2023 CCEA AS-Level Health and Social Care 0003 Practice Paper with Answers

Health can be defined as a state of complete physical, intellectual/mental, emotional and social well-being, and not merely the absence of disease or infirmity — i.e. health is a positive, holistic state, not simply the lack of illness.

[1] basic definition referring to physical and mental well-being; [2] full/adequate definition recognising health as a holistic, positive state (physical, mental/intellectual, emotional and social well-being) and not simply the absence of disease/illness. All other valid responses that convey this holistic understanding should be credited.

A stress-related illness is a physical or psychological illness (e.g. anxiety, depression, high blood pressure, or a physical illness with symptoms triggered or worsened by stress) that is caused, or made worse, by an individual's ongoing exposure to stress. From the case study, Kathleen's financial difficulty in affording fresh food, and/or her increasing anxiety about managing her diabetes, could each contribute to her developing a stress-related illness.

[1] basic definition of stress-related illness (illness caused/worsened by stress); [2] adequate definition with a named example of a stress-related illness or condition; [3] full definition PLUS correct identification of a specific relevant aspect of Kathleen's situation from the case study (e.g. financial worry over food costs, or anxiety about her condition). All other valid responses credited.

Kathleen lives in an area of high unemployment and previously worked as a cleaner (a lower-paid occupation), suggesting she may now be on a limited income; this social class/income factor makes it harder for her to afford fresh, healthy food, which could lead to a poor diet that is difficult to reconcile with the dietary management required for type 2 diabetes, making it harder to control her blood glucose levels and potentially worsening her physical health (e.g. increasing the risk of diabetes-related complications).

[1] basic identification of a relevant socio-economic factor from the case study (income/social class); [2] adequate explanation linking the factor to a physical health effect; [3] competent, fully-developed explanation clearly linking low income/social class to a specific physical health impact via diet/diabetes management. All other valid responses credited.

Managing type 2 diabetes may require Kathleen to follow dietary restrictions and attend regular medical appointments, which could make it harder for her to take part in social activities that revolve around food or that clash with appointment times; the condition may also cause fatigue or other symptoms that reduce her energy for socialising. Since Kathleen already lives alone, any reduction in her social activity could increase her risk of social isolation and loneliness, negatively affecting her social well-being.

[1] basic identification of a social effect (e.g. reduced socialising); [2] adequate explanation linking diabetes management to reduced social participation; [3] competent explanation that clearly connects diabetes-related lifestyle restrictions to social isolation, referencing Kathleen living alone. All other valid responses credited.

Kathleen's difficulty affording fresh food may make it hard for her to follow the recommended diet for managing type 2 diabetes; feeling unable to manage her diet as advised could cause her to feel guilt, worry or a sense of failure, contributing to increased anxiety and reduced self-esteem, and could increase her fear of her condition worsening (linking to the anxiety already described in the case study), negatively affecting her overall psychological/emotional well-being.

[1] basic identification of a psychological effect (e.g. worry/anxiety); [2] adequate explanation linking diet difficulty to a psychological effect; [3] competent explanation clearly connecting inability to afford/maintain the recommended diet to specific psychological impacts (anxiety, reduced self-esteem, fear of worsening health). All other valid responses credited.

A statutory organisation such as Kathleen's local Health and Social Care (HSC) Trust could support her by providing access to diabetes management clinics, a specialist diabetes nurse, dietetic advice and regular GP/practice nurse monitoring of her condition, helping her manage her diabetes more effectively and reducing the risk of complications; the Public Health Agency could also contribute more broadly through public health campaigns promoting healthy eating and diabetes awareness.

A voluntary organisation such as Age NI could support Kathleen (given her age) through services such as befriending schemes to reduce social isolation and loneliness, information and advice on benefits/financial support she may be entitled to (helping address her difficulty affording food), and social activities or groups that could improve her social and psychological well-being alongside the medical support she receives from statutory services.

[1-2] basic identification of a statutory organisation with limited/generic link to Kathleen's needs; [3-4] adequate discussion of a named statutory organisation (e.g. HSC Trust, Public Health Agency) with a specific, relevant service/contribution AND basic identification of a voluntary organisation; [5-6] competent discussion of both a named statutory organisation and a named voluntary organisation (e.g. Age NI, Marie Curie, or another valid NI voluntary organisation), each with a specific, well-explained contribution clearly relevant to Kathleen's circumstances (diabetes management, isolation, financial difficulty). All other valid, correctly-named organisations credited.

An indicative competent response would include:

Physical: poorly-managed diabetes (due to difficulty affording a suitable diet) increases the risk of long-term complications (e.g. cardiovascular disease, nerve damage, vision problems), directly reducing Kathleen's physical health and independence over time.

