Monday, 28 May 2012

Pass It On: Sharing Social Care Knowledge

If you were to ask a front line care worker if they had heard of Skills for Care, the Social Care Institute of Excellence or the National Skills Academy for Social Care my guess is that the majority will have not.

It is not that they need to have heard of these organisations but it is essential that they hear about the work produced by these organisations and that is where social care leadership is so important. We need to disseminate information, new knowledge and best practice to those who are actually delivering care services to those in need.

Last week, for example, Skills for Care launched a new guide – Supporting Dementia Workers – which sets out 8 Common Core Principles for supporting people with dementia.

Earlier in the month the Social Care Institute of Excellence released a briefing on Preventing loneliness and preventing social isolation among older people and in a month or so the National Skills Academy for Social Care will be launching its Leadership Strategy for Social Care.

All very good work but all pointless if it does not reach the majority of social care providers and social care workers.

The responsibility with obtaining and passing on what is produced by these organisations lays with the care providers and the really good providers will actively seek out what’s new and put it into place but there are many other providers out there who will not.

These are not necessarily bad providers, but could be ones that are just inwardly focused on their business without taking the time to look beyond their own service to what they could do to further improve the lives of the people they provide services for. Other, less good providers, will use every excuse in the book not to look beyond their service - “We don’t have enough time for that sort of thing” etc – or they believe that they know best.

This is not just related to the work of the three organisations mentioned. A few years ago when I delivered a series of training seminars on staff development it was obvious that I was “preaching to the converted” with organisations interested in staff development who were sending their managers to the course, similarly only those outward looking providers send staff to conferences and seminars. Unfortunately it is the “unconverted” that we need to reach to ensure that they understand and deliver the knowledge ad best practice to their workforce.

The challenge, therefore, is to find ways to reach those providers who do not look for new information or believe they do not need that information.

Perhaps one solution is for the Care Quality Commission to enhance their registration of managers to include a requirement that all registered managers must provide evidence of Continuing Professional Development annually in order to maintain their registered status. This is a standard requirement (albeit not annually) for most other registered  professionals and it would ensure that all Registered Managers undertake some form of external training that would extend their wider knowledge of new developments in social care.

Additionally those commissioning services could take a more proactive approach to ensuring best practice is disseminated. Where local authorities offer conferences etc for providers we come against the same problems of only the good providers sending staff to them so commissioners need to be more active in ensuring that those they pay money to are fully up to date with best practice and new knowledge.

There are many sources of information, knowledge and good practice in social care but we need to make certain that all of reaches those who are actually delivering front line care services if we want those in need of services to benefit from it.

N.B. For Tweeters:   National Skills Academy for Social Care - @NSASocialcare
                                    Skills for Care - @SkillsforCare
                                    Social Care Institute of Excellence - @SCIE_Socialcare

Thursday, 17 May 2012

Care, Communities and Questions

I read a quote from Care Minister Paul Burstow yesterday saying “We need to reconnect care homes with their communities” and it is evident he said broadly the same thing today (Thurs) at Community Care Live.

But what does that mean?

I know I will stand accused of being a ‘naysayer’ but have care homes ever been connected to their communities?

For starters a care home should be just that, a home. One that looks after those who are no longer able to look after themselves independently and those who are living there should be treated with the same dignity, respect and privacy that everyone should expect from their own home.

So a question, how connected with the community is your home?

Chances are not at all, it is probably the place where you retreat from the community, the place where you can drop the ‘outside world’ persona we all employ and indulge yourself in your own private pleasures, where you can shut out the pressures of modern society and allow you mind to mentally recharge before stepping back through the front door into the hurly-burly of the world. Obviously not every home is a happy home and, sometimes, what happens behind closed doors is truly horrendous but in most instances the home is the place of privacy and the expression of your personal identity, the only invasion from the community is of your choosing and then probably limited to friends and families.

