Tuesday, 22 April 2014

Declaring Independence

What is Independence?

Unfortunately it is one of those words that means different things to different people, it is not easily definable. If you quickly ask a dozen or so people what the word independence means I am sure you will get a series of similar, but never quite the same.

A quick Google search of the term independent and we get;

1.    Free from outside control; not subject to another’s authority
2.    Not depending on another for livelihood or subsistence

Yet neither of these terms can really be applied to social care, can they?

Naturally effective social care depends on those who need care services providing the right level of support to help them to live life as fully as possible but, as a result those who need social care depend on others (i.e. carers, care workers etc.) to provide that livelihood and subsistence and, at the same time, that support is subject to local social services authority about the level of support provided.

So how do we define independence in relation to social care provision?

As the term itself is dependent on each persons’ interpretation of it, it becomes ever more important to understand the individuals needs and how they view what independence means to them.  One person may view support at home as a means to help them live independently while another may consider it interference and a threat to independence yet both may be in equal need of support and at risk from the same sort of issues (e.g. falls). Obviously we declare that individuals have the right to take risks, as long as they have the capacity to judge those risks, yet such individualism presents problems for local authorities and health services that have a duty to safeguard the vulnerable.

This can, inevitably, lead to a situation where local authorities and health services then decide what independence means in their world. So, in other words, we become dependent on another’s authority about what independence means for us!

Real independence is entirely individualistic. For example independence may mean being able to do whatever you wish at any time yet giving a person minimum social care support at home may actually inhibit that freedom, they may become house bound and isolated rather than having the support they need to get out and live the life they wish conversely, for some, too much support may seem restrictive and intrusive to them again inhibiting their own sense of independence and freedom.

So if we are to succeed in truly providing independence to those who need social care services the first question always must be “What does independence mean to you?” followed by “How can we help you to live the independent life you want?”

Obviously there are restrictions on what public services can actually do yet those restrictions should not halt those first two questions. After those two questions co-production (I still do not like that terminology!) can begin as you work toward a support package that brings the best possible independence to the individual, an independence that helps them live the life they want.

Monday, 6 January 2014

Workplace Stress: Time to Think About It Now

Many people will be back to work today. Faced with an inordinately high in-tray or seemingly endless list of unread e-mails to be tackled urgently they will feel an immediate ramp up in stress levels after being able to take it easy for a couple of weeks. Of course a few others will feel relief at getting back to work after a stressful fortnight at home with the kids but the majority of people returning to work today will feel an increase in their stress levels as they get down to their days work.

Obviously there are many who never stopped working and workplace stress is a constant factor that never goes away.

The issues of workplace stress are well recorded as is the impact it has on sickness levels and general well-being yet we talk very little about workplace stress in front line social care. The Health and Safety Executive state the 40% of work related illnesses are stress related and that ‘human health & social work’ is one of the areas where the highest rates occur (http://www.hse.gov.uk/statistics/causdis/stress/index.htm)

Front line care workers, whether providing care in a person’s home or working in a care home are subject to stress in the work place as much as (if not more) to anyone sitting in an office, working in a shop or factory etc. Stress is not limited to the ‘big’ events in life, stress accumulates as the small things niggle away at us and without the opportunity to release that stress externally it eats away inside us causing physical illness that, eventually, can do significant damage to our health.

Imagine the pressure on a home care worker who has to do a number of 30 minute visits to vulnerable people. The time pressure to get their work done in that 30 minutes followed by the pressure of travelling to visit the next person who needs support and care, this can be made even more demanding if the worker never knows who they will be visiting that day or they have a workload that means they have even less time to travel between homes.

Working in a care home can be stressful too. Meeting the needs of those who depend on others for many aspects of their daily lives can take its toll on those responsible for delivering that support and care. Imagine dealing daily with incontinence, challenging behaviour and even death. The stress of working in a shop or office is mild in comparison.

And if that stress is not enough for the front line care worker there are also the issues of low pay and unsociable hours to contend with.

Where people have high levels of stress they react by either internalising it, which leads to health problems or they externalise it, usually by demonstrating aggressive behaviour. In front line social care both are dangerous.

Internalising stress can affect our concentration and, in front line social care, which can lead to dangerous errors, stress also impacts on our immune system making us more prone to any bugs or ailments floating around. In front line social care this can lead to spreading those germs to vulnerable adults whose immune systems are already weak. Given the nature of front line social care, with its culture of low pay and only paying statutory sick pay there is a reluctance for many care workers to take time off for illness unless they are physically unable to leave their house.

Externalising stress is even more dangerous in front line social care. It can lead to abusive behaviour.

Yet despite the acknowledgment that workplace stress has a real impact on peoples’ lives, in social care this is something rarely mentioned or acknowledged. For example, the Skills for Care Manager Induction Standards do not mention the need to monitor and address workplace stress (http://www.skillsforcare.org.uk/Document-library/Standards/Manager-Induction-Standards/Manager-Induction-Standards.pdf) and the Care Quality Commission Standards focus more on competency in their “Guidance about Compliance” on the standard of supporting workers rather than tackle the real issue of workplace stress and its potential to lead to failure to deliver safe services (http://www.cqc.org.uk/sites/default/files/media/documents/guidance_about_compliance_summary.pdf).

If we truly want the best services for the most vulnerable in society then we need to recognise the stress that can be placed on those delivering the actual services. Everyone deals with stress in different ways and, because of that, there needs to be a focus on managers and providers having good quality training and awareness of the issues associated with workplace stress and being able to demonstrate competency in dealing with workplace stress issues.