Witness to Harm-Holding to Account. Improving patient, family and colleague experiences of Fitness to Practise proceedings: A mixed-methods study.

It sometimes seems that we expect our regulators to be superheroes. We expect them to predict, detect and punish wrongdoing. We expect them to protect the rights and interests of vulnerable citizens. We expect them to provide guidance on exemplary ethical behaviour for every eventuality. We expect them to weigh benefits and harms wisely and bestow penalties on offenders that all agree are fair and appropriate. We might even find ourselves wishing that, like Wonder Woman or Spiderman, our professional regulators will be ‘the champions of right and good against evil and injustice’. Whatever we might expect or wish, the track record of regulators of health and social care professionals is much more limited and contested. The care contexts and conduct these regulators are concerned with are much more complex than the generally more straightforward domains of superheroes. In the terrain of the superheroes, villains are wholeheartedly welcomed villainous and interventions to protect vulnerable citizens are unanimously welcomed (by good people at any rate). Superheroes’ decision-making is generally more black and white with few shades of grey and with little of the messiness, ambiguity and complexity of the ‘swampy lowlands’ of contemporary health and social care practice. I was reminded of this last week, as I attended an excellent conference on the theme of ‘Regulating for positive outcomes’. The conference brought together UK health and social care regulators and academics engaged in regulation-related research. Reassuringly, there is now a good deal of activity developing a stronger evidence base for regulatory practice with collaborative interdisciplinary initiatives relating to questions such as ‘How are we to understand and prevent unethical practice?’ ‘What role might patients and the public play in regulatory activities?’ ‘Which factors contribute to different judgements regarding sanctions for misconduct?’ ‘Why, for example, might members of the public view a dentist’s tax evasion more leniently than the regulator?’ And which approach to regulation is most appropriate for 21st century purposes: Right-touch regulation? Relational regulation? Values-based regulation? Or some combination? The conference also included discussion of the potentially detrimental impact of regulators’ interventions relating to responses to complaints and management of ‘warnings’. One speaker referred to doctors’ increased vulnerability to self-harm and mental distress following complaints. The discussion focused on the potential of regulators to be viewed as adversaries rather than as humane and objective investigators charged with public protection and fairness in relation to professionals. Reaching consensus on what it means to be a ‘good regulator’ is challenging. A recent report from the Professional Standards Authority stated that ‘Health and care regulation is incoherent and expensive and there is little evidence for its effectiveness; if it was going to improve care it would have done so by now. It’s time to rethink regulation’. Is it reasonable to expect regulators to improve care? Can we know what care would be like without regulation? We might speculate as to what regulatory success might look like and

Health and social care professionals’ anguish in providing care and support to children who are AIDS orphans in Nelson Mandela Bay: A qualitative study

Purpose The purpose of this paper is to understand the perspectives of frontline health and social care professionals in relation to delays in discharge from community hospitals. Design/methodology/approach A qualitative approach was taken, using semi-structured interviews and non-participant observation, within three community hospitals in NHS Scotland. In total, 12 frontline health and social care professionals were interviewed and observation of the multi-disciplinary team meeting was completed. Thematic content analysis was used to analyse the data produced. Findings The key findings were delayed discharge as an issue, lack of resources and capacity, difficulties in the relationship between acute and community health staff, silo working between health and social care, conflicting pressures on staff, and influence over services and external factors. There were perceived different ways of working within acute health, community health and social work, which were suggested to reduce efficiency, cause tension and ultimately result in delays. All professionals perceived an inability to influence any of the factors causing delays in discharge. Practical implications The internal issues regarding inter-professional working could potentially damage integration, indicating a need to teach collaborative team skills as well as quality improvement training to support staff to challenge and change current ways of working. Originality/value The paper contributes to the evidence base of community hospitals. There are implications for both health and social care policy.

