Individual Journey: Integrated Health and Social Care Report

This report delves into the realm of integrated health and social care, analyzing local resources and provisions that support integrated care working. It identifies current unmet needs related to health, care, and support service provision, particularly for individuals with dementia. The report emphasizes the importance of person-centered care, exploring the roles of health, care, and support service practitioners in this context. It also addresses appropriate leadership in health services to promote effective interprofessional and multidisciplinary team working, including responsibilities for information sharing. Furthermore, the report examines different communication methods and strategies used to provide appropriate support to individuals and meet their care needs. The report highlights the significance of integrated health and social care in providing comprehensive support to individuals and communities, emphasizing the need for collaborative efforts and effective communication within the healthcare system.

Supporting the Individual
Journey through Integrated
Health and Social Care

Table of Contents
INTRODUCTION...........................................................................................................................3
TASK 1............................................................................................................................................3
P1. Local resources and provision that supports integrated care working.............................3
P2. Current local unmet need related to health, care and support service provision..............5
M1...........................................................................................................................................7
D1...........................................................................................................................................7
TASK 2............................................................................................................................................8
P3. Identification of own care needs......................................................................................8
P4 Role of the health, care or support service practitioner in supporting person centred care 11
M2.........................................................................................................................................11
D2.........................................................................................................................................12
TASK 3..........................................................................................................................................12
P5 Appropriate leadership in a health service to promote effective inter professional and
multidisciplinary team working............................................................................................12
P6 Responsibilities of information sharing between multidisciplinary teams.....................12
M3.........................................................................................................................................13
D3.........................................................................................................................................13
TASK 4..........................................................................................................................................13
P7 Different communication methods used to provide appropriate support to different
individuals to meet and review their care need....................................................................13
P8 Communication strategies for the needs of different service users in a healthcare service14
M4.........................................................................................................................................14
M5.........................................................................................................................................15
D4.........................................................................................................................................15
CONCLUSION..............................................................................................................................15
REFERENCES..............................................................................................................................16

INTRODUCTION
Integrated health and social care provides some generalist work- related programmes of
the study which covers key knowledge, practical skills and understanding required in health and
social care and also provides certain specialist emphasis through choice of optional unit. These
courses supported by focused study in the areas of social and health care which also include
specially designed units. In this the opportunity will be given to contribute and develop social
and health care environment through combination of skills and knowledge acquired in various
parts of programme (Bejerholm and et. al., 2015). Some of recurring themes involve that
integration holds key to truly person centred care, transforming and improving lives of the
people and communities should be heart of integration rather that services, systems and
structures. There is no one-size-fits-all solution to the integrated support, even where service is
represented as fully integrated; aligned workforce with the shared training and joint working is
significant step towards the full integration, to benefit families and individuals (Smyth and et. al.,
2014). This assignment is divided into two parts with the two different case and the other part
will include communication methods and strategies associated to identity the needs.
TASK 1
P1. Local resources and provision that supports integrated care working
According to the case healthcare practitioner in charge in local community based
healthcare services. Practitioner is chosen by team manager to research and write a report of
social and health services which are available within the local area to fulfil the needs of
individuals who required multi- disciplinary care. To join up the care and health services,
partners across the local systems will require to work together in different and new ways.
National health and care are working closely with the all areas to provide support them. These
type of programmes operated to bring together voluntary organizations and care and health
services in local areas (Bennett, Breeze and Neilson, 2014). And together these are provided with
innovative combination of medical and non medical individuals support for older and sick people
with multiple long term conditions who have the risk of unplanned hospital admissions.
Integrated care working is a multidisciplinary care which requires different care professionals
like doctors, nurse and care providers, these type of care based on the different professionals and