Then of course we come to the other question – what is a community? The definition is simply ‘a group of people living together in one place’ there is no connotation of that group being connected in any other way. How connected are you to those who live in the same street? The answer will largely depend on where you live, smaller villages tend to have greater connection than large cities but, in general, in even if you know everyone quite well it is unlikely that the community will be the focal point of your life.

Additionally the location of the care home will not necessarily reflect the community of those who live in the home but perhaps the greatest connection with the community already exists as the people working in the home are, more often than not, drawn from the immediate area.

Given all of this it seems something of a something of a meaningless platitude to call for “care homes to reconnect with their communities”

If, however, Mr Burstow means we need to reconnect those who live in the care home with their communities that is a different matter. My last blog focused on the human need for connection (Craving Connection, Fulfilling Personalisation) and, yes there does need to be greater effort made in helping people maintain the social contacts they had before moving into the care home. Our friends our an important part of how we define who we are (and of course who we are not) and by maintaining those social contacts it allows a person to ‘keep hold’ of that identity even when they are in a setting where those around them are there due to circumstance rather than choice. It is equally important that care homes develop a sense of community within the home by finding common ideas and themes that all (or at least the majority) of residents can be involved in.

However, I suspect, and I am happy to be proved wrong, what the Minister actually means is that we need to get communities involved in care homes, particularly the voluntary community who can provide services for the care home and relieve the financial burdens on the state in delivering care services.

There is certainly a case for encouraging volunteers to come into the home especially in the development of community activities within the home but they should certainly not be used as a means of financial avoidance by the state.

It has been stated recently that the ‘Big Society’ appears to be a means of Government misdirection and encouraging ‘communities’ to take over where the Government knife has wielded huge cuts but care of the most vulnerable in society should not be one of those areas and Government MUST TAKE RESPONSIBILITY for those who need care services.

Tuesday, 15 May 2012

Craving Connection, Fulfilling Personalisation

Part of being human is the craving for social contact. You only have to look at the way modern technology has evolved over the last few years a social networking sites have evolved (remember that time when Friends Reunited was all the rave!).

We now Twitter, Facebook, LinkedIn or whatever to maintaining our social circle and, to some extent expand it. Of course it is not just our P.C. that allows us to do this, the vast array of mobile devices allow us to tell the world where we are, what we are up to etc. as well as giving us the chance to check on what are friends and wider social network are doing.

The technology, however, only facilitates this inner desire, this craving for relationships and social contact that is present, to some degree in all of us and has existed since the emergence of man. Family, community, society are hardly the constructs of those who crave isolation.

And if we need to identify  the truth of this  we only need t look at how we punish people - we "send them to Coventry", we ignore them, in prison we use solitary confinement.

Maslow puts this need for connection firmly in the middle of in his classic Hierarchy of Needs, Professor Stephen Reiss identified social contact as one of the 16 basic desires that define our personalities and motivate our actions, the New Economics Foundation identify connecting with people as one of the five ways to wellbeing.

So why don’t we focus enough on this in social care?

Remember the recent Panorama programme where the two care workers roughly washed the resident? When they were doing this they busily maintained their own social relationship by talking in their own language while failing to talk to the individual they were supposed to be caring for? Maybe an extreme example but how many times do we hear of care home residents all sitting around in large lounges in silence? How many times do we hear of cases where care in a person’s home is restricted to 15 minutes or so giving the care worker little or no time to interact with the individual or complaints from care service users that they never know who is going to turn up to care for them?

Part of the problem is, perhaps, that some elements of social care are still to firmly rooted in the medical model of care. Clinical detachment in the health professions serves a purpose, it helps to insulate health professionals from the trauma of getting to attached to people likely to suffer great pain or die, it prevents the psychological transference of distress from those suffering to the professional who, for their own sanity, must remain outside the constant bombardment of anguish and agony not only from the patients but their traumatised families.

Yet can this clinical detachment work in social care? No, for many different reasons. Firstly the clue is in the name SOCIAL Care, social care is not the same as health care, that is the responsibility of the health professionals, social care is about supporting people in their everyday lives, helping them maintain connection with the wider world or, if that is not possible, ensuring that they are able to live as full and active life as possible in their individual circumstances.