Fitness to Practise (FtP) is an emerging area of interest within the health and social care field due to the increasing high profile cases relating to professionalism and conduct of practitioners. Research has ‘yet to catch up’ with the emerging interest and the current body of evidence predominately consists of literature reviews and descriptive or discursive papers which examine the process and functionality of FtP panels. Currently no research has attempted to examine the decisions made or indeed how these decisions were arrived at within the following health and social care professions, Nursing, Paramedic Practice and Social work. Professional regulation for each of these professional groups is established through regulatory bodies. The regulation and determination of FtP of students on leading to registration is the role of the Higher Education Institution (HEI) and is less uniform in its approach. This may lead to disparity and the potential risk of inconsistency, unfair and unjust decisions for students. Aim: In order to gain a greater understanding FtP and professional conduct, this research study aimed to examine the decision-making process involved in ‘FtP’ panels for undergraduate health and social care students, comparing the decision-making process of students, lay person and practitioners (both experienced and inexperienced). This study explored the factors that influence the decision-making processes including experience and skills. Methods: Three simulated ‘FtP’ case studies were created and filmed to examine the decision-making process that takes place in panels for undergraduate nursing/paramedic/social work students. These were informed by real life cases and expertise of professionals within each of the professional groups. Actors were recruited for each of the case studies and the simulations were filmed. Debriefing of the simulation was conducted with the actors and the data collected was analysed using thematic analysis. The case studies were then examined and deconstructed by four focus groups for each case (twelve in total) with degrees of experience, lay people and students. This deconstruction also included an evaluation of the simulation and its potential use in the field of FtP. The data collected was analysed using thematic analysis and key emergent themes were identified. Findings: The findings highlighted two key areas. Firstly, the importance of those involved in panels, 'the people involved in FtP panel' and secondly the ‘decisions that were made during the panels’. These findings suggest that there are a number of identified roles within FtP. The influence of these roles is measured not by the role but the execution of the role and personalities are more influential than identified roles. There is a further suggestion that experience of FtP panels can influence decision-making processes and can make for lengthy yet robust decision-making and that when systematic approaches to decision-making are employed that there is clearer understanding of decisions it leads to more effective decision-making processes. Conclusion: Understanding student FtP decision-making and the influential factors involved in that process will inform HEIs in the overall management of FtP and consequently promote consistency and fairness in decision-making. This will be achieved by recognising the influential factors on the processes of FtP and considering these when FtP are conducted. It should prompt attention to the approaches adopted by individuals during FtP and the need for a more uniformed approach to FtP not dissimilar to that of the regulatory bodies approach. Implications: Recognising that personalities as well as identified roles are influential in the decision-making is important to consider when HEIs reflect panel composition. It is also essential to consider the experience and the skill when selecting panel members for FtP.

Sharing data about patients between health and social care organisations and professionals, such as details of their medication, is essential to provide co-ordinated and person-centred care. While professionals can share data in a number of ways - for example, through shared electronic record systems or multidisciplinary team meetings - there are many factors that make sharing data across the health and social care boundary difficult. These include professional hierarchies, inaccessible electronic systems and concerns around confidentiality. Data-sharing is particularly important for the care of older people, as they are more likely to have multiple or long-term conditions; understanding is needed on how to enable effective data-sharing. To identify factors perceived as influencing effective data-sharing, including the successful adoption of interventions to improve data-sharing, between healthcare and social care organisations and professionals regarding the care of older people. MEDLINE and seven further databases were searched (in March 2023) for qualitative and mixed-methods studies. Relevant websites were searched and citation-chasing completed on included studies. Studies were included if they focused on older people, as defined by the study, and data-sharing, defined as the transfer of information between healthcare and social care organisations, or care professionals, regarding a patient, and were conducted in the United Kingdom. Purposive sampling was used to obtain a final set of studies which were analysed using framework synthesis. Quality appraisal was conducted using the Wallace checklist. Stakeholder and public and patient involvement groups were consulted throughout the project. Twenty-four studies were included; most scored highly on the quality appraisal checklist. Four main themes were identified. Within Goals, we found five purposes of data-sharing: joint (health and social care) assessment, integrated case management, transitions from hospital to home, for residents of care homes, and for palliative care. In Relationships, building interprofessional relationships, and therefore trust and respect, between professionals supported data-sharing, while the presence of professional prejudices and mistrust hindered it. Interorganisational Processes and procedures, such as a shared vision of care and operationalisation of formal agreements, for example data governance, supported data-sharing. Within Technology and infrastructure, the use of technology as a tool supported data-sharing, as did professionals' awareness of the wider care system. There were also specific factors influencing data-sharing related to its purpose; for example, there was a lack of legal frameworks in the area of palliative care. Data-sharing was usually discussed in the context of wider initiatives, for example integrated care, which meant the information provided was often limited. The COVID-19 pandemic has had significant impacts on ways of working; none of our included studies were conducted during or since the pandemic. Our findings indicate the importance of building interprofessional relationships and ensuring that professionals are able to share data in multiple ways. Exploration of the impact of new technologies and ways of working adopted as a result of the COVID-19 pandemic on data-sharing is needed. Additionally, research should explore patient experience and the prevention of digital exclusion among health and social care professionals. The protocol was registered on PROSPERO CRD42023416621. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135660), as part of a series of evidence syntheses under award NIHR130538, and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.

