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Prioritising happiness and kindness influences how we approach everything - including our personal lives, families, communities, schools and workplaces. It also shapes our views on public policy and helps us to consider the wellbeing of future generations too.
We have no religious, political or commercial affiliations and welcome people of all faiths (or none) and all parts of society. Our members make a simple pledge: to create more happiness and less unhappiness in the world.

Our patron is The Dalai Lama.

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Action for Happiness is a charity that promotes a happier and more caring society. We promote how to be happy, kindness, connection & wellbeing

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Radiohead - In Rainbows [Special Edition] Disc 2

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RevivR is a short, self-directed CPR training from British Heart Foundation, that could teach you how to save someone's life.

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In a bid to shift adult social care from analogue to digital as part of the Plan for Change, the Health and Social Care Secretary Wes Streeting has announced a new qualification that will equip care leaders with the skills to use and rapidly deploy technology across care homes and other settings.

The training will focus on tools which have been shown to improve the quality of care and reduce pressure on staff. This includes:

motion sensors that can detect and alert staff when a patient has had a fall

video telecare to allow remote appointments with doctors and carers to reduce the need to travel

artificial intelligence (AI) which can automate routine tasks like note taking or predict when a patient might need additional care

Care technologies like these will help people to receive the best possible care in the community and prevent avoidable trips to the hospital, reducing pressure on the NHS. It supports the government's 10 Year Health Plan to make health and social care fit for the future.

Health and Social Care Secretary, Wes Streeting, said:

We will harness the full potential of cutting-edge technology to transform social care, helping people to live independently in their own homes and improving the quality of care.

By investing in skills training for care workers, introducing a Fair Pay Agreement, and providing more opportunities for career progression, we will help retain the incredible professionals we need.

Our Plan for Change will make sure we have the people and the skills needed to build a national care service.

Speaking at Unison's 2025 National Health Care Conference, the Health and Social Care Secretary also outlined a series of wider measures to boost the recruitment and retention of care staff. The plans will professionalise the adult social care workforce and help staff progress in their careers, leading to better pay and recognition.

This includes:

setting up new job roles - like deputy managers, registered managers, personal assistants and a new enhanced care worker role - in recognition of increasingly complex care requirements. It will mean their skills will be recognised across the health service, so that GPs, doctors and other health professionals understand their expertise

£12 million to fund courses and qualifications for carers to develop new skills, build expertise and advance in their careers

The boost for social care careers will support the 1.59 million strong workforce which provides vital care and support to people of all ages and with diverse, complex needs, and is in recognition of the vital work they do.

The measures come as unpaid carers see the biggest rise in their earnings limit since the 1970s this month, and the first ever Fair Pay Agreement for the sector continues to progress through Parliament.

Baroness Louise Casey will soon begin her independent commission into adult social care which will look at how we recruit, retain and support the workforce as part of its focus on building a social care system fit for the future.

Background information

Care workforce pathway for adult social care

The care workforce pathway is the first universal career structure for the adult social care workforce. It focuses on direct care and support roles. The second part of the pathway includes 4 further role categories to continue to match the breadth of careers in adult social care.

The pathway provides clear guidance for progression and development for professionals in the adult social care sector by outlining the necessary knowledge, skills, values and behaviours they will need in their work or practice. It sets out how people can develop across a long-term career in adult social care with support and training, attracting people to join and remain in the sector and supporting sustainable workforce growth.

Level 5 digital leadership qualification

This new qualification will ensure adult social care leaders and managers have the skills they need to adopt digital innovations and new technology to help transform the sector. This supports the fundamental shift from analogue to digital in adult social care and will support high quality, safe, efficient and person-centred care. This shift is dependent on the adult social care workforce feeling confident, skilled and supported to embed digital ways of working.

Awarding organisations can decide which technologies to focus on and these are included, but not limited to:

smart home technologies

assistive technologies

technologies worn by staff

telecare

diagnostic tools

digital social care records

business software

AI and robotics technology

For further information, see the 'Level 5 Award in Understanding Digital Leadership in Adult Social Care' qualification specification on the Skills for Care qualifications page.

The Care Certificate Standards have been refreshed to bring the contents up to date and in line with the Level 2 Adult Social Care Certificate qualification that was launched in June 2024.

The Care Certificate Standards were developed for use in England and are the recommended minimum training, supervision and assessment that staff new to care (health and adult social care) should receive as part of induction and before they start to deliver care. It provides a foundation for healthcare support and social care worker roles, ensuring that the new worker can provide a compassionate and caring service.

International Recruitment Fund

Additionally, the government will also reduce reliance on overseas recruitment for social care. £12.5 million has been made available for the international recruitment fund to tackle the exploitation of international care workers. This will help find new employment for displaced overseas care workers, prioritising those already in the UK before hiring internationally.

Learning and Development Support Scheme

The Adult Social Care Learning and Development Support Scheme ( LDSS) will continue in financial year 2025 to 2026, backed by up to £12 million. This scheme supports adult social care employers to invest in their workforce through funded training opportunities.

The Level 5 Digital Leadership qualification is eligible for funding under the LDSS.

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Cutting-edge tech introduced in social care

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Care leaders will be trained to use the latest technology to improve patient care, free up staff time and help people live independently in their own homes for longer.

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Tour of an ambulance :: North East Ambulance Service

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Motivational interviewing was first described by Miller in 1983, for a study examining the treatment of alcoholism (now known as alcohol use disorder). The term has widely caught on throughout healthcare systems as a way to help the patient put into practice health promotion strategies such as nutritional recommendations for diet changes or healthier behaviours such as incorporating exercise into a daily routine, by ensuring the patient realises for themselves that they have the power to make changes, they recognise the problem, recognise how to deal with the problem, and feel motivated with a plan going forward to implement the necessary changes. Simply giving a patient advice is not enough - a strategy as to how the information is taken on and how the patient thinks, feels and behaves are integral to incorporating the necessary changes required for their health. A university lecturer, Stephen Rollnick (2010), has studied the technique and specialises in the training of others to understand how to implement it. Rollnick (2010) described that simply giving advice to patients to 'change' is not efficacious on its own.

Motivational interviewing helps to clarify the person's strengths and aspirations, inspires motivation to change and encourages independence in decision making, therefore empowering the person to feel they can take the challenge on to make change. Rollnick (2010) discusses that this style of patient engagement has been shown to promote behavioural change in various healthcare settings, and it improves relationships between clinicians and patients, while improving efficiency in achieving better health outcomes. The principles involve directing, guiding and following.

Motivational interviewing helps ensure the patient realises for themselves that they have the power to make changes

The Royal College of Nursing ( RCN, 2019) summarises the five key skills for motivational interviewing. The first skill involves an open discussion that explores why the person is fearful of change or exploring, using open questions, why the person feels low or lacks motivation recently. Reflective listening ensures the person knows they are understood by the practitioner and reinforces the interest the patient feels the practitioner has in them and their health, by the practitioner being able to reflect a summary of the issues. Clarification shows the person that they are understood. When reflecting it is important to avoid making assumptions, judgments or enforcing your own beliefs - instead focus on expressing that you are 'getting a sense' of what they have told you, then clarify the plan for moving forward. Summarise the concerns, the negative consequences identified, the plan, then elicit motivational statements such as reminding them how well they have done previously and that they can do this again, empowering them through positively appraising the plan they have made.

Tackling the obesity crisis using motivational interviewing

Exercise is found by many researchers to have a positive effect on mood, self-esteem and other aspects of mental health, as well as a high impact on physical health and therefore the risk of long-term health conditions. It is important a patient understands why exercise can help them, but also that they are motivated to change. Exercise can tackle obesity but it can also tackle depression. Pearce et al (2022) observed that exercise is a powerful tool in fighting depression by promoting positive changes in the brain, including neural growth, reduced inflammation, and new activity patterns that promote feelings of calm and well-being, while also releasing endorphins ( Pearce et al, 2022).

Wade et al (2018) studied use of the technique for encouraging weight loss, noting the significant burden obesity has on health services due to it being linked to increased risk of over 20 chronic conditions. Ensuring people are active is a public health challenge and therefore the team wanted to use a behavioural intervention that was already being used in primary care, to examine its effectiveness in encouraging a more active lifestyle for at-risk patients. The researchers looked at changes in physical activity and mental wellbeing as outcomes for examining the community-based intervention grounded in motivational interviewing.

