Research Topics in Insurance Paper Example | Topics and Well Written Essays - 500 words

Topics in Insurance - Research Paper Example At the same time, it can also cover those who are bellow this specified age, but have special needs- the disabled or those suffering from the end stage renal disease. Under this scheme, one is eligible to be covered for the hospital bills under the umbrella of category ‘A’ at the same time, one can enjoy insurance coverage under part ‘B’ or be covered for the prescription of drugs under the scheme’s part ‘B’ This scheme however differs from the Medicaid programme because it mainly focuses on the elderly people at the age of 65 years and above. On the other hand, the Medicaid programme is open to any person in any age group. Similarly, the Medicare scheme solely relies on the federal government for funds while the Medicaid does not entirely depend on the federal government for funding. Part of its budget is footed by the respective semi- autonomous state governments. Medicaid insurance on the other hand relies on the federal government to offer health coverage or to provide home nursing for a specified category of people in the United States of America (US General Accountability Office, 2000). Such categories of people eligible for coverage under this noble programme are the low income earning people in the American society. They include the children, parents of eligible children, the elderly, pregnant women and the disabled who may be in a dire need for home nursing. Ideally, this programme was designed to help the categories of people to afford medical bills under the Medicaid programme, an eligible person is entitled to be wholly or partly be assisted to settle their medical bills. Generally, there are two distinct types of Medicaid- Community Medicaid and the Medicaid nursing. Community Medicaid in its part was designed to assist people who a little or no medical insurance schemes at all. However, medical nursing home scheme on the other hand, is meant for

The role of procoagulant microparticles in haemostasis Essay

The role of procoagulant microparticles in haemostasis - Essay Example Procoagulant MPs mostly appear as a result of apoptosis and vascular cell activation. An increase in the level of monocyte, platelet, or endothelial-derived MPs circulating in the blood is associated with CVD risk factors and indicates poor clinical outcome. They indicate vascular cell damage and interfere with atherothrombosis by exerting effects on vascular and blood cells. Under disease conditions, cellular cross-talk is supported by circulating MPs support, which leads to vascular inflammation, leukocyte adhesion, endothelial dysfunction, and stimulation. Functional tissue factor and exposed membrane phosphatidyserine are procoagulant entities produced by circulating MPs. Platelet derived MPs (PMPs) contain anionic phospholipid PS, which makes them strongly procoagulant. The removal of MPs from the blood of normal human plasma prolongs the clotting time (Ahn, 2005). Platelet derived MPs support thrombin generation in plasma without platelets, which are important for blood clottin g. Platelets form an important substrate for coagulation and their membranes provide a surface for the formation of prothrombinase complex. This enzyme is utilized in the conversion of fibrinogen to fibrin which combines with other factors to form a stable clot (Lawrie et al, 2009). The availability of platelet MPs at the site of vessel injury contributes to the clotting process by providing a large surface membrane necessary for enzymatic process. The exposure of phosphotidyserine during thrombin generation increases enzymatic catalytic effect. The large surface formed by MPs is necessary for activating the coagulation cascade that forms the fibrin clot. Circulating MPs harbor cytoplasmic effectors or functional membrane that promotes prothrombotic responses (Ay et al, 2009). These MPs channel their procoagulant potential to the target in the presence of the appropriate counter ligands. They bind onto soluble immobilized fibrinogen forming aggregates that enhance the delivery of pr ocoagulant entities. In vitro, TF and TF-dependent procoagulant mechanism is facilitated by the interaction of monocytes and endothelial MPs. TF is a constituent protein in minute amounts that flips the endothelial procoagulant properties resulting in the initiation of a TF-driven clotting process. Blood-borne TF can be incorporated in the developing thrombus through a series of TF-dependent, CD15 and CD18, and interactions. Blood-borne TF is mainly harbored by PMPs and monocyte-derived MPs provide the enzyme after lipopolysaccharide stimulation. Polunuclear leukocytes and endothelial-derived MPs also produce blood-borne TF under drastic endothelial activation. These MPs provide the required amount of TF and circulate the enzyme, which is necessary for maintaining a hemostatic balance. MPs, selectins and TF merge into an important triad of thrombosis. The surfaces of platelet and endothelial cells contain an important adhesion molecule called P-selectin (Hugel et al, 2005). The mole cule is utilized during TF accumulation and leukocyte inclusion in the thrombus when an endothelial injury occurs. The accumulation of hematopeic cell-derived TF is similar to the MPs accumulation kinetics before leukocyte-thrombus interaction. A soluble P-selectin enhances the production of leukocyte-derived TF-MPs used to correct hemostasis. The plasma levels of microparticles increase with age, which indicates the contribution of P-selectin pathway. P-selectin pathway also favors the transfer of PF into monocyte derived