BackgroundAlthough mental health promotion is a priority mental health action area for all European countries, high level training resources and high quality skills acquisition in mental health promotion are still relatively rare. The aim of the current paper is to present the results of the DG SANCO-funded PROMISE project concerning the development of European guidelines for training social and health care professionals in mental health promotion.MethodsThe PROMISE project brought together a multidisciplinary scientific committee from eight European sites representing a variety of institutions including universities, mental health service providers and public health organisations. The committee used thematic content analysis to filter and analyse European and international policy documents, scientific literature reviews on mental health promotion and existing mental health promotion programmes with regard to identifying quality criteria for training care professionals on this subject. The resulting PROMISE Guidelines quality criteria were then subjected to an iterative feedback procedure with local steering groups and training professionals at all sites with the aim of developing resource kits and evaluation tools for using the PROMISE Guidelines. Scientific committees also collected information from European, national and local stakeholder groups and professional organisations on existing training programmes, policies and projects.ResultsThe process identified ten quality criteria for training care professionals in mental health promotion: embracing the principle of positive mental health; empowering community stakeholders; adopting an interdisciplinary and intersectoral approach; including people with mental health problems; advocating; consulting the knowledge base; adapting interventions to local contexts; identifying and evaluating risks; using the media; evaluating training, implementation processes and outcomes. The iterative feedback process produced resource kits and evaluation checklists linked with each of these quality criteria in all PROMISE languages.ConclusionsThe development of generic guidelines based on key quality criteria for training health and social care professionals in mental health promotion should contribute in a significant way to implementing policy in this important area.

ObjectivesTo examine the experience of infants, children and their parents, the role of ophthalmologists and other health, social care and education professionals in the certification and registration processes and examine...

BackgroundThe transfer of care between different health and social care systems are often associated with poor outcomes and disengagement. Indeed, following the transition from military to civilian life, ex-service personnel...

