Supporting the area between formal and informal care - Improving employability in social care in the EU

James Churchill EASPD, U.K.

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Improving informal care by health professionals

Informal care is an important issue in many European countries because health care systems tend to become too expensive and because there is a strong need to rethink the benefits of the welfare state. We all know that the European health agenda is more and more influenced by the social agenda: health and well-being have to be considered as two sides of the same medal. Everybody, including people with a disability or a chronic disease, must be considered as citizens that are able to participate in society at their own level of knowledge and skills. In all segments of society we can observe a growing awareness that individuals are able or must be enabled to care for themselves and for their family members, neighbors and friends, thanks to the policy that people should only make use of facilities of health and social care when inevitable.

Several years ago the notions of citizenship and social inclusion are anchored in Dutch legislation. But the transition of a welfare state to a state of “responsible citizenship” is difficult because of several constraints which are met during the transition process. The implementation of the Wmo, the Dutch Law for Social Support, made it possible that all kinds of initiatives in the field of informal care are supported, either with professional aid or with financial budgets, but the initiatives are poorly coordinated and in many places of the Dutch organizations for informal care people are inventing the same wheel. Informal care givers continue to suffer from a sense of overload and are poorly informed about the facilities the local government has established especially for their support. Besides, the Dutch government suffers from the economic crisis. Unpopular measures have to be taken, such as savings on facilities for people with mental disabilities that will have negative effects on their informal care givers. The savings needed to be made also affect the formal care in nursing homes. Because of these developments the nursing homes become more and more dependent on informal care, but do not possess the tools to organize this in a satisfying way for clients, and for formal and informal care givers. Occupational Therapy students of the Amsterdam School of Health Professions recently studied the conditions for good policy on informal care in nursing homes and the role of health professionals in the way the policy is carried out The results of this study will be presented in the workshop.

The aim of this workshop is

• - to present a brief overview of the developments in informal care in the Netherlands
• - to present outcomes of interesting research in this field
• - to present the results of a study on the policy on informal care within nursing homes in the southeast part of Amsterdam
• - to exchange experiences with colleagues from different European countries
• - to discuss the relevance of the implementation of specific competences on informal care support by health professionals in
• the curricula of higher health education

Ruth Zinkstok Hogeschool van Amsterdam, The Netherlands

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Every artist was first an amateur*: The profession of caring redefined

The health care workforce is changing. In countries like the UK over the past thirty years, there has been greater use of support staff who are not necessarily professionally qualified but who undertake care responsibilities that are delegated to them.

While formal health care has always coexisted with – indeed, worked in close harmony with – a voluntary sector, the role played by the latter (be they charity providers or personal carers) looks set to grow. In many countries in the world, of course, the voluntary provision outstrips that which is provided by government. Partly, this change is recognition that care is not the exclusive preserve of the professions.

However, there is also the fact that the fiscal crisis of the state is impacting on what can be offered out of the public purse. In the UK, the Conservation-Liberal Democrat coalition government, in office since May 2010, speaks of encouraging the development of a self-supporting and volunteer-led “Big Society.” In his closing keynote speech, Mark Cole will take a view of what these changes means for the health care professions at large with particular emphasis on the preparatory education and continuing professional development (CPD) that such occupational groups provide.

Engaging with his audience and offering a range of provocative opinions designed to send the conference away with as much food for thought as possible, he will outline what he feels the role of those professions should become in light of this changing landscape; in particular, he will look at the contributions that they can – and should – be making in regard to three key themes, namely, knowledge, professionalism and innovation.

* Ralph Waldo Emerson

Mark Cole Camden & Islington NHS Foundation Trust, U.K.

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A buddy near the crib

A previous research from the Artevelde University College Ghent revealed that the majority of deprived pregnant women have difficulties with finding access to pre-, peri- and postnatal care within the Flemish context. As proven in literature, this high barrier leads to a poorer pregnancy outcome. A lack of a participative relationship seemed to be at the core of this problem. A new paradigm in healthcare is necessary.

The key to breaking down the barriers to antenatal care and to augment the self-efficacy of these women is to create an alternative assistance.

The project "a buddy near the crib: perinatal coaching for underprivileged families", applies a system of coaching for the first time. Students Bachelor in Midwifery take the role of ‘buddy’ to an underprivileged family during pregnancy, birth and early childhood. The project aim responds both to the needs of pregnant families and to the students involved.

Disadvantaged pregnant women have benefit from basic support and have the opportunity to participate in the organization of care. Secondly, midwifery students on their part should develop specific competencies to work with disadvantaged people. They must be trained in applying different thinking patterns specific for the poor.

In the project, fifteen midwifery students, matched to a family through contact at the prenatal consultation, guide a family during a period of eighteen months. Through weekly contact they offer basic support, empowerment and lead the family to health and social care. They discuss issues such as prenatal attachment and birth premium. They accompany the mother when necessary, to health and social care workers. They also go shopping with the mother and even cook together in order to share alternative ways of dealing with daily life and work.

