'Is evidence-based care the best way of ensuring that we get

Evidence--based care comes from research-based evidence. It is this research which is collated by specialists and written up into journals or guidelines that current care practice is based on. These studies are forwarded to health care employers who in turn pass this information on through training of their staff to keep practices up to date (Open University, 2015, p89).

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The basis of evidence-based research is to learn and evolve from previous practice, what was at one time seen as best care practice becomes outdated with newer research providing much better care and improve services.

One such organisation is The National Institute for Health and Care Excellence (NICE) produces evidence-based guidance for healthcare professionals.

The advantages of evidence-based care is to enable care workers to remain up to date on the training they receive. Having research-based evidence prevents harm from occurring, knowing what will work well, not using unnecessary treatments, which would not benefit the service user thus saving resources which could be wasted by providing unnecessary treatment such as prescribing antibiotics for ear infection in children (Open University, 2015, p89).

The disadvantages of evidence-based care are numerous. The guidelines are in place to advice of what works. There needs to be flexibility for both care professionals and service users within the guidelines. The most important person is the service user who must be allowed to express their wishes (Open University, 2015, p90).

Indeed, this does not always occur, service users have stated they feel they are not always involved with decision making regarding their health or care (Open University, 2015, p90). Some service users may feel a suggested treatment is not suitable for them, whether through unwillingness to try or embarrassment. The idea that something will work well may not allow a person to maintain their independence which to them is the most important part. Another factor could be evidence- based care does not allow for care professionals to use their intuition and knowledge of a person to assess a situation which can in turn undermine their skill and expertise (Open University, 2015, p90).

Getting care right involves using a person-centred approach in the planning and continual care of an individual, involving the person in the decision making of what care or treatment they wish to receive. Providing good care can be a challenge to a healthcare practitioner. However, it can be achieved by maintaining staff levels, holding staff accountable for their actions through careful monitoring of their work by carrying out reviews of records such as care plans, assessments, regular mandatory training and staff appraisals and giving support to other healthcare professionals. Having the time to spend on the service user to engage with them in conversation, getting to know who they are, what they like through communication will allow for greater care being provided

Unacceptable care stems from various issues such as understaffing, lack of up to date training, lack of time to spend with the service user, embarrassment in carrying out tasks such as personal care, failure to follow the code of conduct and a lack of empathy with the service user who may struggle with everyday tasks. In the case study of Marie, a care worker at Millstream Court (Open University, 2015, pp.12-17), after completing mandatory training she went out to work with a senior carer. Marie had little experience, felt ill at ease and embarrassed with some of the task's she had to perform such as providing personal care for a male service user. Marie continued to struggle with work but was unprepared for some aspects of the care worker role. Her inability to ask for advice and lack of support from her fellow carers or management made the provision of care unacceptable.

It can seem care agencies or residential homes have a high demand for staff and often employment is based on covering a need rather than employing a person who is capable of the role. The Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England are a set of standards that care professionals such as Marie are required to adhere to in terms of their behaviour and attitude in providing safe care and support. These set of standards which when put into practise should mean service users get the right care at the right time. A failure to adhere to these can unfortunately result in abuse occurring.

Accountability is being able to justify your actions and showing you have completed your job role within its description, follow company policies, procedures and adhere to the Code of Conduct. It is not only the employee's responsibility but also the employers to ensure best care practise is used. Health care workers must also be held accountable to the service user and be able to show why they carry out such tasks in a way which prevents harm. The expectancy of transparency within care is much higher now than it ever has been with employers need to maintain high standards and are regulated by the Care Quality Commission (CQC) an external body who oversee all health care services in England, ensuring they provide safe effective care (Open University, 2015, p78). To ensure staff can give valid reasons for their actions and justify why they completed or did not complete a task, they must fill in paperwork and records of each visit. The records held are a vital part of care work although they often do not show a complete picture of an individual's life. The documents are a way of formal accountability for staff so long as they are accurately maintained. Care professionals do often find they spend more time filling in forms instead of caring which in turn can cause frustration to both parties. This could be deemed as neglect when a care worker spends more time writing up notes than engaging with or providing support to the service user.

The alternative approach to evidence-based care could be knowledge-based care (Open University, 2015, p94). This approach is based on both knowledge and research- based evidence. It comes from putting more emphasis on both the practitioners and service user's previous experiences. With any decisions made being based on all information not just what works the best within the guidelines. SCIE (Social Care Institute for Excellence) is one organisation which is in place to improve the adult social care sector. An example of how an alternative approach may be better could be the case study of Christine Johnson a Health Visitor who uses NICE guidelines to offer advice to a worried parent regarding bed-wetting of her eight-year-old daughter Madison. The advice given in the guidelines is outdated from 2010. Having a familiarity with the family could allow Christine to offer advice and take the parent Ashleigh's opinion into account on what may or may not work. As some of the suggestions in the guidelines may not be suitable for Madison (The Open University, 2015)

Protocols and guidelines are in place to protect both the service user and the care provider. They are usually in the form of instructions which many companies work from. These guidelines should involve service user opinion but often do not take them into consideration. As discussed by Marilyn Francis in the audio case study, (Open University, 2015) who feels that working from a set of guidelines is best for patient and care worker safety. Especially in todays society where blame is placed when things go invariably wrong. Guidelines are a set of recommendations but can have flexibility to suit the needs of the individual. These guidelines are based on evidence-based research so are known to work and what doesn't. It makes providing care in a supportive and structured way easier. Also, being able to pass information on to service users what the research shows allows for safer support. Protocols came into being after pressure from insurance agencies stemming from a rise in negligence claims mainly in hospital environments. The management placed blame on individuals instead of acknowledging failures within the system and limited flexibility. There are some health care professionals feel that protocols can have a negative effect on their job role by 'deskilling' them, taking away from correct training needs and not allowing them to provide more flexible care.

Indeed, what works on paper may not work in practice, while something may not be suitable for one person it could work perfectly well for another. There seems to be far too much emphasis on paperwork and accountability within care than ever. People want more information to make informed choices and clarity on why they should do things in a way that they may feel is not suitable to them. Furthermore evidence-based care can become outdated quickly, healthcare is a rapidly changing profession and what may be suitable today could potentially be a cause of harm tomorrow. Although the research also shows that the guidelines do very often work it can be difficult at times to implement them in a working environment. Guidelines and protocols are in place to support professionals to improve the quality of care they provide to service users but at times they can also limit the provision of care. Knowledge -based care seems a good alternative as it uses both approaches to provide safe effective care and takes into consideration evidence- based care, the professional and service user opinion.