Visame pasaulyje vykstantis gyventojų senėjimo procesas apima ir Lietuvą. Senatvėje vyksta tam tikri fizniai ir pažintiniai pokyčiai, dauguma vyresnio amžiaus suaugusiųjų turi bent vieną lėtinę ligą. Sveikatos ir socialinės priežiūros paslaugų kokybę lemia tiek organizaciniai, techniniai, finansiniai resursai, tiek itin svarbūs tarpasmeniniai faktoriai. Pagrindinės priežastys, sąlygojančios neigiamą požiūrį į senus asmenis, yra žinių trūkumas apie senėjimo procesus ir menkas išprusimas apie vyresnio amžiaus asmenų kintančius poreikius, bendravimo ypatumus. Pusiau struktūruoto interviu forma buvo parengta, vykdant tarptautinį projektą ELLAN – European Later Life Active Network (Nr. 539547-LLP-1- 2013-1-FI-ERASMUS-ENW). Dalyvaujant Lietuvos, Suomijos, Turkijos, Portugalijos, Austrijos tyrėjams parengta vieninga interviu forma, kuri buvo išversta į nacionalines kalbas. Šiame straipsnyje pristatomi Lietuvoje atlikto tyrimo rezultatai. Interviu apėmė tris pagrindines sritis: a) ryšio ir komunikavimo/ bendravimo aspektai; b)savęs priežiūra kasdieniniame gyvenime; c) sveikatos ir socialinės priežiūros specialistų vizija. Iš viso tyrime dalyvavo 17 asmenų, kurių amžius siekė nuo 65 iki 82 metų (9 moterys ir 8 vyrai). Tyrime dalyvavę pagyvenę ir seni žmonės pokalbyje akcentavo tiek teigiamus, tiek neigiamus specialistų bendravimo bruožus ir pateikė tiek sėkmingo, tiek neefektyvaus bendravimo patirtis. Taikant tematinės analizės principus, pagal tiriamųjų pasakojimus, buvo išskirtos šešios didžiosios temos. Penkios iš didžiųjų temų buvo suskirstytos į mažąsias temas. Teminis laukas apėmė: a) bendravimo barjerų priežastis; b) socialinės nelygybės raišką; c) mokymo ir informavimo trūkumus; d) išorines prielaidas sveikimui; e) vidines prielaidas sveikimui; f) profesijų paveikslo viziją. Tyrime dalyvavę asmenys išsakė, jog specialistų neverbalinėje kalboje jiems svarbūs: akių kontaktas, šypsena, maloni veido išraiška. Neigiama tai, kad pastebėjo tolerancijos ir kantrybės stoką, kuri dažniausiai pasireiškia kalbėjimo tono pakėlimu. Šie pavyzdžiai daugiausia atspindi gydytojų ir slaugytojų neigiamų emocijų raišką bendraujant su pagyvenusiais ir senais žmonėmis. Pasitaikė, kad jų vyresnis amžius menkina galimybes gauti iš gydytojų ir slaugytojų sveikatos priežiūros paslaugas. Palankumo siekimą, atsilyginant dovanomis specialistams, taip pat galima priskirti prie socialinės nelygybės raiškos. Tačiau šie tyrime dalyvausių pacientų samprotavimai iki galo gali būti neobjektyvūs, kadangi visuomenėje vyraujančios nuomonės apie papildomą atsilyginimą medikams rodo nebūtinai patirtį, bet ir požiūrį į šį fenomeną. Išryškėjo respondentų nuomonė, jog mokymo (konsultavimo) veikla nėra tinkamai realizuojama, kadangi trūksta individualaus požiūrio, sveikatos priežiūros specialistai (ypač gydytojai) per dažnai vartoja sunkiai suprantamus terminus, informacijos, susijusios su jų sveikata, yra pateikiama nepakankamai. Visi tyrime dalyvavę vyresnio amžiaus asmenys pažymėjo ir teigiamas bendravimo su sveikatos ir socialinės priežiūros specialistais patirtis bei apibūdino savo viziją - kompetentingai dirbančių, savo darbe besilaikančių humanizmo principų, specialistų. Kaip labai svarbios veiklai savybės pažymėtos - rūpestingumas, atlaidumas, kantrybė, išklausymas, pagarba žmogui, savitvarda.

