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BTEC Level 3 Health and Social Care Unit 5 Meeting Individual Care and Support Needs Learning Aim B

Subject: Vocational studies

Age range: 16+

Resource type: Unit of work

Last updated

26 February 2024

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A 21 page booklet covering the content of the BTEC Level 3 Health and Social Care Unit 5 Meeting Individual Care and Support Needs content for Learning AIm B; B1 and B2. It is a word document which can be added to or altered to suit your teaching style. The booklet helps students to be organised with their notes and keep information together and has been updated to reflect the new case studies from Pearson’s November 2018.

There are SIX PowerPoints to aid your delivery and areas for students to make notes, complete activities and sign posting about the assignment assessment criteria. Powerpoints on Ethical theories and application, Managing conflict, Conflict of Interest, The Care Act, Equality Act and the Mental Capacity Act. Some of these have approriate videos embedded within and are designed to be engaging and interesting.

The spec content covered with this package is… B1 Ethical issues and approaches • Ethical theories to include consequentialism, deontology, principlism and virtue ethics. • Managing conflict with service users, carers and/or families, colleagues. • Managing conflict of interests. • Balancing services and resources. • Minimising risk but promoting individual choice and independence for those with care needs and the professionals caring for them. • Sharing information and managing confidentiality.

B2 Legislation and guidance on conflicts of interest, balancing resources and minimising risk • Organisations, legislation and guidance that influence or advise on ethical issues. All legislation and guidance must be current and applicable to England • Organisations, e.g. National Health Service (NHS), Department of Health (DH), National Institute for Clinical Excellence (NICE), Health and Safety Executive (HSE). • Legislation, e.g. Mental Health Act 2007, Human Rights Act 1998, Mental Capacity Act 2005, National Health Service Act 2006 Section 140, Equality Act 2010, Care Act 2014. • Guidance, e.g.: • the DH Decision Support Tool • Five Step Framework • NICE and NHS guidance on Care Pathways and Care Plans • Managing Conflicts of Interest: Guidance for Clinical Commissioning Groups • NHS • HSE guidance on risk assessments. • How this guidance may be counterbalanced by other factors, e.g. religion, personal choice, government policies.

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Hi I have purchased and used the above which has been brilliant but I went to reuse the booklet and it is not on my download? How can I get it again? It is the booklet for Unit 5B/C. I have all the powerpoints. many thanks

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Aisha’s Case Study

Aisha’s vignette mentions how other institutions affecting her life—education, foster care, and criminal justice, in particular—could be assessed through a lens of conflict theory. Using Aisha’s case vignette as a guide, consider how a social worker approaching work with Aisha from a conflict theory perspective would view these systems’ influences on her situation. What insights might such an analysis reveal? Although conflict theory does not inform interventions directly, what might be some approaches that you would consider, perhaps in the macro domain, to address these systems’ effects on Aisha?

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• Lessons from the Ashya...

Lessons from the Ashya King case

• Related content
• Peer review
• Aidan O’Brien , barrister, London ,
• Daniel K Sokol , barrister and medical ethicist, London
• daniel.sokol{at}talk21.com

Clinicians must try to reduce the risk of misunderstandings

On 28 August 2014 the parents of 5 year old Ashya King took him from Southampton General Hospital and boarded a ferry to France. He had been recovering from the removal of a medulloblastoma, a high grade paediatric tumour.

Ashya’s parents and doctors disagreed over his treatment. The parents sought proton beam therapy, arguing that it was less harmful than conventional radiotherapy. 1 Peter Wilson, the lead paediatrician at the hospital, has since commented, “For this particular tumour, the reason why the proton beam was not deemed to be of any benefit is because you have to irradiate most of the brain and spine anyway.” 2 Proton beam therapy is not routinely provided on the NHS in England, although a small budget exists to take children abroad for treatment.

If a child lacks competence to make treatment decisions, the responsibility falls to the child’s parents. Yet, the parents’ right is not absolute. Where their instructions seem to conflict with the child’s best interests, the doctors must seek the court’s authority to override them, save for grave emergencies. A court can invoke its inherent jurisdiction under section 8 of the Children Act 1989 to make “specific issue orders” or “prohibited steps orders.” In doing so, a judge will decide what is in the child’s best interests.