Reward Management Essay Example | Topics and Well Written Essays - 1500 words

Reward Management - Essay Example Unarguably, reward management is a sensitive and controversial area that has been extensively debated at both practical and theoretical levels. 'The significance of pay as a means of attracting, retaining and providing tangible rewards to people is not to be underestimated. It is important to get it right - much harm can be done by getting it wrong. But as a means of generating long-term commitment and motivation, pay has to be regarded as only part of the whole. It is the non-financial rewards that will ultimately make the difference." Michael Armstrong and Duncan Brown Reward structures can speak volumes; not only in their implications of values, equality and worth to the employees and the community they serve, but to the performance of the authority itself. In this context, it is important for the organization to realize that the organizational rewards have many meanings for employees. There are two values associated with every reward - surface and symbolic. The surface value of a reward to an employee is its objective meaning or worth (a measure of spending power of the employee). In addition to the surface value, every reward also has a symbolic value, which is simply the personal or subjective meaning the employee attaches to it. However, a high salary doesn't always mean a high satisfaction with salary! Nor does a rise in salary necessarily translate into a corresponding rise in satisfaction. The DQ-IDC IT-survey of 2004 reveals this very fact . HP, the best paymaster in the industry, has many employees who look dissatisfied with their salary levels. The employees at Siemens also tend to echo the HP employees' views. On the other hand Mindtree, which is near the bottom of the table in terms of size of the packet, has relatively satisfied employees. So does TCS. And Oracle employees are quite satisfied with their salaries despite Oracle featuring quite low on a ctual salaries. It is results like these that make Maslow's hierarchy of needs look like the absolute truth. In short, managers need to tune in to the many meanings rewards can convey - not only to the surface messages but to the symbolic messages as well. Types of rewards Organizations use various types of rewards (listed below) which when combined form the compensation package of the individual. * Base Pay * Incentive systems * Benefits * Perquisites, and * Awards In the Indian context, while the base pay package (the most important rewards people receive for their work) has seen an increase of 11.3%, an interesting feature to be noted is the rising prevalence of variable pay plans. According to the Asia Pacific Salary Increase Survey conducted by Hewitt , a greater proportion of respondents reported having a variable pay plan in 2004 (88.1%) as compared to 2003 (85.3%). Clearly, performance-based pay which was confined to the higher echelons of management is now creeping in to the lower grades as well. Another matter of debate in

