Friday, 30 March 2012

Inspiring Leaders

The concept of leadership in the workplace is not new and the importance of leadership behaviours in successful organisational culture is well established.

But what actually is leadership? For a start the word is a vague word, it is not something you can pick up and look at and it will mean many things to many people dependent where the word is being applied. For example would you expect the same application of leadership from the Prime Minister as you would from a supervisor in social care? On one level the answer would be no yet the same qualities of leadership still apply.

The Institute of Leadership & Management (ILM) have an excellent guide to what is leadership (click here for link) and these can be applied to whatever level of leadership you are engaged in.

The manner in which social care has rapidly changed over the past 25 years or so means that the ideals of leadership may have passed unnoticed, in a bureaucratic system that has focused on standards of quality that tick boxes rather than truly reflect the end result.  Similarly there has been little focus on the ideals of leadership in commissioning services. Even in the drive towards personalisation has focused on the need to provide individualised services without the recognition that  implementing personalisation needs leadership skills to be successful!

In other words the whole culture in social care has ignored leadership values.

Even though nowadays the majority of social care is delivered by private providers I doubt (although would be happy to be proved wrong) that leadership qualities are high on the agenda of many of these providers and that there is a lack of understanding of what leadership entails and how it will ultimately help their business. How many leaders are there in social care with membership of the ILM? Or who have undertaken training in leadership that goes beyond the Registered Managers Award?

Yet training in leadership is only a part of the issue and raises another issue on leadership that is, perhaps, at times missed in social care. A part of the tick box culture has been focused on training, ensuring care workers have ‘done the right courses’ yet, and  I have said this  many times before, training fails without development activities to embed the knowledge gained through training into skills in practice and that is where leadership is important.

Not only should the manager be talking to people who attend courses and asking how they would apply their new learning to their work practices but we should also embed a culture of self-leadership where staff members automatically reflect on this and actively speak to their seniors about ways their learning can be applied in improving care provision.

We need a culture change because the qualities of leadership can have a much more important impact than in general commerce. In most business sectors the aim is to make profit by providing goods or services that people want. The aim is to attract customers and hope that your qualities inspire them to part with their money.

In social care, however, we have the added responsibility of ensuring the quality of life of the people who need social care services and that responsibility deserves good leadership at all levels, from the Department of Health right down to front line carers.

After yesterday’s event I am confident that leadership is coming to social care and will begin to embed itself in business behaviours and care practices which can only help to bring better services to the most vulnerable in society.

Monday, 26 March 2012

Personal Thoughts on Dementia

Quite a few years ago I did a stint as a charity fundraiser (yes I was a Chugger for a short while) and during that time I was raising funds for a dementia charity. It was during that period I had one of the most memorable yet heart wrenching conversations that has stayed with me until this day.

On the streets of Sittingbourne in Kent I met a man who told me about his father who had dementia. His father lived with him and his family but had been deteriorating rapidly and the man was faced with the decision of whether or not to ‘put’ his father into care.

It was obvious that on health grounds the decision was logical but it was clear that the man felt a sense of failure about not being able to look after his father and the option of sending him to a home was an option of last resort that was accompanied by a huge sense of guilt and the pressure of having that decision was tearing the man apart.

On a more personal level my own Grandfather developed dementia, my uncle cared for him but had to work to and it was when he returned from work one day to find my Grandad had tried to microwave some food in metallic dishes that managed to blow the microwave, but luckily not cause a wider fire, that the family seriously had to consider whether a care home might be the most appropriate option.

Dementia is a disease that affects the individual but one that also has a serious impact on the families of sufferers and with the predicted rise in numbers of people with dementia even more families will feel the impact of having to make such decisions along with the feelings of guilt and failure.

The news of increased funding into the research dementia is welcome there it cannot simply be research on treatments and cures. Whilst the application of medical research is the best approach in the long term cures and treatments can often take decades to come to fruition. In the meantime we need to tackle the social impact of the disease, provide more help and guidance to families and raise public awareness of all the issues on which dementia impacts.

