The Time to End Poor Care is NOW

The morning after yet another Panorama expose on appallingly bad care the media response is, as usual, distinctly underwhelming. No loudly broadcast calls for the resignation of senior civil servants, no demands for inquiries into the care system, in fact, nothing.

One particularly difficult issue with social care is that it is far too easy to spread the blame and for nobody to take responsibility.

Commissioners, Regulators and providers can all blame each other and the Government can blame all three! Yet, ultimately, the responsibility for regulating social care lies in Westminster and it is the responsibility of politicians to ensure safe, quality care is available to all.

Yes appallingly bad care exists but good quality care also exists. The quality of care is solely dependent on the care provider and good care providers have to struggle in a system that treats both good and bad care equally. Both are allowed to thrive in a system that is, currently, more focused on money rather than quality and the needs of individuals.

Of course bad care providers are to blame for the care they provide and such providers need to be shut down and banned from providing care services again yet the system allows them to carry on. Regulators can be blamed for not spotting the bad care being provided yet they are constrained by the regulations they regulate and inspections can only provide a snapshot of care provision and inspecting home care in particular is challenging. Commissioners can be blamed for buying services based on price rather than quality and, perhaps, they rely on information provided rather than going out and inspecting the care services they are commissioning services from.

But all of this can only happen because of the framework in which everyone operates.

Contrast this to the NHS and the calls for action following the Mid-Staffs enquiry. Those who stoutly defend the NHS and campaign for better quality do so because the NHS is a single, national, entity yet few of those people so stoutly campaign the fragmented social care system.

The ultimate responsibility for social care lies with Westminster, it is no use politicians blaming other elements within the system because it is the system itself that is broken and urgently needs to be reformed. There increasingly needs to be a system that promotes and rewards good care providers whilst ensuring those who provide bad care are eradicated.

We are promised a new care rating system soon, which is welcome, but it must, obviously, be one that can be trusted, one that will influence commissioning and one that reflects the care individuals need rather than what bureaucrats believe is essential in terms of paperwork!

Yet beyond this we also need a system that has real accountability. The ability of all parties to pass blame on others MUST STOP NOW. Ministers must admit their responsibility for social care services, commissioners must accept they have a responsibility to ensure the services they are commissioning are quality services, regulators must accept their responsibility to rigorously act and eliminate poor care and care providers must be held fully accountable for any failures in their duty to care.

The time to end poor care is now and this has to start with ending the blame game and all those responsible for social care to stand up and shoulder that burden.

Me, Food & Social Care

Apparently I am an overly fussy pernickety eater although I would prefer to say I have a truly sensitive palate which means that there are many foods that are not palatable to me! Many have tried to test and trick me but always have failed.

It is not something that has any significant impact on my life and I doubt I am the only person like this.

Yet what if someone with a similar palate found themselves suffering with dementia and placed in a care home. Without knowing the persons likes (because the dislikes will be far too many to mention!) it would be easy to try and give the individual just what is on the menu. Personally if that happened to me I would simply not eat what was in front of me, but how does that act get viewed by the care provider? Am I being awkward? Am I refusing to eat? The more I insist that I will not eat what’s in front of is my behaviour becoming ‘challenging’?

If I have no relative’s to speak up for me to explain my eating foibles what happens next?

If I am refusing to eat what is in front of me yet I don’t have the capacity to express that how can I be sure that my behaviour is interpreted correctly? And how will my non-eating be reacted to?

If I lack capacity then someone will make a decision in my ‘best interest’ under the guidance of the Mental Capacity Act. Obviously it would be in my best interest to eat yet if I were forced to eat something that tasted extremely bad to me the more likely my behaviour would become more challenging and I would probably be labelled as such and because of my limited likes it attempts to try different foods would also probably fail and lead to more ‘challenging behaviour’.

This is, of course, hypothetical yet there are, undoubtedly, many people in similar situations, it may not be with food but with other aspects of daily life.

This is why carers and families are so important in the social care system. Social care professionals need to understand the person who needs care services and, where individuals are unable to articulate their needs, listening to carers and families is vital in providing quality personalised care.

The quality of social care is not just about now, it is about the future and the quality of care we want to receive in the future if we find ourselves needing care services. Quality services can only be achieved by understanding the individual and, equally important, their individuality. By the time care ‘professionals’ become involved in a person’s needs it is likely those needs have already progressed to a point where understanding individuality becomes more difficult making it ever more important for those professionals to engage with carers and families to truly get to understand what makes the person needing care service tick.

Carers and families have a responsibility too. As someone they love begins to deteriorate through age-related conditions they should prepare that information to ensure they are able to pass it on. Obviously, as individuals, we also have a responsibility to make sure those things are known in case we need social care services in the future.

In reality the real onus is on those paid to provide social care services to ensure they are providing personalised care based on the information given to them by the individual, their carer’s and their families.

If I ever need social care services I want those people providing those services to understand all of my needs and provide care based on those needs. Undoubtedly you do to. So let’s focus on moving toward that for the benefit of those who need care services now.