A member of the professional team performs an intake interview in order to match the family’s expectancy with the reality of the buddy’s possibilities and limits. A standardized closing interview evaluating the family’s appreciation and progress towards health care is planned.

The team members, a midwife, a social worker and a health researcher, supports the students through a peer review every two weeks. The students and professionals communicate on a digital platform and report about each contact using a standardized form. The data are analyzed using quantitative research methods.. Furthermore, issues discussed during the meetings with peers and practical information discovered by the students ‘on the way’ are collected in a mindmap. This mindmap was intended to create a blueprint for buddy’s with frequently asked questions and the answers. This expertise can be consulted by the buddies at anytime. Also the emotional impact of being a buddy needed special attention from the professional supervisors. Sharing their experiences help the buddies to deal with difficulties such as priority issues, drop-out and frustration about unchangeable situations.

To conclude, this project resulted in a ‘buddy model’. The model should lead to a large deployment for various professional and charity organizations as well as student groups. The students, specifically trained in the care of disadvantaged people, will convey their skills and act as multipliers in the field to those organizations.

The intergenerational transfer of child poverty is thus interrupted at the beginning of life, often a decisive turning point.

An De Craecker Jana Vanden Broeck Artevelde University College Ghent, Belgium

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Future challenges to the provision of health care in the 21st century

This presentation will attempt to outline the future broader and far reaching trends and challenges that face the provision of European health care in the 21^st centurys.

Reference will be made to contemporary debates in the political science, economics and public policy literature. The paper will therefore attempt provide a birds-eye view of the political, social, scientific and ethical factors need to be taken into consideration if the infrastructure of health care provision is going to be "fit for purpose" in the next 20 to 50 years. It will analyse the future demographic trends in relation to health care, both in terms of the portfolio of skills and human resources required by the medical and paramedical professions, as well as the ramifications of an ageing population.

The presentation will also assess the implications of the reconfiguration of the health sector throughout Europe, particularly in relation to the retrenchment of public sector provision, and the growth of a multiplicity of health care providers, including those from the voluntary and private sectors. A further important issue that warrants consideration is the widely expectations of the recipients of health care, who are increasingly being seen as "consumers", who are endowed with the inherent rights to make informed choices regarding the treatment they receive, and by whom. This is exasperated by the exponential advancement in medical science, and what is scientifically and humanly possible to achieve. In addition, it will be important to recognise the growing disparities and inequalities in accessing health care by different groups within societies, disaggregated by socio-economic status, geographical location, age and disability. This latter point will draw heavily on the Social Determinants of Health literature.

Raymond Lang University College London, U.K.

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Providing palliative care - A delicate balance between formal and informal care

Palliative care is an approach that attempts to improve the quality of life of patients with a progressive, life threatening illness and their family. It is a total care that focuses not only on the physical, but also the emotional, social and spiritual dimension of a person. Palliative care in Belgium has moved beyond its pioneering years and the literature emphasizes the importance of professionalization: practice should be evidence based instead of based on authority or limited interpersonal consensus, clinical care pathways are being developed for palliative patients, expertise is formulated in terms of competency profiles, palliative care is evaluated using objective criteria etc. On the other hand, however, there is the demographic fact that the population all over Europe is ageing: More and more people will need care while it is already obvious that society can’t afford mere professional help for all these people. Consequently, informal care provided by non-professionals such as volunteers will become more and more important in the future. Non-professional care providers already play an important role in the different palliative care settings.

This raises some interesting questions that are relevant, not only for palliative care, but for health care in general: Are informal care providers necessary only for economic-financial reasons are do they have an added value compared to the care provided by health care professionals? What are important criteria in the selection of volunteers? What are central points of interest for an organization that relies on both volunteers and professionals? What is needed for a fruitful cooperation between these two types of care providers and what are the pitfalls? This speech will illustrate how these issues have been tackled within our Palliative Care Network.

There are also some educational implications worthy of debate: What role can universities and other institutes for higher education play in this? What are the skills and attitudes a professional needs in order to be able to work with volunteers both in patient care and interdisciplinary meetings? Do the present health care curricula take into account these challenges or are there important flaws?

Alexander Verstaen Palliatieve Zorg Noord West Vlaanderen, Belgium

Alexander Verstaen is a doctor of psychology, psychotherapist and director of the Palliative Care Network North-West-Flanders (Belgium). He is a Board Member and lecturer of the School for Comparative Philosophy in Antwerp (Belgium) and teaches as a visiting professor in several psychotherapy training programs. Recently, he founded “Perennis”, a centre for spiritual care, development and therapy. The first initiative of this centre is the 2-year training program “spiritual care for patients with a life threatening illness” which started in september 2010.

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