It would be good to see greater research on how we can improve social care to meet the needs of those with dementia. There is, currently, a lot of good work going on in this area and we need to make certain that this reaches a wider number of care providers and becomes a standard for dementia care.

Today’s announcement is a starting point, one that will hopefully be extended in the social care White Paper due shortly.  The amount promised for research stills pales compared with research spending on other issues yet it is a start in recognising such an important issue. But we also need funding to support the care of people with dementia and funding for support services for the families who have to come to terms with the impact of dementia on their lives. 

Wednesday, 21 March 2012

Social Care: The Public Perception Hurdle

Social care is something that impacts on the lives of millions in the UK, those who use services, those who provide or commission services, those who care, unpaid, for family members and those who work in providing care. Yet the general public and, more particularly, the national media seem less than enthused about the subject.

One clue to this may be found in the health/NHS debate that has been vigorously contested in Parliament and through the media.

A few days ago the Guardian published a list of 30 odd organisation connected with health and where they stood on the Health & Social Care Bill. Of this only 1 was an organisation that directly represented patients yet there were 10 ‘Royal Colleges’ representing various healthcare professions.

The Royal Colleges do, of course, command tremendous respect and it is easy to understand why. These organisations represent the people whom we may need to save our lives and while there may be a general social decline in the trust of ‘experts’ the Royal Colleges carry a lot of weight in terms of public opinion and media attention.

While there is a multitude of organisations connected with and campaigning for social care none carry the same weight and gravitas as those connected with health.

Naturally part of this has to do with history the Royal College of Physicians dates back to 1518 and even the relatively young Royal College of Nursing is fast approaching its Centenary. Yet social care, in its current form detached from the ‘medical model’ is relatively new and there are relatively few ‘professional’ organisations connected with it.

Obviously the College of Social Work has just come into existence and, perhaps, its most immediate task is to embed itself in the public domain as an authoritative voice on social care.

Aside from this though other organisations may be too detached from the public perception of the immediate issue, for example the Association of Directors of Adult Social Services represent the councils commissioning social care rather than being directly involved in delivering it. Compare a Social Services Director (essentially a civil servant) to a Surgeon or Physician who gives hands on (literally!) health care, we have to have more faith in the medical professional because their actions will directly affect us.

Aside from these ‘professional’ organisations most of the others either represent the care users themselves or the organisations providing care services. With the former the Guardian list has shown users groups do not command the attention that they perhaps should but unless the public attention is grabbed by social care it seems unlikely that the users of social care will either. Trade organisations will suffer from the same inertia of public interest particularly as the predominant coverage of social care is where the system goes wrong and providers fail.

The Royal Colleges also act as centralised points for dissemination of research and innovative practice and whilst there is an abundance of excellent research available in social care and many academic institutions carrying out that work the route through to public perception appears fragmented.

Even in terms of ‘think-tanks’ representation of social care is limited. The Kings Fund and the Institute of Public Policy Research both, certainly, provide excellent contribution to the social care debate but their primary focus is elsewhere.

Social care is diverse but no more so than health provision and obviously the two overlap in significant areas. We need to achieve greater public awareness and interest in social care but, at present, lack the structure and gravitas to engage the attention of the majority of the mainstream media and, through them, the general public.

Perhaps we need a Think-Tank solely dedicated to social care to disseminate research and practice, command media attention and generally raise the profile of social care or, perhaps, more professional recognition of those who work in front line care (a College of Registered Social Care Managers?) to add to the College of Social Work.

Putting social care high on the national agenda is important and we need to look at how this can be best achieved for the benefit of the millions involved in social care.

Thursday, 15 March 2012

Social Identity and Social Care

Do you prefer to shop in Asda, Morrisons, Sainburys, or Tesco (or any other supermarket). Chances are that you prefer one over the rest even if shop around. It is all to do with social identity and supermarkets often market their image to appeal to a particular social identity. The same is true of newspapers, cars and even political parties.