Social Care - It's Not Rocket Science

How long has the debate around integrated care been going on? It’s a constant theme running through the social care debate yet one that remains fully unresolved and one that seems difficult to achieve but why?

It’s not rocket science!

Take, for example, the space shuttle. That feat of engineering consisted of 2.5 million component parts, including more than 200 miles of wiring! Thousands of scientists, designers, engineers and manufacturers managed to come together to create a single machine that enabled regular space travel. Even so that would not have happened without the thousands of others who also played a role. The astronauts who flew the shuttle were also products of a system that selected, trained and developed them to ensure they were capable of operating such a complex machine. Then there were those on the ground who made sure the launch and landing were successfully achieved.

Yet we struggle to give individuals the integrated care and support they need!

The component parts of providing integrated care are considerably less than those needed for space travel and the cost considerably less!

Yet bringing together social care, health, housing, benefits and employment for the benefit of an individual seem to be an impossible task for the bureaucracy of the U.K.

Obviously because social care is so low on the bureaucratic pecking order it means that the other elements needed for integrated care tend to take precedent. Social care is a small part of the Department of Health and Housing and Benefits sit within in two other Whitehall departments. At the level of the Whitehall bureaucracy focus is on departmental achievement and policy formation with little or no consideration to the individual yet by changing focus to achieving integrated care for the individual departmental achievement and policy formation could actually improve.

With the space shuttle, the goal was achieving manned space travel that could benefit the space programme by being reusable. All those thousands of people involved in the project came together to achieve that goal, integrating their role into that single achievement. Obviously there were disasters yet overall that particular programme was a success.

Those in Government should learn that if the goal of social care is the life of the individual we can begin to make social care the Primary service under which all other elements needed to provide effective integration are mustered and directed by social care services.

Completely effective social care means having a fully integrated service whose goal is the needs of the individual, why is it so hard after all it’s not rocket science.

The Sense of Adventure

Do you like to think outside the box, push outside you comfort zone, expand your horizons or perhaps extend the frontiers of your knowledge?

It seems to be a naturally occurring part of human nature to seek out new experiences and find ways to enhance our lives by discovering new things. Obviously we all do this in completely different ways. The adrenalin junkie will take to extreme sports to conquer the elements by seeking outrageously dangerous thrills, excitedly relishing the physical and mental challenge they have set themselves. Others may take joy in food, the adventure of seeking out a new restaurant, savouring the ambience, sounds and aromas surrounding whilst eagerly anticipating the new tastes they are about to experience. Others could simply be avid readers who regularly and enthusiastically, seek out new authors to stimulate their imagination and mind.

Essentially, within all of us, to a greater or lesser degree, there is a need to have new experiences to keep us from become to stale and bored with life.

Yet, when it comes to providing social care, what do we do to stimulate and expand the experiences of social care workers to keep them interested in their work and to stimulate them to encourage them to expand their horizons when it comes to how they deliver care services?

Outside of social care, many businesses go beyond general training with such things as ‘team-bonding’ activities and whilst these may have become something of a joke or simply an excuse to have a good time the principle behind the idea is a sound one. It is something different in the workplace and should, if well planned and designed, give sensory experiences that go beyond those normally experienced in the workplace.

Unfortunately regular classroom training does not usually provide the extra sensory aspect, in fact much social care training is done simply to comply with regulations rather than truly benefit the care workers. Additionally training only forms a part of the learning process and without the other elements training becomes little more than a chore, especially if it is one of those courses that has been done year after year!

Add to this the increasing pressure in care services, to do as much as possible in ever decreasing time-slots, little time is left for workers to engage in personal growth through work and take the importantly essential opportunity to reflect on the work they are doing and what they could do to improve that work.

And now to completely flip the coin – what about those we provide social care services for?

There is this public perception of older peoples’ homes being rows of old-fashioned arm chairs filled with elderly people who just sit there between getting up and going to bed. While there a many homes where that may be the case there are many that provide excellently managed activities which stimulate and stretch the minds and senses of those they care for.

There is some great work around at the moment focussing on raising awareness of loneliness amongst older people who may have no family and only see carers for brief visits. But loneliness is not just about having no-one around you. You can be lonely in a crowded space, just like those people who are left to sit around all day in those poor care homes. Loneliness is not necessarily being alone but about being engaged or stimulated in some way. In social care we need to ensure that those we provide care and support are stimulated and engaged and given the chance to have new experiences or re-live the thrills of past exploits.

Cognitive decline does not necessarily mean a loss of all the senses!

We all have a sense of adventure laying somewhere within us and that naturally stimulates our need to seek out new experiences which in turn helps us keep fresh and stops us becoming bored. Social care must be about providing those who need services with a good quality of life and that sense of adventure is an important part of that quality. Similarly we need to keep social care workers engaged and stimulated as this obviously helps in retaining staff and encouraging them to fully immerse themselves in the quality of care they provide.

