Local Community Resources and Provision for Integrated Care Planning

This report discusses the local community resources and provision in Slough Borough that support integrated care planning and working. It explores the difference between health and social care providers and the types of interagency care provision. The report also evaluates the local resources and identifies the unmet needs related to healthcare provision in the community.

Project

Table of Contents
Introduction......................................................................................................................................4
PART A...........................................................................................................................................4
LO1..................................................................................................................................................4
Local community resources and provision that supports integrated care planning/working. 4
Local unmet needs related to healthcare provision................................................................5
Difference between health and social care providers and types of interagency care provision
................................................................................................................................................6
Evaluation of local resources..................................................................................................6
PART B............................................................................................................................................7
LO2..................................................................................................................................................7
Individual’s capacity to identify own care needs...................................................................7
Role of healthcare professionals in supporting individuals through person-centred care......7
Process of different person-centred assessments in defining own care pathway...................9
Evaluation of a capacity assessment to identify areas of improvements................................9
Reflection.............................................................................................................................10
LO3................................................................................................................................................10
Impact of own relationship with individual and multidisciplinary team in delivery of care
pathway.................................................................................................................................10
LO4................................................................................................................................................11
Need for person-centred communication in implementing person-centred plans................11
Conclusion.....................................................................................................................................12
References......................................................................................................................................13

Introduction
Dementia is an overall term which is used for diseases and conditions characterized by a loss
of cognitive functioning like thinking, remembering, reasoning, language, problem solving etc.
which affects the daily activities of a person. This also affects their ability of taking decisions
regarding basic things which are important in living a normal life and doing day-to-day
activities. Thus this condition requires that the patient is taken care of by the health professionals
so that they can live their lives effectively without depending on others. Dementia is increasing
in the old population of Slough Borough council with a prediction of 50% increase in the total
number of older people with dementia over the next 15 years. Slough Borough council is the
local authority for Borough of Slough in South East England, UK. As the problems related to
dementia in its population is increasing it is important that the people are given with high health
care which can help in giving personal care to the patients so that they can feel a part of the
community and can be supported in their old age. In this report a care assessment in which an
individual can choose their own pathway of care will be made along with a reflection on the
assessment in fulfilling the needs of case assessment.
PART A
LO1
Local community resources and provision that supports integrated care planning/working
In order to provide high quality and integrated care to the people who are in their old age
and whose independence or well-being are at risk it is important that the local community’s
social and healthcare units provide care to the people. This can help in protecting public health
and preventing ill health and premature mortality along with reducing health inequalities in
community so that high health benefits can be provided to people. There are a significant number
of people in Slough Borough who rely on adult social care services which makes it important to
provide integrated health and social care services to them so that the well-being of society can be
increased (Buggy and Moore, 2017). There are various resources present in Slough that provide
integrated healthcare services like Public Health Nursing 4 Slough which provides an integrated
0-19 public health nursing service and up to 25 years for individuals with Special Educational
Needs and Disability (SEND). The team provides supportive, focused and caring culture so that
innovative solutions can be found and better health in the society can be promoted. Berkshire

Healthcare NHS Foundation Trust (BHFT) is a specialist mental health and community health
services trust which also helps in providing integrated healthcare facilities to the patients in
Slough. The Joint Strategic Needs assessment (JSNA) is the means by which local authority and
its partners assess the healthcare needs of Slough Borough which help in determining the level of
integration of healthcare services which needs to be done. There are also various services present
in the Borough which help in providing services to the dementia patients like Langley Haven
Dementia Care Home, Care Services Slough, Oak houses etc. These centres provide high quality
services to the patients of dementia so that they can live their lives efficiently and also do their
regular daily activities effectively. These service providers also stay in touch with the family
members of patients so that high quality and effective services can be rendered to the patients
through integrated health care.
Thus all the above determined organisations help in providing integrated healthcare
services to the people who need support to live their daily lives in an efficient manner. Also
many residential and nursing care homes are available in the Slough Borough that helps in
providing personal, emotional and other care to the people while also enabling them to live as
independently as possible in a safe environment (Bearne and Sevdalis, 2019). This help in
increasing the sustainability of the healthcare system and also help in ensuring that the healthcare
needs of people are effectively met. The Care Act, 2014 help in improving the health care
facilities by including various new responsibilities so that along with integrated health care the
patients are also given independence, well being and dignity. Thus in Slough Borough various
community resources and provisions are present that help in enhancing the health facilities so
that better care and protection can be given to people along with ensuring integration of health
and social care so that overall promotion of well being in the society can take place (Gillespis
and Hawkins, 2017).
Local unmet needs related to healthcare provision
In order to ensure healthy society it is important that all the healthcare related needs are
efficiently fulfilled so that the health and well being of the people in society can be promoted
which can help in ensuring a better and sustainable environment. This can be made possible by
identifying all the unmet needs related to healthcare so that health conditions in population can
be prevented and better health facilities can be given to population (McEvoy and Jatana, 2017).
In the Slough Borough, the unmet need/gap related to healthcare provision which has been

