Pregnancy is a very important process for women and nursing students have the knowledge of pregnancy is very helpful for future nursing practice. This essay will first introduce the importance of informed consent. Some common discomfort symptom and the way of how to relieve will be listed. Then, the process from pregnancy until after childbirth of women will be discussed. The client has been chosen and part of the information will be based on the client’s experiences. After this, a full assessment for newborn baby will be listed and physiological changes will be discussed. It will also mention some support services in New Zealand. Finally, breastfeeding, bottle feeding and sterilisation of baby equipments will be mentioned. All appendixes will be attached at the back of the essay.

Informed consent plays a vital role when people receive healthcare services or participate in researches and experiments. According to the Code of Health and Disability (1994), informed consent reflects client have their rights to be informed about all the information they should know thus to ensure they can freely make their decision (Ministry of health, 1994). There are three key factors to promote informed consent. First, communication effectively can help clients to have a good understanding of the information which has been provided (Health and disability commissioner, 2000). Second, providing all information including the therapeutic use and the side effects to ensure clients that clients make an informed decision. All the information has been provided have to follow honestly and accurately. Last, clients have the right to freely make their choices. Services can only be given to someone has signed an informed consent form (Health and disability commissioner, 2000). Clients also have their rights to refuse or stop any medical experiment (Health and disability commissioner, 2000). Overall, informed consent is to promote the clients rights and ensure clients have understand the whole process of any research or service. It also ensures the quality of the research and clients will fully participate in the project (Health and disability commissioner, 2000).

In this assignment, my client will be addressed as Mrs. F and her husband as Mr. F to ensure their confidentiality. The first visit to them was to introduce all the information of the procedures and explain the purpose of the project. Getting permission from my patient is also an important purpose for me to visit her. In addition, clients should know their rights before I start my project.

I introduced myself and the purpose for me to do this project to Mrs. F and Mr. F when I first visited them. Then, I explained all the details of this assignment to her, such as, what parts I would like to know from her and the time of visits. To obtain the informed consent from Mrs. F, I explained all her rights to ensure she feels secure to share her experiences and she could stop the interview at the any stage and all her information will be confidential. I also got permission from Mr. F as he is the baby’s father. After all the introduction and explanations, Mrs. F finally signed the consent form.

1b. Learning issues

The learning issue has attached in Appendix I of the assignment.

Second visit

Pregnancy and birth

2a. Common discomforts of pregnancy and the way of relieving them.

There are many common discomforts for women during pregnancy. Knowing how to minimise and relieve the discomforts during pregnancy can benefit both mother and baby (Pillitteri, 2010). The common discomforts and the ways of relieving it will be listed in appendix II.

2b. Discomforts experienced by my client during her

Mrs. F had experience constipation, swollen ankle and urinary frequently during her pregnant.

First, constipation happens due to the pressure of baby growth against the bowel (Pillitteri, 2010). Mrs. F told me that she increased fibre intake in her diet, by eating vegetables grains and fruits to relieve constipation.

Second, swollen ankle is caused by the pressure from uterine to slow down the blood circulation (Pillitteri, 2010). Mrs. F’s ways of relieved this symptom are putting her legs on the chair when have a rest and doing some exercise to increase her blood circulation.

Finally, urinating frequently happens at the early and late stages of pregnant due to the pressure of baby growth against the bladder (Pillitteri, 2010). Mrs. F shared her methods of how to reduce the symptoms that is avoiding to take any drink contain caffeine. Mrs. F said those symptoms are bothering her at the beginning. However, it does not influence her normal life after she tried the methods above as it is meet a part of content in Appendix II.

By getting all the information, she searched online, such as Ministry of Health and some other reliable websites. She also got some suggestions from her midwife.

2c. Adjustment made during pregnancy by the mother and father.

There are some adjustments during the pregnant of Mrs. F between her and her husband. Mr. A started doing most of the housework, such as, cleaning, shopping and cooking. Mrs. F also resigned her job because she needs more time to rest. They got lots of helpful information from previous pregnant friends, midwife and website.

2d. Advices from the father.

Mr. A had some suggestions to other expectant fathers. Fully supporting their wife is one of the most important parts. For instance, do some housework and take care of his wife. Another thing is to encourage pregnant women do some exercise everyday to promote their wellbeing.

Birth

2e. Clients’ experience of childbirth.

Mrs. F had childbirth after 39 weeks and she had psychological preparation before her estimate date. She started having painful contraction first and her water broken after 30 minutes later. Then, Mr. F took her to the hospital immediately. Mrs. F felt the rhythm of contractions is getting frequent and she felt very exhausted. Finally, Mrs. F had a cesarean section due to the fetus position is inappropriate. Her husband was stayed with her and supported her during the whole process. She told me that she could not feel any painful during the cesarean section because of the anaesthetic injection. She got the most of information from her antenatal class, midwife and well child health book. For example, doing some walking could make the labour easier and prevent infection of her wound after a cesarean birth. The well child health book has lots of health information for mother to get will known of their baby and mother can document the development of the baby up to 5 years old.