Intellectual: Kathleen must learn and apply new knowledge and skills to manage her condition (e.g. monitoring blood glucose, understanding dietary requirements, recognising warning signs), which can be cognitively and practically demanding, particularly alongside financial stress.

Emotional: the anxiety described in the case study, and any feelings of failure or worry about managing her diet and finances, could contribute to a stress-related illness, low mood, or reduced self-esteem, creating a cycle where poor emotional well-being makes it even harder for her to manage her diabetes effectively.

Social: living alone, combined with the practical restrictions of managing diabetes and limited income for social activities, increases Kathleen's risk of social isolation and loneliness, which can further worsen her psychological well-being.

Effects on income and employment: as a retired former cleaner living in an area of high unemployment, Kathleen's income is likely already limited; managing a chronic condition can bring additional costs (e.g. specific foods, prescriptions, transport to appointments), further straining her limited finances.

Effects on education: while Kathleen herself is retired, if family members (e.g. a grandchild) provide care or support for her, this could affect their own education (e.g. reduced time for schoolwork/reduced attendance if caring responsibilities increase).

Effects on leisure activities: Kathleen's reduced income and the practical demands of managing her condition may limit her ability to take part in leisure or social activities she previously enjoyed, further increasing isolation.

Effects on relationships: if family members take on a caring or supporting role for Kathleen (e.g. helping with shopping, appointments or finances), this could strain their own time, finances and relationships (e.g. balancing caring responsibilities with work or their own family life), though it could also strengthen family bonds through increased contact and mutual support.

Overall, Kathleen's diabetes and socio-economic circumstances interact and compound one another: financial hardship makes managing her diabetes more difficult, poor diabetes management increases physical health risks, and the resulting stress and potential isolation affect her emotional and social well-being, illustrating why a holistic understanding of health (addressing physical, intellectual, emotional and social needs together, alongside practical/financial support) is essential when supporting a service user such as Kathleen.

Levels-of-response (QWC) mark scheme, out of 12 marks.

Level 1 — Basic (1–4 marks): A limited discussion, addressing only one or two dimensions of well-being (e.g. physical only) with little or no reference to family/relationship effects; weak use of terminology; answer may lack structure. Cannot progress beyond this level if the answer addresses only physical impact with no reference to the other PIES dimensions or wider family effects.

Level 2 — Adequate (5–8 marks): A reasonably competent discussion covering most PIES dimensions (physical, intellectual, emotional, social) for Kathleen, with some reference to effects on family/relationships or on income/employment/leisure, but with limited depth or one area underdeveloped; generally clear communication with occasional lapses in terminology or structure.

Level 3 — Competent (9–12 marks): A full, well-organised discussion covering ALL FOUR PIES dimensions for Kathleen AND a clear discussion of the wider effects on family/those close to her, referencing relevant impacts on education, employment, income, leisure activities and relationships; shows clear understanding of the interconnected/holistic nature of these impacts (e.g. how financial hardship worsens health, which worsens social/emotional well-being); correct, precise use of specialist terminology throughout; coherent structure; accurate spelling, punctuation and grammar.

0 marks: No creditable response. Strict criteria caps apply: an answer omitting a required dimension (e.g. covering only Kathleen's own well-being with no discussion of family/wider effects) cannot reach Level 3 regardless of length or detail elsewhere.

A statutory organisation is one that is set up, funded and run by (or on behalf of) the government, providing services that the government is legally required to provide (e.g. the Department of Health, the Public Health Agency, and Health and Social Care Trusts).

[1] basic definition (organisation funded/run by government); [2] full definition referring to legally-required services provided by/on behalf of government. All other valid responses credited.

(i) Public Health Agency — statutory. (ii) Age NI — voluntary. (iii) a private nursing home — private/commercial. (iv) Health and Social Care Trust — statutory.

[0.5] each for each correctly matched organisation (rounded, award [1] per two correct, [2] for all four correct); all four correct required for full [2] marks; [1] mark for at least two correctly matched.

The World Health Organisation (WHO) is a global (United Nations) organisation that contributes to health and well-being by setting international health standards and guidelines, coordinating responses to global health threats (e.g. disease outbreaks/pandemics), publishing research and health data to guide policy, and supporting countries in strengthening their own health systems — its work influences national policy and practice in Northern Ireland, for example through guidance adopted by the Department of Health.