The research took place in Essex and the project title was, 'Let's Get Moving'. Eligible participants had to be between 18 and 74 years old with a body mass index of 28-35 kg/m ². Firstly, a motivational interviewing appointment was carried out for half an hour, at the beginning of the patient's involvement. The person was then signposted to relevant activities and the data was collated. The 12-week data were collated during a face-to-face appointment, then at 6 and 12 months follow-ups were carried out over the phone. In order to measure the outcomes, the team got the participants to self-report physical activity levels using the International Physical Activity Questionnaire (IPAQ), and mental wellbeing was measured using the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS). Of the 2084 participants, about 60% were female and two-thirds had a disability. The sample was predominantly White or White British and therefore may not be generalisable across all ethnicities and cultures. The study found that there were significant increases in vigorous and moderate intensity physical activity, walking and mental wellbeing ( Wade et al, 2018). Therefore, the researchers concluded that physical activity intervention grounded in motivational interviewing appears to be highly effective, although bias could not be ruled out for the study ( Wade et al, 2018).
'The researchers concluded that physical activity intervention grounded in motivational interviewing appears to be highly effective.'
Motivational interviewing for newly discharged patients in the community

Brandberg et al (2021) studied the self-management challenges that exist following hospital discharge with patients with multiple conditions. The aim of their research was to describe the challenges faced over time during the four weeks following hospital discharge, as it is common for vulnerable patients to often be readmitted, and this would inevitably relate to challenges faced following leaving the hospital. Motivational interviewing was used for 16 participants, who either had heart failure or chronic obstructive pulmonary disease in combination with at least one other comorbidity. The participant then had four or five motivational interviewing sessions with a trained social worker over a period of 4 weeks, which were all digitally recorded and analysed using content analysis. The researchers noted that when people feel motivated, engaged and have a greater sense of psychological wellbeing, positive health behaviours are far more likely. They noted the importance of patient autonomy. This can be difficult when a patient is generally chronically unwell yet they face the prospect of leaving a full care environment full of practitioners to possibly living independently alone again, and this could be following months in hospital. Follow-up care would be given when required in the community but it is still a very different environment to adjust to, making the patient vulnerable and possibly overwhelmed, demotivated and anxious about their situation, leading to worse health behaviours, health outcomes and possible readmission.

The patients had their first motivational interview sessions 1-2 days following discharge to ensure first contact was established and to acknowledge any concerns or questions arising early. The patients then had sessions weekly thereafter, post-hospitalisation. These sessions helped to examine change over time post-discharge and to capture the difficulties that may lead someone back to readmission. However, due to motivational interviewing the practice enabled these difficulties to be acknowledged and managed in the community, while also observing issues that can be applied to practice for patient populations. By the fourth session, some patients stated they felt they could manage their situation and no longer required the intervention.

Brandberg et al (2021) noted the importance of motivational interviewing as it can help the patients to self-manage and therefore avoids deterioration or readmission. Brandberg et al (2021) felt the four key areas that motivational interviewing could address in order to avoid readmission and to encourage better health following discharge, were: managing medications; managing symptoms or signs or worsening illness post-discharge; acquiring knowledge of follow-up; and acquiring knowledge of and control over whom to contact for different healthcare needs. The sessions enabled the researchers to observe that self-management is a dynamic process affected by managing system-centred care along with the burden of living with multiple comorbidities. They noted that patients with multiple comorbidities need support during the first 2-weeks post-discharge and that system-centred healthcare does not necessarily suit someone with multiple chronic conditions, instead targeting a single-disease population, which in Western culture is difficult to apply given the amount of people living with multiple chronic illnesses. By adapting the process in the community following patient discharge, through empowerment and identification of changing needs using motivational interviewing, this may be a better way to encourage good health to stay on track and to avoid hospital readmission.

Brandberg et al (2021) discussed that self-management is a dynamic process that changes rapidly throughout the first weeks following hospital discharge. Patient needs shift and change during this time and if these are identified and addressed through motivational interviewing in this early post-discharge period, outcomes may be improved for both the patient and healthcare system.

There are multiple other areas that can be addressed using motivational interviewing. Addiction is an ever-increasing public health concern and also could benefit from the intervention, as found by Satre et al (2016) in their randomised controlled trial, which found cannabis use and hazardous alcohol use could be helped through the use of the intervention. Similarly, Ma et al (2014) found the intervention benefited patients with hypertension.

In fact, Ma et al (2014) found the systolic blood pressure and diastolic blood pressure of hypertensive patients significantly decreased in the participants who received motivational interviewing for 6 months. They concluded that the intervention should be used in hospitals and in primary care, and that training should be provided to nurses so they could practice this in their work with any patient.

Conclusion

In summary, the key is to ensure all staff know how to engage a patient using this method, as by motivating and empowering a patient to choose for themselves, and repeating this conversation regularly with the patient, not only can any concerns be addressed as they arise, but adherence to healthier behaviours can be increased.

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Practice Nursing - Using motivational interviewing to improve health outcomes

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Exercise is found by many researchers to have a positive effect on mood, self-esteem and other aspects of mental health, as well as a high impact on physical health and therefore the risk of long-term health conditions. It is important a patient understands why exercise can help them, but also that they are motivated to change.

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One of the most famous cyclical models of reflection leading you through six stages exploring an experience: description, feelings, evaluation, analysis, conclusion and action plan.

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An evaluation of the Newcastle upon Tyne Hospitals 4Ps

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An evaluation of the Newcastle upon Tyne Hospitals 4Ps

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Programme for the development of nurses, midwives

and allied healthcare professionals’ research skills

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Professional standards of practice and behaviour for nurses, midwives and nursing associates. All standards apply within your professional scope of practice.

Contents:

About us

The Nursing and Midwifery Council exists to protect the public. We do this by making sure that only those who meet our requirements are allowed to practise as a nurse or midwife in the UK, or a nursing associate in England. We take action if concerns are raised about whether a nurse, midwife or nursing associate is fit to practise.

It is against the law to claim to be, or to practise as, a nurse or midwife in the UK, or as a nursing associate in England, if you are not on the relevant part of our register.

It is also a criminal offence for anyone who, with intent to deceive, causes or permits someone else to falsely represent them as being on the register, or makes a false representation about them being on the NMC register.

Publication date: 29 January 2015
Effective from: 31 March 2015
Updated to reflect the regulation of nursing associates: 10 October 2018

A note on this version of the Code

All regulators review their Codes from time to time to make sure they continue to reflect public expectations. This new version of the Code is substantially similar to the 2015 version, but it has been updated to reflect our new responsibilities for the regulation of nursing associates. In joining the register, nursing associates will uphold the Code.

The current versions of our Code, standards and guidance can always be found on our website. Those on our register should make sure they are using the most up to date version of the Code.

For more information about the Code, please visit: www.nmc.org.uk/code.

Introduction

The Code contains the professional standards that registered nurses, midwives and nursing associates ¹ must uphold. Nurses, midwives and nursing associates must act in line with the Code, whether they are providing direct care to individuals, groups or communities or bringing their professional knowledge to bear on nursing ² and midwifery practice in other roles, such as leadership, education, or research. The values and principles set out in the Code can be applied in a range of different practice settings, but they are not negotiable or discretionary.

Our role is to set the standards in the Code, but these are not just our standards. They are the standards that patients and members of the public tell us they expect from health professionals. They are the standards shown every day by those on our register.

When joining our register, and then renewing their registration, nurses, midwives and nursing associates commit to upholding these standards. This commitment to professional standards is fundamental to being part of a profession. We can take action if those on our register fail to uphold the Code. In serious cases, this can include removing them from the register.

The Code sets out common standards of conduct and behaviour for those on our register. This provides a clear, consistent and positive message to patients, service users and colleagues about what they can expect of those who provide nursing or midwifery care.

The professions we regulate have different knowledge and skills, set out in three distinct standards of proficiency. They can work in diverse contexts and have different levels of autonomy and responsibility. However, all of the professions we regulate exercise professional judgement and are accountable for their work.

Nurses, midwives and nursing associates uphold the Code within the limits of their competence. This means, for example, that while a nurse and nursing associate will play different roles in an aspect of care, they will both uphold the standards in the Code within the contribution they make to overall care. The professional commitment to work within one's competence is a key underpinning principle of the Code (see section 13) which, given the significance of its impact on public protection, should be upheld at all times.

In addition, nurses, midwives and nursing associates are expected to work within the limits of their competence, which may extend beyond the standards they demonstrated in order to join the register.