The issue of our identity becomes more complicated because we combine these various elements to form our identity and differences with others. Two people could both be Guardian reading, Asda shoppers and would have that in common but equally one may be a Labour supporter and one may be a LibDem, so both would consider themselves to be different to the other.

There is a link between social identity and self-esteem, if we can find ‘our place’ in the world we can be considerably more content in our overall well-being.  There are of course, extremes as can be seen in the crowd mentality of football team supporters but social identity seems to be an integral part of being human.

We are all different, we define ourselves as much by who we are not as by who we are and often our social identity defines the choices we make about our lives. Because of that the ‘market’ panders to our wishes in terms of supplying goods and services that we can identify with.

With a serious exception – Social Care

The provision of social care is a market economy nowadays with around 80% of all care provision being supplied by private organisations (Companies & Charities). Now this change has been relatively rapid and the ‘market’ may not have fully established itself but there does need to be a consideration of this if we are to provide services that truly support individuals.

This has to be a key element to the personalisation agenda.

Let’s be brutally honestyou will have chosen to avoid certain people and certain places and you will have made choices that you feel are ‘more’ you.

Are the same sorts of choices available in social care provision? And to what extant do assessments of those who may need social care services look beyond the physical needs of the individual to the needs of sustaining their social identity.

Helping to maintain a person’s social identity is important for mental well-being. Imagine if you were left with no choice in any service you needed, how frustrating it would be to be placed in the company of others that you had little in common with or your day was dictated by what others considered good.

In our everyday lives we choose who we wish to spend time with and generally we choose people who share the same ideas, enthusiasms and outlook on life. Obviously there are times when we have to ‘put up’ with people at work etc. but we will always chose to spend our more intimate moments with friends. So what does it feel like to a person who has to have personal intimate care from somebody they have had no choice in selecting?

Our social identity is the core of who we are and it seems wrong that just because age means we may need support and care from others that this social identity is taken away by lack of choice in social care services.

Wednesday, 14 March 2012

Public Service & Private Profit: The BIGGEST Elephant in the Social Care Room

There were a number of respondents who raised concerns over the business ethic of the care homes they worked for. These respondents felt the organisation and/or general management were driven by profit, rather than providing high-quality care” RCN – Persistent Challenges to Providing Quality Care 2012

If there is to be any resolution of the current care crisis and to ensure the provision of quality care for the most vulnerable adults in our society then the BIGGEST elephant in the room has to be tackled or, at the very least, talked about openly.

The majority of social care provision is delivered by private sector companies who do so in order to make a profit. Direct public sector provision has dwindled and continues to do so as more local authorities look to close or sell care homes.

The reason for this is relatively simply – it’s cheaper. By outsourcing care services local authorities save on administration costs yet more specifically the save on wage costs. Private companies are less bound by conditions that local authority employers have to abide by, particularly in terms of pensions and the myriad of different companies delivering social care means the workforce is fragmented, largely un-unionised which has allowed care worker wages to remain low at a national average of £6.71 per hour (Skills for Care NDMS Data). 

Undoubtedly the poor pay and conditions associated with working in social care contribute to the continual recruitment and retention problems which, in themselves, have an impact on the quality of care provision.

Now there is no doubt that what local authorities have paid in fees for social care provision has dropped, in real terms, over the last few years firstly by lower than inflation increases and more recently by totally freezing fee increases and there is equally no doubt that social care needs greater investment.

There is also the additional fact that many of those who have to pay for their own care provision are forced to pay a higher amount in order to ‘make up’ for the low fees paid by local authorities despite receiving exactly the same quality of care by the provider.

Yet the issue that has to be addressed is what guarantees are there that increasing fees will drive improvement in the quality of care or workers’ pay rather than line the pockets of those who run their companies for profit?

One solution by a respondent to the RCN survey was to suggest a cap on the amount of profit that could be made ensuring the rest was reinvested into the care of residents.