Information is a key issue for people who use health services and their families and friends. In the UK, this was raised consistently by those involved in a national ‘listening exercise’, in 2005.1 The resulting White Paper Our Health, Our Care Our Say2 reinforced much of the government information strategy published in the previous year.3 The Brain and Spine Foundation is a UK-based charity that aims to improve the quality of life for people with neurological conditions (http://www.brainandspine.org.uk). The organization was awarded a grant by the Department of Health to produce a toolkit to help health and social care professionals providing information to people affected by neurological conditions. The project forms part of the implementation of The National Service Framework (NSF) for Long-term Conditions, published last year.4 The toolkit is being developed in association with the Neurological Alliance (http://www.neural.org.uk) and the Long-term Medical Conditions Alliance (LMCA; http://www.LMCA.org.uk). A series of small discussion groups were held last year throughout England and Wales to explore: (i) current obstacles in the provision of and access to information, (ii) how a toolkit might be used and (iii) to refine the toolkit's content and shape. Discussions were held with groups of people affected by neurological conditions, with voluntary sector organizations concerned with neurological conditions and with mixed groups of health and social care professionals from a variety of settings. In addition, a questionnaire survey of health and social care professionals was conducted. Care for people with neurological conditions in the UK has been very patchy. While there are some world-class centres of expertise, there are also areas of the country where there is little specialist provision.5 Traditionally, for people with neurological conditions, the majority of input has been provided by specialists (e.g. neurologists and rehabilitation consultants). However, because of shortages in these workforces, and the long-term nature of many of the conditions, people have often been left without specialist support. Access to information has become a major issue for these people who may have little contact with health and social care professionals after initial diagnosis of their condition. This is consistently reported both by individuals affected by neurological conditions as well as organizations representing them.5 A key issue explored in developing the toolkit relates to why people do not get the information they want, despite much information apparently being available, and from a proliferation of sources. Two explanations were found. First, information provided by health professionals does not always match with the information sought after by people with neurological, and other long-term conditions. Secondly, people often want very local information, whereas what is generally available is not specific to their geographical location or situation. These issues are explored further below. Another issue that became evident was that health and social care professionals did not always recognize their role in relation to providing information to people with whom they came into contact. There is a need to encourage health-care professionals to view every consultation as an opportunity to assess information needs and ensure that these are met directly or by referral to a dependable alternative source. The toolkit will, therefore, aim to signpost to sources of information on the issues of concern to people with neurological conditions. It was found that there are four key areas consistently identified by people affected by neurological conditions where they want more information. Interestingly, the groups of health and social care professionals consulted also identified these issues as a problem area for information giving. The lack of information related to benefits, employment and finance was an issue raised repeatedly by people with neurological conditions when they discussed information. When asked what information requests they found difficult to address, health professionals also identified information about benefits. This is not a new issue and surveys from the neurological charities have been reporting this for years.6 It is possible that the reason this issue has not been addressed is that health professionals do not see such issues as within their remit. These ‘social care issues’ are often seen as being the province of those working outside health-care settings. There may be a tendency to see people with a diagnosis of a long-term condition as having a continuum of needs; starting with medical needs, and medical information needs, at the diagnostic phase and progressing to ‘social’ needs later on as someone adapts to their illness or disability, and particularly if it progresses/degenerates. However, when people with neurological conditions talk about their information needs, it is clear that some of their first concerns on diagnosis are their employment and financial status –Should I go back to work tomorrow? What should I tell my employer? If I leave work how will I support myself and my family? What support will my partner get if they need to look after me? Should I move house? The health professional is more likely at this time to be focused on providing information about possible treatment options or a drug regime. Concerns about sex and relationship issues were often raised (even in focus groups where people who did not know each other). People had found information on sources of support very hard to access. Health and social care professionals were similarly at a loss to know where to go for such information. There seemed to be a tendency to hope the questions were not asked and very few health-care professionals said that they would ever raise the issue as they would not know how to deal with this or whom to refer to. This is a significant quality of life issue for people affected by many neurological, and other long-term conditions, including cancer. There is a need to address it and ensure that health and social care professionals are signposted to sources of information and advice. Complementary therapies have played a large part in the management of neurological conditions, partly because of the fact that there are often very few surgical or drug treatments available. Many health professionals find it difficult to provide information about treatments that they feel do not have a robust evidence base and that have not been traditionally available in the National Health Service (NHS). While for some conditions this is changing, it is likely that people with a life-long illness for which there is no cure will continue to seek both ‘wonder cures’ and palliative treatments. Using the toolkit health professionals will be able to signpost people to information about various complementary therapies and information about which therapies people with a similar condition have found helpful. This kind of information is often available through local and national voluntary sector organizations. Providing a diagnosis and prognosis is clearly within the domain of health-care professionals, yet all agree it is a difficult area to address. People affected by neurological conditions often report that they do not get adequate information about what to expect. Again this possibly stems from the fact that there was, and still is for many, very little that can be offered in the way of treatment and cure. Neurological conditions can also be very unpredictable. If health-care professionals view their domain as providing information about treatment options and medicines there may well be limited information they can give. There are, however, as outlined above, a range of other information needs that people with neurological conditions have at diagnosis. If these needs are addressed it is likely both that people would feel more able to manage their condition and also report that their information needs had been met. The information people often valued the most, and which they found hard to access, was about local services and sources of support. For example, people talked about finding someone who could help them fill in their benefit form, the local rehabilitation service that accepted self-referrals, the MS support group that met two streets away, yet had taken 18 months to discover. Addressing local information presents a challenge for a toolkit that has been designed for health and social care professionals across England and which will necessarily be focused at a countrywide level. As noted above, however, this is a crucial finding of the work conducted with people affected by neurological conditions. Those working on the Better Information3 strategy also identified the need for local information and the Department of Health has recently announced their intention to pilot a local integrated approach to information in order that local health and social care organizations jointly maintain an accessible database of all services and support groups in their local area.2 The project will provide a template for local information in the toolkit outlining what information should be available, based on issues that people affected by neurological conditions have raised as information needs, and indicating possible local sources of information and support locally. The ground work will necessarily be conducted at a local level, but it is hoped by providing a template and sources list we will avert excessive duplication of effort, whilst ensuring that the content of local directories and databases are focused on the needs of people affected by neurological conditions. In addition, it will be very important to ensure local voluntary organizations supporting and representing people with neurological conditions are involved in commissioning local information databases. This will be essential; to ensure firstly that the resource is focused on local needs; secondly, that the very valuable services and support provided by voluntary sector groups are included and thirdly, because of the local knowledge they have about sources of health and social care support in its widest sense. Often, during the discussions with people affected by neurological conditions, they talked about eventually tracking down the information, or service or person, through contact with a local support group or voluntary organization. For example, if you wanted to know who could help you fill out a benefit form, how to get a wheelchair, where to get hydrotherapy, who to talk to about a relationship problem the local branch of the Parkinson's Disease Society or MS Society would be a very good starting point. At national level, voluntary sector organizations produce the information often reported to be the most useful by people affected by neurological conditions. Most include in their information portfolios fact sheets and booklets about the issues raised above (complementary therapies, sex and relationships, prognosis, benefits) and about many other aspects of living with a neurological condition. There is reluctance, however, amongst health and social care professionals to provide information about these organizations to people affected by neurological conditions. A survey by the Motor Neurone Disease Association7 in 2002 found that 44% of people diagnosed with motor neurone disease that year had not been told of the Association or given contact details. In the discussions to develop the toolkit people often reported stumbling on a local or national voluntary organization ‘by accident’. The toolkit will need to make it easier for health professionals to signpost to these sources of information and support. Health professionals may feel better assured about directing people to voluntary sector sources of information if they could guarantee the quality. The Department of Health have also recently announced the intention to develop an Information Accreditation Scheme (IAS).3 It will be very important that voluntary sector providers of information are enabled to participate in this scheme in order that they can continue to disseminate the information that people affected by neurological, and other long-term conditions find so useful. A pilot version of the toolkit is currently being produced. This will be a signposting tool with generic checklists and templates. It is anticipated there will be a launch towards the end of 2006. Nikki Joule is an independent health policy consultant and Project Officer at the Brain and Spine Foundation (http://www.brainandspine.org.uk). She is also on the Steering Group of the Patient Information Forum (http://www.pifonline.org.uk).