The Public Health Agency (a statutory organisation) contributes to health and well-being in Northern Ireland by leading and delivering health improvement and health protection programmes (e.g. immunisation programmes, screening services, and campaigns promoting healthy lifestyles such as smoking cessation or healthy eating), monitoring and reporting on the health of the population, and working to reduce health inequalities between different groups and areas.

WHO (3 marks): [1] basic identification of WHO's role (e.g. global health organisation); [2] adequate description of one relevant function; [3] competent discussion of WHO's contribution with a specific, relevant example (e.g. setting standards, coordinating global health responses). Named statutory organisation (3 marks): [1] basic identification (e.g. names an organisation such as Public Health Agency, DoH or a HSC Trust); [2] adequate description of a relevant function; [3] competent discussion with specific, relevant examples of services/programmes provided. All other valid, correctly-named organisations and functions credited.

The medical approach to health promotion focuses on preventing ill health through medical intervention, such as vaccination/immunisation programmes, screening for disease, and medical advice from health professionals. A strength of this approach is that it can be highly effective at preventing specific diseases at a population level (e.g. reducing the incidence of measles through vaccination); a weakness is that it can be seen as a 'top-down' approach that does not address the underlying behavioural or social causes of poor health, and depends on the public engaging with medical services.

The behaviour change approach focuses on encouraging individuals to change unhealthy behaviours or lifestyle habits (e.g. giving up smoking, taking more exercise, reducing alcohol intake) through advice, support and encouragement, on the basis that individuals are responsible for and capable of changing their own health-related behaviour. A strength is that it empowers individuals and can lead to long-term, sustainable improvements in health if successful; a weakness is that it can be difficult to achieve lasting behaviour change, particularly for individuals facing addiction, or social/economic circumstances (such as poverty) that make healthy choices harder to sustain, and it can be seen as unfairly placing responsibility on the individual rather than addressing wider social causes.

Medical approach (3 marks): [1] basic description; [2] adequate description with a relevant example (e.g. vaccination, screening); [3] competent description including at least one clear strength or weakness (evaluation). Behaviour change approach (3 marks): [1] basic description; [2] adequate description with a relevant example (e.g. smoking cessation, exercise); [3] competent description including at least one clear strength or weakness (evaluation). All other valid responses credited.

Marie Curie is a suitable voluntary organisation, as it specialises in providing care and support for people with a terminal illness. It could support Marcus specifically by providing nursing care in his own home or in a Marie Curie hospice, helping to manage his symptoms and pain, and by offering emotional and bereavement support both to Marcus and to his family members.

[1] correct/valid voluntary organisation named (e.g. Marie Curie, or another organisation clearly relevant to terminal illness/palliative care support); [1] basic description of a relevant service provided; [1] fully developed, specific description of how the named organisation would help Marcus and/or his family in this particular situation.

An indicative competent response would include:

Statutory organisations (e.g. HSC Trusts, Public Health Agency, DoH) are funded by government and are legally required to provide services, meaning they offer universal, free-at-the-point-of-use core health and social care to the whole population, and can plan and coordinate services at a large scale (e.g. national vaccination or screening programmes). A weakness is that statutory services are often under significant financial and demand pressure (e.g. long waiting lists), and being large, centrally-run organisations they can sometimes be less flexible or personalised in meeting individual needs.

Voluntary organisations (e.g. Age NI, Marie Curie, Mencap, Praxis) are typically not-for-profit and often rely on donations, fundraising and volunteers; a strength is that they can often respond more flexibly and personally to specific, sometimes niche, needs (e.g. specific conditions or groups) that statutory services may not fully cover, and can provide valuable emotional/practical support and advocacy. A weakness is that their funding can be less secure/predictable than statutory funding (dependent on donations), which can limit the scale or consistency of the services they can guarantee.

Private/commercial organisations (e.g. private nursing homes, pharmacies, private practitioners) are run for profit; a strength is that they can offer faster access to services (e.g. shorter waiting times for private treatment) and can increase overall service capacity/choice for those who can afford to pay. A weakness is that private care is not free, so access can depend on an individual's ability to pay, potentially increasing health inequalities between those who can and cannot afford private provision.

Overall evaluation: in practice, statutory, voluntary and private organisations often work together (e.g. HSC Trusts commissioning services from voluntary or private providers) to meet the full range of population health and well-being needs, since each sector has different strengths that can complement the others' weaknesses; a mixed model can therefore provide more comprehensive, responsive coverage than any one sector alone, though ensuring fair and equal access (regardless of ability to pay) across the different sectors remains an ongoing challenge.

Levels-of-response (QWC) mark scheme, out of 9 marks.

Level 1 — Basic (1–3 marks): Limited discussion, describing one or two sectors with little evaluation (strengths/weaknesses not clearly identified); weak terminology/structure.

