The demands upon the social care workforce in the UK are only likely to increase over the next decades. The social care sector is heavily reliant on NVQs and this is regulated through the Care Standards Act (2000). It is thus important that these qualifications appropriately support staff development. The purpose of the research was to explore this in one social care organisation (Homecare) through researching staff perspectives on factors that inhibited or supported learning through NVQs and to examine the Homecare/Centre delivery of NVQs and workplace learning with this in mind. The research is broadly qualitative in design and draws on the principles of narrative research combined with analysis focused on key themes (interpersonal, personal and organisational factors). The research found that an understanding of the key concepts of workplace learning is relevant to the delivery of NVQs and can help these qualifications be implemented successfully as a part of a more holistic approach to teaching, learning and the assessment of competence in the workplace. The research identified that the organisation had a particular approach that strategically integrated assessment both at organisational and practice level. Additionally the research identified areas within the NVQ process, where integrated assessment proved of benefit to practice through professional level development of skills and knowledge, values and reflective learning and confidence. From this eight key elements of an enhanced model of NVQ delivery were identified that constitute the contribution to practice. The contribution to theory lies in linking the literatures of NVQs, competence and workplace learning and the suggestion that previous understanding of NVQs as behaviourist and atomistic is not as important as the approach to assessment adopted by organisations. The research has relevance to any social care organisation but also to wider audiences where NVQs are used as it adds to understanding of workplace learning through a depth of practitioner-researcher understanding of specific qualifications in a specific context.

Institutional Ethnography (IE) is a method of inquiry into the social organisation of knowledge. It begins with a disjuncture/troubling experience impacting a specific group of workers and adopts their standpoint/subject positon to look out into the wider institution and trace the work and textual practices that organised (and produced) the disjuncture under investigation. The study took the standpoint of Senior Social Care Workers (SSCWs) from one RCH in Scotland to uncover the complex social organisation of “abandonment” SSCWs described when there was insufficient support from NHS services to care appropriately for sick and dying residents. The focal point of inquiry was on SSCWs descriptions of being “pushed” into “difficult” decision-making conversions with family members about “serious illness” andthe Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) – without the support of doctors (or nurses).To inquire into how SSCWs work had become tied into the medical, legal and bureaucratic practices that rule death, dying and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision making in Scotland's RCHs the study drew on ten open-ended interviews (SSCWs, n= 4 and others whose work influenced SSCWs working practices, n= 6). Interview transcripts were examined to uncover SSCWs accounts of their knowledgeable work related to managing illness, death and dying - along with the characteristic tensions,frustrations and contradictions embedded in those accounts. The study traced how doctors and nurses were routinely, and systematically, absent from RCHs - leaving residents systematically excluded from the level of care that they needed. It also traced how SSCWs work with “serious illness” and “difficult” conversations was co-ordinated in disquieting ways in an apparent commitment to high quality “palliative care”.What was discussed between SSCWs and family members during conversations about “serious illness” and the DNACPR form was out of step with the DNACPR policy, the rhetoric of palliative care, and the actual needs of SSCWS, family members, and residents for medical support. However, the study shows that what happened in the RCH was not simply an error of practice. This is becauseit was textually planned, organised, and co-ordinated across healthcare institutions, professional groups, the regulatory body acting on behalf of the Scottish Government and the management and care staff of the RCH itself. SSCWs - and others – were organised to take up the powerful ruling discourse of palliative care in ways which treated residents and family members withincreasing objectivity, where institutional needs to reduce NHS spending and to protect the income generating potential of the care home as a business ruled over individual needs. In taking up and enacting the powerful ruling discourse of palliative care, SSCWs – and others- (intentionally but unknowingly) took up the very tools of oppression that dominated and overpowered their own and others lives. The knowledge generated by this research can be used to show SSCWs and others how they unknowingly participate in taking up actions that are not in their own or others interests. This is the basis of changing the conditions of SSCWs and others lives thereby advancing anti-oppressive work.

