Equality

Patient autonomy

Patient autonomy means ensuring that patients make informed decisions and give consent based on good information.  It is important not to make assumptions about what patients/clients and their carers want, but to work in partnership for the best outcomes.

Introduction

All of the activities in this unit help you to learn about how culture influences that the care that is provided; the importance of taking diversity and individuals’ beliefs and preferences into account when providing care; and about the legislative requirements and policy in relation to equality and diversity.

Providing person centred care involves:

  • demonstrating cultural competence
  • patient/client autonomy and ensuring that people receiving care can make informed decisions and give consent based on good information 
  • co-production of care - including people as equal partners in decisions about their care
  • empowering people to be part of decision making processes about things that impact on them and their care.

The activities below will help you understand more about how you can be part of this happening in your work setting for the people that you provide care for.

You will also find the ‘Patient Client Involvement’ section in the Policy Unit useful and in particular the ‘Challenges to PFPI’ when considering Patient/client autonomy, inclusion and empowerment.

Everyone matters

In Everyone Matters: 2020 Workforce Vision, the Scottish Government outline the aims for a range of person centred values to be shared and embedded across NHSScotland. They are:

  • care and compassion
  • dignity and respect
  • openness, honesty and responsibility
  • quality and teamwork

In doing this, they highlight that we need to embed these values in everything that we do. 
Read this document and consider how it supports Equality and Diversity in your role.

Keeping up to date with Everyone Matters: 2020 Workforce Vision

Find out what your local Health Board Everyone Matters: 2020 Workforce Vision plans are. You will find these by searching on the intranet or internet.

What impact do these plans have for clients/patients, your role and work setting?

Keep up to date with Everyone Matters: 2020 Workforce Vision by adding a bookmark to the relevant intranet or web page and an alert to your Flying Start NHS® portfolio and /or make a date in your diary to revisit.

Person centred care: What is happening?

Complete one of the activities below

1. Use the intranet to find out more about how person centred care is being put into action on your Health Board and consider

  • how this will impact on the people receiving care in your work setting 
  • how you and your colleagues can make changes in the way that you work so that the care provided is more person centred

Discuss what you have read and any changes that you think could be made with your mentor. Are there actions that you and your team can take forward?

2. If you are unable to access the Health Board Intranet, read the Scottish Government say in A Route Map to the 2020 Vision for Health and Social Care (pages 3 and 5) then either look at the Patient Opinion website (use the search to find something that is pertinent to your work setting or care you provide) or read the script in the ‘Who cares?’ resource in Little Things Make a Big Difference: Valuing people then watch the videos of the sections that have most resonance for you.

Consider the following questions:

  • how can you put the patient/client and their best interests first?
  • how do you know what is in a patient’s best interests?
  • how do you gather information and feedback from patient's, carers and families?
  • how do you use this to improve your practice and influence the care provided by others in your team, ward or service area?
  • how can you make these changes? 
  • who or what do you need to support you make these changes, consider what may be available outside of the NHS - perhaps in the third sector?


Discuss what you thought with your mentor and record your reflections for your portfolio.

Assets-based approaches

Health assets have been defined as: 
any factor or resource which enhances the ability of individuals, communities and populations to maintain and sustain health and wellbeing and to help to reduce health inequalities. These assets can operate at the level of the individual, family or community and population as protective and promoting factors to buffer against life’s stresses.” (Morgan and Ziglio 2007 cited by the Scottish Recovery Network).

Read the recovery and the assets-based approach article published by the Scottish Recovery Network and consider the following questions:

  • what were the key messages for you in the article?
  • what similarities and differences are there between this type of assets based approach and the approach to health and ability taken in your work setting?

Record the key points and issues and add this to your portfolio. 

Thinking about your values

Your values and beliefs influence the care that you provide (this is explored in the Cultural Competence section of this unit) and you need to be aware of how this impacts on the care that you provide and how you see the needs of your patients/clients.

NES are developing resources to support Values Based Reflective Practice and have put 4 questions at the heart of this method of reflection.

These questions are:

  • whose needs are being met? 
  • what does the situation say about abilities and capabilities? 
  • what does it say about me or us as professionals? 
  • where is value, power and voice in this situation?

Reflect on the care that you provide using these questions. Record your reflections for your portfolio.

Including everyone

Taking into account equality, diversity, culture and socioeconomic influences is central to the provision of person centred health services.

Think about the Equality Act (2010) protected characteristics’ (age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage and civil partnership, pregnancy and maternity)., diversity of the people who work in and access your service; socioeconomic and geographic factors impacting on people who display any of these characteristics. Answer the following questions:

  • can you identify factors that may impact on people having equal access to services? This may be supportive, can hinder or prevent access
  • how does or could the service be flexible or adapt to ensure equal access for everyone?
  • are there factors that impact on staff members that also need to be considered?

Discuss any issues that you have identified with your mentor or manager and also highlight where thing are working well.

Co-production – working with patients/clients

'Essentially co-production is:

  • an assets approach which builds on the skills, knowledge, experience, networks and resources that individuals and communities bring
  • built on equal relationships, where individuals, families, communities and service providers have a reciprocal and equal relationship
  • an approach where services ‘do with, not to’ the people who use them and who act as their own catalysts for change’ (Hanley,2013 p14)

This is the direction that healthcare in Scotland is moving and is central to person centred care. It differs from the traditional model of healthcare where healthcare professionals make decisions about the care and treatment that people receive.

Can you identify:

  • aspects of the care that is provided by your service where the traditional approach is taken
  • aspects of care that have elements of coproduction
  • how equality and diversity might affect your approach to co-production
  • where care could be adapted to move towards coproduction
  • how carers, family or friends could be included in planning and carrying out care if this is appropriate

Patient/Client information

Review a number of patient/client information sources e.g. leaflets or literature, websites. 

Does this information:

  • meet the needs of the patients/clients who need or want it 
  • take into account the needs of people with different abilities, knowledge and understanding e.g. language, format , content
  • take into account the ‘protected characteristics’ (age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage and civil partnership, pregnancy and maternity)

Also consider:

  • if there are sufficient resources available 
  • if not, how these can be accessed 
  • how the availability or lack of suitable information impacts on patient/client’s involvement in decisions about care

You may wish to discuss this with you mentor or make suggestions to the relevant team.

Multi-Professional Team Approach

Consider if and how the multi-professional team facilitates person centred care, co-production and patient/client autonomy.

Answer the following questions:

  • how consistent team approach to person centred care, co-production and patient/client autonomy is
  • the aspects of care that the team would like to improve for patients/clients and carers
  • how the team can address these issues result in service improvement
  • how this fits with local improvement initiatives, plans and goals

Portfolio Activity

Did you find the experience of considering promoting person centred care and co-production practice challenging?

Discuss your experience with your mentor and records your experience and reflections for your portfolio.