Mrs. F made a simple birth plan as it was her first time of pregnant. The plan includes the hospital she preferred to go, the person she would like to stay with her during labour, her preferred way of having labour and some method to relieve her pain. Mrs. F said the most of the requirements from her plan has been met. However, there are some differences between the plan and the actual birth. For example, the painful relieve method was not very effective because the pain level is over her imagination.

2f. Father’s response to birth.

Mr. F was in expectation to see his baby. At the same time, he was very worried about his wife and baby’s health status during the labour. However, after he knew that they were well, he was very excited, cheerful and exhausted. He also felt very busy after Mrs. F gave birth because he has lots of other things to prepare.

2g. Learning issues.

The Appendix III has concluded all the new things that I have learnt from second visit.

Third visit

3a. Client expectations of the puerperium and the actual experience

Puerperium is the time that around 6 weeks after the women give the childbirth. The most change in women during puerperium is physical. Mrs F. was expecting breastfeeding will be easy for her baby. However, she found placing her baby in the right position to breastfeeding was very difficult. After many times, she got used to it.

3b. Mr. F’s experiences of becoming father

Mr. F found his role has changed a lot after he became a father. He is concerned that his wife will get postnatal depression which is mood swing during the first 2 weeks after she gives childbirth. Evidence shows that 13 percent of New Zealand women easily get postnatal depression after childbirth. Sleep disruption is one of the factors could affect women (Plunket, 2012). Therefore, Mr. F took more responsibility to look after his baby during the night time to ensure his wife got enough sleep. Learning how to change diaper was also a challenge thing for him that he felt more and more responsibility he should take on his baby.

3c. Support and follow up care

There are many support services in New Zealand that provide information and help newborn parents. Lead Maternity Carer (LMC) and Well Child service provides support to pregnancy women. The detail will be listed in appendix VI. Mrs. F found her midwife is very helpful. She received a lot of information on breast feeding, showering and immunisation. It was not only beneficial for herself but also for the new born.

3d. Full assessment of the new born

A full assessment of the new born (head to toes) will be attached in Appendix IV.

3e. Physiological changes in the newborn

Physiological changes such as physiological weight loss, Meconium, Mongolian blue spots and physiological jaundice are explained in detail as appendix V. For a new mother, knowing the cause and the symptoms of physiological jaundice are very important. The way of managing this symptom is the mother should feed her baby every two to three hours. This could decrease the level of jaundice. If the symptoms do not disappear, parent should seek medical assistance (Medlineplus, 2011).

3f. The Well Child book has many information and assessment of the newborn baby. The assessment includes Apgar, hearing, vision, weight, height, full physical examination and immunisation (Ministry of health, 2010). Birth assessments cover all of them. From first week to six week, the assessment concentrated on weight, vision, hearing, full physical assessment and health protection. From eight to ten week, the assessment has added the examination that includes skin and sleeping observation. During three to seven month, PEDS check will start assessing. Oral health assessment starts from nine month to three year old. B4 school check includes oral health, growth check, PDES and SDQ check. All this assessments is to ensure the normal development of the baby (Ministry of health, 2010). Documentation the information of newborn baby could help parents and health professionals observe the development of the baby and also identify the problems of the baby (Ministry of health, 2010). There are some ways for parents and health professionals to assess the hearing and vision of newborn. For 4 to 6 weeks old baby, hearing can be assessed by making noisy and the baby is able to response to it. The vision can be assessed by observing whether they will response to light. For 5 to 7 month old baby, hearing can be assessed by coping parent’s word. The vision can be assessed by placing toys in front of them to see if they will reach it (Ministry of health, 2010).

3g. The roles of plunket nurse

Plunket nurse works with family to look after the baby and provide information to the family. They provide services for the baby were born until the baby up to five years old. Plunket nurses have many roles. Firstly, they come to visit and assess the health of the new mother and her newborn baby. Secondly, they provide information to the parents and educate the new mother about breastfeeding, showering, immunisation and other basic needs (Skelton, 2012).

3h. Learning issues

The learning issue is attached as an appendix VI.

Fourth Visit

Infant feeding

4a. Experience of feeding her baby

Mrs. F gave breastfed her baby up to 6 months. Her family, friend and midwife influenced her choices as they told her about the benefits of breastfeeding. Mrs. F gained a lot of information about breastfeeding and all her family and other health professionals offered her support. For example, the way of feeding, the time of feeding and the amount of feeding. She found the support very helpful as it made the breast feeding process a lot easier.

4b. Advantages and disadvantages of breastfeeding

The advantages and disadvantages of breastfeeding are attached as an appendix ……….

4c. The mother’s experience of breast feeding

Mrs. F breastfed her baby up to 6 months and she felt painful sometimes. Every time when she heard the baby cry, she put her finger on the baby’s lip and baby will lick mother’s finger. Then, Mrs. F will know that her baby is feeling hungry. When the baby felt full, he will stop sucking Mrs. F’s nipple. Mrs. F told me that she followed the signs most of the time and it was very helpful.