The Code should be useful for everyone who cares about good nursing and midwifery.

Patients and service users, and those who care for them, can use it to provide feedback to nurses, midwives and nursing associates about the care they receive.

Those on our register can use it to promote safe and effective practice in their place of work.

Employer organisations should support their staff in upholding the standards in their professional Code as part of providing the quality and safety expected by service users and regulators.

Educators can use the Code to help students understand what it means to be a registered professional and how keeping to the Code helps to achieve that.

For the many committed and expert practitioners on our register, this Code should be seen as a way of reinforcing professionalism. Through revalidation, nurses, midwives and nursing associates provide evidence of their continued ability to practise safely and effectively. The Code is central to the revalidation process as a focus for professional reflection. This gives the Code significance in the professional life of those on our register, and raises its status and importance for employers.

The Code contains a series of statements that taken together signify what good practice by nurses, midwives and nursing associates looks like. It puts the interests of patients and service users first, is safe and effective, and promotes trust through professionalism.
1 Anyone practising as a registered nurse or midwife in the UK, or a nursing associate in England, has to be registered with us. The nursing associate role is being used only in England.
² We have used the phrase 'nursing' in this document to apply to the work of nurses and nursing associates. Nursing associates are a distinct profession with their own part of our register, but they are part of the nursing team.

Prioritise people

You put the interests of people using or needing nursing or midwifery services first. You make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised, assessed and responded to. You make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.

1 Treat people as individuals and uphold their dignity

To achieve this, you must:

1.1 treat people with kindness, respect and compassion

1.2 make sure you deliver the fundamentals of care effectively

1.3 avoid making assumptions and recognise diversity and individual choice

1.4 make sure that any treatment, assistance or care for which you are responsible is delivered without undue delay

1.5 respect and uphold people's human rights
The fundamentals of care include, but are not limited to, nutrition, hydration, bladder and bowel care, physical handling and making sure that those receiving care are kept in clean and hygienic conditions. It includes making sure that those receiving care have adequate access to nutrition and hydration, and making sure that you provide help to those who are not able to feed themselves or drink fluid unaided.
2 Listen to people and respond to their preferences and concerns

To achieve this, you must:

2.1 work in partnership with people to make sure you deliver care effectively

2.2 recognise and respect the contribution that people can make to their own health and wellbeing

2.3 encourage and empower people to share decisions about their treatment and care

2.4 respect the level to which people receiving care want to be involved in decisions about their own health, wellbeing and care

2.5 respect, support and document a person's right to accept or refuse care and treatment

2.6 recognise when people are anxious or in distress and respond compassionately and politely

3 Make sure that people's physical, social and psychological needs are assessed and responded to

To achieve this, you must:

3.1 pay special attention to promoting wellbeing, preventing ill health and meeting the changing health and care needs of people during all life stages

3.2 recognise and respond compassionately to the needs of those who are in the last few days and hours of life

3.3 act in partnership with those receiving care, helping them to access relevant health and social care, information and support when they need it

3.4 act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care

4 Act in the best interests of people at all times

To achieve this, you must:

4.1 balance the need to act in the best interests of people at all times with the requirement to respect a person's right to accept or refuse treatment

4.2 make sure that you get properly informed consent and document it before carrying out any action

4.3 keep to all relevant laws about mental capacity that apply in the country in which you are practising, and make sure that the rights and best interests of those who lack capacity are still at the centre of the decision-making process

4.4 tell colleagues, your manager and the person receiving care if you have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for that person's care (see the note below)
You can only make a 'conscientious objection' in limited circumstances. For more information, please visit our website at www.nmc.org.uk/standards/code/conscientious-objection-by-nurses-and-midwives/
5 Respect people's right to privacy and confidentiality

As a nurse, midwife or nursing associate, you owe a duty of confidentiality to all those who are receiving care. This includes making sure that they are informed about their care and that information about them is shared appropriately.

To achieve this, you must:

5.1 respect a person's right to privacy in all aspects of their care

5.2 make sure that people are informed about how and why information is used and shared by those who will be providing care

5.3 respect that a person's right to privacy and confidentiality continues after they have died

5.4 share necessary information with other health and care professionals and agencies only when the interests of patient safety and public protection override the need for confidentiality

5.5 share with people, their families and their carers, as far as the law allows, the information they want or need to know about their health, care and ongoing treatment sensitively and in a way they can understand

Practise effectively

You assess need and deliver or advise on treatment, or give help (including preventative or rehabilitative care) without too much delay and to the best of your abilities, on the basis of the best evidence available and best practice. You communicate effectively, keeping clear and accurate records and sharing skills, knowledge and experience where appropriate. You reflect and act on any feedback you receive to improve your practice.

6 Always practise in line with the best available evidence

To achieve this, you must:

6.1 make sure that any information or advice given is evidence-based, including information relating to using any health and care products or services

6.2 maintain the knowledge and skills you need for safe and effective practice

7 Communicate clearly

To achieve this, you must:

7.1 use terms that people in your care, colleagues and the public can understand

7.2 take reasonable steps to meet people's language and communication needs, providing, wherever possible, assistance to those who need help to communicate their own or other people's needs

7.3 use a range of verbal and non-verbal communication methods, and consider cultural sensitivities, to better understand and respond to people's personal and health needs

7.4 check people's understanding from time to time to keep misunderstanding or mistakes to a minimum

7.5 be able to communicate clearly and effectively in English

8 Work cooperatively

To achieve this, you must:

8.1 respect the skills, expertise and contributions of your colleagues, referring matters to them when appropriate

8.2 maintain effective communication with colleagues

8.3 keep colleagues informed when you are sharing the care of individuals with other health and care professionals and staff

8.4 work with colleagues to evaluate the quality of your work and that of the team

8.5 work with colleagues to preserve the safety of those receiving care

8.6 share information to identify and reduce risk

8.7 be supportive of colleagues who are encountering health or performance problems. However, this support must never compromise or be at the expense of patient or public safety

9 Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues

To achieve this, you must:

9.1 provide honest, accurate and constructive feedback to colleagues

9.2 gather and reflect on feedback from a variety of sources, using it to improve your practice and performance

9.3 deal with differences of professional opinion with colleagues by discussion and informed debate, respecting their views and opinions and behaving in a professional way at all times

9.4 support students' and colleagues' learning to help them develop their professional competence and confidence

10 Keep clear and accurate records relevant to your practice

This applies to the records that are relevant to your scope of practice. It includes but is not limited to patient records.

To achieve this, you must:

10.1 complete all records at the time or as soon as possible after an event, recording if the notes are written some time after the event

10.2 identify any risks or problems that have arisen and the steps taken to deal with them, so that colleagues who use the records have all the information they need

10.3 complete all records accurately and without any falsification, taking immediate and appropriate action if you become aware that someone has not kept to these requirements

10.4 attribute any entries you make in any paper or electronic records to yourself, making sure they are clearly written, dated and timed, and do not include unnecessary abbreviations, jargon or speculation

10.5 take all steps to make sure that all records are kept securely

10.6 collect, treat and store all data and research findings appropriately

11 Be accountable for your decisions to delegate tasks and duties to other people

To achieve this, you must:

11.1 only delegate tasks and duties that are within the other person's scope of competence, making sure that they fully understand your instructions

11.2 make sure that everyone you delegate tasks to is adequately supervised and supported so they can provide safe and compassionate care

11.3 confirm that the outcome of any task you have delegated to someone else meets the required standard

12 Have in place an indemnity arrangement which provides appropriate cover for any practice you take on as a nurse, midwife or nursing associate in the United Kingdom

To achieve this, you must:

12.1 make sure that you have an appropriate indemnity arrangement in place relevant to your scope of practice

For more information, please visit: www.nmc.org.uk/indemnity

Preserve safety

You make sure that patient and public safety is not affected. You work within the limits of your competence, exercising your professional 'duty of candour' and raising concerns immediately whenever you come across situations that put patients or public safety at risk. You take necessary action to deal with any concerns where appropriate.

