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Chapter 51 Making Good Decisions

This chapter examines our understanding of what is involved in making good decisions. It works logically through the issues and process, exploring how good decisions are made.

We begin by stating that a good decision is well made when it meets a number of requirements: it is based on accurate information; carefully thought through; with all appropriate people included in the consultations. Also, a good decision has good outcomes, in that it achieves the decisionmaker's goals: the service user is fully involved; all stakeholders have been fully consulted; it is based on accurate, full information; it has been given sufficient consideration; it can be explained coherently and credibly; it can be implemented; it has a good outcome.

The discussion of this logical sequence in the chapter is illustrated by an example which is worked through to show how these abstract statements apply in practice.

Part VIII Illustrating Practice in Different Settings

We have reached the stage of this book when we can test our grasp of the range, depth and complexities of everything covered in previous Parts. In the first two chapters of this Part, 52 and 53, we focus on working through some of the main practice aspects of everyday health and social care cases. Chapter 52 deals with practice with children and young people and Chapter 53 deals with adults. The Resource File before chapter 53 covers how to deal with a complaint. The final Chapter in this Part, 54, deals with residential and day care as central features of the services, which require quality improvement.

Chapter 52 Health and Social Care with Children

This chapter deals with the actual practice of carrying out health and social care work with children, young people. As you encounter the examples in the chapter, you will find the questions which need to be asked, during the process of assessing; planning; implementation and review/ evaluation. All this has to be carried out according to laws, policies and procedures.

At the same time, you have to work with parents other family members. In the process, where appropriate, you will need to carry out carer assessments and planning.

Chapter 53 Health and Social Care with Adults

This chapter works through practice with adults who receive health and social care services and also includes working with carers. At the outset it is necessary to confirm that the practice conforms to laws, policies and procedures. Then, the work follows the sequence of assessment, planning, implementation and review/evaluation. There may be tensions and dilemmas of practice. In this case, there is the chance that there will be a complaint made by the service user, in which case the practitioner will need to know how to deal with this.

Chapter 54 Residential and Day Care

This chapter focuses on setting a context for residential and day services and specifying what constitutes good residential and day services. It is designed to be read in conjunction with the Resource File which follows, with a view to encouraging us to examine these services analytically and critically.

Some aspects of residential care and day care have been neglected by researchers. At the same time standards in both areas have been criticised as inadequate, including in inquiry reports. Traditionally, services, especially in the day sector, have been criticised as unimaginative and uninspiring. Residential care has been criticised as too institutional and disempowering.

Carers' and service users' contributions to these criticisms have been increasingly heard since the 1990s. This is the point at which to focus on what constitutes good quality residential provision. We should note that residential care is built around the ideas of group care and group living in which, over the last quarter of the twentieth century, the literature emphasised the prime importance of cultivating good relationships between staff and residents. Another relevant and linked idea is that of enabling residents to live independently, to the full.

The quality of residential care depends on promoting values and principles underlying practice which respect residents and safeguard their rights. If we are seeking information about the quality of residential care, we need to check out four particular aspects: 1 structure of the establishment, 2 physical layout, 3 signs of the quality of interaction between staff and residents, 4 evidence of the regime. There are various aspects of the regime, but a good deal can be judged from how flexible it is, in terms of meeting the needs of individuals.

Day services have been traditionally weak in three main aspects: 1 their lack of flexibility. It could be said that day services in many areas have been synonymous with day care in a day centre with an extremely rigid routine; 2 their lack of evening provision; 3 their tendency to 'warehouse' attenders, along with a lack of choice and empowerment in the programme.

There is a need to rethink day services. Five particular points could be used as a starter for building better provision: 1 starting from people's needs and constructing more flexible provision around meeting them; 2 providing more than companionship, in the form of programmes which are genuinely likely to rehabilitate people and offer new experiences and challenges; 3 promoting independence and inclusion; 4 being inclusive in the sense of promoting an atmosphere of cultural and ethnic sensitivity; 5 providing services which have the potential for integrating people into the wider community.

Part IX Continuing Professional Development

This final Part of the book includes one chapter and a following Resource File, which between them deal with the issues and information necessary to moving on to continuing professional development.

Chapter 55 Moving On

This chapter deals with continuing professional development. It begins by reviewing learning to date, explores how to make a record of personal and professional development, assess what work and study to undertake next and discusses how to move forward. The key questions this chapter uses are: Where am I now? Where do I want to go from here? How can I get there?

The review and evaluation of learning to date involves individual and group review and evaluation. There is a need for an individual 'exit' tutorial on most courses. There will probably be some kind of student and staff formal end of course event. At the same time, it will be helpful to record strengths and weaknesses of the course and how much has been gained.

There is also the question of what to do next, in terms of work and study. A Force Field analysis is proposed to help this. This focuses on four questions:

What is the goal?

What forces could prevent me from achieving the goal?

What forces could combat these?

What other resources could I draw on?