healthcare who can work together to provide care those who are suffering from the multiple
diseases. Resources and provision from the local system is very essential for these type of
programmes to provide benefit to people and community such as:
System leadership: This is a local vision programme which focuses to achieve system
change through the management and leadership development. These are run by local vision sties
and leadership centre are matched with the enabler with system leadership (Curtis and Burns,
2015). These type of programme provides support to the integrated care working.
Care support team: Better team and support is very important to provide good quality of
care to people and community. Working with the better team will always give good results. The
health and care of people can be implemented with the care support team and goals and targets
can be achieved.
NHS interim management and support: It offers NHS organisations which need short
term support like access management expertise that exists throughout NHS (Vogelpoel and
Jarrold, 2014). Teams are made with professionals and the nurses who can provide a better care
to the people who are seeking for it.
In context of borough of Waltham Forest, people suffering from dementia has certain
options or getting care services and improve their condition in order to remain mentally stable
and healthy. It involves different health care services and social care facilities which provide
support to make such patient feel relieved in respect of overcoming with dementia.
Healthcare services – The health care facilities available for dementia in Waltham forest
consist psychiatric hospitals like NHS continuing care. However, community nurses or paid
carers are available for people having dementia and many people get support in residential care
homes. Moreover, admiral nurses having expertise in practical, clinical and emotional supporting
to people with dementia and their family members for overcoming with the same.
Social care services – The social care services consist charities for people with dementia
such as Alzheimer's society to facilitate well living and determine nearly medical help. Secondly,
day centre services are available for them in Waltham Forest like The Morley Centre offering
wide range of activities including music, relaxation, group discussions, crossword puzzles,
reminiscences, quizzes and aromatherapy. Additionally, local community centres provides
multisensory activities to people with dementia like gardening, baking, doing puzzles and many
more for improving their medical situation perspectively.

Aim of integrated health and social working ensure that gaps in services has to be
improved and addressed, outcome and experiences for service users should be promoted. Joint
funding arrangements have supported drive toward joint commissioning, the practical application
of this varied across areas (Gardiner, Geldenhuys and Gott, 2018). Strategic involving complete
integration of governance and processes of member organization. Geographic covers all the
services with certain place, this can also involve virtual arrangements where action is aligned but
not under a single management. Integrated care can take place at system, locality level or level of
individual service users or team.
Integrated care and support provide the care to the local places, where people need help
with the care and support. Integrated care will succeed, like better planning, free access for to the
good informations and more personal involvement of individual using services. It also gives
clarity over the local areas what should be aiming to attain practically, in efforts to the integrated
service (Goodyear and et. al., 2015). Integrated support and care feel s and looks like for
individuals and local areas are asked too, sign up to using it. Pioneers support rapid promotion,
uptake of lessons and dissemination across the country. This also receive central support to face
certain challenges provided by national partners. This also support sharing of learning to provide
support to all areas to overcome barriers or challenges to integrated support and care at pace and
scale so, it becomes norm rather than exception. Practitioners provided by these kind of
programmes help them to provide a good quality of care and treatment in local areas in which
community and individuals need it, this can implement in the care and support all over the
country.
Support and provision can help to manage the care in local areas and also it will provide
the treatment and care to old and people who are suffering from multiple diseases. To provide
integrated care and support in local areas needs funding and support from the different healthcare
and multi agency, providing these type of programmes will help to community and individuals
for good health and treatment.
P2. Current local unmet need related to health, care and support service provision
Unmet need is very difficult to define and also harder still to measure. To provide care
district nurses deliver the care at home but some people do not receive any benefit from these
facilities. Some of them receive little care but they need some more care. There are no
overcrowded queues or rooms to bring these unmet need to light (Hajli and et. al., 2014). The