13 Recognise and work within the limits of your competence

To achieve this, you must, as appropriate:

13.1 accurately identify, observe and assess signs of normal or worsening physical and mental health in the person receiving care

13.2 make a timely referral to another practitioner when any action, care or treatment is required

13.3 ask for help from a suitably qualified and experienced professional to carry out any action or procedure that is beyond the limits of your competence

13.4 take account of your own personal safety as well as the safety of people in your care

13.5 complete the necessary training before carrying out a new role

14 Be open and candid with all service users about all aspects of care and treatment, including when any mistakes or harm have taken place

To achieve this, you must:

14.1 act immediately to put right the situation if someone has suffered actual harm for any reason or an incident has happened which had the potential for harm

14.2 explain fully and promptly what has happened, including the likely effects, and apologise to the person affected and, where appropriate, their advocate, family or carers

14.3 document all these events formally and take further action (escalate) if appropriate so they can be dealt with quickly
The professional duty of candour is about openness and honesty when things go wrong. "Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress." Joint statement from the Chief Executives of statutory regulators of healthcare professionals.
15 Always offer help if an emergency arises in your practice setting or anywhere else

To achieve this, you must:

15.1 only act in an emergency within the limits of your knowledge and competence

15.2 arrange, wherever possible, for emergency care to be accessed and provided promptly

15.3 take account of your own safety, the safety of others and the availability of other options for providing care

16 Act without delay if you believe that there is a risk to patient safety or public protection

To achieve this, you must:

16.1 raise and, if necessary, escalate any concerns you may have about patient or public safety, or the level of care people are receiving in your workplace or any other health and care setting and use the channels available to you in line with our guidance and your local working practices

16.2 raise your concerns immediately if you are being asked to practise beyond your role, experience and training

16.3 tell someone in authority at the first reasonable opportunity if you experience problems that may prevent you working within the Code or other national standards, taking prompt action to tackle the causes of concern if you can

16.4 acknowledge and act on all concerns raised to you, investigating, escalating or dealing with those concerns where it is appropriate for you to do so

16.5 not obstruct, intimidate, victimise or in any way hinder a colleague, member of staff, person you care for or member of the public who wants to raise a concern

16.6 protect anyone you have management responsibility for from any harm, detriment, victimisation or unwarranted treatment after a concern is raised

For more information, please visit our website at www.nmc.org.uk/raisingconcerns.

17 Raise concerns immediately if you believe a person is vulnerable or at risk and needs extra support and protection

To achieve this, you must:

17.1 take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse

17.2 share information if you believe someone may be at risk of harm, in line with the laws relating to the disclosure of information

17.3 have knowledge of and keep to the relevant laws and policies about protecting and caring for vulnerable people

18 Advise on, prescribe, supply, dispense or administer medicines within the limits of your training and competence, the law, our guidance and other relevant policies, guidance and regulations

To achieve this, you must:

18.1 prescribe, advise on, or provide medicines or treatment, including repeat prescriptions (only if you are suitably qualified) if you have enough knowledge of that person's health and are satisfied that the medicines or treatment serve that person's health needs

18.2 keep to appropriate guidelines when giving advice on using controlled drugs and recording the prescribing, supply, dispensing or administration of controlled drugs

18.3 make sure that the care or treatment you advise on, prescribe, supply, dispense or administer for each person is compatible with any other care or treatment they are receiving, including (where possible) over-the-counter medicines

18.4 take all steps to keep medicines stored securely

18.5 wherever possible, avoid prescribing for yourself or for anyone with whom you have a close personal relationship

Prescribing is not within the scope of practice of everyone on our register. Nursing associates don't prescribe, but they may supply, dispense and administer medicines. Nurses and midwives who have successfully completed a further qualification in prescribing and recorded it on our register are the only people on our register that can prescribe.

For more information, please visit: www.nmc.org.uk/standards

19 Be aware of, and reduce as far as possible, any potential for harm associated with your practice

To achieve this, you must:

19.1 take measures to reduce as far as possible, the likelihood of mistakes, near misses, harm and the effect of harm if it takes place

19.2 take account of current evidence, knowledge and developments in reducing mistakes and the effect of them and the impact of human factors and system failures (see the note below)

19.3 keep to and promote recommended practice in relation to controlling and preventing infection

19.4 take all reasonable personal precautions necessary to avoid any potential health risks to colleagues, people receiving care and the public
Human factors refer to environmental, organisational and job factors, and human and individual characteristics, which influence behaviour at work in a way which can affect health and safety - Health and Safety Executive. You can find more information at www.hse.gov.uk
Promote professionalism and trust
20 Uphold the reputation of your profession at all times
You uphold the reputation of your profession at all times. You should display a personal commitment to the standards of practice and behaviour set out in the Code. You should be a model of integrity and leadership for others to aspire to. This should lead to trust and confidence in the profession from patients, people receiving care, other health and care professionals and the public.

To achieve this, you must:

20.1 keep to and uphold the standards and values set out in the Code

20.2 act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment

20.3 be aware at all times of how your behaviour can affect and influence the behaviour of other people

20.4 keep to the laws of the country in which you are practising

20.5 treat people in a way that does not take advantage of their vulnerability or cause them upset or distress

20.6 stay objective and have clear professional boundaries at all times with people in your care (including those who have been in your care in the past), their families and carers

20.7 make sure you do not express your personal beliefs (including political, religious or moral beliefs) to people in an inappropriate way

20.8 act as a role model of professional behaviour for students and newly qualified nurses, midwives and nursing associates to aspire to

20.9 maintain the level of health you need to carry out your professional role

20.10 use all forms of spoken, written and digital communication (including social media and networking sites) responsibly, respecting the right to privacy of others at all times

For more guidance on using social media and networking sites, please visit: www.nmc.org.uk/standards

21 Uphold your position as a registered nurse, midwife or nursing associate

To achieve this, you must:

21.1 refuse all but the most trivial gifts, favours or hospitality as accepting them could be interpreted as an attempt to gain preferential treatment

21.2 never ask for or accept loans from anyone in your care or anyone close to them

21.3 act with honesty and integrity in any financial dealings you have with everyone you have a professional relationship with, including people in your care

21.4 make sure that any advertisements, publications or published material you produce or have produced for your professional services are accurate, responsible, ethical, do not mislead or exploit vulnerabilities and accurately reflect your relevant skills, experience and qualifications

21.5 never use your status as a registered professional to promote causes that are not related to health

21.6 cooperate with the media only when it is appropriate to do so, and then always protecting the confidentiality and dignity of people receiving treatment or care

22 Fulfil all registration requirements

To achieve this, you must:

22.1 meet any reasonable requests so we can oversee the registration process

22.2 keep to our prescribed hours of practice and carry out continuing professional development activities

22.3 keep your knowledge and skills up to date, taking part in appropriate and regular learning and professional development activities that aim to maintain and develop your competence and improve your performance

For more information, please visit: www.nmc.org.uk/standards

23 Cooperate with all investigations and audits

This includes investigations or audits either against you or relating to others, whether individuals or organisations. It also includes cooperating with requests to act as a witness in any hearing that forms part of an investigation, even after you have left the register.

To achieve this, you must:

23.1 cooperate with any audits of training records, registration records or other relevant audits that we may want to carry out to make sure you are still fit to practise

23.2 tell both us and any employers as soon as you can about any caution or charge against you, or if you have received a conditional discharge in relation to, or have been found guilty of, a criminal offence (other than a protected caution or conviction)

23.3 tell any employers you work for if you have had your practice restricted or had any other conditions imposed on you by us or any other relevant body.

23.4 tell us and your employers at the first reasonable opportunity if you are or have been disciplined by any regulatory or licensing organisation, including those who operate outside of the professional health and care environment
When telling your employers, this includes telling (i) any person, body or organisation you are employed by, or intend to be employed by, as a nurse, midwife or nursing associate; and (ii) any person, body or organisation with whom you have an arrangement to provide services as a nurse, midwife or nursing associate. For more information, please visit our website at www.nmc.org.uk
23.5 give your NMC Pin when any reasonable request for it is made

24 Respond to any complaints made against you professionally

To achieve this, you must:

24.1 never allow someone's complaint to affect the care that is provided to them

24.2 use all complaints as a form of feedback and an opportunity for reflection and learning to improve practice

25 Provide leadership to make sure people's wellbeing is protected and to improve their experiences of the health and care system

To achieve this, you must:

25.1 identify priorities, manage time, staff and resources effectively and deal with risk to make sure that the quality of care or service you deliver is maintained and improved, putting the needs of those receiving care or services first
Throughout their career, all our registrants will have opportunities to demonstrate leadership qualities, regardless of whether or not they occupy formal leadership positions.
25.2 support any staff you may be responsible for to follow the Code at all times. They must have the knowledge, skills and competence for safe practice; and understand how to raise any concerns linked to any circumstances where the Code has, or could be, broken

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Read the NMC Code, code of conduct for nurses and midwives, online

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Caring with Confidence: The Code in Action - The Nursing and Midwifery Council

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Our core role is to regulate, and to ensure we regulate as well as possible, we proactively support our professions.