4d. To select an appropriate formula

The mother should choose the appropriate formula for their baby based on the age and allergic history. Some babies allergic to milk power due to their body have reaction with the protein in the milk formula. Therefore, parents should be very careful when they select formula for their baby (Kids with food allergies foundation, 2009).

4e. Process for safe cleaning and sterilisation of bottle, teats and other equipment

The Appendix VII will show all the details about safe cleaning and sterilisation method for baby production.

4f. The mother’s experience of bottle feeding and introduction of solid.

Mrs. F gave her baby breastfeeding topped up with formula. She found bottle feeding a lot easier and quicker than breastfeeding. However, adjusting water temperature was quite difficult for her.

The mother should have enough knowledge of solid food before providing it to her baby. The development and growth of the baby are the key considerations when supplying solid food to them. Solid food should be provided when baby is around 5 to 6 months old (Extension, 2012). The mother also needs to ensure that the baby is able to swallow solid food, digest solid food and sit straight. The ways of giving solid food are showed as following. Mother should make sure her baby is happy before giving solid food to him and provide solid food after giving breastfeeding or formula (Extension, 2012). Putting the baby on a feeding chair will be easy for mother to feed them. Mother should always give a small amount of food on the spoon when feeding them. Also, giving the baby enough time to swallow the food and get used to the new flavour. A mother should grasp all the knowledge of the time and the way to provide solid food as it will make the feeding process easier for her (Extension, 2012).

4g. The learning issue is given as appendix VIII.

Reflection

I have learnt lots of new knowledge from this project. To prepare informed consent before interviewing my client and keep confidentiality are very important to establish the trust between us. Having the knowledge from pregnancy to birth will help me in the future when I am dealing with pregnant women. For example, I would able to give them some useful information during their pregnancy. I also can provide some New Zealand health services for them to ensure both mother and infant’s health. Time management is another important part that I have learnt. I wrote some questions before I go to visit my client because it is very helpful for me to have a clear idea when I interview my client. Controlling the time also help me to have an efficient conversation with my client as she will not feel so tired or hasted about our talking.

In conclusion, informed consent is very important for any research as people have the right to make their own decision. Mrs. F shared all her experiences from pregnancy until after childbirth and Mr. F also shared his experience of becoming a father. There are many common discomfort symptoms during pregnancy and relieved ways could help to reduce the uncomfortable level. LMC and Well child services provide lots of supports to pregnant women and they can get useful information from the services. The experience of this interview is helpful to the future nursing practice.

Introduction

The World Health Organisation defines HCV as a liver disease caused by Hepatitis C virus: A virus that can potentially cause both acute and chronic hepatitis, with severity that ranges from mild illness lasting only a few weeks to a lifelong illness

(WHO, 2011).

Antiviral medicines can cure more than 95% of persons with Hepatitis C infection thereby reducing the risk of death from cirrhosis and liver cancer, but access to diagnosis and treatment is low and there is currently no effective vaccine against hepatitis C

(WHO, 2015)

. Egypt has the highest rate of Hepatitis C in the world

(Guerra et al., 2012)


.

Nearly 4.4 per cent of adult Egyptians are infected and about 40,000 die of the disease every year.

(World bank,


2017)

. The most common HCV genotype in Egypt is genotype 4, which accounts for 85% of total HCV cases

(Elgharably et al., 2012).

Currently, the primary treatment option for HCV is pegylated interferon and ribavirin (PIR) whose success in achieving Sustained Virologic Response (SVR) is ~40% for individuals with genotype 4. Ledipasvir and Sofosbuvir is an antiviral treatment combination that is relatively effective across all genotypes with 90% of SVR and fewer side effects but at much higher costs

(Kendeel et al., 2017).

In a bid to lower the costs of this treatment, the Egyptian Government has negotiated a probable 90% discount (Discussions not yet officially finalised) from EGP400,000 to EGP40,000. The Egyptian Government has thus requested for a Cost Effectiveness Analysis to compare the existing treatment intervention (Pegylated Interferon and Ribavirin (PIR) with the new one; Ledipasvir and Sofosbuvir (LS) to help them make an informed decision.

A Cost Effectiveness Analysis (CEA) is used because it is useful for identifying interventions which offer large health gains in relation to their costs to warrant adoption and is based on the comparative assessment of costs and benefits, with benefits focusing on health gains

(Drummond et al., 2015).

Cost Effectiveness Threshold (CETs) based on opportunity costs, describes the amount of money that, if removed from the healthcare system, would result in one less unit of health being generated, or equivalently, the cost of generating health in the current system. To express CEA results, incremental cost effectiveness ratios (ICER) is used. This refers to the ratio of the difference in costs to the difference in effects between two treatments. (

Woods et al., 2016; Drummond et al., 2015)

Methods

Model structure

A Markov model developed on excel was used to compare cost effectiveness of PIR and LS, to simulate the different health transition states of a cohort of individuals with HCV through a lifespan. Previous studies have shown that this model is useful for chronic conditions like HCV because it allows for synthesis of data on costs, effects, health related quality of life, evaluation of several health states over a specific defined time period and takes dependent variables into account

(Buxton et al., 1997)

Figure 1: Markov Model Schematic

FIG 1: Markov model schematic showing the transition states

(Fig 1).

