3.2. Describe factors that influence national and local service delivery

This guide will help you answer 3.2. Describe factors that influence national and local service delivery.

Service delivery in health and social care depends on many factors, both nationally and locally. These factors shape how care is provided, who can access it, and how effectively services meet the needs of individuals and communities. Understanding these factors can help care workers deliver the best possible support while recognising the challenges and pressures on the system.

Government Policies and Legislation

The government creates laws and policies to guide health and social care services. These establish how services are funded, regulated, and prioritised. For example, the Health and Social Care Act 2012 reformed how healthcare is commissioned and delivered in England. It introduced Clinical Commissioning Groups (CCGs), run by GPs, to plan and buy health services for local populations.

Key acts influencing care delivery include:

• The Care Act 2014 – Sets duties for councils to assess care needs and promote wellbeing.
• The Equality Act 2010 – Aims to prevent discrimination and ensure equal access to services.
• The Children Act 1989 – Focuses on protecting and supporting children and families.

When the government updates legislation, organisations must adjust their services. This can involve staff training, developing new systems, or focusing on specific priorities like mental health or prevention.

Funding and Budgets

Health and social care services depend on funding from the government. This money comes through national budgets, such as the NHS budget, and local authority funding for social care. Limited funding can mean services need to prioritise urgent needs, which may lead to waiting lists or fewer preventative services.

For example:

• NHS England gets funding via general taxation, influencing national healthcare services.
• Local councils manage social care budgets, which vary depending on area-specific needs.

Cuts to funding or changes in allocations can impact the availability of services, especially in deprived areas. Funding challenges also place pressure on recruitment, training, and purchasing of equipment.

Population Demographics

The age, ethnicity, and overall health of the population directly impact the demand for services. For example:

• An ageing population increases demand for nursing homes, carers, and community-based services.
• Areas with high birth rates may need more maternity care, health visitors, and paediatric services.
• Communities with diverse ethnic groups may need multilingual staff or culturally sensitive services.

Demographic information helps services plan their delivery. For example, urban areas with high population turnover may prioritise walk-in centres, while rural areas may rely more on community-based outreach.

Local Health and Social Care Needs

The health and social challenges in an area significantly influence service provision. Local authorities conduct ‘Joint Strategic Needs Assessments’ (JSNAs) to identify these needs. Using the results, they decide which services to make available.

Examples of local variations include:

• Higher levels of long-term conditions like diabetes in one area may lead to more diabetes clinics and specialist nurses locally.
• High unemployment or poverty rates may mean more mental health services and housing support are needed.

These needs can shift rapidly, such as during a disease outbreak or economic downturn, meaning services must adapt quickly.

Workforce Availability

Service delivery relies on a skilled and knowledgeable workforce. This includes doctors, nurses, carers, social workers, and support staff. The availability of qualified staff impacts how services can be delivered.

Challenges include:

• Shortages of trained health and social care professionals, particularly in rural or less affluent areas.
• Retaining staff in demanding roles with high stress or low pay.
• Recruiting new staff with appropriate skills during times of higher demand.

Organisations depend on workforce planning to ensure there are enough professionals available in the right locations.

Technological Advancements

Technology plays a big role in modern service delivery. It is used to diagnose illnesses, monitor patients, and deliver treatments. Records are stored digitally, and telemedicine enables consultations via video.

Benefits include:

• Quicker access to specialists.
• Electronic records shared easily across different services.
• Improved monitoring for patients with long-term conditions, using wearable devices.

However, rolling out new technology may be slower in underfunded areas or for people unfamiliar with using digital tools.

Partnership Working

Effective health and social care often requires strong partnerships between services and organisations. Hospitals, GPs, care homes, mental health teams, charities, and private providers need to work together to meet community needs.

For instance:

• A person leaving hospital may need follow-up care from their GP, rehabilitation services, and support with personal care at home.
• Charities like Age UK or Mind may fill gaps in services for older people or those with mental health challenges.

Breakdowns in communication between organisations can lead to serious problems, like delays in care or patients falling through the gaps.

Social and Economic Factors

Social determinants of health, such as housing, employment, and education, influence service needs. Deprivation or high unemployment in an area can increase demand for social care, mental health services, and housing support.

For example:

• Homelessness can create higher demand for health services, as those without shelter are more likely to face long-term health problems.
• Poor air quality in urban areas can lead to more respiratory issues, requiring more NHS resources.

Services need to respond sensitively to the challenges people face in everyday life, beyond their immediate health or care needs.

Cultural and Religious Influences

Cultural and religious beliefs affect how people access and respond to services. For example:

• Some groups may prefer same-sex carers for personal care tasks.
• Religious observances may impact when or how people receive treatment.

It can improve satisfaction and outcomes when services respect and adapt to these preferences.

Emergency Situations

Emergency events such as pandemics, natural disasters, or large-scale accidents place sudden, high demand on services. For example, the COVID-19 pandemic led to increased use of intensive care units, community testing programmes, and vaccination sites.

Crises often require services to prioritise urgent needs over routine care. Resources are reallocated, and staff may take on new or additional roles to cope with demand.

Inspection and Regulation

National and local services are inspected to ensure they meet quality standards. Regulators like the Care Quality Commission (CQC) in England assess whether services are safe, effective, caring, and well-led.

Outcomes from inspections influence:

• Funding and commissioning decisions.
• The reputation of providers.
• Confidence among those using the services.

Failing services may face penalties, such as being taken over by another provider or being shut down.

Public Expectations

Public opinion and expectations shape how services are designed. People expect timely access to care, high standards, and respect for their preferences. If services fail to meet expectations, public inquiries or media attention can push for reform.

Feedback from the public also helps improve services, as surveys or complaints highlight what is working and what needs attention.

Barriers to Access

Some people face barriers that prevent them from easily accessing services. Barriers include:

• Lack of transport in rural areas.
• Physical disabilities preventing access to certain buildings.
• Language barriers for those who do not speak fluent English.

Addressing these issues makes services more inclusive and equitable.

Final Thoughts

Health and social care delivery is influenced by a wide range of factors nationally and locally. These include laws, funding, population needs, workforce challenges, and technological developments. Social and cultural factors, public feedback, and emergencies also play significant roles. By recognising these factors, professionals can better adapt to challenges and deliver high-quality, effective care.