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Code of Ethics for the Nutrition and Dietetics Profession

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Code of Ethics for the Nutrition and Dietetics Profession

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Introduction

Good patient communication is key, particularly when a patient is waiting for planned care or treatment. From referral by a primary care clinician through to discharge from secondary care - clear, accessible communication is vital throughout.

The Elective Recovery Delivery Plan commits to providing better information and support to patients. As we begin to implement new, innovative ways of delivering healthcare, it is more important than ever that patients feel confident they are supported throughout their journey.

Prolonged periods of industrial action and continuing pressures have inevitably had an impact on planned care. In this context, it is important that integrated care boards (ICBs) and providers do all they can to offer support to those affected by delays, including with patient communications.

This guide sets out key communication principles to help providers deliver personalised, patient-centred communications. It includes considerations for communicating to patients about new models of care as well as helpful information and resources.

Communicating with patients waiting for planned care - key principles

Good patient communication should start from the first point of contact with the NHS. The following principles should be applied to all communication with patients, particularly those on an elective care pathway. We also need to be mindful of the specific communications and support needs of those who are waiting to receive a diagnosis.

Providers and their boards must ensure these are applied consistently and equitably across their services and populations. Helpful resources are provided in Appendix A.

You can also download a version of these principles here.

Personalised

Your communications should give clear, easy to understand steps for the patient's care, including likely and honest appointment timescales, and what they can expect to happen and when. It is also important that patients fully understand their diagnosis and the department they are in contact with. This will help reduce anxiety and enable the patient to have an informed discussion about their treatment.

Patients need to fully understand how their care and treatment will be delivered and the implications of any of their decisions on this; providers should welcome and encourage questions from patients. When communicating with patients, you should consider the differing needs of your population including:

health inequalities, e.g., factors that will influence a patient's need for care and their ability to access it

needs of people with protected characteristics in line with the Equalities Act 2010 (this includes their preferred means of communication)

their capacity to make a decision based on part one of the two-stage test of capacity under the Mental Capacity Act

the accessibility and understandability of information for patients - medical terminology may need to be explained in every day terms

literacy levels

language translation - both written and spoken

reasonable adjustment requirements such as easy read appointment letters

Patients should be signposted to resources that will help prepare them for conversations about their care and any additional support they may require. This could be leaflets sent out with appointment letters, links to charity or partner websites, or signposting the information available on My Planned Care. Patients who are digitally excluded should be identified and provided with support to help make informed decisions. Patients should also be informed on what information they will need to bring to their appointments, i.e. appointment letters, details of medicines etc.

Some patients may qualify for help with their health costs. Information should be made available in alternative formats i.e., easy read and in different languages upon request.

Information and communications must comply with the Equality Act 2010 and reflect the accessible information standard. This includes making sure that advice for patients on preparing for appointments/treatment is accessible in several different formats.

Reasonable adjustments

People with disabilities have a right to ask for reasonable adjustments to their care. Every person is different and will need different changes. Some common examples of reasonable adjustments include:

staff using accessible language

flexibility in appointment times

longer appointments

a hospital and care passport so that the person can share information about their needs and wishes

easy read and plain English written information

enabling carers to accompany people at their appointments

All organisations that provide NHS or adult social care must follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand, so they can communicate effectively with health and social care services. You should try to be 'anticipatory', meaning you should think about what is likely to be needed in advance and plan accordingly.

Clear language

Language should be clear, accessible, and easy to understand. This should apply to written and verbal communication with patients. Simple tools like the Flesch Reading Ease Score, available on Microsoft Word, can help with this.

Acronyms and technical terms should be avoided. If they are needed, they should be explained. Try to avoid language that may put patients off from discussing their care.

It is good to consider different ways to receive feedback, i.e. via patient experience surveys, to see if patients find the information they are given accessible or if it can be improved.

Patients should be supported to understand their care, treatment and support options and risks, benefits and outcomes of these options. It is important they have access to the relevant information so they can make informed decisions that are right for them. Decision support tools are available to support shared decision making for a number of conditions and procedures.

Patient initiated follow up (PIFU) is an example of when patients are moved on to a pathway where they are in control of next steps, so it is important they understand how the process works.

You should make it easy for patients to quickly get information about their upcoming care and to raise any questions. Reasonable adjustments and inequalities should be considered, including alternative options for any patients with specific language or communication needs.

Providers may approach this using various solutions. You may direct patients to the Patient Advice and Liaison Service (PALS), have a dedicated contact centre, or assign individual healthcare professionals as a contact.

For all these options, patients should be clear on the department they are in contact with, opening hours for the service and they should be able to leave a message out of hours. An alternative email should also be available, and this inbox should be regularly checked to ensure patients receive a timely response, i.e., within 48 hours.

Patient groups strongly support the creation of a Single Point of Contact (SPOC) and would like to see every trust working towards this.

Managing appointments, delays and cancellations

As part of the shared decision making process, if treatment is subject to delay, withdrawn or the patient decides not to go ahead, then alternative options should be discussed.

When an appointment needs to be rescheduled it is important to be clear about why the decision was made. Ideally a new appointment will be communicated at the same time, however, the NHS constitution states a new appointment date should be communicated within 28 days.

If the next steps are uncertain or there is likely to be a long delay, open and honest communications will help manage expectations.

The patient should always be clear on which part of the organisation is contacting them to change their appointment. Some patients may be in touch with various departments for multiple conditions, so we need to make it as easy as possible for them to contact the right place if they have any concerns.

We know any delay to a patient's appointment can impact their physical and mental wellbeing. It is helpful to acknowledge this delay in communications and, where appropriate, you should signpost to materials that can help the patient manage their condition as well as highlight mental health support. Many providers will have developed this information as part of their trust specific pages on the My Planned Care website It should be clear to patients who they should contact if their condition deteriorates.

Interim information and services

While a patient waits for an appointment, diagnosis or care, you should provide them with supportive, accessible information to them to help them manage their symptoms or condition. This includes signposting helpful information and resources available from voluntary, community and social enterprise sector organisations.

The health and wellbeing pages on the My Planned Care website include information and resources for patients on a wide range of topics including: preparing for your operation, looking after yourself and your mental health while you are waiting, and how you can check and manage risks relating to existing conditions that might affect your planned treatment and care.

Providing information to patients about the practical steps they can take to be as fit and healthy as possible before a planned procedure or operation and signposting them to relevant support can help patients to be active partners in their own health while they are waiting.

Communicating appointment type

We are moving away from delivering care in traditional ways. We now offer virtual and group outpatient appointments, and PIFU allows patients to book an appointment when they feel it is required. The patient should be aware of the pathway they are on and understand how it works.

Clear, concise information should be provided on how to prepare for the appointment, particularly where this will take place remotely. For phone appointments, the patient's phone number should be confirmed. Patients should know how to update this if they change numbers. For video appointments, patients should be advised what equipment they will need and how to set this up to get the most out of the appointment. A guide for patients, including translated versions, is available. You can also tailor these FAQs for your patients.

Further resources including a video consultation toolkit, patient leaflets and animations are available here.

Patient Initiated Follow Up (PIFU)

PIFU allows patients to arrange their follow up appointments as and when they need them, rather than at routine intervals.

Shared decision-making must be used to ensure that patients are fully involved in the decision to be moved onto a PIFU pathway. PIFU must not be used to move people off the waiting list without a shared decision-making conversation. During this discussion the patient should be advised of the purpose and benefits of PIFU and when, and how, to get back in touch with the service if they need an appointment.

The decision to place a patient on a PIFU pathway should be confirmed to the patient in writing in a way they understand (in accordance with the Accessible Information Standard). This should clearly state the duration they will remain on PIFU, how to arrange an appointment if they need one and include contact details in line with the principles set out above.

The patient should be reminded at regular intervals when their PIFU is due to expire, and confirmation sent once their PIFU has ended advising them to return to their GP if they need further care and support. Template patient letters and other practical patient facing resources are available here.

It is a good idea to socialise PIFU on other communications channels such as on your website. This provides patients with somewhere to find out more information if they need it. Draft web content, and other editable communications materials are available in the PIFU campaign toolkit.