But to flip the argument a little, most people go into business to make money and any threat to the profitability of the care sector would discourage people entering it. With the demographics indicating increasing amounts of social care provision being needed there will be a demand for more suppliers. So what happens if the suppliers are not there? There will then be pressure for local authorities to take responsibility for providing care at the higher costs associated with the public sector.

There is no obvious or easy solution to the dilemma but it is one that has to be recognised as a major part of the debate on social care. 

Tuesday, 13 March 2012

Thoughts on Leadership & Management

There has, of late, been a strong emphasis on leadership in social care but at yesterday’s SCA Conference (which I  followed avidly  on Twitter thanks to the tweets of @cpeanose) the issue of the importance of management was raised. So I thought it would be a  good opportunity to reflect  on Leadership and Management.

Leadership is about people skills. The good leader is one who sets out a vision and inspires and motivates their team to achieve that vision. The leader is the role model who sets the example for others to follow and leadership is about effective communication using the skills of listening and giving effective feedback.

Management, on the other hand, is about the tasks. The good manager organises workloads, ensures targets are set and outcomes are met. Effective management is about assessing, evaluating and planning.

Having laid that out it must be said the truly effective leader is one who is a good leader AND a good manager. In a previous blog (Social Care Leadership: Visions, Targets and Goals) I stated the importance of setting out a vision as one aspect of being a good leader. Yet equally important is achieving that vision through targets and goals and that is where effective management skills are required. The manger needs to take the vision and break it down into achievable steps, to set the goals that will achieve the final vision and assess what is needed to reach each step. The leader then needs to come back to the fore and  communicate those objectives to the team in a way that  motivates and inspires them to achievement. The manager returns to assess progress and evaluate what further action the ‘leadership’ side needs to take.

The important issue is the balance of leadership and management skills. By way of illustration I, back in the dim distant past when I left school, worked for a national menswear retailer where I had the opportunity to work with a number of branch managers. One I recall was a brilliant people person, he could sell snow to eskimos and he could inspire the staff to up their game. The problem was he was hopeless at managing, you needed to discreetly stay close to him to ensure that what he promised was actually delivered because he would be immediately forget that promise when the customer was out of sight. Another manager I worked with would, literally, hide from people. He would stay in his small office doing paperwork or live in the stockroom checking deliveries and his level of communication with the staff was minimal leaving it others to discuss how we stood in terms of targets etc.

A truly effective leader is a person who can completely balance those leadership and management skills, of course, in the real world such perfection is unlikely and this is where the real skill of leadership comes in.

The true skill of leadership is recognising the qualities and short comings in your own ability and organising your team to counter any deficiencies. Someone whose people oriented skills out balance the task oriented skills needs to acknowledge this and be prepared to delegate some of the management tasks to the team member most capable in that area. Similarly where the balance lies the other way it is important to identify the best communicator in the team and allow them to help motivate and inspire the team towards goals.

Leadership and management are not separate entities but are two sides of the same coin and to  achieve real success  those ‘in power’ must endeavour to achieve a balance between the two.

Monday, 12 March 2012

Social Care MUST be a Part of the Budget Debate

If past years are any guide the political agenda for the next week and a bit will focus on the Budget. There will be, and has already been, calls for changes at either end of the tax spectrum, we will see senior politicians  offer ‘expert’ insight  into what the Government should be doing (probably having already been briefed in what they are actually doing!) but, undoubtedly, the thing least likely to be on the agenda is social care.

Obviously the lives of the most vulnerable in society should be at the top of the agenda when it comes to talking about the nations finances and how we use the national income to provide for them first.

Yet most  politicians are too wrapped up in party ideologies   to focus on the real issue facing the country – an increasing elderly demographic that will require more social care services in the future.

Take, for example, last weekend’s LibDem spring conference where the call has been for lower tax for those on lower incomes and higher tax for the wealthy. Whilst lower tax would certainly benefit the large number of low paid social care workers taxation is an issue that does not immediately impact on the lives of social care users.

