers, J. (2007) Nursing Care Plans: Nursing Diagnosis and

Interventions. St Louis: Mosby Elsevier.

11. Leathard, A. (2001) Going Inter Professional. Working together for Health and

Welfare. London: Routledge.

12. Loxley, A. (1997) Collaboration in Health and Welfare. Working with Difference.

Tyne and Wear: Atheneaum Gateshead

13. Malone, J. R and Bucknall, T. (2010) Models and Frameworks for Implementing

Evidence Based Practice. Linking Evidence to Action. Susses: John Wiley and

Sons Ltd.

14. Martin, V. (2003) Leading Change in Health and Social Care. London: Routledge

Publishers.

15. Martin, V. and Rogers, A. (2004) Leading Inter Professional Teams in Health and

Social Care. Oxon: Routledge Publishers.

16. Mayer, G.G. Madden, M. J. and Lawrence E (1990). Patient Care Delivery

Models. Aspen Publishers.

17. Meads, G. Ashcroft, J. Barr, H. Scott, R. and Wild A (2005) The case for Inter

Professional Collaboration in Health and Social Care. Oxford:Blackwell Publishing

18. Pollard, K. Thomas, J. and Miers, M. (2010) Understanding Inter Professional

Working in the Health and Social Care: Theory and Practice. Hampshire:

MacMillan Publishers Ltd.

17
19. Room, G. (1995) Beyond the Threshold. The Measurement of and Analysis of

Social Exclusion. Bristol: Policy Press.

20. Roper, N. Logan, W. and Tierney, A. (2000) The Roper-Logan-Tierney Model of

Nursing. New York: Churchill Livingstone

21. Sud, H. and Gorman, J. (2008) Developing a Risk Assessment Tool to Improve

Patient Safety. Nursing Times, 104: 36, 26-27.

22. www.show.scot.nhs.uk/diversity_inclusion.index.aspx

18