Level 2 — Adequate (4–6 marks): Describes all three sectors (statutory, voluntary, private) with at least some evaluative comment (a strength or weakness) for most sectors, but evaluation may be underdeveloped or one sector may be covered in less depth; generally clear communication.

Level 3 — Competent (7–9 marks): Full, balanced evaluation of all three sectors, each with clearly identified and explained strengths AND weaknesses, and a reasoned overall conclusion/comparison (e.g. recognising the sectors' complementary roles); correct, precise use of specialist terminology; coherent structure; accurate spelling, punctuation and grammar.

0 marks: No creditable response. An answer that omits one of the three sectors entirely cannot reach Level 3, regardless of the depth of discussion of the other two.

Person-centred care is an approach to care that focuses on the individual service user as a whole person, placing their own preferences, needs, wishes and views at the centre of all decisions about their care, rather than fitting the individual around a standardised or organisation-led approach to care.

[1] basic definition (care focused on the individual); [2] full definition referring to the individual's preferences/needs/wishes being central to decisions about their care.

David's physical needs (e.g. personal hygiene, nutrition, mobility, physical health/access to medical care, exercise) could be identified through an initial and ongoing assessment carried out by support workers and other professionals (e.g. his GP, a community nurse), in consultation with David himself, to understand his specific level of need and ability. These needs could be met by support workers assisting David with personal care and daily living tasks as required (while encouraging him to do as much as possible independently, in line with a person-centred approach), ensuring he has access to a balanced diet and opportunities for physical activity, and supporting him to attend health appointments (e.g. with his GP or other health professionals) to monitor and maintain his physical health.

[1] basic identification of a physical need relevant to David; [2] adequate description of how this need is identified and/or met; [3] competent description covering both identification (e.g. assessment) and meeting the need (specific support provided) in the supported living context; [4] full, well-developed description referencing person-centred practice (promoting David's independence) alongside appropriate physical support. All other valid responses credited.

David's intellectual needs (e.g. stimulation, opportunities to learn, make decisions, and develop new skills) could be identified through discussion with David about his interests and abilities, and observation/assessment by support workers of the level of support he needs to engage in activities. These needs could be met by support workers providing David with opportunities to learn new practical skills (e.g. cooking, budgeting, using public transport) at a pace and level suited to him, encouraging him to make his own choices and decisions wherever possible (supporting empowerment), and, where appropriate, supporting his access to suitable further education, training or supported employment opportunities that match his interests and abilities.

[1] basic identification of an intellectual need relevant to David; [2] adequate description of how this need is identified and/or met; [3] competent description covering both identification and specific support provided; [4] full, well-developed description referencing choice/empowerment and skill development appropriate to David's supported living context. All other valid responses credited.

David's emotional needs (e.g. to feel valued, secure, and able to express his feelings) could be identified through building a trusting relationship between David and his support workers, in which he feels comfortable communicating how he feels, and by being alert to changes in his mood or behaviour that might indicate emotional distress. These needs could be met by support workers providing consistent, reassuring and respectful relationships with David, giving him opportunities to talk about his feelings and concerns, praising and encouraging him to build his self-esteem and confidence, and ensuring he feels genuinely listened to and respected as an individual, in line with the values of care.

[1] basic identification of an emotional need relevant to David; [2] adequate description of how this need is identified and/or met; [3] competent description covering both identification and specific support provided; [4] full, well-developed description referencing trust/relationship-building and self-esteem, appropriate to David's context. All other valid responses credited.

David's social needs (e.g. friendship, belonging, participation in the wider community) could be identified through discussion with David about his social interests and existing relationships, and by observing his level of social contact and participation within the supported living complex and the wider community. These needs could be met by support workers helping David to build and maintain friendships with other residents and people in the community, encouraging and facilitating his participation in social or leisure activities and community groups that interest him, and supporting him to maintain contact with family members, helping to prevent social isolation and promote his sense of belonging.

[1] basic identification of a social need relevant to David; [2] adequate description of how this need is identified and/or met; [3] competent description covering both identification and specific support provided; [4] full, well-developed description referencing community participation/relationship-building appropriate to David's context. All other valid responses credited.

An occupational therapist assesses an individual's ability to carry out everyday activities (such as personal care, cooking, or using household equipment) and identifies ways to help them live as independently as possible, either by teaching new skills/strategies or by recommending equipment or adaptations to the individual's environment. For David, an occupational therapist could carry out an assessment of his daily living skills within the supported living complex and, for example, recommend specific adapted equipment (such as easy-grip kitchen utensils or a visual step-by-step guide for a task like meal preparation) and provide structured teaching/practice sessions to help David learn to carry out that task more independently, gradually reducing his reliance on support workers for that particular activity.

