Stakeholder as one who is involved in or affected by a course of action. Patients are part of the stakeholder group that both pays for our health care system and are the end-user of it. The interests of health care organizations, medical professionals and other health care providers are represented through various government bodies, professional organizations and labour unions.

We must try and understand quality considering the perspectives of staff and also perspectives of those who use services. Quality might have the same outcome but opinions of the health and social care staff and the patients might be quite different.

In simple terms, quality is fitness for purpose. Quality is about meeting the service users’ requirements. If quality is about meeting service users’ requirements, it is important to discover what these requirements are. If we provide services with extras that service users don’t want, we will not be adding quality.

Stakeholders can be the external agencies eg Care Quality Commission; Supporting People; National Institute for Clinical Excellence; Health Service Commissioners; local authorities; users of services eg direct users of services, families, carers; professionals; managers; support workers.

There are many organisations in the UK known as health and social care regulators. Each organisation oversees one or more of the health and social care professions by regulating individual professionals across the UK. These organisations, also known as regulators, were set up to protect the public so that whenever you see a health or social care professional, whether private or in the NHS, you can be sure they meet the standards set by the relevant regulator.

To practise profession in health and social care, people must be registered with the relevant regulator. If they are not registered and still practise, then they are breaking the law and they may be prosecuted. These registers are made up of only those professionals who have demonstrated that they have met the standards set.

These registers are open to the public. So if you want to check your professional is registered, you can do this either online or by calling the relevant organisation.

In health and social care, professionals, clinicians and others, whose work is informed by traditional bodies of knowledge, are increasingly aware of the need for continuous personal development. High- quality services cannot be sustained unless health and care staff are consistently engaged in learning, individually and together.

All care services need to work to standards and have a system for measuring that they are meeting standards. The health care system has audits which check that services meet quality standards, while social services have inspection units which register and inspect services. Standards are influenced by laws, subsequent regulations, codes of conduct and values.

All organisations such as homes, day centres or community services, need a system to monitor how effectively services are being delivered and whether service users’ are having their needs met. Organisations may have their own quality monitoring systems. At a local level, quality assurance groups may seek to clarify, prioritise or set standards.

Different parts of the system and external agencies need to work together, as part of a culture of open and honest cooperation, to identify potential or actual serious quality failures and take corrective action in the interests of protecting patients.

CSCI’s report, The State of Social Care in England 2009, concludes that services do not meet the expectations. The report is believed to highlight that social care services are struggling to meet people’s needs. Fewer people are receiving the care they need to enable them to live independent lives in their own homes. It is all so understood that the report will say there are continuing and chronic difficulties in recruitment and retention of staff throughout the whole care sector.

People, whether they pay for their care or are publicly funded, are not always getting the individualised help that they need to make decisions about their support which in the long term can be costly to individuals, family carers, councils and the NHS.

People are not always getting quality personalised support, particularly those with multiple and complex needs, some of whom may have little, if any, choice about their care. There are concerns about people who are ‘lost to the system’ because they are ineligible for publicly funded support or are ‘self-funders’.

There is an increased demand and resources are limited which is putting a lot of pressure. The report states that people who have complex needs are not getting personalised care. It notes excellent examples of people receiving the support they need but adds that too many people are not getting the right amount of personalised care.

Many people do not get the information, advice or support they need to help them make informed choices about their care.