In cases such as Ashya’s, where there is a disagreement about treatment options, the onus is on the hospital to refer the matter to the courts. 3 (Ashya’s father has claimed that the hospital’s threat to apply for a court order prompted the family to remove Ashya.) That is the law. In practice, court orders can usually be averted by ongoing and open communication between the family and the medical team. We don’t know what the nature of the communication was in Ashya’s case; however, in general terms, the tendency to avoid difficult conversations must be resisted, and warning signs of a brewing disagreement—such as changes in the nature of a family’s questions or their body language—must be acted on quickly. Joseph Fins, the US bioethicist and professor of medicine, has written, “Too often, the culture of intensive care promotes and rewards diagnostic acumen and technical competence at the expense of communication. The result is that patients and family may feel bewildered and isolated at a time of crisis.” 4

On discovering Ashya’s absence the hospital informed Hampshire Police. The hospital feared that, if Ashya’s nasogastric tube was displaced, feed could enter his lungs, with potentially fatal consequences. Without a gag reflex, he was at risk of choking. And the battery to his food pump was believed to be fast running out.

Ashya’s parents had “parental responsibility” when they removed him from hospital. It is therefore arguable that no permission from medical staff or the courts was needed. That the parents removed Ashya without telling anyone at the hospital, even if not legally obliged to do so, indicates the extent of the breakdown in trust between the family and the medical team.

Once alerted to the situation the Crown Prosecution Service confirmed, on the basis of information from the hospital, that Ashya’s life was at serious risk and that he needed urgent medical care. On 29 August Southampton Magistrates’ Court issued a European arrest warrant. The basis on which it was issued remains unclear, but Hampshire police have said that it was “based around neglect.”

Section 1 of the Children and Young Persons Act 1933 makes it an offence for an adult with parental responsibility to wilfully neglect the child in a manner that is likely to cause injury. This offence includes the failure to provide adequate medical aid. It was probably under this broadly defined offence that the police acted.

As a matter of law, criminal proceedings must be ongoing for a European arrest warrant to be issued. There must also be a realistic prospect of conviction. The first requirement does not seem to have been satisfied in this case. It is unclear whether the second was.

On 29 August Portsmouth Social Services successfully applied to the High Court to make Ashya a ward of court. 5 The court now had control over all matters relating to Ashya’s welfare and demanded that he be presented to the nearest hospital at once. The next day Ashya and his parents were found in Spain. Ashya appeared to have suffered no ill effects from his travels. His parents were transferred to prison pending extradition proceedings. This triggered a public backlash against the hospital and police.

On 2 September the Crown Prosecution Service arranged for the discharge of the European arrest warrant on the basis of insufficient evidence for a realistic prospect of a criminal conviction. On 5 September the High Court allowed Ashya to undergo proton beam treatment in a clinic in Prague. Despite this, the question remains as to whether the statutory authorities acted in a heavyhanded manner.

In a rapidly evolving situation the hospital and police were required to act quickly, without any clear knowledge of the intentions of Ashya’s parents. The attempts to contact Ashya’s parents after his disappearance were fruitless.

The law can be a blunt instrument, but without knowing what the authorities knew at the time of making their decision we must be slow to criticise their actions with the benefit of hindsight. Although the temporary separation of Ashya and his parents was regrettable, less robust and proactive measures by the authorities may have led to a more tragic outcome.

In terms of clinical ethics, the case highlights the interdependence of patient and family and the vital importance of clinicians and families working together towards the shared goal of doing what is best for the child. Although not infallible, mutually acceptable plans can—with time, negotiation, cultural and religious sensitivity, and a relationship of trust—almost always be found. The trick is to get the family on board early and to maintain regular contact, with opportunities for questions, so that the risk of misunderstandings, unrealistic expectations, and later opposition is reduced. Perhaps such “preventive ethics” might have avoided the total loss of trust in Ashya’s case.

Cite this as: BMJ 2014;349:g5563

Competing interests: None declared.

Provenance and peer review: Commissioned; not peer reviewed.

thebmj.com Patient Partnership: When doctors and patients disagree ( BMJ 2014;349:g5567, doi: 10.1136/bmj.g5567 )

• ↵ Dyer C. Judge rules that boy with brain cancer can be treated in Prague. BMJ 2014 ; 349 : g5570 . OpenUrl FREE Full Text
• ↵ Boseley S. Ashya King given legal go-ahead for cancer treatment in Prague. Guardian 5 Sep 2014 . www.theguardian.com/uk-news/2014/sep/05/ashya-king-prague-proton-beam-therapy-court-ruling .
• ↵ Glass v UK [2004] 1 FLR 1019 , [70]-[83] (Eur Ct HR).
• ↵ Fins J. A palliative ethic of care. Jones and Bartlett Publishers, 2006.
• ↵ High Court of Justice Family Division. Order No PO14P00645. 29 Aug 2014. www.judiciary.gov.uk/wp-content/uploads/2014/09/king.pdf .

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Social workers given guidance on inappropriate relationships with clients

Aisha was flattered when her children's social worker began paying her attention. She had been going through a spell of mental health problems and felt a mess.

The attention turned into a friendship and eventually an affair. But the social worker was a domineering Christian fundamentalist who sought to convert Aisha and stop her taking her medication. When she objected, he said he had the power to take away her children.