identified is regarding reaching to the people who are at risk of losing independence for primary
prevention, before the injury or illness occurs. Also better housing needs are unmet in the
Borough which affects provision of better healthcare facilities to the people which must be
identified and effective measures must be taken so that health care infrastructure of the
community can be stabilised. Primary prevention is also important so that the diseases can be
cured at the primary level which can help in improving the health of people in community. In
order to deal with these issues effective measures need to be taken like developing models which
can enable people to become more responsible for their own care and support along with
assistance from council, voluntary sector and NHS partners. Also supporting people by providing
them guided pathway so that they can gain information regarding improvement in their health.
Difference between health and social care providers and types of interagency care provision
Healthcare providers provide nursing facilities to the patients, who are ill, have disability
or diseases. The treatment, care or after care given to these people are related with healthcare
facilities. On the other hand social care is related with daily assistance given to people so that
they can lead their lives properly by maintaining independence, social interaction along with
supported care home facilities (Suzuk and Takayasu, 2017). These facilities can be integrated so
that overall benefits can be given to the patients which can help in improving their health and in
also promoting a healthy society. Interagency collaboration is a system of care wherein families
and agencies come together for the purpose of improving the health conditions of children and
families through interdependent problem solving. Interagency collaboration helps in addressing
intractable, cross-over problems like homelessness and poverty and also to address the needs of
vulnerable and at-risk families having complex problems. This can help in providing more
personal care so that better services can be provided to the patients so that improvement in their
health can occur. In the Slough Borough the interagency and integrated health facilities can help
in improving the overall health of the community so that improvement can take place in public
health.
Evaluation of local resources
The local resources that are present in Slough Borough are able to effectively meet the needs
of multidisciplinary care so that the health of people in Borough can be promoted and people in
society can lead healthy lives. There are various healthcare institutes working in the Borough
that are able to provide both health and social care services to their patients so that better health

outcomes can be achieved. The multidisciplinary teams are able to provide many benefits both to
the patients and the health professionals so that job satisfaction of team members can also be
increased (Patel and Yoon, 2020). In the Slough community the local resources are optimally
utilised so that better services can be given to the people that can help in improving their health
through specialised care provided to them. This help in enhancing the quality of services that are
provided to people along with enhancing the probability of smooth recovery of patient. Through
social care services more independence can be provided to the patients so that they can lead their
lives respectfully and live in the society in a normal manner which help in enhancing the
cohesion among community members.
PART B
LO2
Individual’s capacity to identify own care needs
Capacity is the ability of an individual to take decisions regarding various aspects of their
lives so that they can decide their own good and bad. The assessment of capacity is set out under
the Mental Capacity Act (MCA), 2005 which provides a framework under which the people who
do not have the ability to decide for themselves are taken care of like the old people dealing with
dementia. It is important that the individual capacity of the patients is identified so that they can
be involved in taking care of themselves on a daily basis (Arakelian and von Vogelsang, 2017).
Also they can be given choice on their care they receive so that they can be made capable in
taking their own decisions for their good. It is important that the individual’s capacity in taking
their own care is identified through interview with the patients, their family and friends and
through observation. This help in analysing the ability of the patient in making their own
decisions.
An individual who is suffering from dementia can identify their own care needs by
analysing their ability of taking medicines on time, finding their things at proper place, being
able to recognise things etc. The level of difficulty faced by the patients can help in determining
the need of a patient for care through healthcare professional so that they do not face difficulty in
leading their lives on a daily basis. It will also help their family members in taking their care in
an efficient manner through professionals in these services so that their requirements are met on
time and also their medications can improve.