Many vulnerable adults do not pay tax, employment amongst those with learning disabilities, for instance, is incredibly low, and they are dependent on the State to be able to live day to day. Many of those who live in care settings only retain a personal expenses allowance of £22.60 (increasing to £23.25 in April) and many of those receiving social care services at home only have their pension or benefit payment to live on.

Many of us have benefitted from the historically low interest rates, which has allowed some of the increasing rate of inflation to be balanced out but, again, many of the most vulnerable in society are not home owners or have already paid the mortgage on their home or, indeed, had to sell it for care services.

Therefore, it  is important  that the Budget reflect the increasing pressure on the low incomes of the most vulnerable.

The actions of the Chancellor can impact on the costs faced by the population, where this may be offset by raising the income tax threshold the vulnerable, who pay no tax, are more vulnerable to increasing prices caused by the Governments actions.

Over recent years the services available for the vulnerable have been reduced or costs increased, the rising fuel costs have pushed up food prices and made the cost of care in the home more expensive, VAT has risen as has the general cost of living.

Social Care needs to be at the top of the agenda and this includes being at the top of the Chancellors agenda when delivering the budget.

The first aim of a civilised society should be to care for the most needy in that society and George Osborne should  take the responsibility  for ensuring that the most vulnerable are not disadvantaged by next weeks budget.

Friday, 9 March 2012

Dear MPs - Why Social Care IS Important

Anyone catching the Future of Social Care debate in the House of Commons yesterday must have been struck by the lack of MPs bothering to turn up to discuss on of the most important issues facing the country at the moment.

Perhaps every MP should look to their own constituency and take a real look at the demographics and data of those  they are paid to represent  in order to  realise the importance of social care  in their community.

I live in the district of Shepway and delving into the data makes startling reading. I would hasten to add that the local MP (Damian Collins – Folkestone & Hythe) did attend the debate and make a contribution through an intervention, but I think it is important to share some of the facts and figures to demonstrate why MPs need to look to their own constituency to  realise the importance  of focusing on social care.

Shepway has an estimated population of 101,200, not a major metropolis but it does have one of the largest care sectors in the county of Kent and, despite persistent rumours of affluence in the south east, is in the top 100 most deprived districts in the country.

Of that population 15% is over the age of 70 & 6% over the age of 80. Many of these will be recipients of some form of social care services either at home or in care home settings, of which there are 110 in Shepway (the same number as registered in Brighton & Hove despite the huge population difference). Obviously with a huge amount of care provision there is an equally large social care workforce, all of whom are affected by social care policy set out by Westminster and the policies of Westminster therefore have an impact on the local economy.

Naturally paid for social care provision is not the only aspect of social care. Data from 2001 suggests that around 10% of the districts population are providing unpaid care to family or friends, with 279 of these being under the age of 18. Again decisions made in Westminster have a direct impact on the lives of these people and on those people they care for.
Around 10% of the people who live in Shepway claim Disability benefits (2011 figs) the majority of whom have physical disabilities but it also includes 1365 people with learning disabilities and 1071 with mental health issues.

Social care should be about people not about facts and figures but it is important that those  we pay to represent us  are aware of the importance on social care and just how much social care impacts on the lives of their constituents.

There may be many demands on an MPs time and there may be many areas of policy the promote or prefer to be associated with but the bottom line is they  are paid to represent us  and they should especially be representing the most vulnerable section of the community they have been elected to represent.

There has been much emphasis on leadership in social care of late and one key element of leadership is acting as a role model. Members of Parliament need to act as role models in supporting the vulnerable in society, that means visibly showing active interest and that means turning up for debates in the House!

Thursday, 8 March 2012

Whose Responsible - Unblurring the Boundaries Will Help Care Provision

Much of the debate surrounding social care at present focuses on funding issues, who pays, how much should individuals pay etc. yet there are significant other issues that need to be addressed.