The role of procoagulant microparticles in haemostasis Essay

The role of procoagulant microparticles in haemostasis - Essay Example Procoagulant MPs mostly appear as a result of apoptosis and vascular cell activation. An increase in the level of monocyte, platelet, or endothelial-derived MPs circulating in the blood is associated with CVD risk factors and indicates poor clinical outcome. They indicate vascular cell damage and interfere with atherothrombosis by exerting effects on vascular and blood cells. Under disease conditions, cellular cross-talk is supported by circulating MPs support, which leads to vascular inflammation, leukocyte adhesion, endothelial dysfunction, and stimulation. Functional tissue factor and exposed membrane phosphatidyserine are procoagulant entities produced by circulating MPs. Platelet derived MPs (PMPs) contain anionic phospholipid PS, which makes them strongly procoagulant. The removal of MPs from the blood of normal human plasma prolongs the clotting time (Ahn, 2005). Platelet derived MPs support thrombin generation in plasma without platelets, which are important for blood clottin g. Platelets form an important substrate for coagulation and their membranes provide a surface for the formation of prothrombinase complex. This enzyme is utilized in the conversion of fibrinogen to fibrin which combines with other factors to form a stable clot (Lawrie et al, 2009). The availability of platelet MPs at the site of vessel injury contributes to the clotting process by providing a large surface membrane necessary for enzymatic process. The exposure of phosphotidyserine during thrombin generation increases enzymatic catalytic effect. The large surface formed by MPs is necessary for activating the coagulation cascade that forms the fibrin clot. Circulating MPs harbor cytoplasmic effectors or functional membrane that promotes prothrombotic responses (Ay et al, 2009). These MPs channel their procoagulant potential to the target in the presence of the appropriate counter ligands. They bind onto soluble immobilized fibrinogen forming aggregates that enhance the delivery of pr ocoagulant entities. In vitro, TF and TF-dependent procoagulant mechanism is facilitated by the interaction of monocytes and endothelial MPs. TF is a constituent protein in minute amounts that flips the endothelial procoagulant properties resulting in the initiation of a TF-driven clotting process. Blood-borne TF can be incorporated in the developing thrombus through a series of TF-dependent, CD15 and CD18, and interactions. Blood-borne TF is mainly harbored by PMPs and monocyte-derived MPs provide the enzyme after lipopolysaccharide stimulation. Polunuclear leukocytes and endothelial-derived MPs also produce blood-borne TF under drastic endothelial activation. These MPs provide the required amount of TF and circulate the enzyme, which is necessary for maintaining a hemostatic balance. MPs, selectins and TF merge into an important triad of thrombosis. The surfaces of platelet and endothelial cells contain an important adhesion molecule called P-selectin (Hugel et al, 2005). The mole cule is utilized during TF accumulation and leukocyte inclusion in the thrombus when an endothelial injury occurs. The accumulation of hematopeic cell-derived TF is similar to the MPs accumulation kinetics before leukocyte-thrombus interaction. A soluble P-selectin enhances the production of leukocyte-derived TF-MPs used to correct hemostasis. The plasma levels of microparticles increase with age, which indicates the contribution of P-selectin pathway. P-selectin pathway also favors the transfer of PF into monocyte derived

Educating in math Essay Example | Topics and Well Written Essays - 500 words

Educating in math - Essay Example Every problem in mathematics requires understanding of the underlying concept and using the ideas to solve the problem. By studying mathematics major, I have the opportunity to work on many mathematics problems in various topics such as geometry, calculus and statistics. Through the study of mathematics, my analytical skills will be enhanced, and this will help me think clearly. For instance, one of the analytical skills needed in mathematics is paying attention to detail. This will allow my mind develop the ability to think critically and come up with logical arguments. In addition, one the important skills in mathematics is the ability to investigate in order to understand and solve mathematics problems. This skill also contributes to improving my thinking through deeper analysis and examination of a problem. Studying mathematics involves interpreting texts, mathematical expressions, functions and graphs. As a student, I have to communicate these ideas to the teacher and fellow students in order to demonstrate my understanding. Therefore, through mathematics, my communication skills will be greatly enhanced. The math major course gives me the opportunity to engage with fellow students and the teachers in understanding mathematical concepts and solving problems. Communication is important in every aspect of life, and mathematics helps me improve on this important skill. This will be vital not only to my social life but also throughout my career. The knowledge acquired by studying mathematics major is important in enhancing creativity and innovation. In particular, the knowledge gained through studying various topics in mathematics will help me create solutions to current problems. For example, the ideas gained through the study of statistics could be used to provide creative solutions on how to manage an organization’s data. The math major course offers the flexibility one needs in providing creative and innovative solutions to various problems.