We are, by nature, social creatures and while the degree that socialisation is needed by individuals vary, quality social contact still forms an important part of our lives. How can we know what level of social relationship individuals need unless we make the effort to establish a significant relationship to find out?

Personalisation is the social care buzzword at present and it is a goal that we should strive to achieve but how can we provide personalisation through clinical detachment? We need to build relationships with care users to understand their personal needs but more importantly to provide them with the type of social relationship that is cornerstone of being human.

Monday, 14 May 2012

Skills, Social Care & Society

Very soon the whole social care consultation merry-go-round will start once again with the emergence of the White Paper. When the Government  publish this  undoubtedly the focus, once more, will be on who pays for care services and how they do so, leaving out HOW MUCH such services really cost.

Part of the debate on social care is about providing quality services but there is little discussion how this is achieved and how the front line care workforce is trained to deliver that quality and why training is so important to achieving the best possible outcomes for those who rely on care services.

Everyone sitting in an office right now knows about Health & Safety at Work, to most it is something that is fairly abstract but rigorously enforced by the ‘Health & Safety Police’ in a manner that appears somewhat obsessive. Yet in social care health and safety is a lot more immediate and is not only about the workers but also about the people they support and care for. Slips, trips and falls, for example, become a much greater hazard for those who are frail and have problems with mobility, it is not just a case of worrying where computer terminal wires trail but all small lumps and bumps in the flooring become potentially hazardous.

Care workers, therefore, have to have a  greater awareness  of health and safety than the average worker and, of course that level of training costs.

One of the favourite things in social care is to compare the workforce (in terms of pay conditions etc) with the retail sector. I have often questioned this comparison but the issue of training helps illustrate why the comparison is a false one, particularly moving and handling. Obviously both jobs involve manual handling, lifting etc but in a supermarket the only handling involves inanimate objects. How much more complex the need to be able to handle people, to help them in and out of bed or the bath, how to use the more complex equipment, such as hoists, which need to be tailored to the individual.

Care workers, therefore, have to have a  greater awareness  of moving and handling than the average worker and, of course that level of training costs.

The same applies to many of the basic training elements in many workplaces where care workers have the additional element of having to take into account how that knowledge applies to those they work with.

Beyond that the care workforce is expected to have additional knowledge that is, generally, only otherwise found in the health sector. This includes infection control and ensuring that the risk of infection is minimised, they need to understand the concepts of cross contamination, the hazards of handling bodily waste and how to deal with contamination if it occurs. Care workers need awareness of medication, how to store it, deliver it and record its use and care workers need to understand the signs and symptoms of adult abuse and what to do if they suspect abuse has taken place.

Society also expects care workers to deliver dignity and respect to those they provide services for. While the words dignity and respect are often bandied about very little is said about what this involves and the principle skill is communication and care workers need to be trained in the complexities of communication in order to listen to and understand the needs of the individual to deliver the best possible service.

Social care is often portrayed as a generic service where care workers are transferable. But, in fact, care services are far from generic, older peoples services are vastly different from learning disability services or mental health service or physical disability services and aside from the general skills listed above there are also specialist skills needed by the care worker dependent on the service they are working in. Knowledge of dementia is an essential skill for working with older people but not in many other services, (although in learning disability services dementia is an issue that is probably needs more consideration as the population ages), knowledge of autism and epilepsy is needed in learning disability services where these conditions are prevalent and, of course, knowledge about specific learning disabilities need to be known in order to provide the best possible service.

Overall then the care workforce  needs  extensive skills and knowledge to deliver the best quality care. This sometimes fails, as demonstrated by Winterbourne View and Ash Court but this cannot be surprising in a society that undervalues care workers and fails to see the importance in ensuring care services are funded sufficiently to allow the full spectrum of  specialist  training to match the  specialist  service that care workers are expected to deliver.

When the White Paper is  published  and the consultation process around the proposed draft social care bill starts they needs to be a greater examination of what we expect the social care workforce to deliver, the skills and knowledge that are needed to deliver quality care and how much investment is needed to ensure these skills are in place.