The dissertation paper focuses on problems related to social services and mapping of changes that have taken place since the most recent update of the Act on Social Services (the Welfare Code). The theoretical part of the paper concentrates on the Act on Social Services whose enactment has brought many significant changes into the welfare system that impact above all on the providers and users of social services. The practical part of the paper describes the opinions that selected registered providers of social services have about the legislative update.

Introduction - Health and social care sector activities in the United Kingdom have a considerable carbon footprint which impacts on the natural environment. Waste management is one area of focus for the reduction of this environmental impact. Previous research has studied the quantities and compositions of healthcare waste highlighting the potential for recycling. Limited research to date has investigated both health and social care waste management in a holistic study incorporating the behaviour, composition and systems. The current study aimed to investigate waste management behaviour, systems and compositions at four health and social care sites in the South West of England, then derive a framework of health and social care waste management behaviour incorporating points of intervention for the improvement of waste management practices. Methods - A mixed methods multi-strategy concurrent triangulation design was used to investigate the waste management at four health and social care sites in the South West of England. This consisted of a management interview sub-study investigating waste management policy, guidance and training. An observational sub-study was used to investigate health and social care employee waste management behaviour. An audit of the clinical and domestic waste streams provided an overview of the waste composition at each site. Finally a self-report questionnaire sub-study of decision making was conducted to investigate the conscious and habitual aspects of waste management decision making. The findings from these four sub-studies were then synthesised through a data triangulation process. Findings - The domestic waste bins were most commonly used to dispose of waste during the observational sub-study. The waste audit sub-study found the domestic waste stream contained the largest percentage of potentially recyclable waste. The observational sub-study also uncovered twenty unique primary themes influencing the employee waste management behaviour. These themes included aspects internal to the health and social employee such as confusion, and external themes such as equipment. The management interviews highlighted a lack of waste management training and a reliance on the local site waste management policies to guide and monitor employee waste management behaviour. Discussion - The health and social care waste management behaviour improvement framework (HWMBIF) is presented. The HWMBIF is a novel framework, derived from the triangulated data of the current study, for understanding and improving waste management behaviour at the participating sites. Several interventions based in the HWMBIF and on the study findings are presented. Future research will focus on testing and refining the HWMBIF, the suggested interventions and developing further interventions.

This paper deals with the issue of refugees who had to leave boarder regions of Czechoslovakia in 1938 after Germans occupied them as a result of the Munich Conference. It analyzes their numbers, motivations, professions etc. and then focuses on the management of refugee care. It tries to characterize the basic attributes of the care and especially concentrates on their feeding, clothing, employment, emigration and medical service. From September 1938 to March 1939 almost 200 thousand refugees escaped to reduced Czechoslovakia (so called "Second Republic") which caused serious problems. There was confusion in the country but authorities in cooperation with NGOs and private companies managed to provide refugees with basic accommodation, clothing and feeding. However, their employment and permanent settlement remained, due to the economic problems of the state and winter season, which made seasonal works impossible, unsolved till German occupation in March 1939.

Yes / In England, care homes for older people have been subject to four different regulatory bodies within the last six years (see Table 1). The government has announced further change with the creation of a new regulator of adult health and social care in 2009 (CSCI, 2007). The current regulatory body, the Commission for Social Care Inspection (CSCI) will merge with the Healthcare Commission and the Mental Health Act Commission to create the Care Quality Commission. The Department of Health (DOH) is currently reviewing the future regulation of health and adult social care in England (DOH, 2005; DOH, 2006a) and the way that CSCI carries out the regulation and inspection of a range of social care agencies including care homes for older people. Substantial reforms of the regulatory system of regulation and inspection were embodied in the Care Standards Act (CSA) 2000 that was part of the wider Government agenda to modernize health and social care services. The Act established new regulatory bodies for care services and workers and along with the regulations and mandatory National Minimum Standards (NMS) created a framework to ensure greater consistency of quality and to better protect vulnerable children and adults (Engelman and Spencer, 2003). The impact of these changes for both inspectors and providers of care services has been significant. Regulators have had to adjust and adopt new ways of working whilst carrying out their statutory responsibilities. Care providers have had to respond to the revised changes in standards and requirements of registration. This article examines inspection as a mechanism for improving the quality of care standards. It reports on a study conducted in 2004 that sought the views of managers of care homes for older people about the NMS and the inspection process at that time. The role of inspectors will be considered in light of the findings and published literature.