This study aimed to identify the factors that have the greatest influence on UK social care and health sector professionals’ certainty that an older person is being financially abused, their likelihood of intervention, and the type of action most likely to be taken. A factorial survey approach, applying a fractional factorial design, was used. Health and social care professionals (n = 152) viewed a single sample of 50 elder financial abuse case vignettes; the vignettes contained seven pieces of information (factors). Following multiple regression analysis, incremental F tests were used to compare the impact of each factor on judgements. Factors that had a significant influence on judgements of certainty that financial abuse was occurring included the older person’s mental capacity and the nature of the financial problem suspected. Mental capacity accounted for more than twice the variance in likelihood of action than the type of financial problem. Participants from social care were more likely to act and chose more actions compared to health sector participants. The results are discussed in relation to a bystander intervention model. The impact of the older person’s mental capacity on decision-making suggests the need for training to ensure action is also taken in cases where older people have full mental capacity and are being abused. Training also needs to highlight the more subtle types of financial abuse, the types that appear not to lead to certainty or action.

Background: Health and social care professionals’ ability to address the needs of patients and their relatives at end of life is likely to have been impacted by the COVID-19 pandemic. Aim: To explore health and social care professionals’ experiences of providing end of life care during the COVID-19 pandemic to help inform current/future clinical practice and policy. Design: A qualitative interview study. Data were analysed using thematic analysis. Setting/participants: Sixteen health and social care professionals working across a range of clinical settings in supporting dying patients during the first wave (March–June 2020) of the COVID-19 pandemic in the United Kingdom. Results: Participants reported emotional and practical challenges to providing end of life care during the pandemic, including increases in patient numbers, reduced staffing levels and relying on virtual platforms for sensitive, emotive conversations with relatives. Participants were central to promoting connections between patients and their families at end of life and creating opportunities for a final contact before the death. However, the provision of support varied as a consequence of the pressures of the pandemic. Results are discussed under two themes: (1) challenges and facilitators to providing end of life care, and (2) support needs of relatives when a family member was dying during the COVID-19 pandemic. Conclusion: There is a need for flexible visiting arrangements at end of life during a pandemic. A systems-level approach is necessary to promote the wellbeing of health and social care professionals providing end of life care during and after a pandemic.

