Secondary 6 Health Management And Social Care Practice Paper: Concepts Of Health And Illness, Life Course And Care, Community Care And Social Services, Social Policy And Resource Allocation, Health Promotion And Education, Ethics And Professional Codes

Secondary 6 Health Management and Social Care Practice Paper: Concepts of Health and Illness, Life Course and Care, Community Care and Social Services, Social Policy and Resource Allocation, Health Promotion and Education, Ethics and Professional Codes

2026-11-14

Health Management and Social Care – Secondary 6 – Practice Paper

S6 Health Management and Social Care paper, 24 parts in 60 minutes: disease rates, falls risk, day care costs, health financing, ageing, promotion outcomes, ethics.

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Paper details　S6 Health Management and Social Care practice paper with 24 parts and marking points on disease rates, Barthel scoring, falls risk, day care unit cost, health financing and ethics.

Section A: Concepts of Health and Illness (16 marks)

A district has 240 000 residents. In one year 168 die of heart disease, 84 of them before the age of 65; 96 000 residents are aged 40 or above, 1 440 new diabetes cases are diagnosed, and 3 840 diabetic patients are under treatment in the district at year end.

#	Question	Answer and marking notes
1	(a) Calculate the crude death rate from heart disease in the district per 100 000 population, to one decimal place, with the unit shown.	Answer: 168 divided by 240 000, multiplied by 100 000, gives 70.0 deaths per 100 000 population (3 marks); the unit carries 1 mark. Marking points: 2 marks for the working, 1 for the value and 1 for the unit; an unadjusted 0.07 scores nothing.
2	(b) Using the population aged 40 or above as the denominator, calculate the incidence rate of diabetes per 1 000 people, to one decimal place.	Answer: 1 440 divided by 96 000, multiplied by 1 000, gives 15.0 per 1 000 (3 marks); 1 mark for noting the denominator is the population at risk rather than the whole district. Marking points: using 240 000 as the denominator earns only 1 mark.
3	(c) Calculate the share of heart disease deaths occurring before the age of 65, as a percentage to one decimal place, and explain what the measure shows.	Answer: 84 divided by 168, multiplied by 100, gives 50.0 per cent (2 marks); this is the share of premature deaths, showing the burden of lost years of life and avoidable mortality (2 marks). Marking points: 2 marks for the value and 2 for an explanation that mentions lost life years or avoidability.
4	(d) Calculate the year-end prevalence of diabetes per 1 000 people, to one decimal place, and explain why prevalence is higher than incidence.	Answer: 3 840 divided by 96 000, multiplied by 1 000, gives 40.0 per 1 000 (2 marks); prevalence is about 2.67 times incidence because diabetes is not cured, so patients stay in the group and cases accumulate (2 marks). Marking points: 2 marks for the value and 2 for explaining with duration of illness.

Section B: Life Course and Care (17 marks)

Mr Chan, aged 78 and living alone, fractured his hip after a fall. Barthel scores are 5 for feeding, 0 for bathing, 5 for dressing, 5 for toileting, 10 for transfer and 5 for walking. His Timed Up and Go test takes 18 seconds against a reference cut-off of 12 seconds. The district has 96 000 people aged 65 or above, 12.5 per cent of whom live alone.

#	Question	Answer and marking notes
5	(a) Add up Mr Chan’s Barthel items to give the total score and classify his level of functional dependence.	Answer: 5 plus 0 plus 5 plus 5 plus 10 plus 5 gives 30 (2 marks); a total of 0 to 40 means severe dependence, so Mr Chan needs intensive personal care (2 marks). Marking points: 2 marks for the addition and total, 2 for the correct classification.
6	(b) Calculate how far the Timed Up and Go result exceeds the cut-off, in seconds and as a percentage to one decimal place, and judge the falls risk.	Answer: 18 minus 12 gives 6 seconds (2 marks); against a 12 second reference the excess is 6 divided by 12, that is 50.0 per cent (2 marks); half again over the cut-off indicates high falls risk, requiring a home safety review and balance training (1 mark).
7	(c) Find the number of older people living alone, the total home visits needed each year at 24 visits per person, and the number of social workers required if each can make 1 200 visits a year.	Answer: 96 000 times 12.5 per cent gives 12000 people (2 marks); times 24 gives 288000 visits (1 mark); divided by 1 200 gives 240 social workers (1 mark). Marking points: one mark band per value, and the division should come out as a whole number.
8	(d) Explain Mr Chan’s situation from a life course perspective and suggest two interventions that fit it.	Answer: cumulative advantage and disadvantage, where early education, occupation, income and marital status shape health capital and support networks in later life, so living alone with a fracture reflects accumulated disadvantage (2 marks); interventions such as strength and bone health work from midlife, and preventive visits at transitions like retirement or bereavement (2 marks). Marking points: the answer must mention accumulation and timing, otherwise 1 mark only.