The model was simulated equally

between 2

000 people for LS and PIR who both begun at cycle 0. It is assumed that both treatment regimens were for a period of 6 months with population of interest being people having genotype 4 with moderate disease and whose average age is 40 years. In cycle 0, people are treated with either PIR or LS for a period of 6 months and either achieve SVR or remain in moderate state. People in SVR were assumed to incur no further costs and cannot be re-infected with HCV. The cycles are such that people who are non-responsive to treatment (No SVRs) continue to have moderate disease and could either progress to Liver Cirrhosis or to liver failure or all-cause mortality. From the health states prior to liver failure, patients are assumed to face the same risk of all-cause mortality in addition to facing an excess risk of death due to their liver disease. The model assumes that no further drug treatment options are available for people who do not achieve SVR and that there was no disutility during the antiviral treatment

The data presented in

Table 1

belowwasprovidedby the Egyptian government.

Due to the absence of local utility valuations, values were derived from a survey of UK patients at different disease stages who completed a Euroqol questionnaire. (EQ-5D-3L). (These are further discussed in the limitations.)

Viewpoint Adopted

As recommended by the Gates refence case guidelines, going by the health services perspective was used in this case.

(Claxton et al., 2014)

The information provided by the Egyptian government pointed to the fact that costs other than the direct healthcare costs were not readily available and I justified the audience of this report using the kind of data given for the assessment to be conducted.

Time Horizon

The model applied 34 cycles and a life expectancy of 75 years. The government negotiations for a discounted price are ongoing. This model has thus assumed the figures bearing the likelihood of obtaining a successful negotiation in mind

. (Murphy et al., 2006)

T


able 1:

A table displaying summary of parameter values used in the Markov model and their measurements used.

Outcome measure

Quality Adjusted Life Years (QALYs) are useful in measuring the Quality of Life (QoL) and disease burden. They are calculated by adjusting the time spent in a particular disease state by the utility weight of that state.

(NICE, July 2009)

which were the outcome measures for this model were unavailable for Egypt and thus, values derived from a survey of UK patients at different disease stages and who completed a Euroqol (EQ-5D-3L) were used. Utility weights were incorporated to consider how the different treatment options. Patients with HCV have lower QoL of life than the general population which is further reduced when they transition to Cirrhosis state.

Discounting

A rate of 3.5% discount was applied to costs and outcomes per year as per the Egyptian guidelinesto account for diminishing marginal utility, coupled with the expectation that in the future that will make consumption higher.

(Brouwer et al., 2001, Page 114-118)

Sensitivity Analyses

One Way Analysis (Deterministic Sensitivity Analysis (DSA)

To address methodological uncertainty, time horizon is extended to 75 years of age and 36 cycles (reflecting old age and until everyone in the model dies), and discounting rates are varied between 2% and 6%, as per Egyptian reporting guidelines

(Fox-Rusby et al, 2005)

. Costs were discounted using 2015 and 2018 rates. ** Additionally, the uncertainty regarding the discount was analysed, using a cost of 400,000 EGP for LS.  Alternative treatment assumptions were tested in two further analyses, one being treating with PIR and LS in every cycle, and one being treating everyone with PIR in every cycle, but only once with LS. Disease state transition probabilities, QoL weights and costs, and treatment effectiveness and costs. 95% confidence intervals (C.Is) were used to test how sensitive the ICER was to the given parameter, as recommended. The point parameters used in this analysis were: probabilities of disease transitions and QoL weights and costs. The sensitivity of ICER to a given parameter was tested by calculating Confidence Intervals (Upper and lower boundaries of the 95% C.I).

Probabilistic Sensitivity Analysis (PSA)

PSA enables us to address parametric uncertainties simultaneously. All of the parameters in this model were sampled from their parametric distributions.  Transition states and treatment effectiveness were assigned Beta distributions as they are bounded by 0 and 1, Quality of Life Weights were assigned lognormal because they are bounded by 1 but could be less than 0, and costs as gamma distributions as they cannot be negative. Gamma distribution was used for cost parameters to account for skewness of cost data. I conducted 1000 stochastic simulations and calculated a cost effectiveness analysis aimed to address sampling uncertainties around mean estimates that allowed varying of the parameters in the model simultaneously and show the probability that a given strategy would be cost effective at various willingness to pay thresholds. Lifelong extension was applied because there is sufficient evidence to indicate that the treatment offers life extension, normally at least additional 3 months.

Base Case Results

Table 2

: Summary of results of outcomes and costs for PIR and LS. The base case ICER value was EGP 11,932/QALY

.

Deterministic Sensitivity Analysis Results.