Specialist Advice (including Advice and Guidance)

Specialist advice enables GPs to seek the opinion of a subject matter expert, ahead of, or as well as making a referral to secondary care.

Patients have told us they would like clearer information about specialist advice. It should be clearly explained to the patient by the primary care clinician when specialist advice is being sought and what that means for the patient. To support interactions between the clinician and patient, further information should be shared e.g. in the form of a patient leaflet, FAQs or on relevant webpages. Example patient information and resources are available in the Specialist Advice Toolkit.

Patient choice

In many cases patients have the right to choose their healthcare provider when being referred for treatment into secondary care.

At the point of referral, the referring clinician should discuss with the patient what matters most to them. This could be going to a hospital with the shortest waiting times, a provider close to family and friends or looking at ratings from the Care Quality Commission (CQC). The patient should then be offered a minimum of five, clinically appropriate, options. They can make their decision during the appointment or can decide to take time to consider their options.

If you know they have access to online services, the patient should be sent a link and log in details to the e-referral website and encouraged to visit the My Planned Care website to carry out more research if they require.

Once they have made their decision, the patient should use the link to ERS to make their choice. They can also call the national referral helpline (0345 608 8888).

Alternative choice

Hospitals are now contacting patients who have waited longer than 40 weeks for treatment and do not have an appointment within the next eight weeks to give them the opportunity to consider travelling to a different hospital if one can be found with a shorter waiting time.

Those eligible will be contacted by the hospital they are currently under the care of and will be made aware of the offer and will be given details on how to progress. Template communications have been shared with operational teams to support this.

If a patient opts to request to move, they submit their details online or over the phone and will also share how far they are willing to travel (50 miles, 100 miles or nationally). The patient will then be clinically validated by their current hospital and, if approved, it is then the role of the ICB to make every effort to identify an appropriate alternative hospital.

If an alternative isn't found locally and the patient is willing to travel nationally, their details will be uploaded to the digital mutual aid system (DMAS) and other hospitals will be able to offer to treat the patient if appropriate.

If an alternative hospital is identified the patient should be contacted and asked if they would like to proceed. If one isn't found the patient will be informed and will remain with their current provider and will receive an appointment as soon as one becomes available.

Patients who choose to exercise their choice both at the point of referral and over 40 weeks may be eligible for the Healthcare Travel Costs Scheme and should be made aware of how to make a claim for help. If a patient has questions about help with health costs, they can contact the NHS Business Services Authority online or call 0300 330 1343. As part of alternative choice, ICBs have been asked to ensure that the longest waiting patients who are prepared to travel beyond their local hospitals to receive earlier treatment are not disadvantaged based on their personal circumstances. Each individual will be reviewed on a case-by-case basis.

Reducing missed appointments (Did Not Attend or Was Not Brought)

Patients miss appointments for a range of reasons. These are often outside of their control and could relate to the quality of communications they received.

As a minimum, all providers should use appointment reminders such as letters, SMS and phone calls and offer patients an accessible option to cancel and rearrange appointments if they need to.

Capturing patients' preferred means of communication, appointment times and appointment types as well as providing appointment information in a way that suits the patient e.g., available in different languages and in accessible formats will improve both patient experience and outcomes.

If a patient misses an appointment, you should be inquisitive to find out why the patient did not attend and to put measures in place to help patients attend future appointments. Patients who did not attend should not be moved or discharged to a PIFU pathway instead of being assessed appropriately.

When cancellations are made it is important to understand the reasons, and support where possible. More detail is available in the reducing did not attends (DNAs) in outpatient services guidance. Template appointment letters and reminders are also available.

Further guidance and support materials are available on the Outpatient Recovery and Transformation FutureNHS workspace.

Validation

Validation ensures healthcare providers are prioritising patients based on their individual needs, resulting in accurate waiting lists. The process enables patients to be more involved while they way for care, providing a better patient experience.

Patients on a waiting list should be regularly contacted as per the guidance. This provides patients with a touch point with their healthcare provider where they will be able to discuss changes to their condition, so teams can sure they are on the right pathway to receive the best care and treatment for their needs.

While a patient is waiting, they should be provided with information and support to help them manage their condition. This includes highlighting helpful information and resources available from voluntary, community and social enterprise sector organisations.

As per the guidance, validation can be undertaken using a digital solution such as text messages, an online patient form or an automated chatbot. If a digital solution is not suitable for a patient or they don't respond, they should be contacted through other communication methods such as a letter or phone call.

During any communication with patients, it is important they are aware of the purpose of the contact and feel empowered to give open, honest updates on their condition. Where a patient's condition has changed resulting in a possible change to their pathway, a clinical assessment should take place and any changes clearly communicated with the patient. Where this is done through a letter, key information should be included, and a point of contact should be given so the patient can raise questions.

Appendix A: resources

Good communication with patients: core principles - a downloadable version of the communication principles.

Help with travel costs

Template letters

Patient support

Reasonable Adjustments

Accessible information standard

Publication reference: PRN00626

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Good communication with patients waiting for care

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Good patient communication is key, particularly when a patient is waiting for planned care or treatment. From referral by a primary care clinician through to discharge from secondary care - clear, accessible communication is vital throughout. The Elective Recovery Delivery Plan commits to providing better information and support to patients.

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Dignity: Information and good communication - SCIE

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People often find it difficult to navigate social care and health provision to find out what is available and how their needs might be met. Giving people the information they need to make their own plans and decisions is central to the Care Act 2014, to the Mental Capacity Act 2005 and to the person-centred care agenda. It is the basics of promoting dignity in care.

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The 5R framework for reflection will guide you through Reporting, Responding, Relating, Reasoning, and Reconstructing to make sense of a learning experience.

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Driscoll (1994) developed this model of reflection based on the three simple questions - What? So what? Now what? - originally asked by Terry Borton (1970). The model provides one of the simplest frameworks for reflection. In practice you should ask yourself the three questions after a critical incident that has taken place and you want to extract learning from.

'What?' helps you describe the situation you want to learn from. You should identify the facts and feelings of the situation.

'So What?' allows you to extract the meaning of 'What?'. Moreover, you should question what knowledge you and others had in the situation, and what knowledge or theories that could help you make sense of the situation.

'Now what?' allows you to create an action plan for the future based on the previous questions.

Below is further information on the model - each stage includes guiding questions to ask yourself and a couple of examples of how this might look in a reflection.

This is just one model of reflection. Test it out and see how it works for you. If you find that only some of the outlined questions are helpful, focus on those. However, by thinking about each stage you are likely to engage more critically with your learning experience.

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One of the simplest frameworks of reflection - by moving through three reflective stages, you will think about an experience, its implications, and what that means for the future.

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British Sign Language - Learn BSL Online

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British Sign Language online course, free resources, games, information, and greeting cards. Learn British Sign Language today.

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Widgit Symbol Resources | Ready-Made Teaching Materials

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Widgit Symbol Resource Packs, hundreds of symbol resource packs, created in partnership with professionals

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Makaton uses signs and symbols to help people communicate. It is designed to support the development of spoken language.

Makaton signs are based on the gestures used in BSL (British Sign Language - the language of the Deaf community). However, unlike BSL, Makaton signs are used in conjunction with speech at all times and in English grammatical word order.

With Makaton, children and adults can communicate using signs and symbols. Many people then drop the signs or symbols naturally at their own pace, as they develop speech. Makaton is extremely flexible as it can be personalised to the individual's needs and used at a level that is suitable for them.

Who uses Makaton?

Today, over 100,000 children and adults use Makaton symbols and signs, either as their main method of communication, or as a way to support speech. Makaton is the UK's leading language programme used by adults and children with learning or communication difficulties and by everyone who shares their lives.

Increasingly, Makaton is being used in an inclusive way with all children, not just for those with communication difficulties. Lots of parents of typically-developing children and settings such as nurseries, mainstream schools and Children's Centres use it with their children too. It is beneficial for children with EAL (English as an additional language) as a way to help those children develop their spoken English skills.

Using signs can help children who are non-verbal (either because they have communication difficulties or because they are little babies/toddlers) by promoting their communication development. Many children's understanding develops ahead of their spoken language. Signing can help little children express themselves during this time and prevent or alleviate their frustrations caused by their current inability to communicate.