Essay on Assam Essay Example for Free

Essay on Assam Essay Assam has been aptly described by some as ‘the Shangrila of the North-Eastern India’ – a state having breathtaking scenic beauty, rarest floras and faunas, lofty hills, lush tea gardens, undulating plains, mighty waterways, dense forests, fertile valleys, etc. It lies as a jewel of exquisite beauty and charm on the Northeastern horizon of India. Since the days of Hiuen-Tsang it has fascinated the rest of the world with her aura of myth and mysteries, history and folklore, music and dance. Known as Pragjyotishpura (land of Eastern lights) in ancient time and Kamrupa in medieval times, Assam is the anglicised name for the state. The name of the state may have come from the word ‘Ahom the people who migrated to the Brahmaputra valley in the early 13th century and gave shape to the Assamese of today. The state lies between 89 °. 50†² to 96 °, 10†² E. longitude and 24 °. 30†² to 28 °, 40†² N. latitude. Seven Indian states and two foreign countries touch its boundary. Spread over an area of 78, 438 sq. km. State has a total population of 26, 638, 407 according to Census, 2001. We have a clear picture of Assam only from the early 13th cent, when the country was conquered by Ahoms. Later they were ousted by the Burmese, who handed over the area to the British by the treaty of Yandaboo in 1826. All the major races of the world such as, Austro-Asiatic, the Indo- Aryans, Indo-Tibetans, Indo-Burmese, Mongolians, etc. have combined to make the great Assamese people of today. Assam, however, has remained practically a land of Tibeto- Burmese people. Assamiya or Assamese is the lingua franca of the state. Assam can be divided into three natural regions, namely the Brahmaputra valley, the Barak valley and the Hilly regions. These regions are quite distinct from one another with regard to the composition of people, manner of living and culture. The mighty Brahmaputra along with Barak has nourished the state from time immemorial and has been a source of solace as well as a source of sorrow for the people of the state. The economy of the state is overwhelmingly agricultural and about 75% of the population directly or indirectly depends on this sector for their livelihood. Rice, fruits, aracanut, jute, sugar cane, and tea are the chief agricultural produce of the state. The state also produces nearly half of the country’s total output of tea. he state is rich in natural resources such as oil, gas, coal, and limestone. The perfect fusion of heritage, tradition, faiths, and beliefs of  numerous races has resulted in many festivals in the state. The main festivals of Assam are the ‘Bihus’ which are celebrated all over the state by every one with great pomp and grandeur. The most colourful amongst the three ‘Bihus’ is the spring festival known as Rongali Bihu. Nature has abundantly blessed Assam with charming sights and exciting natural scenery. Kaziranga National Park and Manas Sanctuary are the chief tourist centres famous for Royal Bengal tiger, one-horned rhinos and golden langur. The other attractions of the state are the famous Kamakhya temple near Guwahati, Umananda temple, Navagraha temple, Kareng Ghar, Rang ghar, Talatal Ghar, Majuli island, Jatinga, etc. Nestling in the Himalayan foothills the state is rich in cultural heritage, natural beauty, and mineral resources. There is no denying the fact that the state of Assam during the last fifty years has made great strides in many fields. But a lot more remains to be done to bring the state to the forefront of development and progress. Given better political stability, adequate stress on industrialisation, proper utilisation of resources available and less militancy, the state can leap forward to an era of prosperity and all-round development.

