The Role of Other Service
Providers
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A team of professionals who work together
to provide the best care for end of life
patient.
Multi-disciplinary and multi-agency working
involves appropriately utilising knowledge,
skills and best practice from multiple
disciplines and across service provider
boundaries, e.g. health, social care or
voluntary and private sector providers to
redefine, re-scope and reframe health and
social care delivery issues and reach
solutions based on an improved collective
understanding of complex patient need(s).
Delivering continuity of care requires
individuals and organisations to think and
work in a joined-up way so that each is
aware and acts in full knowledge of the
other. This will require active partnerships
particularly between the NHS, social care
and the voluntary sector. Expertise and
insight should be shared to ensure that
system-wide specifications and joint
accountability for outcomes for care are
developed and delivered.
Information sharing agreements will help
support working together, although their
absence should never obstruct necessary
and appropriate sharing. Central to all this
should be the appreciation that a
person-centred approach to care requires
attention to the continuity of the
relationships that are built with that
person, the continuity of the information
that is shared with and about them, and
the continuity of how their care is
managed.