Makaton can help children/young people & adults to:

Communicate what they need, want, think or feel

Make themselves understood by using signs / symbols

Develop their attention, looking and listening skills

Develop their understanding of speech and promote their communication development

Develop their language & literacy skills

How to use Makaton

Use the sign/symbol for the keyword (most important information-carrying word in the sentence. E.g. Would you something to eat?

Remember to always speak at the same time as signing - the signs are there to support (augment) speech, not replace it

Use clear, short sentences

Make sure you use eye-contact, facial expression and body language to convey the meaning of your communication

Use objects of references (props/toys/pictures/photos) to give additional visual cues

You can do 'hand-over-hand' signing to help encourage your child to make the relevant gesture/sign

Reward all attempts to communicate! Even if their sign is not quite right, encourage them and then model the correct sign yourself (as you would with speech). Their signing will improve with time & practice

Have fun with signing! Sing, read stories and play games - make the learning experience as enjoyable as possible.

What does the Makaton Charity do?

The Makaton Charity is responsible for developing and sharing the Makaton Language Programme. They provide:

Training for parents, carers and professionals

Resources in a wide range of printed and electronic formats

Online 'Sign of the Week' clips #wetalkmakaton

Information to help others make information & resources accessible

Support and advice to families and professionals

Influence society by working in partnership with other organisations to empower people.

We are both licensed Regional Makaton Tutors and can provide Makaton Training in and around SW London. Please contact us on info@singinghands.co.uk or call 020 8288 1706 if you would like Makaton Training in this area.

If we are not available, then other members of our local Makaton tutor network might be able to help and we can put you in touch with them. If you are further afield, please contact the Makaton Charity for further information and to find dates and locations of training courses nearest to you.
www.makaton.org
The Makaton Charity
Westmead House
Farnborough
Hampshire
GU14 7LP
Tel: 01276 606760
Fax: 01276 36725
Email: info@makaton.org

To join in with Makaton's "Sign of the Week" #wetalkmakaton
Please visit www.wetalkmakaton.org

For more information on using Makaton signs & symbols software on iPads,
With the MyChoicePad app
Please visit http://www.mychoicepad.com/

Find out more about how to create your own materials using Widgit software with Makaton line drawings and symbols
Please visit www.widgit.com

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Makaton uses signs and symbols to help people communicate. It is designed to support the development of spoken language. Makaton signs are based on the gestures used in BSL (British Sign Language - the language of the Deaf community). However, unlike BSL, Makaton signs are used in conjunction with speech at all times and in...

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Olaf is a three-year-old fox red Labrador therapist and a published author. He was invited to speak at the Cheltenham Literature Festival 2023. Olaf is a family pet registered with the Pets As Therapy (PAT) Charity. His job is to make people smile when, with his human mum (a specialist teacher and mindfulness coach), he visits hospitals and schools.

Every Thursday morning, Olaf goes to Battledown Special School. He enjoys his visits so much that he set his second book there! Team Olaf to the Rescue is a heartwarming story about his classroom adventures (it very cleverly rhymes!). With help from his merry band of canine mates, Olaf saves the school's Christmas celebrations and gives the children a party they will never forget. All the dogs in Team Olaf are Olaf's real friends whom he sees every day on his walks. They all play a vital role in the story, showing kindness, creativity, and bravery. Fun activities are added to stimulate the reader's imagination and memory.

Battledown School uses Makaton as part of their teaching and learning, so we included their symbols in the book to enable more of Olaf's human friends to enjoy it. We were delighted Makaton wanted to be involved in our project and are grateful to the Team for their expertise and patience. They provided symbols for the concepts/story words and explained where to place them on the page, so that the story makes sense to the Makaton reader.

Olaf's first book, Mr. Olaf the Therapist, is a mindfulness scrapbook, diarying his experiences in a mainstream school and his work in the NHS. As a PAT dog, Olaf visits Cheltenham General Hospital where he is a valued member of the Knightsbridge (Gastric) and Critical Care Teams. He has been doing this for over two years but is still banned from the staff rooms because of the doughnuts... It is a privilege and humbling to be welcomed so warmly by patients, their families, and Olaf's NHS colleagues. Olaf also shares his lifestyle wisdom with self-care activities and mindfulness questions to help us reflect on our own work/life balance.

Olaf gives all the proceeds from his books to the Pets as Therapy charity. He attends promotional PAT events e.g., Crufts and Goodwuff.

For more information about PAT and/or to buy Olaf's books, please visit Pets as Therapy.

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Makaton is a unique language programme that uses symbols, signs and speech to enable people to communicate. It supports the development of essential communication skills such as attention and listening, comprehension, memory, recall and organisation

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National paediatric early warning system (PEWS) observation and escalation charts

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PEWS chart have been collaboratively developed by clinical teams across England to standardised the approach of tracking the deterioration of children in hospital and are to be used on general children's wards.

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Communication group practical 6/2/25

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Types of apprenticeships With more than 350 different NHS careers, there are hundreds of different jobs which can be done through an apprenticeship.

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Resources for students - The Nursing and Midwifery Council

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The NMC Website, NMC Online and our other online services will be unavailable from 07:15 to 10:00 on Saturday 20 January whilst we carry out essential maintenance. Apologies for any inconvenience caused.

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Nursing gives you the opportunity to make a difference to people’s lives on a daily basis. There are four key areas of nursing you can choose to specialise in, with each leading on to a wide range of rewarding roles with plenty of scope for progression.

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The standards of proficiency for radiographers

Expectations of you

You must meet all the standards of proficiency to register with us and meet the standards relevant to your scope of practice to stay registered with us. It is important that you read and understand this document.

If your practice is called into question we will consider these standards (and our standards of conduct, performance and ethics) in deciding what action, if any, we need to take.

The standards set out in this document complement information and guidance issued by other organisations, such as your professional body or your employer.

We recognise the valuable role played by professional bodies in providing guidance and advice about good practice which can help you to meet the standards in this document

Your scope of practice

Your scope of practice is the area or areas of your profession in which you have the knowledge, skills and experience to practise lawfully, safely and effectively, in a way that meets our standards and does not pose any danger to the public or to yourself.

We recognise that a registrant's scope of practice will change over time and that the practice of experienced registrants often becomes more focused and specialised than that of newly registered colleagues. This might be because of specialisation in a certain area or with a particular client group, or a movement into roles in management, education or research.

Every time you renew your registration, you will be asked to sign a declaration that you continue to meet the standards of proficiency that apply to your scope of practice.

Your particular scope of practice may mean that you are unable to continue to demonstrate that you meet all of the standards that apply for the whole of your profession.

As long as you make sure that you are practising safely and effectively within your given scope of practice and do not practise in the areas where you are not proficient to do so, this will not be a problem. If you want to move outside of your scope of practice, you should be certain that you are capable of working lawfully, safely and effectively. This means that you need to exercise personal judgement by undertaking any necessary training or gaining experience, before moving into a new area of practice.

Meeting the standards

It is important that you meet our standards and are able to practise lawfully, safely and effectively. However, we do not dictate how you should meet our standards. There is normally more than one way in which each standard can be met and the way in which you meet our standards might change over time because of improvements in technology or changes in your practice.

We often receive questions from registrants who are concerned that something they have been asked to do, a policy, or the way in which they work might mean they cannot meet our standards. They are often worried that this might have an effect on their registration.

As an autonomous professional, you need to make informed, reasoned decisions about your practice to ensure that you meet the standards that apply to you. This includes seeking advice and support from education providers, employers, colleagues, professional bodies, unions and others to ensure that the wellbeing of service users is safeguarded at all times. So long as you do this and can justify your decisions if asked to, it is very unlikely that you will not meet our standards.

We recognise that our registrants work in a range of different settings, which include direct practice, management, education, research and roles in industry. We also recognise that the use of terminology can be an emotive issue.

Our registrants work with very different people and use different terms to describe the groups that use, or are affected by, their services. Some of our registrants work with patients, others with clients and others with service users. The terms that you use will depend on how and where you work. We have used terms in these standards which we believe best reflect the groups that you work with.

In the standards of proficiency, we use phrases such as 'understand', 'know', and 'be able to'. This is so the standards remain applicable to current registrants in maintaining their fitness
to practise, as well as prospective registrants who have not yet started practising and are applying for registration for the first time.

These standards may change in the future We have produced these standards after speaking to our stakeholders and holding a formal public consultation. We will continue to listen to our stakeholders and will keep our standards under continual review. Therefore, we may make further changes in the future to take into account changes in practice.