This paper offers an empirically informed ethical analysis of the recent history of health and social care regulation in the UK focused especially on the contributions made by the Professional Standards Authority for Health and Social Care. The paper is largely organised around two broad questions: First, in what respects can regulation support, mobilise and model professionalism and professional identity? Second, nested within this, given that regulation can support the professional identities of diverse practitioners can it, at the same time, help enable coordination across, and integration of, health and social care activities? These concerns, we suggest, highlight the value of viewing professional regulation in the context of the broader collaborative zeitgeist in health and care and as shaping the ethical landscape for professionals. We thereby make a case for the value of attending to the ethical orientation of professional regulation.

Survivors of abuse in care settings have had to fight over many years for their rights for justice. They experienced physical, emotional, and sexual abuse at the hands of individuals, and abuse and neglect because of failures in care systems. At times, some social work and care professionals abused children in their care. Others were complicit in failing to address such abuse. However, social work and social care professionals have also been central in supporting survivors of abuse in care, in bringing offenders to account, and enabling justice processes. The activism and demands of survivors have led to social and governmental responses in a number of countries, including public inquiries, apologies, reparation and redress schemes, and commemorative activity. However, these responses have often been ad hoc and contested. This article will detail the furtherance of justice for survivors of childhood abuse in care in Scotland through the development of a human rights-based model. It will examine the challenges to these developments, particularly in terms of accountability and financial redress. This will be compared to interventions in other countries, including different parts of the UK. Developments in theory and the implications for social work and social care professionals will be highlighted.

Introduction: The necessity of intersectoral information exchange is well-establish, because the complexity in health-related issues are increasing world-wide, and solving complex problems is beyond the capacity of single sector or specialty. The exchange of written information is the most commonly used communication strategy to share information across specialties and care services. Problem: Written information exchange calls for caution, as texts can be read and interpreted differently across locations. Further, particular discourses shape a shared consciousness about a person, and it is known that stigmatising language may negatively influence professionals’ attitudes on a client/patient. Despite the importance and extend of intersectorally shared written information, little attention has been given to the writing practises that happens across sectors. More knowledge is therefore needed order to support intersectoral care. Context: Intersectoral care provision is a cornerstone in the Danish care systems,which is why the Danish system is a good case for exploring practises of written intersectoral information exchange. Aim: In this qualitative study, we identified textual and discursive practises of two forms used for the purpose of exchange information between social care and health care professionals (GPs) in pathways of clients from a job centre in a large city in Denmark in 2023. The research was aimed at professionals who participate in these practises. Involvement: The study design was decided in collaboration with researchers, healthcare professionals and social care professional. Social care decided the method of data collection, and they assisted and supported the concrete data collection. Further, the social workers acted as gatekeepers to the clients’/patients’ enrolment. Clients/patients collected themselves the part of their personal health journal that would be included as data. Methods: Data were collected from seven clients/patients unemployed ethnic minorities with complex problems. A critical text analysis was conducted to identify the linguistic elements. The textual practise was analysed in the frame of institutional ethnography using Dorothy E. Smith’s “text-reader-conversation” methodology. We analysed each forms separately, and then analysed the forms in pairs related to each of the seven pathway. Preliminary results: Our on-going analyses have revealed writing practices, which per see aimed at sharing intersectoral knowledge in complex cases. However, these practices followed an institutionalised course of action, and, at best, they functioned as written administrative processes to support a course of action, which have already been decided at a macro-level. Lessons learned: This study outlined that intersectoral information exchange is not equivalent to increased coordination in care. In fact, the findings in this study indicates that some written information exchange, as the forms scrutinised in this study, are so standardised that they become more a piece of one sector’s mandatory work rather than support intersectoral pathways. This is important knowledge to the international audience, because it can increase the attention towards better writing practices and better use of shared information. Next step: This study is a part of a PhD project, which aims at developing a prototype tool to assess the risk of complexity in intersectoral pathways for vulnerable persons. Thus, the modeling continues.