Role of healthcare professionals in supporting individuals through person-centred care
Healthcare professionals play an important role in supporting the individuals through
person-centred care as they help in taking care by collaborating with the patient so that their
needs can be known and well understood so that effective actions can be taken. The professionals
are also well equipped and have knowledge about the mental state of a person and their feelings
which help them in giving more effective care (Brown and Fletcher, 2016). Also through person-
centred care they can help in giving individuals special and specific care as per their
requirements and their individual capacities so that better services can be given to them. This
help in taking better care of the patients of dementia so that they can lead their later stages of life
happily.
I can support in giving healthcare services to the patients by understanding their ability in
taking care of themselves and making efficient decisions. This will help me in analysing the
amount of care each patient requires which will help me in providing effective services to them.
Also i can observe the patients so that their decision making capacities can be known and the
requirement of care of each patient can be assessed. Also i can help them in memorising more of
their regular things through games, songs and other activities so that the dementia patients can be
helped in a better manner. Also through making a chart and a plan i can help them in efficiently
remembering things so that they can perform their daily based work more easily. Further i think
that through care and support the patients can be given comfort and they can live happily. I can
prepare a care plan for taking care of the dementia patient and also working with
multidisciplinary team members so that better results can be achieved. It can also help in making
the dementia patients in leading their lives more independently. Following are the steps that can
be followed while preparing a care plan for the patients:
 Discussing the situation: It is important that the conditions and changes in patients are
discussed with their loved ones so that they can be made to understand the condition of
patients in a better manner.
 Developing a team: A team that will be responsible for taking care of the patient then
needs to be developed comprising both of nurses and family members so that the care
needed by patient can be efficiently given.

 Determining the patient’s needs: It is important to determine the needs of patients
depending on the stage of dementia.
 Creating the plan: A plan needs to be made by the caretakers which need to be followed
so that the patient can lead a daily life effectively.
 Taking action: It is important that the team members involve in taking care of patient
follow the plan and coordinate with each other so that the needs of patient are met
effectively.
Following is a care plan which can help in assessing the dementia patients and taking their care
efficiently:
There are many healthcare professionals who are involved in taking care of dementia
patients and also follow the healthcare plan of the patients so that they can be given effective
medications like Geriatrician, neurologist, psychiatrist, psychologist, neuropsychologist, geriatric
care manager, nurses, hospital or care centre staff etc. All these professionals coordinate their
roles and duties together so that effective care can be provided to the dementia patients which
can help them in leading their lives in a better manner.

Process of different person-centred assessments in defining own care pathway
Person-centred care is related with providing social and health care services to the patients
by involving the patients, their families and friends so that decisions that are made can help in
meeting the requirements of the patients in an efficient manner. It is important that each patient
care needs are determined separately so that each patient can be given treatment in accordance
with their needs (Cruz and Mateus, 2016). The healthcare professionals need that they make their
strategies related to routines and practices more flexible so that the services given to patients can
be provided as per their needs and in accordance with what is good for them. This help in
making them more comfortable in taking the services of the health professionals and also they do
not oppose them. Also it helps in increasing the respect and dignity of health workers towards
their patients so that the quality of services which is provided to them improve and help in
gaining effective results. It also help the patients in getting the care they want and need which
help in their proper care and in supporting them through their disease.
The individuals should be assessed separately and individually so that their care needs can
be analysed and they can be given support as per their requirements so that their health
conditions can be made better. Also it is important that the quality of services given to them are
improved which help in improving the healthcare services given to the patients. It also help in
creating a path through which maximum benefit in accordance with the needs of patients can be
given so that high rate of improvement in the health of society can be achieved (Donnelly and
MacEntee, 2016).
Evaluation of a capacity assessment to identify areas of improvements
The capacity assessments must be evaluate regularly so that the requirements of care with
time can be analysed which help in assessing the increasing needs of patients. It also help in
determining the areas which require improvements so that better services can be given to the
patients. The areas of improvements can also help improving the experience of people so that
they can feel satisfied with the care given to them. The patients of dementia can become more
confident about leading their lives and being more dependent on their family and friends so that
they can lead their lives more efficiently. It can help in improving the outcomes of their health as
this can help in lowering their blood pressure and making their live more happily by getting
proper care based on their requirements (Hunter and Malloy, 2016). The capacity assessments
can also help in determining the individual requirement of the care that is required by them so