We will always publicise any changes to the standards that we make by, for instance, publishing notices on our website and informing professional bodies.

We also expect you to keep to our standards of conduct, performance and ethics and standards for continuing professional development. We publish these in separate documents, which you can find on our website.

Registrant radiographers must:

1.1 know the limits of their practice and when to seek advice or refer to another professional

1.2 be able to manage their own workload and resources effectively and be able to practise accordingly

3.1 understand the need to maintain high standards of personal and professional conduct

3.2 understand the importance of maintaining their own health

3.3 understand both the need to keep skills and knowledge up to date and the importance of life-long learning

4.1 be able to assess a professional situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem

4.2 be able to make reasoned decisions to initiate, continue, modify or cease radiotherapy treatment or diagnostic imaging examinations and record the decisions and reasoning appropriately

4.3 be able to initiate resolution of problems and be able to exercise personal initiative

4.4 recognise that they are personally responsible for and must be able to justify their decisions

4.5 be able to make and receive appropriate referrals

4.6 understand the importance of participation in training, supervision and mentoring

5.1 understand the requirement to adapt practice to meet the needs of different groups and individuals

5.2 understand the emotions, behaviours and psychosocial needs of people undergoing radiotherapy or diagnostic imaging, as well as that of their families and carers

5.3 be able to provide appropriate information and support for service users throughout their radiotherapy treatment and care or diagnostic imaging examinations

7.1 be aware of the limits of the concept of confidentiality

7.2 understand the principles of information governance and be aware of the safe and effective use of health and social care information

7.3 be able to recognise and respond appropriately to situations where it is necessary to share information to safeguard service users or the wider public

10.1 be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines

10.2 recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines

11.1 understand the value of reflection on practice and the need to record the outcome of such reflection

11.2 recognise the value of multidisciplinary team reviews and other methods of review

Download the standards of proficiency document

These standards are effective from Tuesday 28 May 2013.

Reviewing the standards of proficiency

We keep our standards under continual review, to look at how they are working and check whether they continue to reflect current practice. We also conduct a periodic review of the standards every five years.

We are currently in the early stages of reviewing the Standards of proficiency for all of our professions. This means that we are seeking feedback on the standards to highlight any areas that may need updating.

We hope to hold a public consultation on the standards during Summer 2020, but this is subject to COVID-19. This will be an opportunity for anyone to provide their comments on the Standards of proficiency.

We will publicise any changes to the standards that we make by, for instance, publishing notes on our website and informing professional bodies.

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Expectations of you You must meet all the standards of proficiency to register with us and meet the standards relevant to your scope of practice to stay registered with us. It is important that you read and understand this document.

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The standards of proficiency for physiotherapists

These standards came into effect on 1 September 2023, replacing previous versions.

These standards set out safe and effective practice in the professions we regulate. They are the threshold standards we consider necessary to protect members of the public.

Professionals must meet all the standards of proficiency to register with us and meet the standards relevant to their scope of practice to stay registered with us.

Expectations of you

A note about our expectations of you
You must meet all the standards of proficiency to register with us and meet the standards relevant to your scope of practice to stay registered with us.

If your practice is called into question, we will consider these standards (and the standards of conduct, performance and ethics) in deciding what action, if any, we need to take.

The standards of proficiency complement information and guidance issued by other organisations, such as your professional body or your employer. We recognise the valuable role played by professional bodies in providing guidance and advice about good practice which can help you to meet the standards in this document.

We also expect registrants to meet the HCPC standards of conduct, performance and ethics and standards for continuing professional development.

Your scope of practice

Your scope of practice
Your scope of practice is the area or areas of your profession in which you have the knowledge, skills and experience to practise lawfully, safely and effectively, in a way that meets the standards and does not pose any danger to the public or to yourself.

We recognise that a registrant's scope of practice will change over time and that the practice of experienced registrants often becomes more focused and specialised than that of newly registered colleagues. This might be because of specialisation in a certain area or with a particular client group, or a movement into roles in management, education or research. Every time you renew your registration, you will be asked to sign a declaration that you continue to meet the standards of proficiency that apply to your scope of practice.

Your particular scope of practice may mean that you are unable to continue to demonstrate that you meet all of the standards that apply for the whole of your profession.

As long as you make sure that you are practising safely and effectively within your given scope of practice and do not practise in the areas where you are not proficient to do so, this will not be a problem. If you want to move outside of your scope of practice, you should be certain that you are capable of working lawfully, safely and effectively. This means that you need to exercise personal judgement by undertaking any necessary training or gaining experience, before moving into a new area of practice.
More information on scope of practice

Meeting the standards

Meeting the standards
It is important that you meet these standards and are able to practise lawfully, safely and effectively. However, we do not dictate how you should meet the standards. There is normally more than one way in which each standard can be met and the way in which you meet the standards might change over time because of improvements in technology or changes in your practice.

We often receive questions from registrants who are concerned that something they have been asked to do, a policy, or the way in which they work might mean they cannot meet the standards. They are often worried that this might have an effect on their registration.

As an autonomous professional, you need to make informed, reasoned decisions about your practice to ensure that you meet the standards that apply to you. This includes seeking advice and support from education providers, employers, colleagues, professional bodies, unions and others to ensure that the wellbeing of service users is safeguarded at all times. So long as you do this and can justify your decisions if asked to, it is very unlikely that you will not meet the standards.

Language
We recognise that our registrants work in a range of different settings, which include direct practice, management, education, research and roles in industry. We also recognise that the use of terminology can be an emotive issue.

Our registrants work with very different people and use different terms to describe the groups that use, or are affected by, their services. Some of our registrants work with patients, others with clients and others with service users. The terms that you use will depend on how and where you work. We have used terms in these standards which we believe best reflect the groups that you work with.

In the standards of proficiency, we use phrases such as 'understand' and 'know'. This is so the standards remain applicable to current registrants in maintaining their fitness to practise, as well as prospective registrants who have not yet started practising and are applying for registration for the first time.

These standards are effective from 1 September 2023.

The standards include generic elements, which apply to all our registrants, and profession-specific elements, which are relevant to registrants belonging to one of the professions we regulate.

The standards are not hierarchical and are all equally important for practice.

The generic standards, which apply to all professions, are written in bold text.

The profession-specific standards are written in plain text.

At the point of registration, physiotherapists must be able to:

1.2 recognise the need to manage their own workload and resources safely and effectively, including managing the emotional burden that comes with working in a pressured environment

1.3 keep their skills and knowledge up to date and understand the importance of continuing professional development throughout their career

9.2 manage records and all other information in accordance with applicable legislation, protocols and guidelines

9.3 use digital record keeping tools, where required

10.2 recognise the value of multi-disciplinary reviews, case conferences and other methods of review

We first published standards of proficiency for physiotherapists when our Register opened in July 2003.

We review the standards regularly to look at how they are working and to check whether they continue to reflect current practice in the professions we regulate. Our most recent review began in 2019 and included a formal consultation and close collaboration with key stakeholders, registrants and professional bodies. The revised sets of standards for all 15 professions were formally approved by our Council in March 2022 and came into effect on 1 September 2023.

The profession-specific standards for physiotherapists were developed with the input of the relevant professional bodies and the views of stakeholders during our consultation work. We are confident that the standards are fit for purpose and reflect safe and effective professional practice in physiotherapy.

As part of our commitment to ensuring the standards remain relevant to current professional practice, will continue to listen to our stakeholders and keep the standards under regular review.

This may result in updates to the standards in future, which may include corrections, amendments or changes to ensure the standards remain relevant.

This is a crucial component in fulfilling our purpose to promote excellence in the professions we regulate, and championing high quality care that the public can access safely and with confidence.

This document contains minor amendments to typographical errors, meaning it may differ slightly from previous versions published on our website.

The publication code for these standards is 20230901POLPUB PHSoP .

What's changed?

On 1 September 2023 the updated standards of proficiency came into in effect, which included changes to the standards for all professions and changes to profession-specific standards.

To see the changes between the previous and updated sets of standards, download the comparison table for physiotherapists.

You can also view information on the view key changes for all professions, access comparison tables for the other professions. helpful resources or

Published:

01/09/2023

Resources

Standards and guidance

Subcategory:

Professional standards

Audience

Registrants

Profession

Physiotherapists

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These standards came into effect on 1 September 2023, replacing previous versions. These standards set out safe and effective practice in the professions we regulate. They are the threshold standards we consider necessary to protect members of the public.

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