local authorities of the particular area required to seek to know unmet needs for the social care.
Recent research from age United Kingdom estimates that 1.2 million older individuals are not
receiving social care which they need, number they report increased by half since 2010, which
shows that most of people do not receive the care and treatment in local areas. There are some
people who are suffering from the multiple diseases and older people who do not able to fulfil
basic needs, want has to provide the needs they want. This not only impact the people struggling
to manage without support they require; it also add additional strain on the families and their
carers. Knock on consequences for health service are inevitable. Many people are struggling to
get by may eventually reach to get care and find themselves among growing number of patients
who are delayed in the healthcare while they waited to get care they want to be discharge safely.
At the other hand, it has been analysed that services user with dementia has to wait for a
long in order to take appointment with psychiatrist. However, it will responsible for major
complications in condition of dementia which is very difficult to address in future. In addition to
this, it is necessary for care providers that they should improve the policy of taking appointment
so that waiting for a long for appointment will not impacts negatively on their psychological
condition. Moreover, it is observed that day centre are not sufficient for overall patients of
dementia which create issue of gaining related facilities for improving health condition.
Meanwhile, care professionals not give priority to such people having problem of dementia will
results into occurrence of complexities which is harmful for the patients.
Most difficult unmet need for the dementia patient is waiting long time for GPs which
can affect person's health because sometimes individual need early care and treatment for such
types of condition if they do not get care and treatment in certain period they may fall ill. Some
people do not go to healthcare because they have to wait for long time which is annoying. In this
condition they can get irritated which can result to aggression and violent behaviours at times.
The multidisciplinary team for providing care facilities to a person having issue of
dementia will consists several important team members such as mental health therapist, care
worker, nurse and social workers. However, they are required to put efforts in order to fulfil
actual care & social needs of patient with dementia. Moreover, it will provide support to make an
individual feel relief that facilitate to overcome the specific health problem as soon as possible.
Integrated health and social care system rations services to people with highest needs and
also heavily means tested, health system feels pride to being 'free at point of use' and which

meets broad range of needs. But there are certain needs in local areas which are unmet and
impacting the health of people who are living there (Holly and Poletick, 2014). Sometimes
financial problem can be a reason to unmet the needs, due to poor financial condition NHS will
not be able to fulfil the needs of every individual. For individuals who need social care, it is an
essential and important part of their living. In reality unmet need for care is refers to young
person with the disability unable to access training or job because of the lack of support. Lack of
care can negatively impact on the people's lives. Quality of service in integrated health and care
is very important, because the staff should be well trained, who can provide reliable and decent
care. The care provider has to provide proper care do not cut the visits short and rush all the time.
For this requirement people has to pay properly or fund has provided to the NHS. Even people
know that a better care costs.
M1
There are different needs for social care and healthcare. Social care providers are those
who provides support to people who are suffering with dementia. For example Alzheimer's
society and carer trust help to dementia people to overcome and cure their problems. They help
them with their daily activities such as washing, dressing and feeding, it also include needing
help in the terms of maintaining social interaction, helping with the complex relationships,
independence and protection from the vulnerable situations (Kendal and et. al., 2017). Healthcare
professionals helps with the care and treatment of dementia which involves control, prevention
treatment of disease, disability or injury and after care of an individual with these needs.
Community nurses, paid carers and admiral nurses provide treatment and care to dementia
people and Alzheimer's society, local community service and day care centres helps dementia
people to provide support with both emotionally and physically. They also give support at homes
so that it can be easy for such people to deal with their problems.
D1
According to the case study multidisciplinary care is very important in local areas. There
will be nurses and different professionals who will work to improve the health of the individual.
As a practitioner is provided with the local area where needs of community and people are high,
in this practitioner has to evaluate the all needs and has to separate the people who are with
needs. This will make easy for the integrated health and care to provide care which people want,
because multidisciplinary working can approached in more than single way as case study in