Below is a tornado diagram that shows how input parameters affected the overall ICER. Probability of LS in achieving SVR and QoL weight for one cycle in moderate state were parameters the model was most sensitive to. Using lower CI range increases ICER to EGP 126,28334. This pointed out to the need for focus using research in this area to have a better certain estimate of QoL weight for one cycle in moderate state. The model was robust to the following parameters: Probabilities to transition from cirrhosis to Liver Failure, Liver failure to death, cirrhosis to Liver failure and cost of a moderate disease cycle.

Figure 2 Tornado Diagram

The results of the model’s sensitivity to alternative assumptions showed a decrease in the ICER upon extending the time horizon in the model to 101 years old and implying that choosing a longer time horizon could mean reaping more benefits captured from the initial cost. Smaller ICERS aren’t recommended for use in decision making because the likelihood of living till 101 years old is quite rare which is what the model depicts as the time everyone will have died or all costs and outcomes of the treatment will have been accounted for. Using this time zone can be misleading though it captures more outcomes from LS rather than using life expectancy in this case.LS also demonstrates a higher ICER compared to base case which can be interpreted as the most cost-effective treatment option being once at point 0. Treating patients at every cycle is unlikely to reap significant outcomes in comparison to the base case scenario.

Probabilistic sensitivity analysis Results

Distributions for the parameters of the model were chosen and values selected from each of the distributions randomly. The resultant base ICER after running 1000 simulations was too high at 14,470,868. The costs and life years associated with each option were then evaluated. The process was repeated 1000 times and the results plotted on the CE plane shown below in

Fig 3.

The results clustering of points in the North East Quadrant on the cost effectiveness plane suggested that for majority of the simulations, LS is more effective and pricier compared with PIR. The dots on the North West side of the plane (usually favouring the existing treatment) indicates some uncertainty on whether LS is cost effective.

Figure 3: A Cost effectiveness plane showing incremental QALYs gained plotted against incremental costs.

Discussion

The aim of this report is to compare cost effectiveness of adopting LS vis a vis PIR which is the existing treatment method. The first step to answering this is by calculating a cost effectiveness threshold.

(WHO Choice method; Woods et al., 2016)

argued for the use of opportunity costs to estimate a CET range for Egypt. I used the midpoint between previous WHO and Woods et al methodologies estimate of EGP 82,810 and EGP 21,586. The LS cost falls below this thresh hold and therefore, suggests that LS is cost effective at 78% and 68% of the corresponding

Figure 4:

Cost Effectiveness Acceptability Curve showing Willingness to Pay Thresholds in Egypt.

Limitations of the assessment.

There are several limitations to using a markov model for analysis. Structurally, Markov model assumes that transition probabilities are constant over time which might not often be accurate especially in the case of limited data. The ICER as a ratio statistic poses particular problems for confidence interval estimation since a non-negligible probability on the neighbourhood of zero on the denominator makes a formula for variance of the ICER intractable.

(


Brouwer et al, 2001, page 179)

The results obtained from this study were obtained from a single-arms (non-randomised) comparison across different RCTs which is limiting as a meta-analysis of RCTs should have been used instead for better detailed findings. The utility values from which QALYs were calculated were derived from a survey of UK patients at different disease stages which could lead to an overestimation because of the difference in the country’s classification. Egypt is a lower Middle-Income country

(World Bank, 2019)

and therefore a country of similar proximity should have been used instead of those from a high-income country. (UK). An additional meta-analysis of relevant non-health costs and outcomes would be useful to decision makers. The cost data with direct costs is single-handedly inadequate for an analysis of such nature.

Several assumptions have limited this model as follows: First, it is rather inaccurate to assume that the adherence levels of people on PIR and LS would be the same considering that it is already known that PIR has known side effects like diarrhoea and vomiting. Incorporating disutility weights which would have resulted in a smaller ICER, leading to an increase in cost effectiveness of LS.

(El Sisi et al.,2013).

Assuming lengths of treatment would be equal for PIR and LS is arguable because LS treatment is usually much shorter than PIR

(Gomaa et al, 2017)

.Not clearly expressing HCC and decompensated cirrhosis as separate health states limits the validity of the model and incorrectly assumes a similarity in transition to death for both of the conditions.

Failure to examine treatment effectiveness in both arms of the group despite high genotype 4 prevalence constrained the study. In order to achieve heterogeneity, the population should be clustered into subgroups like onset, virus, genotype, public vs private insurance, region etc and a stratified analysis carried out to ascertain the differences in cost effectiveness between the sub clusters. This would improve results generalisability which is currently constrained due to existence of regional differences, healthcare practises and treatment accessibility in the prevalence of HCV.

(El Sisi et al.,2013)

Conclusion

In view of the arguments made above, the results obtained suggest that implementing LS treatment intervention for people with HCV in Egypt is likely to be cost effective in comparison to the existing intervention (PIR especially given failure of PIR. Research on societal perspectives would be beneficial for the HCV program to succeed.

This, however, is subject to multiple factors such as successful negotiation of the discount by the Egyptian government, budget impact analysis study, other pressing public health priorities competing for government resources and what Cost Effectiveness Threshold set by Egypt. To bridge the knowledge gap, research on factors such as treatment effectiveness and utility weights would go a long way in improving the quality of the study.