Child Observation Case Study

Child Observation Case Study Care has been taken to ensure the provisioning of adequate information to the mother of the child to be placed under observation. I have informed the mother of my reasons for conducting the exercise. I have reassured her on the protection of confidentiality of all my observations and have informed her that I will use a pseudonym for referring to her daughter in all my written work. I have accordingly asked her to chose a pseudonym for her daughter and have accepted her suggestion for calling the child Kirsty. Kirstys mother, Jane, has been informed that the child will not be influenced or pressurised in any way. She will be free to answer or not to answer questions and even to withdraw from the exercise at any time she so desires. I have obtained her consent to the conducting of the observation exercise in writing. The signed consent statement is available in Appendix 1. Whilst Kirstys father was not at home at the time of the study, Jane informed me that he was aware of the exercise and had agreed to the same. 1.3. Observation Process The exercise was conducted at the garden of Kirstys house. Kirsty lives with her parents in a small cottage near the beach. The house has a small fenced garden. It was quiet and sunny when the observation was conducted in the presence of Jane, and her neighbour, Priya, a young woman in her mid-twenties. Whilst it is recommended that the observation was conducted in the presence of the childs mother, care should be taken to ensure that she does not actively participate in the observation process. I carried the Sheridan Scale for 5 year olds for the exercise and noted my observations in the appropriate boxes during the observation process. The observation began at 11 am and continued for a couple of hours, wherein I observed Kirstys behaviour in the course of some small games that she played, first with her dolls and then with her set of building blocks. 1.4 Views of Family Jane informed me about Kirstys mild asthma, which had first surfaced when she was three and continued to trouble her even today. She was under medical treatment and her GP had advised her that most children outgrew childhood asthma by the time they were 15 or 16 years old. Jane informed me happily about the childs excessive attachment to her father, who had a travelling job and was out of the home for more than two weeks each month. Whilst both parents loved their daughter, the father absolutely doted on her and showered her with gifts when he was home. The child had of late begun to act wilfully and was apt to become very upset and show signs of aggressive behaviour if her wishes were not met immediately. Her school teacher had also spoken to Jane about Kirstys wilful behaviour athatupset once in a while. 1.5. Summarisation of use of Sheridan Scale and Assessment Framework Triangle Asthma, even if it is mild, is known to adversely affect the development of children. Janes information on the whole reinforced my findings from the application of the Sheridan scale for 5 year olds. I had carefully applied the Sheridan test for various parameters, including posture and large movements, vision and fine movements, hearing and speech, and, to some extent, social behaviour and play. Whilst the child responded positively to the various facets of the test, and was particularly proficient in dancing with me to tapping of feet, skipping, sketching and painting, she appeared to have trouble in skipping and in participating in more strenuous forms of physical activity. Her mother also became apprehensive if the child engaged in dancing and running. I also found her to be more wilful and apt to become upset if she did not find what she was looking for, or if her smaller wishes, like asking for a glass of water were not immediately fulfilled. She appeared to miss her father, who had to constantly go on business trips. The Common Assessment Framework triangle helped me in understanding the developmental needs of the child from three perspectives a) the developmental needs of the child b) family and environment factors and c) parenting capacity. Use of the CAF triangle helped me in realising that whilst the parents were taking good care of her various physical, health and educational needs, their overprotective nature was resulting in slowing down of her self care skills as well as her emotional and behavioural development. 2. Psychological Theories and Life Span Development Cognitive development is a process whereby a childs conception of the world alters with respect to age and experience. Cognitive psychology, primarily known as the developmental stage theory, seeks to explain the quantitative and qualitative intellectual abilities that occur during a childs developmental years. The work of Piaget is important in understanding human development. Piaget suggests that the idea of cognitive development is intrinsic to the human organism and language is contingent on cognitive development. Piaget proposed that reality is essentially a dynamic structure of continuous change, one that involves transformations and states. Whilst transformations refer to the various changes that a person/thing undergoes, states refer to periods in between transformations. A childs cognitive development is primarily dependent on his/her ability to adapt to various situations. Therefore, if human intelligence is to be adaptive, it must be able to represent both the transformational and static aspects of reality. He suggested that whilst operative intelligence directs dynamic or transformational aspects of reality, figurative intelligence represents static periods in between. In understanding cognitive development, Piaget essentially focuses on accommodation and assimilation. Whilst the former focuses on absorbing ones environment by altering pre existing schemas in order to fit the new information, the latter concentrates on assimilating new information by fitting it into pre existing cognitive schemas. Whilst placing Kirstys development within the context of Piagets stages of development in it recognises that children adopt particular types of behaviour and actions during each stage I feel that she was adequately well developed, both operatively and figuratively. Moreover, she was able to assimilate and accommodate to the environment with equal ease. Her enthusiasm to play Introduction Community care essentially aims to provide individuals in need with social, medical and health support in their own homes, as far as possible, rather than in residential establishments or in long-stay institutions. The enactment of the NHS and Community Care Act in 1990 marked a watershed in the evolution of community care practice in the UK (Means, et al, 2002, p 71). Implemented after years of discussion on the