[1-2] basic/adequate description of the general role of an occupational therapist; [3-4] competent description of the OT's role, correctly applied in general terms to David's situation; [5] full, specific and well-developed example of a particular way an OT could support David's independence in his supported living setting.

An example of discriminatory practice David might experience is being spoken about (rather than directly to) by staff or visitors, or being excluded from decisions about his own care because it is wrongly assumed that, due to his learning disability, he is not capable of understanding or contributing to those decisions — this fails to respect his right to be involved and treated with dignity as an individual.

An example of anti-discriminatory practice that could prevent or address this is staff training and supervision on person-centred and empowering practice, ensuring all staff are taught to communicate directly with David (using accessible language/formats appropriate to his needs), to involve him actively in decisions about his own care wherever possible, and for managers to challenge and address any instances of staff excluding or talking over David, using disciplinary procedures if necessary for persistent poor practice.

[1-2] basic/adequate description of a relevant example of discriminatory practice; [3] competent, specific description of discriminatory practice relevant to David's situation; [4] adequate description of a relevant anti-discriminatory measure; [5] competent, specific description of an anti-discriminatory practice measure clearly linked to preventing/addressing the discriminatory practice identified. All other valid, relevant examples credited.

An indicative competent response would include:

How managers can promote anti-discriminatory practice: managers can introduce and enforce clear policies, such as complaints procedures (giving service users and families a formal route to raise concerns about discriminatory treatment) and whistle-blowing policies (protecting and encouraging staff who report discriminatory practice by colleagues). Managers can promote good practice through regular staff training (e.g. on equality, diversity, disability awareness and person-centred care) and ongoing supervision, monitoring staff practice and providing feedback. Managers should also set a positive example through their own practice (modelling respectful, inclusive behaviour), and must be willing to directly challenge discriminatory practice when they see or hear about it, using formal disciplinary procedures where necessary, or reporting serious concerns to a staff member's professional regulatory body.

Impact of discriminatory practice: if David experiences discrimination (e.g. being excluded from decisions, or having assumptions made about his capabilities because of his learning disability), this could seriously harm his psychological well-being — reducing his self-esteem and confidence, and potentially causing anxiety, frustration or distress. Socially, discrimination can lead to exclusion from activities or relationships, increasing isolation. Physically, if David's genuine needs and preferences are ignored or misunderstood because of discriminatory assumptions, he may not receive appropriate physical care/support, potentially affecting his physical health.

Impact of anti-discriminatory practice: conversely, when David is treated fairly, listened to, and actively involved in decisions about his own care (anti-discriminatory, person-centred practice), this is likely to improve his psychological well-being (greater confidence, sense of control and self-worth), support positive social relationships and inclusion, and ensure his physical care needs are correctly identified and met because his own views and preferences are properly taken into account.

Overall analysis: promoting anti-discriminatory practice therefore requires a combination of clear policies, staff training/supervision, management role-modelling, and a willingness to challenge poor practice; when this is done effectively, it has a direct and significant positive impact across all dimensions of a service user's holistic health and well-being, whereas a failure to address discriminatory practice can seriously and lastingly harm a vulnerable service user such as David.

Levels-of-response (QWC) mark scheme, out of 12 marks.

Level 1 — Basic (1–4 marks): Limited analysis, naming one or two ways managers could act, with little or no discussion of impact on well-being; weak terminology/structure. Cannot progress beyond this level if only the 'how managers promote anti-discriminatory practice' element is addressed with no discussion of impact on well-being, or vice versa.

Level 2 — Adequate (5–8 marks): Covers both required elements (how managers promote anti-discriminatory practice, AND impact on well-being) but with limited depth in one or both — e.g. only one or two management strategies described, or impact discussed for only one or two of the physical/social/psychological dimensions, or only discriminatory (not anti-discriminatory) impact considered; generally clear communication.

Level 3 — Competent (9–12 marks): Full, well-developed analysis covering multiple management strategies (e.g. policies, training/supervision, role-modelling, challenging practice/discipline) AND a balanced evaluation of the impact of BOTH discriminatory and anti-discriminatory practice across the physical, social AND psychological dimensions of well-being, applied appropriately to a service user such as David; correct, precise use of specialist terminology throughout; coherent structure; accurate spelling, punctuation and grammar.

0 marks: No creditable response. Strict criteria caps apply: an answer that omits the impact-on-well-being element entirely, or omits the management-strategies element entirely, cannot reach Level 3.