No / to measure general practitioners' knowledge of, confidence with and attitudes to the diagnosis and management of dementia in primary care. Setting: 20 general practices of varying size and prior research experience in Central Scotland, and 16 similarly varied practices in north London. Participants: 127 general practitioners who had volunteered to join a randomised controlled trial of educational interventions about dementia diagnosis and management. Methods: self-completion questionnaires covering knowledge, confidence and attitudes were retrieved from practitioners prior to the educational interventions. Results: general practitioners' knowledge of dementia diagnosis and management is good, but poor awareness of its epidemiology leads to an over-estimate of caseload. Knowledge of local diagnostic and support services is less good, and one third of general practitioners expressed limited confidence in their diagnostic skills, whilst two-thirds lacked confidence in management of behaviour and other problems in dementia. The main difficulties identified by general practitioners were talking with patients about the diagnosis, responding to behaviour problems and coordinating support services. General practitioners perceived lack of time and lack of social services support as the major obstacles to good quality care more often than they identified their own unfamiliarity with current management or with local resources. Attitudes to the disclosure of the diagnosis, and to the potential for improving the quality of life of patients and carers varied, but a third of general practitioners believed that dementia care is within a specialist's domain, not that of general practice. More experienced and male general practitioners were more pessimistic about dementia care, as were general practitioners with lower knowledge about dementia. Those reporting greater difficulty with dementia diagnosis and management and those with lower knowledge scores were also less likely to express attitudes endorsing open communication with patient and carer. Conclusion: educational support for general practitioners should concentrate on epidemiological knowledge, disclosure of the diagnosis and management of behaviour problems in dementia. The availability and profile of support services, particularly social care, need to be enhanced, if earlier diagnosis is to be pursued as a policy objective in primary care.

In recent years there has been a resurgence of interest in the use of arts, humanities and media-based approaches to teaching students in medicine, health, and social care-related disciplines. Here, it is widely assumed that 'the arts' are an undifferentiated force for good which will humanise curricula dominated by medical and scientific perspectives. Such approaches tend, however, to be implemented in something of a theoretical vacuum with little consideration of critical perspectives derived from cultural studies. 'Cinemeducation' is a term recently coined for the use of mainstream films which touch on particular medical conditions or 'disorders' in the education of medical students (Alexander et al, eds 2005). What is overlooked by advocates of this approach is that such films often perpetuate stereotypical views of the nature and causes of physical and emotional ill-being, and collude in their medicalisation. Scriptwriters and directors may also give in to the temptation to sensationalise or misrepresent conditions because this makes for box office success. Finally, there are subtleties related to denotation and connotation in film which mean that little can straightforwardly be assumed about educational outcomes. This presentation will draw on a study of both independent and mainstream films related to memory loss and cognitive impairment in the context of my own teaching in dementia studies, and will include clips from source material. Drawing on Ricoeur's concept of the hermeneutics of suspicion I seek to introduce a note of caution to the current 'arts and health' agenda.

Yes / Ex Memoria is a short film - just 15 minutes long - which focuses on the experience of Eva, a woman with dementia living in a nursing home. The film - which is the result of a collaboration between Bradford Dementia Group (BDG), writer/director Josh Appignanesi, and producer Mia Bays - attempts to show how life might be experienced from Eva's point of view, in her 'version of reality'. In this article I will outline the to the making of Ex Memoria, explain how the film is being used on the Dementia Studies courses provided by BDG, and - without giving away too much of the story for people who haven't yet seen the film - summarise some of the responses to it.

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