One of these is how the interface between public services and private providers operates.
Yesterday’s report on healthcare in care homes published by the Care Quality Commission has, perhaps inadvertently, highlighted the issue of where responsibility lays at this interface.

The report states “some homes did not adequately demonstrate person-focused care planning” and “just over half of residents (55%) were aware that they had a care plan in place that sets out their needs.”

Yet contrast this with another recent CQC document entitled ‘What standards you have a right to expect from the regulation of your care home’ (see document here) which states that people who use services should “get the care that you and your social care professional agree will make a difference to your health and wellbeing.”
Comparing the two does raise the question – who has responsibility for care planning, the home or the social services professional? And who has the responsibility for ensuring that the person using the service is aware of that plan.

Obviously  it is important  that both work together  with the individual in preparing the plan but where does the ‘final’ responsibility actually lay? Implementing the plan of care naturally falls with the care provider but once a person enters a care home how much monitoring of that plan takes place by social service care management?

Added into this needs to be the role of healthcare professionals in care planning, the demographics of care provision have changed dramatically over the last 20 years, people are likely to be much older when needing care home provision and are likely to have much greater health needs, particularly due to the fact that dementia is not classed as nursing need despite being a disease, so many of those with dementia are in ‘residential’ rather than ‘nursing’ homes.

With older people in care age related medical conditions need addressing in care planning – who is responsible for ensuring that appropriate health professionals are involved in this? In addition there should also be some form of involvement by those health professionals in assessing the health care needs on a regular basis.

Quite rightly there is a drive to ensure personalisation and independence for all those who access care services but at the same time this should not diminish the responsibility of professionals to ensure effective care planning is in place. Unfortunately the current system has an interface between public service and private provision that blurs the boundaries of responsibility and the only people who lose out because of that are the people who use services.

As the debate on the future of social care moves forward we must look beyond the question of who pays and play closer attention to the issues and responsibilities that have a direct impact on the quality of care provided.

Tuesday, 6 March 2012

Why I Am Supporting #Twobby - End the Care Crisis

Back in 2008 I sat in the press conference where then Health Minister, Alan Johnson, announced that the Labour Government was launching a consultation on a social care Green Paper. Now a Green Paper is, in itself, a consultation document – so it was the announcement of a consultation on a consultation! This, effectively, meant that the then Labour Government would not have to tackle the issue of social care before a General Election, something that was raised by numerous journalists at the time.

Since May 2010 we have had a Conservative/LibDem  Government whose only action, so far, has been to launch yet another consultation – Dilnot – with the promise of a White Paper which appears to be delayed yet again, although reports last week suggested we will get a draft version which will be open for consultation!
Apart from the blatant prevarication by all parties there is also the issue of what the constant consultations involve and that is the issue of who pays what for social care.

Yet the issues go deeper than that, social care has been facing cuts since well before the recession actually kicked in with issues over less than inflation fee increases by local authorities going back to at least 2007.

So it is not only a case of who pays but also is enough actually being paid?

Principle in this question of how much is being paid is what we are paying social care staff. At the end of last year the BBC revealed that many care workers are actually getting less than the minimum wage

If we want to provide the best possible quality of care for the most vulnerable in society then we need the best possible workers to provide that care and support. Yet care workers have been described as ‘vulnerable workers’ by the TUC and there seems to be little political action on improving the image of care work to encourage more people into the sector.

In 2010/2011 there were around 1.5 million adults accessing Local Authority funded social care services and this does not include those ineligible for funding and who are having to pay for their own care. And the issue of social care will only become more pressing over time, more people will need care and support services as the population continues to live longer and WE WILL NEED more workers to provide that support.

Government should be about leadership yet ALL political parties seem to prefer to run and hide when it comes to dealing with social care.

I am supporting #Twobby because those who sit in Westminster need to STAND UP and take action on social care NOW rather than endlessly prevaricate in the hope that it will go away