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Winterbourne View Review

This report will be exploring the failures, rules, laws and policies, that were not adhered to and what could have been done to ensure that such failings do not occur again. This report will be looking more at the laws that were broken during the 5week period shown on the Panorama undercover investigation.

Winterbourne view was a residential hospital based in Bristol owned by Castlebeck care, that at full capacity housed 24 patients with learning disabilities and Autism many with the mental capacity of very young children as young as 4 years old, the hospital at the time was also costing the tax payer around 4 million a year to run. In 2011 a senior nurse (Terry Brian) that worked in Winterbourne view contacted BBC’s Panorama after he had made several complaints to he’s Senior bosses and to the

‘

CQC’ about many acts of abuse that were being perpetrated on the patients in there care, but nothing was done about it and the abuse continued. Panorama sent in an undercover carer/Support worker (Joe Casey) and after 1 weeks training Joe was sent in to work as a Carer, over the 5week period he was able to film the abuse that occurred on the grounds of Winterbourne view.

Joe Casey

Undercover Carer

QCQ are the governing body that determines the standards of care that is provided in England, policies are set also as guidance mainly by a group of politicians to ensure that laws like the Mental Health act 2014 and the Care Act 2014 are upheld.  Since the Winterbourne view video was aired a full review of events has taken place in May 2011 and it was found that there were major failing to report incidents, and even worst when they were reported there was a delay in responding to these reports meant the abuse continued.

Laws Breached

Humans rights act 1998

• 
  Article 3 (prohibition of torture)
  
• 
  Article 5 (right to liberty and security)
  
• 
  Article 8 (right to your private and family life)
  
• 
  Article 10 (freedom of expression)
  
• 
  Article 14 (prohibition of discrimination)
  
• 
  Mental Health Act 2014
  
• 
  Offences against the person act 1861 (ABH section 47)
  
• 
  Abuse
  
• 
  Neglect
  

Systematic Failings

• 
  Report incidents
  
• 
  Act on incidents that were reported
  

The first incident that stands out for me is 10 minutes into the video you will see a woman in her 40’s is in the corridor,  as 3 of the carers/support workers are walking passed her, she throws something at one of them and straight away they jump on her using and illegal choke hold, this is never acceptable the necessary training should have been provided to deal with a situation like this, policy also states that restraining a patient should be the last resort when all options have been exhausted as restraints can not only cause injury but also cause a lot of distress.

The patients at Winterbourne view were placed there under the

Mental Health Act 1983

which states that a person can be removed from the home if they are deemed unsafe to themselves or the people around them,  and then placed in a facility like Winterbourne view in which they would be assessed and then rehomed in appropriate accommodation to facilitate their needs, which could take up to 6 months under

section 3

of the

Mental health act 1983

. As a care provider there is a Duty of Care which means we have a duty to provide the best care we can to ensure that any individual we are caring for is able to live a happy and comfortable life. Even though many acts of abuse occurred on the premises I believe that many things were not addressed, the fact the assessments were not done in the allotted time and social services had not done follow ups to ascertain why these assessments had not been done meaning that patients were living at the hospital for much longer than 6 months some up to 3 years making it impossible for them to have any quality of life or receive the necessary care they needed.

Simon was a patient at Winterbourne that was placed there for assessment, he was a high profile patient as he was determined by the carers there as over friendly and liked to give hugs which the carers did not like, he was the focus of a lot of their abuse and seemed to be targeted, also Simone an 18 year old girl with a personality disorder, that had been living there for 4 months. Simone and Simon both go through continued abuse which go’s as far as

ABH (Actual Bodily Harm)

which is an offence on

section 47

which covers assaults that cause injury that aren’t serious. In addition offences under the

Human rights act 1998

that covers 16 human rights were perpetrated

.

Codes of Conduct

forexample

Promote and uphold the privacy, dignity, rights health and wellbeing of people in care, also communicate in an open and effective way to promote health



determines the way that a patient is treated while in care they may not be set by law but when upheld they ensure that we are providing the best care we can at many stages in the video you will see none of these codes are being upheld there is an incident with a young lady that doesn’t want to get out of bed firstly, policy states that when dealing with a female patient a female should always be present if a male carer or support worker is attending you will see a Support worker/manager (Wayne Rogers) burst into the room and demand she gets up and have a bath, when she refuses Wayne then escalates the situation by threatening to drag her out of bed and force her to have a shower under the

Human Rights Act 1998 Article 3,10 & 14

this patient has a right to refuse a bath if she doesn’t want one and not to be force to do anything that she doesn’t want do, in addition when this incident occurs policy and code of conduct states that a full log of events should be written so as events can then be investigated to determine if your action were necessary, or to be held accountable for your actions, this was not the case at Winterbourne view Wayne did not follow this policy and nobody came forward to dispute his account either.