Section C: Community Care and Social Services (17 marks)

A day care centre for older people has 60 places and an average daily attendance of 52, giving 8 760 attendances a year. It employs 12 staff: 3 nurses, 2 social workers and 7 care workers. Monthly cost is 468 000 dollars over 26 opening days. Residential care in the same district costs 18 000 dollars a month and community care 6 500 dollars a month.

#	Question	Answer and marking notes
9	(a) Calculate the occupancy rate of the centre as a percentage to one decimal place.	Answer: 52 divided by 60, multiplied by 100, gives 86.7 per cent (3 marks); 1 mark for noting that the 8 unused places reflect transport or health barriers. Marking points: 3 marks for the value and 1 for the interpretation.
10	(b) Calculate the average number of attendances served by each staff member per year, to one decimal place.	Answer: 8 760 divided by 12 gives 730.0 attendances (3 marks); 1 mark for noting that the ratio ignores differences in hours between nurses and care workers. Marking points: 3 marks for the value, 1 for the limitation.
11	(c) Taking 26 opening days a month, find the monthly number of attendances and the cost per attendance in dollars, to one decimal place.	Answer: 52 times 26 gives 1352 attendances (2 marks); 468 000 divided by 1 352 gives 346.2 dollars (2 marks); 1 mark for noting that costs are spread over attendances rather than people, so frequent users lower the unit cost.
12	(d) Compare the monthly cost of residential and community care, calculate the percentage saved by community care to one decimal place, and give one consideration beyond cost.	Answer: 18 000 minus 6 500 gives 11500 dollars (1 mark); divided by 18 000 and multiplied by 100 gives 63.9 per cent (2 marks); 1 mark for considerations such as the older person’s preference, home safety, carer burden or quality of care.

Section D: Social Policy and Resource Allocation (17 marks)

Total health expenditure in a place is 240 billion dollars, of which 180 billion is public and 60 billion private. Gross domestic product is 3 000 billion dollars and the population is 7.5 million. People aged 65 or above number 1.5 million, 20 per cent of the population, and use 120 billion dollars of the spending.

#	Question	Answer and marking notes
13	(a) Calculate the share of total health expenditure that is public, to one decimal place.	Answer: 1 800 divided by 2 400, multiplied by 100, gives 75.0 per cent (3 marks); 1 mark for noting that the remaining 25.0 per cent falls on the private market.
14	(b) Calculate total health expenditure as a percentage of gross domestic product, to one decimal place.	Answer: 2 400 divided by 30 000, multiplied by 100, gives 8.0 per cent (3 marks); 1 mark for noting that the ratio allows comparison across economies but ignores population structure.
15	(c) Calculate health expenditure per person in dollars, to the nearest dollar.	Answer: 240 billion dollars is 240 000 000 000 dollars, which divided by 7 500 000 people gives 32000 dollars (3 marks); 1 mark for noting that the average hides differences by age and illness. Marking points: 1 mark for the unit conversion, 2 for the value, 1 for the limitation.
16	(d) Calculate health spending per older person and per non-older person in dollars, find the ratio to one decimal place, and comment on allocating resources by age.	Answer: 120 billion dollars over 1.5 million people gives 80000 dollars and the other 120 billion over 6 million gives 20000 dollars (2 marks); the ratio is 4.0 times (2 marks); the justification rests on need rather than age itself, since older people carry more chronic illness and functional loss, so needs-based allocation is fairer and age alone should not be a cut-off (1 mark).