Re-Igniting Dementia Awareness

Familiarity, they say, breeds contempt. Perhaps it is more accurate to say that familiarity dulls awareness. As we deal with things day after day everything becomes so routine we become less conscious of what we are doing and settle into a humdrum existence of habitual practice without actually reflecting on what we are doing.

As Dementia Awareness Week kicks off it is obviously a naturally perfect time to raise the awareness of those who work with people with dementia and to vigorously re-ignite understanding of dementia and the impact it has on the lives of those who need social care support.

The first question to ask yourselves or, naturally, put to those who you supervise, is why does this individual need the support we give? In many situations social care workers have little time to reflect on individual needs, especially where the notorious 15 minute visits occur, it is a case of get in do whatever the job requires and leave again. Yet an understanding of why those jobs are required gives purpose to the work and can re-invigorate the efforts to provide a better service for the individual.

Understanding why someone needs social care services must completely go beyond what the individual is unable to do, hence the need for the actual service, and focus on why they are unable to do those things. To say that an individual has dementia is not enough. What type of dementia do they have? How does that type of dementia affect an individual? How is this individual particularly affected?

Another aspect of familiarity that often totally impacts on the way we do things is not to notice those small incremental changes in people we see every day, or indeed in ourselves.

For example when people lose or gain weight, any serious dieter knows that those close to them are less likely to comment on their weight loss than a person they see less regularly and immediately. Or, similarly, we can look at an old photo of ourselves and realise that we have changed without ever really noticing those changes taking place.

Obviously in the same manner those who provide front line care can fail to notice small incremental changes and deterioration in those they provide care services for, those declines in mobility or mental functioning that are so gradual that they slip past conscious awareness but accumulatively mean the individual has deteriorated considerably over a period of time.

Re-igniting awareness must include assessing those changes in an individual, care workers should be encouraged to reflect on those changes and what they mean to the individual and the care services they receive. This is an essentially important aspect of care as while an individual may receive regular care reviews, care workers may not report those small changes as they have gone unnoticed and yet spotting these can prevent a crisis later on and ensure better care provision in the long run.

Those who own and run services providing social care services for people with dementia should use the opportunity of dementia awareness week to include re-igniting awareness through their staff development activities.

It is absolutely completely essential to raise awareness about dementia nationally yet we should quickly and rapidly recognise the importance of re-igniting awareness amongst those who provide care services to really boost the quality of dementia care.  

Defining Leadership

My thoughts on Leadership for Care Industry News http://www.careindustrynews.co.uk/key-care-professionals-comment/

Shift from Care Service to Customer Service

I am fairly certain that you, like me, have been to a restaurant at some point in time where the staff rushed you through your meal and that you, like me, found it irritating and uncomfortable. I am also pretty certain that you, like me, would think twice about using that restaurant again and that many people who experienced that would, like me, probably tell any number of people about that bad service.

Now transpose that scenario to social care.

The now infamous 15 minute care visits are just one aspect of this, longer visits may equally involve care staff having to rush around leaving the individual who needs the service bemused and bewildered at the very least. At the worst it will leave the feeling a burden, someone in the way while the care staff do what they have to before shooting off to the next person. Add to this the times when the individual never knows who is going to turn up to help as staff rotation is based on the needs of the provider rather than continuity for the individual.

Of course this is not limited to home care, many care homes I’ve seen have a task-orientated culture where staff rush around trying to get jobs done and individuals merely become another box to tick on the endless ‘to do’ list and in the worst cases, as demonstrated on the Fiona Phillips’ Panorama programme last year (http://www.bbc.co.uk/programmes/b01gybn7) sometimes staff even fail to acknowledge the individual when they are undertaken their jobs.

The crucial issue here is that the person who needs the care service cannot just suddenly stop using the service because they are unhappy with it and if they are left feeling like a burden to the care service then they are unlikely to complain anyway and, equally, there may be a lack of opportunity for them to mention the bad service to anyone else.

Unfortunately we do not look upon those who need care services as customers. Look at the terminology, ‘service-user’, ‘client’, ‘resident’ or even ‘patient’.

Could you honestly imagine sitting down with your bank manager and having a ‘co-production’ meeting about your finances?

People who need social care services are getting a service and, as such, should be treated as customers no matter how that service is paid for. In many instances of course they are paying directly for that service.

We need to become a customer focused service which starts with acknowledging the individual as someone who has the right to be treated as a paying customer. Social services departments need meet the needs of customers rather than ‘commission’ services and regular reviews should not be just about immediate care needs but should also focus on customer care and the level of customer service that goes with the tasks being provided.

The needs to be a culture change in social care with a shift from task based commissioning to real customer service and customer service skills need to be high on the training list for all staff of undertake services for their customers. Personalisation must mean the customer comes first and what we want as customers will always vary. Some may like short sharp visits just so they can get on with their lives without strangers getting under their feet, many others will prefer visits that include a chat about what’s happening in the world, especially if they are isolated and unable to leave home. Whatever they want though it should be at the top of the list of services provided, after all, the customer is always right.