social and financial viability of maintaining people in institutions and homes, the NHS and Community Care Act, initiated by Margaret Thatcher, showcased her desire to radically change the practice and delivery of social and health care in the UK (Means, et al, 2002, p 71). The years following the passing of the Act have witnessed significant developments in the practice and delivery of social work in the country. This short essay attempts to investigate the basic reasons for the enactment of the NHS and the Community Care Act, its basic ideology and thrust, and its impact on the social work sector of the country. The essay also studies the developments in social care that have occurred in the years following the act, with particular focus on direct payments for people with learning disabilities, social care provisions for carers and the contemporary emphasis on personalisation. NHS and Community Care Act 1990 Whilst the initiation of the policy of community care in the UK is by and large attributed to Margaret Thatchers conservative government, the concept of community care, even at that time, was not exactly new (Borzaga Defourny, 2001, p 43). The need for community care existed from the beginning of the 1950s. It aimed to provide a better and more cost effective way to help individuals with mental health concerns and physical disabilities by removing them from impersonal, old, and often harsh institutional environments, and taking care of them in their home environments (Borzaga Defourny, 2001, p 43). Although various governments, since the 1950s, supported the need to introduce community care and tried to bring in appropriate changes, lack of concrete action on the issue resulted in constant increase of the number of people in residential establishments and large institutions during the 1960s, 70s and 80s (Borzaga Defourny, 2001, p 43). With numerous negative stories coming out in the media on the difficult conditions in such establishments, Sir Roy Griffiths was invited by Margaret Thatcher to investigate the issue of community care for the residents of such establishments and make appropriate recommendations (Harris, 2002, p 11). The Griffiths, (1988), Report named Community Care: Agenda for Action, followed by the publication of a White Paper Caring for People: Community Care in the Next Decade and Beyond in 1989 led to the enactment of the NHS and Community Care Act 1990 (Cass, 2007, p 241). Apart from being a strong attempt to improve the lives of people in long term institutions and residential establishments, the law was also an outcome of the conservative governments desire to bring market reforms into the public sector and stimulate the private sector to enter the social services, as well as its conviction that competitive markets would be better able to provide more economic services than a bureaucratised public sector (Harris, 2009, p 3). With social services being among the highest revenue spending departments at the local authority level and domiciliary and residential services for older people consuming the bulk of social service funds, community care for older people presented an obvious area for introduction and implementation of market principles (Harris, 2009, p 3). The act split the role of local and health authorities by altering their internal structures, so that local authority departments were required to ascertain the needs of individuals and thereafter purchase required services from providers (Lewis, et al, 1994, p 28). Health organisations, in order to become providers of such services, became NHS trusts that competed with each other. The act also required local social service and health authorities to jointly agree to community care plans for the local implementation of individual care plans for long term and vulnerable psychiatric patients (Lewis, et al, 1994, p 28). The act has however come in for varying degrees of criticism from service users, observers and experts, with some observers claiming the altered care conditions to be unresponsive, inefficient and offering little choice or equity (Malin, et al, 2002, p 17). Other experts, who were not so pessimistic, stated that whilst the system was based upon an excellent idea, it was little better in practice than the previous systems of bureaucratic resource allocation and received little commitment from social services; the lead community care agency (Malin, et al, 2002, p 17). The commitment of local authorities was diluted by the service legacies of the past and vested professional interest, even as social services and health services workers were unable to work well together (Malin, et al, 2002, p 17). Little collaboration took place between social and health services and the impact of the reforms was undermined by chronic government underfunding. The voluntary sector became the main benefici ary of this thrust for the development of a mixed economy of care (Malin, et al, 2002, p 17). Developments after the Enactment of the NHS and Community Care Act The assumption of government by the labour party in 1997 resulted in the progressive adoption of numerous forward looking policies in various areas of social care. The publication of a white paper in 1998 reinforced the governments commitment to promotion of community based care and peoples independence (Means, et al, 2002, p 79). The paper focused on assisting people to achieve and maintain independence through prevention and rehabilitation strategies, with specific grants being introduced to facilitate their implementation. The Health Act of 1999 removed obstacles to the joint working of health and social services departments through provisions for pooling of budgets and merging of services (Means, et al, 2002, p 79). The formulation of the NHS plan aimed to improve partnership between health and social care, the development of intermediate care and the construction of capacity for care through cash for change grants for development of capacity across social and health care systems (Means, et al, 2002, p 79). Direct Payments for Individuals with Learning Disabilities The Community Care (Direct Payments) Act 1996, which came into operation in April 1997, marked a radical change in the provision of community care for people with disabilities, including those with learning difficulties (Tucker, et al, 2008, p 210). It was illegal, prior to the implementation of the act, for local authorities to support people with disabilities by making cash payments in lieu of providing community care services. Policymakers however realised that many local authorities were successfully supporting independent living schemes, centres for independent living and personal assistance schemes (Tucker, et al, 2008, p 210). Such schemes handled community care payments for disabled people and provided them with