Friday, 11 May 2012

Why Care Can't Wait

Panorama has discovered a series of cases in which elderly people have been unsafe and unprotected in nursing homes. Instead of being looked after, vulnerable, elderly people were insulted, neglected, roughly handled or physically assaulted.

Sound familiar?

Yet it is not the episode aired on 23rd April this year where Fiona Phillips exposed the treatment of Maria Worroll at Ash Court. It is an episode that was aired on 12th February 2007. So, in five years, why has nothing been done to prevent these things occurring?

We have had other exposés in between most notably the abuse of people with Learning Disabilities at Winterbourne view but none of these seem to be able to make politicians care enough about social care to take real action on improving the lives of the most vulnerable.

We cannot solely blame the politicians, the national media must take some responsibility. Such events soon disappear from the news agenda and while Panorama will provide us with regular exposés they seem to lack the inclination to ask WHY is this still happening?

I was reminded of that Panorama episode when I was flicking through my copies of the magazine I used to write for. Ironically my column in that same edition focused on the success in care training that had been achieved as had been highlighted in that years “State of Social Care” report from the CSCI. At that point the National Minimum Standards required all care providers to have at least 50% of their staff with NVQ level 2 and real progress was being made on that. Unfortunately that requirement was dropped in 2010 and, in fact, there are no specific requirements at all for care providers to have qualified staff.

In that same column I also raise concerns about whether the level of success in training care workers can be sustained because of diminishing fee increase from Local Authorities and question the effect that proposed registration of care workers may have on the sector. Five years later those fees have continued to be lower than inflation (in the last few years there have been no increases at all) and the registration of care workers has evaporated into thin air.

My reason for looking through those back copies was to try and find when it was that Ivan Lewis faced a question from a backbencher on the practice of local authorities not raising fees to care providers or, if they were, at a rate below inflation. This was in March 2008 and he condemned the practice stating that care providers should, at the very least, expect an increase in fees that kept pace with inflation. Of course this has not happened and the amount being paid to provide care and support has fallen behind in real terms.

So, in essence, nothing has happened to tackle the issues facing social care over the past five years, now we face another delay to action on care.

In five years we still have Panorama exposes on care, we still have no actions on care worker registration and the amount paid to provide care and support to the vulnerable continues to fall behind and while we have had tinkering around the edges with changes in regulator etc no substantive political act has been taken in that time. 

We have had a consultation in 2008/2009 which led to a Green Paper in July 2009 followed but another consultation and a White Paper in March 2010. Then, with the change in Government, we had the Dilnot Commission launched in July 2010 and the Dilnot Report published in July 2011.

Surely we have had enough talking. 

This is why care can’t wait and we need action NOW not later

Thursday, 10 May 2012

Lest We Forget

            Many elderly people who use care services are, generally, over the age of 80 and they have lived through a great deal in life.

            My Nan, for example, turned 90 this year. She not only lived through the Second World War, she gave birth to my father in 1943 in Bermondsey, London.

Can anyone, nowadays, imagine what it would be like to bring up an infant under what was, effectively, the German Bomber flight path to the Capital?

My Nan now has advanced Parkinson’s disease and relies on carers coming to her Warden-Assisted home to get her up and put her to bed. She can do very little in between times.

            My Nan is, of course, not alone there are millions of elderly people relying on carers, either paid or unpaid, to help them live their daily lives and to them it must seem nonsense when we talk of austerity. Austerity is, surely, living through rationing and experiencing such delights as powdered egg (I’ll be honest and say the thought of it makes me cringe). Austerity is living part of your daily life in bomb shelters in the fear of losing your home or your life.

            The same generation has lived through economic good and bad times since then, from ‘never having it so good’ in the 60’s through the three day week and electricity blackouts of the 70’s and all else up till now. Surely having been through all of that they should be able to enjoy economic stability at the end of their lives and know that their care provision is not impacted by the banking/government created recession that we are in today.