There is a point in the documentary when you will see Simone subjected to a planned assault committed by more than one support worker, several cups of water are thrown all over her to control her behaviour as it is determined she is having a bad day and unable to control, this is not the correct way to resolve a situation like this as care workers you are trained to stay calm in situations like this and as a result of their conduct Simone ended up being restrained even though she hadn’t really done anything wrong. This could also be deemed as assault and an offense under the

Mental Health Act




3

that determine your rights against Torture and Inhumane Treatment should it be in the workplace or in your place of residence.

CQC (

Care Quality Commission


the regulatory body that determines the quality of care that is provided in England by Health care professionals, support workers and anyone that works in a healthcare setting

) they also played a massive role in allowing the continued abuse to go on, and were found to have known about the abuse to as far back as in 2008. As a result of the Panoroma being video was aired, a full review of the company

Castlebeck Care

that owned Winterbourne view and all the other hospitals owned by them were given a full review and 3 other hospitals owned by

Castlebeck Care



also were shut down, but addition there was a nationwide review of all institutional hospitals. Also new legislation and policies were put in place to ensure that the rights of patients that are place in hospitals under the mental health act are treated more humanly.  Also put in place as a policy, was the care plan to ensure that every patient is treated to their individual needs, also policies that give patients more rights over the care that they receive.

In addition to this report the Department of Health (DOH) did a report about the staff mistreatment and the abuse of the patients at the winterbourne hospital. The 24 patients that resided at winterbourne view were relocated to appropriate accommodation to assist their needs. Six out of 11 care workers who admitted a total of 38 charges of neglect or abuse of patients at a private hospital have been jailed.

• 
  Wayne Rogers, 32,
  
  
  
  
  jailed for two years
  
• 
  Alison Dove, 25, jailed for 20 months
  
• 
  Graham Doyle, 26, jailed for 20 months
  
• 
  Nurse Sookalingum Appoo, 59, jailed for six months
  
• 
  Nurse Kelvin Fore, 33,
  
  
  
  
  also jailed for six months
  
• 
  Holly Laura Draper , 24, jailed for 12 months;
  
• 
  Daniel Brake, 27, six month jail sentence suspended for two years and ordered to carry out 200 hours of unpaid work;
  

• 
  Charlotte Cotterall , 22, was given a four-month jail term suspended for two years.
  
  
  Cotterell was ordered to do 150 hours of unpaid work
  
• 
  Michael
  
  
  
  
  Ezneagu, 29, was given a six month jail sentence suspended for two years and ordered to carry out 200 hours of unpaid work;
  
• 
  Neil Ferguson, 28, was given a six
  
  
  month jail term was suspended for two years and ordered to carry out 200 hours of unpaid work;
  
• 
  Jason Gardiner, 43, was given a four month jail term was suspended for two years and ordered to carry out 200 hours of unpaid work.
  

The Burns Group Home Care

Welcome to The Burns Group Home Care, this brochure will give you some guidance and a brief recap on some of the information on the regulations and policies, also what is expected of you and of us to ensure we are providing continuous good care, and to keep your journey with us a comfortable and happy one. Most of the information on this brochure you would have received in training but take the time to read over it again as there is some further information that will be useful to you.

MAKING LIVES EASIER BY PROVIDING QUALITY CARE

Main office contact:

0208 345 8822

Head office contact:

01753 555 1876

Address:



17 Crescent road



Address

: Peabody House

Crouch end




London N8 8AL




Middlesex




L23 8BB

When providing care, we need to take in to account the dignity and respect of our clients and work following statutory guidance/policies as these are set out to ensure we are providing a service that involves the client in every step we take as the guidelines of the government request we do.  The Executive and legislature branches make up the government, the legislative part within a government is who sets the laws, the executives initiate the policies and put the laws that are set by the legislature into practice. The only time the Judiciary will come into play is to resolve any disputes between parties in a legal setting by relaying the laws that are put in place by the legislative branch. So a bill cant be passed until the legislature has looked over the proposed terms.

Policies and Regulations

Even though policies are not laws, they are clear guidance that is set out by governing bodies to ensure that legislations/laws such as the

Care Act 2014

andthe

Mental Health Act 2014

are followed correctly

.

The relationship between Laws/Legislation and policies are very important, policies are put in place to ensure that laws are upheld and more importantly, to ensure that every individual is treated like an individual, so understanding that everybody’s individual needs are different, this is for example why we have a care plan, to promote person centred care, to promote wellbeing, it is important that we read the clients care plan and understand every clients personal needs because something that may be good for one client may not be good for another.

Ethical practice

As a care workers/assistants you are expected to respect your clients privacy and dignity and keep confidentiality, but in some instances you

WILL

need to breach policy and report to the office.

Example

: you are with a client and you notice the client is extremely depressed every time that you attend, while talking to the client they tell you that they are having suicidal thoughts we expect you to report something  like this to the office we do not expect you to keep anything like this to yourself.

Contact


your


coordinator

,

do not write in your MARS chart

and

report


straight


away

if your client does act on how they feel and you have not reported it not only can you be held responsible but your future as a care assistant could also be in jeopardy as this is a major safeguarding issue.