Aisha's ordeal is one of a growing number of cases of social workers found to have formed inappropriate relationships with their clients, which has led to disciplinary action, including dismissal and removal from the professional register.

The General Social Care Council (GSCC), social work's regulators for England, will on Monday respond to the trend by publishing guidance on observing what it calls "professional boundaries". Social workers, it will say, need to take particular care to ensure their support for vulnerable clients does not develop into something more.

Penny Thompson, the GSCC chief executive, said the guidance was "not a list of do's and don'ts" but was designed to stimulate reflection and discussion around a series of cases that had been heard by the body's conduct committee.

There were grey areas in a social worker's dealings with a client that did not apply to other caring professions, Thompson said. "Making a relationship with the service user is part of the professional duty. That's the basis for making an assessment of how they are and what needs to happen or change."

The GSCC, which regulates almost 103,000 social workers and social work students, says the number being disciplined for inappropriate relationships is relatively small: 53 cases since 2006. However, these cases represent almost one in five of all 278 misconduct findings in that period. By contrast, one in 27 of all fitness-to-practise cases heard last year by the General Medical Council involved an alleged improper relationship between a doctor and a patient.

Cases outlined in the GSCC guidance include:

A male social worker who took a married female client from his office to a nearby pub, where he complimented her on her appearance, suggested he could pay for her to go to university, touched her hands repeatedly and hugged and kissed her.

A manager in a fostering service who treated children whose cases were allocated to his team, taking them swimming, to football matches and out for meals.

A female social work student who by chance met and began a relationship with the father of two children whose case she had been allocated while on placement. She had the children to stay with her while their mother was in hospital.

Thompson said social workers should always note and report situations that could be misconstrued, such as having a cup of coffee with a client in a cafe or finding themselves discussing spiritual or faith matters with them.

A good test of whether a situation was improper was for a social worker to ask themselves if they would feel comfortable discussing it. "If you feel you couldn't talk to your supervisor, or even a friend or colleague, about what you are doing, that might give you a pointer that maybe all is not well and there could be issues about boundaries," Thompson said.

Aisha's case, which led to the striking off the professional register of her children's social worker, Rodney Smith, reveals some of the complexities of the issues involved. Even now, Aisha, 46, admits she felt supported by some aspects of the relationship, which began during the three years that Smith was assigned by the local council to her family and continued for more than five years. "There were parts of me that didn't like it and parts that did," she said. "It was a bit confusing."

Aisha, a mother of six who lives in east London, was brought up in a strict Muslim family, had little education and had an arranged marriage as a teenager. She has been in several abusive relationships.

When Smith arrived, she was feeling particularly low because her weight had increased as a consequence of the medication she was taking for her psychosis. "He started to say that I intrigued him, that he was interested in me as a person and he felt sorry for me." Soon, he was urging her to stop taking the drugs.

Conversations turned to religion, with Smith telling Aisha that Islam was "corrupt", that her children had been taken by the devil and that she would find peace only through Christianity. He gave her a Bible and tapes of sermons and took her to church.

The relationship ultimately became sexual, although Smith was married with children. Feeling increasingly desperate, Aisha managed to break free only by going to her MP to report Smith's behaviour and his threats to take away her children.

Aisha said: "I was quite flattered that somebody in a high position like that would want to get involved with riff-raff like me."

Aisha's name has been changed

Andy Atkins now coaches social workers on observing professional boundaries. But he himself paid a high price for crossing them.

Employed as a mental health social worker by Leeds council, Atkins became involved with a woman who had been his client and with whom he was still in contact through his work with a support group. Two months after he began the relationship, he told his line manager and was immediately sent home.

There followed two years of recrimination and anxiety: a 17-month suspension, followed by dismissal, three months' unemployment, reinstatement on appeal with a final written warning and, finally, an admonishment placed on his record for nine months by the GSCC.

"It cost a lot of money and a lot of heartache for everybody concerned," said Atkins, 59. "They are not interested in 'Andy Atkins has fallen in love'; they are interested in proving your guilt."

Atkins was a practising social worker for 24 years, for 18 of them as an "approved" mental health specialist. He was not allowed to return to such work on reinstatement and eventually took early retirement this year, enabling him to focus on coaching through his business, Professional Boundaries Training.

He welcomes the GSCC guidance, saying social workers have never been taught enough about the "slippery slope" of boundary violation that can start with something as innocent as sending a Christmas card to a client or calling them on a personal phone.

"That's a particular one I remember: someone had noted the number and stored it for the future. They then rang me to say they were thinking of committing suicide. The message you give to clients if you give out your number is that you are available 24 hours a day."

Atkins's own story has had a happy ending: Anita, the woman he fell in love with, is now his wife.

• Social care
• Relationships

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