            Why should those who have been through and seen so much bear the brunt of failed policies and economic mismanagement?

            Social Care is an important part of our society yet it seems those in Westminster fail to see the impact it has on those who need social care services, their families and those who provide care services. Social Care is about peoples’ lives not about political expediency, social care should be about providing the best possible services not just those that are financially viable.

            When David Cameron stood outside Downing Street as he took office he said. “I want to make sure that my Government always looks after the elderly, the frail, the poorest in our country”. Two years on and they are still waiting

            Every year politicians stand at the Cenotaph and, quite rightly, honour those who have fallen in conflict yet they also need to honour those who survived and provide the best possible support and care services, let’s not impose under-funded services on those who deserve better.

Wednesday, 9 May 2012

Shiny New House on Rotting Foundations

If someone spent time and money putting up a shiny new conservatory at the expense of sorting out the subsidence and rotting foundations in their house, what would you think of them?

If a business tried to launch a shiny new product with expensive advertising and a fancy, high profile launch at the expense of repairing the decrepit machinery in their crumbling factory that limits their ability to make the product, what would you think of them?

In both cases you would think they are fools.

So why should we think any less of the Government today.

Electoral reform and democratising the House of Lords will be the shiny product launch today, the new conservatory under in which the coalition can bask while ignoring the crumbling social care system which is subsiding fast under the Governments lack of action on supporting the most vulnerable in society.

The plight of millions is being ignored, the millions of unpaid carers who look after the millions of individuals who need care, the millions who receive funded services or who have to pay for those services themselves and the million or so low paid workers who are expected to deliver high quality care yet are in danger of being in a poverty trap themselves.

And while the coalition basks in the vain glory of their shiny House of Lords they forget another important point. Those millions affected by social care are also voters and why should those ignored by the coalition, left sinking in the financial quagmire of social care, even consider voting for the two parties that have flagrantly displayed contempt for the most vulnerable in pursing political expediency over the more pressing needs?

Of course the previous Government was no better but now at least the Labour leopard has the chance to change its spots and pursue the goal of achieving the best possible outcome for those who need and deliver care services.

The Government have exposed themselves as fools by, yet again, prevaricating over social care. Social justice is what underpins modern democracy and the shiny new house will be sitting on the rotting foundations of social justice presided over by the current Government

Friday, 4 May 2012

Politics, Passion & Social Care

In the classic sociological text “The Profession and Vocation of Politics” Max Weber states that ‘three qualities are pre-eminently decisive for a politician: passion, a sense of responsibility, judgement’. Passion, Weber argues, is not the romanticism of the intellectually interesting lacking all objective as ‘simply to feel passion, however genuinely, is not sufficient to make a politician unless in the form of a service to a cause. There has to be responsibility to that cause and judgement maintaining inner composure whilst being open to realities.

Weber warns, however, that ‘the politician has to overcome a quite trivial, all too human enemy which threatens him from within: common vanity, the mortal enemy of all dedication to a cause’.

Yesterday’s elections had another low turnout and the debate on voter apathy roles on with debates on ways to improve turnout but if we take Weber’s view the voter apathy can be explained by the lack of passion and responsibility of a cause to inspire voters in to the voting booth.

Over recent years Party Politics seems to have become just that, politics focused on which party can win, can they get enough seats to maintain a majority and what action can they take to maintain power. This is the common vanity that has best our politics, the passion for party success rather than passion and responsibility for a cause that will inspire the electorate.

What our politicians, at all levels, need to do is find the cause that impacts on their voting base and fight with passion for that cause and, if elected take responsibility for that cause. Those who simply get elected, then either settle into the party compliant role or who tilt at windmills on subjects that have little or no effect for the people who voted them into power will simply generate more and more apathy as voters fail to understand the point in electing anybody.

There can be many causes to promote but the ultimate goal has to be a cause that acts for the betterment of the people and, surely, there can be no greater cause than the one that seeks to help the most vulnerable in society to maintain their place in that society with dignity and respect.