briefing demonstrate. The success of this practice may have negative impact on the organization
than positive in some cases. Integrated health and care can improve the individuals and
community need in a local areas those are not receiving care properly. The professionals and
well trained nurses who will be engage to provide a good quality of care with the trained.
Multidisciplinary care is important in such cases because dementia patients needs help
with their multiple needs which can be provided by multidisciplinary care social and health care
gives proper support and treatment to these patient by recognising their all needs and providing
suitable treatment. This type of care is beneficial but sometimes it can be more complex. Team
work needs cooperation and mutual understanding, problem with these terms can create issues so
patient may not be able to get good quality of treatment that can effect negatively to patient's
health.
TASK 2
P3. Identification of own care needs
According to the below health care plan, healthcare or support service, identify the own
needs is very essential part.
Patient's name John Date of Birth 08/04/85
Address #1274, 3rd floor,
oxford street, London,
UK.
Phone [phone]
Carer details or
emergency contact
4479806053 Other care plan YES
NO
GP Name/ Practice GFR Medical records No. 5486
Nurse currently
involved in patient
care
Carla
Presenting Issue(s)
What are the patient's
current health issues
Dementia Diabetes High blood pressure

Patient History
Record relevant
biological and social
history including any
family with the disease
and any relevant
health problems
No
A patient having issue of dementia with challenging behaviour and other health problem
of diabetes which is required to be overcome. Meanwhile, it is essential to establish an effective
plan of care which should be applied to make them patient well-being. The care plan consist
number of interventions which are given below. Firstly, it is necessary to offer certain activities
like gardening, magazines, puzzles and serviette folding which facilitate sensory stimulation to
improve their situation. Secondly, providing choice of alternative practices like hand massage
with essential oils, hair grooming and other liked things of patient. Thirdly, antipsychotics
medications should be given in order to improve challenging behaviour due to dementia to
overcome the same. However, management of diabetes is also essential by monitoring blood
glucose level, eating healthy meals, engaging physical activity, performing proper hygiene,
recognising & managing hypoglycaemia, medications on time and provide foot & dental care
properly. To regulate diabetes person should be provided with proper diet that will help to stable
the condition. Blood pressure can be maintain by providing treatment for dementia which is
major issue to become aggressive and angry. Concealing GP exercise and day care can help
individual to regulate their blood pressure and maintain food habits which will reduce the other
health risks.
Importance of sanctioning patient to be an active participant in their own care has
received large policy attention now a days. The case I was dealing with the patient was suffering
with chronic kidney disease and with lower back. In this case patient can be provided with own
care plans so patient can able to fulfil the own needs. Patient has some primary responsibilities to
manage healthcare in case of their broad lives and needs to be identified within provision of the
services and healthcare professionals interact with the patients. While not all the patients want
active role. Services need to be identified and health care professionals that many people want to

be progressive partners and participants in their own care. I used to give a context in that patients
will able to participate and also can share the decisions as per their interest, thus making sure
they can gain a good experience. Patients are co-manager and co-creator of their own well being
and health when patients are receipt of the services and not just recipients of the services so these
things helped me to make them identify their own needs. It can be in different areas such as
information, education programmes, decision making and communication.
Communication: Communication involve the style and the content of non verbal and
verbal communication between healthcare professionals and patients (Litman, 2016). If patient is
provided treatment and awareness about the own care it will help to reduce the particular health
problem. When I was providing care and treatment to the patient who was suffering from chronic
kidney disease and lower back pain it made me understand that proper communication is very
important. I identified as very important style to make an interaction with the patient and
understand problems and issues. Effective way of communication with the patients, made patient
to speak about their problems properly. Using only those word which patient can understand
make it easy for both patients and professionals. Person centred care plan are to meet the health
and social care needs. Interacting with the people and making them understand about their own
health and how they identify own care needs and can fulfil these.
Information: Support and information for the patients is part of centre content of
majority of integrated health and care (Voorberg, Bekkers and Tummers, 2015). People have to
advised and provide information to progress self management of people's problems with the
health like pain. I made patient aware about the common hygiene and health have to be provided
so people can well maintain. I also created awareness about the most common infection and
prevention from that can help people to manage the own health care. Providing patients written
and verbal information about their available treatment, diagnosis and outcomes of therapies, it
helps to help to patient to decide about their own care.
If people will get to know about the importance of identification of own care needs, they
will work towards the own care needs. Providing more information about the chronic kidney and
lower back pain which can help the patient.
Education: Providing education about the identification of own care needs can make
people realise how essential they are for their own care and support. I used to support people to
achieve the goals to achieve their needs. Person centred care plan is made for the individuals and