that the practices can be made more effective which can help them in dealing with their disease
in more effective manner.
The scope of improvements should be identified regularly so that the patients can be given
proper care and can be helped through their daily routines. It also help in making the health
professionals more confidents and satisfied with their jobs as they are to give better services to
the patients. It will also help in improving the overall health quality which is given to the patients
and also help in improving the health care practices (Irish and Piolino, 2016).
Reflection
While making a care assessment of the patient i took care that all the aspects are covered
related to the patient so that overall care can be given to them and their experience with health
professional in getting person centred care can increase. I also observed the patients carefully so
that their care needs can be determined closely so that better services can be provided to them.
The care assessment made by me helped in taking good care of the patients and in effectively
meeting their requirements so that they can lead their regular and daily lives more efficiently.
While taking care of the patients i regularly analysed and evaluated the care assessment plan so
that the improvement in services can be done and patients can be given effective services as they
grow older and more incapable of making their decisions. I used my skills and talents in an
efficient manner so that best level of services can be given to them which can help in improving
their health and also in realising that they are being taken care of efficiently.
LO3
Impact of own relationship with individual and multidisciplinary team in delivery of care
pathway
In order to effectively deliver the care pathway so that better services can be provided to the
patients it is important that a positive relationship is maintained with the patients and
multidisciplinary teams which can help in effective implementation of the care pathway.
Multidisciplinary teams include professionals from different disciplines in primary, community,
social care and mental care services so that better services can be provided to the patient
depending on the disease along with its severity (Wu and Klein, 2017). It is important that i
maintain a positive relation with the dementia patient so that i can better understand their need
and the level of care which they require so that i can collaborate with the multidisciplinary team

and help in providing effective services to the patients. Own relationship thus creates a positive
impact on providing better services to the patients so that better outcomes can be achieved. It is
important that i follow participative leadership style that can help me in better collaborating with
the multidisciplinary team members and also in delivering my professional roles effectively
(Merriel and Siassakos, 2016).
It is important that the information is shared among the multidisciplinary teams so that it can
be utilised in providing better services to the patients and also in effectively using and
understanding the information related to the patient so that specific and personalised health and
social care services can be provided to them. Effective communication plays an important role in
improving the way through which information is shared so that high quality services can be
given to patients. The team members can collaborate together through sharing information so
that the health of patient can be improved thoroughly by proving effective treatment. It also helps
in coordinating their efforts so that the health of patient can be improved (Fletcher, 2016).
LO4
Need for person-centred communication in implementing person-centred plans
In order to effectively implement person-centred plan it is important that a person-centred
communication is developed which can help in enhancing the effectiveness of delivering better
health care services to the patients. This can help in better exploring the symptoms of the patients
and providing them with alternatives of care based on the information gained from them. This
also helps in developing a person centred plan so that treatment can be given to the patients
based on their requirements which can help in improving their health conditions in a better
manner. It also encourage the participation of patients in their own personal care so that they can
be involved in decision making regarding their treatment which can help them in achieving
overall caring services (Housley, 2017). This help in developing more effective and personalised
care services for the patients that can help in improving the patient’s health and also in
improving their social well being. Various communication strategies and types can be used so
that effective communication can be established and better care can be provided to the patients.
Use of communication sources like phones, e-mails, video chats etc. can be used in order to
establish effective communication and provide person-centred services to the patients so that
effective services can be provide to them.

Conclusion
From this report it can be said that the patients must be given care based on their individual
requirement so that they can live their lives with more confidence and also can feel taken care of.
The patient of dementia should be given effective care so that they can carry out their regular
routines more independently and confidently which is important for their dignity. Also it is
important that their capacity to make decisions are analysed which help in determining the level
of services that they need so that they can live respectfully in society and their living standards
can be improved.

References
Books and Journals
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2016. The perspectives of stakeholders of intellectual disability liaison nurses: a model
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synthesis, structural characterization and antioxidant capacity assessment of a new
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