Personal Care

Whenproviding personal care you are expected to

respect

your

client’s needs

, ask questions to determine what your client wants and needs actually are. Make sure

dignity

is kept by making sure all windows and doors are closed when providing any form of personal care and always ensure that your client is happy with you and whatever task you are attending to.

Medication

Every clientyou attend will have a

Care Plan

in the care plan you will findthe

MARS Chart (medication administration records chart)

you are expected to give a full account of any medication given to clients and follow codes in your MARS chart, if client refuses medication that is to be marked clearly in your chart. If at any time a client refuses medication that you feel can be dangerous to there wellbeing you

NEED TO

mark it clearly on the chart in addition give a full account in your care plan and contact your local office to make a report of it also so we can determine if its something we need to report ourselves. If at any time you have any confusion remember your five rights: Right person, Right drug, Right dose Right Route and Right time.

Health and safety

When attending a client’s home, if you are using equipment you are expected to make sure that the equipment that you are using is safe and all maintenance of equipment is up to date. Check your equipment before using it, check the dates of the last time the equipment had any maintenance and make sure all fixtures are safe and in place if you see any issues contact your local office Do not attempt to use this equipment as may there be any injuries to your client you may be held responsible please follow

LOLER regulations

when using any equipment to ensure the safety of you and your client, and please remember no lifting and handling equipment should be used singled handed, you will always have a second staff member attending never attempt to use any equipment singled handed at any time.

Attending a client’s home

When attending a client’s home we ask that you show the upmost respect, if you are doing any task for your client that you gain consent before doing anything you ensure that your client is happy with you doing it.

Example:

if you attend a lunch call and your client asks for something eat and you find that the food requested is out of date, we ask that you do not just throw it in the bin get consent from your client and explain to your client why you think it may not be safe to eat, that is the approach we expect you to have when doing any task at a client’s home.

All the information provided in this brochure is to guide into a comfortable and happy future with our company, but we need you to keep in mind that these are requirements of the government and the legislations and policies set out are a legal requirement, when laws like the Care act 2014 and the Mental health act 2014 are set out they go through a process to ensure that it will be effective nationwide. The Government of the United Kingdom formally referred as Her Majesty’s Government is led by the Prime Minister who selects all remaining ministers known as Senior Ministers they are the supreme decision makers known as the Cabinet. Government ministers all sit in parliament and are accountable to it, the government is dependent on parliament to make primary legislation, but before any of these laws can be passed a request to the queen must be made and she will make the final decision on all bills are passed.

Important information for you

In this brochure we have covered many rights for our clients, but we would also like you to know your rights, and what they mean for you as an employee of our company.

Refresher training

Every year we a required to offer you a refresher course as the care industry is ever changing and new a more innovative equipment and techniques are being run out we know the only way to keep at the top of our game is to ensure our employees are equipped with all the knowledge, but this is also a requirement by law, you will be paid at the hourly rate on your day of training but it is expected that you attend, any employee that does not attend the refresher course will be removed from rota until they attend, in addition to that we also run additional courses throughout the year so you apply to do a Level 2 NVQ or your Level 3 NVQ if you have you level 2 already. We do also run additional sort courses if you wish to advance in your particular area of interest, you will find all notifications of any courses running in the notice board of your office please feel free to apply if you are interested.

You would have already signed your contract we suggest you read through this as it will give a full breakdown of a lot of the information we will cover, on your signed contract if you are a full time employee we would require a minimum of 36 hours, but if you wish to do more you are welcomed to request, part time requirement of 15 hours that will be paid at the national rate of

£9.23 p/h

.  This rate can also raise to

£12.00p/h

after 6 months additional training is required.

Annual leave

As a full time employee, you will acquire 28 days of paid annual leave every year, part employees receive 14 days paid annual leave which is paid at a calculated rate, meaning we will use your pay from the past 3 months to calculate your rate of pay. Annual leave is renewed every year in January on the 1st of the month, so we do suggest you use these days as we are not required to roll over any unused days we may do so in exceptional circumstances, but you will lose them if unused.

Sick Pay

As an employee of our company you are entitled to Statutory sick pay, this will be paid if you find yourself sick for more than 4 days, but a signed and dated sick note from your doctor will be needed before we can make any payments for sick leave and that will be paid for up to 6 months at the national rate of

£94.25 p/w

As a company we pride ourselves on providing high standards of care and a safe and friendly environment for our staff, but we know that everything does not always run smoothly 100% of the time, we are here to help resolve any problems you may have client or personal, but if you find that you’re not getting the right support or an issue is not being resolved in the right way a list of numbers are below, we will try to resolve any issues professionally and respectfully, once again we would like to welcome you to our family, we hope that you enjoy working here as much as we do, everyday making people’s lives that little bit easier by providing quality care.

References

• Copyright © 2019 Citizens Advice [online]citizenadvice.org.uk/rightsatwork  citizen advice
• Library + learning commons https//:bowvalleycollege.libguides.com 22 Feb 2019
• BBC news Winterbourne view: careworkers jailed for abuse [online]
  https://www.bbc.co.uk/news/uk-england-bristol-20092894
  
  26 oct 2012