Social care is a cause that has largely gone unsung by politicians, primarily because it is not a traditional policy area, and its increasing importance to society is grossly under-estimated as the population ages and we see an increase in age related conditions which will need greater numbers to provide services.

After years of prevarication and tinkering around the edges social care is crying out for a political champion to fight for the cause affecting so many people, social care is crying out for politicians to take responsibility for the care and support of the vulnerable in society and social care is crying out for passion in raising awareness of the needs of those who use care services.

The politician that can show genuine passion for helping the most vulnerable, who can take responsibility for ensuring the social care system is the best it can possibly be and show that the passion is directed at the people who need support rather than just a reason to be elected is the politician who can attract voters to the polling booths and the type of politician this country needs a lot more of right now.

Thursday, 3 May 2012

Let's Get Social Care Out of the Darkened Corner

The Health & Social Care Act 2008 received Royal Assent on 22nd July 2008 but the bulk of the provisions relating to social care where not put in force until 1st October 2010. So, in essence, there was a two year gap between the final stage of the Parliament and the implementation of the Act. Of course, this is just the end of the process, a bill has to travel through the parliamentary process. For example, the controversial Health & Social Care Act 2012 had its first reading in Parliament on 19 Jan 2011 and received Royal Assent on 27 Mar 2012, probably an extreme example but it highlights the length the process can take.

What’s the point of that little tour of the Parliamentary process?

Simply speaking, the current Government has three years, at the most, left and unless they take action soon on social care there will not be any changes to the current system while this Government is in power, if they do, eventually, legislate it will be left to the next Government, whoever they are, to implement any changes made. And, more importantly, it could be close to three years to see any substantive change in the social care system (always assuming the Government put any substantive changes in a bill!).

To most of us in the sector such prevarication on social care is not unusual and not just limited to the Government in power at present. I won’t repeat the gist of my previous blog (Politicians Seem Clueless About Social Care) but suggest what we need is a radical approach to reforming social care at the very top.

When Ivan Lewis was named care minister in 2006 he promised a radical review of social care, unfortunately that never happened and the first announcement of a consultation on social care came only once Alan Johnson took over the role of Health Secretary from Patricia Hewitt a year later. This suggests that any real action on social care is decided by the senior minister who sits on the cabinet.

Obviously the Health Minister is generally more concerned about Health Care rather than Social Care as evidenced by this Governments pushing through the 2012 Act despite opposition from many health professional organisations. Social Care seems to occupy a tiny corner within the Department of Health thinking.

But why does social care sit in the Department of Health?

Social Care is not a minor area of public policy to be handily attached to what appears to be the most appropriate Ministry.

The number of people receiving local authority funded services in 2010/2011 was 1.6 million and this excludes people who pay for their own care and people deemed by social services as not having sufficient need level to qualify for support and who are cared for by unpaid family members etc., so true figure of those who may need social care services is considerably higher.

Skills for Care estimate that the social care workforce also numbers 1.6 million. So, at a minimum, 3.2 million people are involved in social care services. Add to this the fact that Skills for Care also “work closely with the 40,600 organisations that offer social care people who use services, carers and with other key stakeholdersand it is hard to see why social care does not get much more attention than say the Department of Culture, Media & Sport which has a Cabinet Minister in Charge.

It is also important to remember that social care is not just about health, although that may play a significant part in end of life care etc. the role of social care is to support and care for individuals in their day to day living and health remains the responsibility of health professionals. The public often only connect social care with elderly care but it goes beyond this and beyond the remit of health.

For adults below the age of 65 who need social care services much of the focus is on appropriate housing, employment opportunities and living independently. The latter of which is also a focus of social care for the elderly. Social care is about maintaining links with society and maintaining social well-being in addition to health well-being.

We need action on social care and we need political consensus rather than political paralysis. Let’s start by achieving consensus that social care should not sit in a darkened corner of the Department of Health and it deserves its own Ministry with its own Minister who sits on the Cabinet and has the opportunity to bring forward legislation but more importantly to show that Westminster is truly serious about working for the millions in the country who receive or are involved in delivering, social care services.