Section E: Health Promotion and Education (17 marks)

A school health promotion programme has 800 students, 560 of whom join. After six months the share of participants doing 30 minutes of exercise daily rises from 35 per cent to 49 per cent, and the smoking rate falls from 6 per cent to 4.5 per cent. The programme costs 168 000 dollars.

#	Question	Answer and marking notes
17	(a) Calculate the participation rate of the programme as a percentage to one decimal place.	Answer: 560 divided by 800, multiplied by 100, gives 70.0 per cent (3 marks); 1 mark for noting that the 240 non-participants are the hardest group to reach.
18	(b) Calculate the absolute change in the exercise share in percentage points and the relative change as a percentage to one decimal place, and distinguish the two.	Answer: 49 minus 35 gives 14.0 percentage points (2 marks); against a base of 35, 14 divided by 35 and multiplied by 100 gives 40.0 per cent (2 marks); 1 mark for explaining that points are a difference between rates while relative change uses the starting rate as denominator, so here the relative change is larger.
19	(c) Calculate the fall in the smoking rate in percentage points and as a relative percentage to one decimal place.	Answer: 6 minus 4.5 gives 1.5 percentage points (2 marks); against a base of 6, 1.5 divided by 6 and multiplied by 100 gives 25.0 per cent (2 marks). Marking points: 2 marks each, and confusing the two earns half.
20	(d) Calculate how many people must be reached to prevent one smoker, to the nearest whole number, and the average cost per participant in dollars.	Answer: an absolute fall of 1.5 per cent is 0.015, and 1 divided by 0.015 gives 67 people (2 marks); 168 000 divided by 560 gives 300 dollars (2 marks). Marking points: rounding up must be stated, otherwise 1 mark.

Section F: Ethics and Professional Codes (16 marks)

Mrs Lee, aged 78, refuses her blood pressure medicine and asks that her family not be told. Her son asks staff to hide a terminal diagnosis from her. A community rehabilitation service nearby has 120 people on its waiting list and can serve only 40 a month; managers consider raising this to 48.

#	Question	Answer and marking notes
21	(a) Use the cases above to show how the four principles of bioethics, autonomy, beneficence, non-maleficence and justice, apply, one sentence each.	Answer: autonomy means respecting Mrs Lee’s refusal and her right to know (1 mark); beneficence means acting for her best interest with treatment and rehabilitation support (1 mark); non-maleficence means that hiding a terminal diagnosis may stop her arranging her affairs and is a psychological harm (1 mark); justice means allocating scarce places by consistent criteria (1 mark). Marking points: each principle must be tied to a case detail; generic statements score nothing.
22	(b) State two situations in which confidential information may properly be disclosed and one procedure to follow when disclosing.	Answer: for example explicit consent, an immediate serious risk of self-harm or harm to others, or a statutory reporting duty such as elder abuse (1 mark each, 2 marks); procedure such as disclosing only the minimum necessary, recording the reason and recipient, and informing the person beforehand (2 marks). Marking points: situations must be concrete and the procedure must be an actionable step.
23	(c) With 40 places a month, find the waiting time in months to one decimal place; if this rises to 48, find the new waiting time and the percentage reduction, both to one decimal place.	Answer: 120 divided by 40 gives 3.0 months (1 mark); 120 divided by 48 gives 2.5 months (1 mark); the 0.5 month reduction divided by 3 and multiplied by 100 gives 16.7 per cent (2 marks). Marking points: one mark band per value, all to one decimal place.
24	(d) Propose a set of criteria for allocating the waiting list and explain how unfairness to older people or any single group can be avoided.	Answer: criteria such as scored functional impairment, carer burden and level of risk, with a maximum waiting period and periodic review (2 marks); fairness needs published criteria, one assessment scale for all applicants, a fast track for urgent cases, recorded reasons and an appeal route (2 marks). Marking points: criteria must be workable and at least two safeguards given.

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