their help. With this plan I could help patients to identify and fulfil their own care needs which
benefit both healthcare and individuals. Educating about the lower back problems and chronic
kidney disease so they can follow the plans regarding the condition.
As being a practitioner, has to help the patient with the chronic kidney diseases and lower
back pain. Patient with chronic kidney disease has their own needs
P4 Role of the health, care or support service practitioner in supporting person centred care
Person centred care is a way of doing and thinking which sees individuals using social
and health services as equal partners in developing, monitoring and planning care to ensure it
meets to the individual's needs. People who are suffering with the dementia, for them it is very
important. As a practitioner I made sure that individuals in these type of cases has to be
recognised and the quality of the care should be improved for them. There is so much work to be
done to provide help in social and health services be more person centred. This has become
much of priority since past decade. I improved the quality of service which I was providing to
the patients. I helped people to get a proper care and with their needs. As in case of dementia
patient will need more care and needs, so it has to be fulfil as patient require. I helped the patient
to identify their own needs and hoe can they get a proper care. Their are some basic needs for the
dementia, diabetes and high blood pressure which has to be taken care by a practitioner such as
dressing, cooking, help while sitting and others. I have taken care of all these needs which made
patient more relief as patient was getting help with the needs. I made sure that this patient has to
get treatment for all the health issues like dementia, diabetes and high blood pressure. Organised
care home services which can help basic needs of daily life. For example GPs, nurses and mental
health therapist gives treatment for all the health problems so that person can improve his quality
of life.
M2
My own involvement in different person centred assessments consist the criteria of
making effective communication with patient and their family members in order to determine
their actual requirements. However, gathered information is helpful to make accurate care plan
for their well-being. I created awareness in patient hat person centred care is very important to
fulfil the own needs. Such as hygiene, proper diet and self care is very essential to get a good
life. Being practitioner I made sure that person should take care themselves by giving some
attention to themselves.

D2
The differences in care assessments are based on kind of health issue and related
symptoms to determine actual cause of disease in order to provide integrated care for patients. It
will facilitate to gather appropriate information and make decision in ream of care professions
for giving more effective treatment for improving patients outcomes. GP assessment is very
important to check whether person is progressing or not. If there is no improvement practitioner
has to better their quality of care and treatment. Mental health therapist assessment on regular
bases is required, it will cure person with their all the mental issues.
TASK 3
P5 Appropriate leadership in a health service to promote effective inter professional and
multidisciplinary team working
Leadership plays a major role to work with the multidisciplinary and inter professional
team. It needs mutual understanding which a leader should have to provide an effective care to
the patients. It also need greater inter professional collaboration. This will result in a good
quality of care and benefits to the organization as well as patient. This mainly focuses on the
health and needs of people, those who seek for the better treatment and care (Lloyd-Evans and et.
al., 2014). Working with inter professional and multidisciplinary team can have impact on the
organisation, it can be either positive or negative. In this case task as goals can be joint and
accomplish by working together. Multidisciplinary and inter professional team work is complex
process because it has different expertise, skills, knowledge and professionals. It also explore the
more understanding and knowledge about the particular condition which is faced in healthcare.
More about the human resource management, education and organizational behaviour can be
understand properly.
P6 Responsibilities of information sharing between multidisciplinary teams
Collaborative work is domain of healthcare which is extremely dynamic in the nature,
taking different forms and multiple modes, each one is supported by the different practices and
mechanisms. This flexibility and variety makes healthcare work challenging and ideal object of
the study for the decision making and collaborative work. Working together to make sure
support and care is coordinated is crucial (Ness, Borg and Davidson, 2014). There are different
responsibilities and roles involved in the care at home require to be defined carefully. People