help to organise assistance or support. The Community Care (Direct Payments) Act built on this situation, allowing direct payments to be made to replace care services, which otherwise would be given by social service departments (Tucker, et al, 2008, p 210). Direct payments provide flexibility in the way services are provided to eligible people. The giving of money, in lieu of social care services, helps people to achieve greater control and choice over their lives and enables them to decide on the time and mode of delivery of services (Tucker, et al, 2008, p 210). Direct payments can not only be used for services to satisfy the needs of children or their families but also enables carers to purchase the services they need to sustain them in their roles. Research conducted in 1997 in the utilisation of direct payments by people with learning difficulties revealed that whilst utilisation of direct payments by people with learning disabilities was increasing, such utilisation was low among women and individuals from minority or black ethnic groups (Tucker, et al, 2008, p 210). Research also revealed the presence of wide differences in the interpretation of the capacity of persons for consenting to direct payments by local authorities. Whils t some local authorities felt that direct payments could be sanctioned to all persons with learning difficulties who were able, with assistance, to successfully control and use direct payments, other authorities did not heed the fact that such people could indeed be assisted to communicate decisions and consequently assumed their inability to consent to direct payments. Such interpretations, it was felt, could debar many people in need from obtaining the facility for direct payments (Tucker, et al, 2008, p 211). Assistance for Carers Recent years have seen a number of social care initiatives for easing the condition of carers. Carers are people who provide assistance and support, without payment, to family members or friends, who are unable to manage without such assistance, on account of illness, frailty or disability (Government Equalities Office, 2010, p 1). Carers can include adults who care for other adults, parents who care for disabled or ill children, or young people who care for other family members. The governments social care policies for carers include supporting people with caring responsibilities for (a) identifying themselves at early stages, (b) recognising the worth of their contribution, and (c) involving them from the beginning in designing and planning individual care (Government Equalities Office, 2010, p 1). Such policies aim to enable carers to (a) satisfy their educational needs and employment potential, and (b) provide personalised support, both for carers and the people they support, to enjoy family and community life and remain physically and mentally well. Whilst the NHS and community care Act 1990 looked at carers as valued resources because of their ability to provide support, it did not refer to their rights; relying instead on rhetoric to deliver the message of their value to society (Government Equalities Office, 2010, p 2). Succeeding years have however witnessed greater focus on the needs of carers and to progressive introduction of suitable laws and appropriate policies. The passing of the Carers (Recognition and Services) Act 1995 drew attention to the needs of carers. This was followed by the passing of the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004 (Government Equalities Office, 2010, p 2). These acts entitle carers for (a) assess ment of their needs, (b) services in their own right and support in accessing education training, employment and leisure opportunities. The proposed equality bill introduces four new opportunities for carers. It (a) requires public authorities to give due consideration to socio-economic disadvantages, whilst exercising strategic planning functions, (b) takes account of associative discrimination with regard to disabled people, (c) provides for prevention of indirect discrimination, and (d) calls upon public bodies to ensure that their policies are designed to eliminate harassment and discrimination and further equality of opportunity (Government Equalities Office, 2010, p 2). Personalisation The concept of personalisation in social care, whilst discussed for some years, was formally inducted into social care practice in the UK with the publication of Putting People First in 2007. The concordat outlined the concept of a personalised adult social care system, where individuals will have extensive control and choice over the services received by them. The government committed that social services would progressively be tailored to meet the preferences of citizens, with person centred planning along with self directed support becoming mainstream activities, assisted by personal budgets for maximising control and choice (Aldred, 2008, p 31). Whilst personal budgets and direct payments form an important aspect of personalisation, the idea concerns fitting services to the needs of people, focusing on outcomes, and recognising the worth of the opinions of service users assessing their own needs, planning their service, and producing their outcomes (Aldred, 2008, p 31). Conclusions and the Way Forward This essay investigates the reasons behind the enactment of the NHS and the Community Care Act and studies the developments in social care that have occurred in the years following the act, especially in areas of direct payments for people with learning disabilities, social care for carers and personalisation. It is obvious from the results of the study that social care in the UK has experienced significant change and metamorphosis since the enactment of the 1990 act. Whilst significant progress has been made a consensus s growing that the British social care system is facing a crisis because of drivers like increasing demographic pressures, alterations in family and social structures, rising public expectations, increasing desire for greater choice and control, and eligibility for services (Glasby, et al, 2010, p 11). The need to move people out of local accommodation because of rising rents exemplifies the challenges faced by the social care system. With the financial system becoming more challenging, the social care system will have to find ways of improving efficiencies without diluting the quality of care (Glasby, et al, 2010, p 11). The next round of social reforms, whilst attempting to achieve better delivery efficiencies will have to renew its commitment to satisfying social expectations and basic human rights, reducing costs, preventing future needs, helping people to regain independence, freeing individuals to contribute, and supporting carers to care and contribute to society (Glasby, et al, 2010, p 11).