Wednesday, 24 April 2013

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 ( 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.

Friday, 19 April 2013


We often hear the terms, integration, connected thinking, joined- up thinking etc. when talking about providing the best possible care services yet perhaps the most important thing we need to develop is “CONNECTED UNDERSTANDING”.

Because different aspects of the care system work in different ways it means barriers are created through a lack of understanding how other elements of the system work and because social care is such a fragmented wide-spread system it means opportunities for not understanding are immense as points of view differ drastically.

An example, some see social care as a public service. In one sense this is right, social care is organised by central Government, commissioned and paid for through local Government, Social Workers, employed by local authorities are public servants etc. Yet the bulk of social care is actually delivered by private sector organisations, where the motivation of those who own the companies is, ultimately, profit and compliance with regulation about achieving it at the lowest possible cost in order to protect profit. Those, usually low paid workers, who are actually responsible for delivering intimate care services would hardly class themselves as public servants, a term which is generally associated with better working conditions (e.g. pensions) than those in the care work sector.

Another aspect to this gap is that those who receive care services funded by local authorities may well be receiving a public service, albeit provided by the private sector, but there are many more people receiving care services from the same providers who are having to pay for it themselves, and often paying more to make up the LA shortfall in funding. How does their care equate to public service provision?

Yet even between ‘public service’ elements of care provision similar barriers of understanding exist. Not simply because of different ways of working between sectors, e.g. between Social Service departments and the NHS, but also current economic conditions which create misunderstanding. Local authorities are having to cut their spending yet NHS funding is not under the same pressure and it is important that both sides understand what the other are doing and, more important, are able to do over the coming few years.

Beyond this is the fact that public service integration needs to go beyond just health and social services, it needs to include housing, welfare etc, again a lack of understanding which can create barriers that impact on the lives of those who actually need to access services.

Obviously this nit-picking difference between those various elements who deliver social care services pales into relative insignificance compared to the lack of understanding faced by the general public about social care, a situation generated by the fragmented system which sends out mixed and confusing messages. Who is eligible for care? What is the difference between Local Authority funded care and NHS Continuing Care? How much do I actually have to pay?

If we are to really deliver quality care services we really need to begin to start working on connected understanding, we need those at the top of the chain to have a greater understanding of actual care delivery and we need those who deliver care to understand why Government, Local Authorities and Health Services operate in the way they do. Naturally the most important thing is that those involved in all aspects of care delivery understand the needs of those who need care services and understand how to connect with them.

Friday, 12 April 2013

What makes you, you?

As a follow on from my last post How Do You Feel About Memories I think it is also important to consider how we stereotype those who need care services and what we need to consider, especially when thinking about older peoples services.

Stereotyping is a natural human trait, we find it easier to put groups of people in specific categories rather than struggle with having to think about everyone as an individual. It is easier, for example, to put all football fans, in the same category rather than struggle to think about the 100’s of thousands of individuals within that category.

In many instances stereotyping is used as a political weapon to demonise a ‘group’ of people, as shown recently by labeling all benefits claimants as ‘shirkers’ who live of the hard work of the ‘strivers’ in society. Of course that analogy, much touted recently, fails to take into account,perhaps the worst type of benefit fraudster, those who work but still claim benefits – are they shirkers or strivers? This is why stereotyping politically in dangerous.

Yet even in the social care world, where awareness of individuality is more recognised there is a tendency to stereotype, not as a means of demonization but as bureaucratic convenience. Yet there are pitfalls we must avoid if we are to ensure that social care services are truly personalised.

We don’t just stereotype people we also tend to stereotype history. The bulldog British spirit of World War Two, the Swinging Sixties, etc and there is a tendency toward selective memory of the past. How often, for example, do we see moans about the youth culture of today yet the complaints are made by those who grew up during the era of ‘mods and rockers’ ‘punk rockers’ etc who were on the receiving end of similar complaints.

How does all this apply to social care?

Imagine a care home, in one seat a 75 year old in the next a 100 year old. Both old people in an old peoples home to most, yet there is a 25 year age gap. Now imagine someone 25 years younger or older than you. The 100 year old is actually sufficiently older to be the younger persons parent.

The 100 year would have been born in 1913, just before the First World War and would have reached their teens in 1926 and spent their formative years during the depression and would have been 26 at the outbreak of World War Two and approaching their 50’s as the Swinging Sixties started.

The 75 year old was born in 1938, so just 7 as the Second World War ended. What can you remember about your life as a seven year old? They entered their teens in the early 50’s, the time of rock and roll and the beginning of modern youth culture. Just 22 as the 60’s started so, as someone in their 20’s, their experience of the decade would have been completely different from the older person, now middle-aged.

As the general population ages and degenerative diseases impact on lives more and more it is so important that we take into account all aspects of the individual. Old people are not just old people, their lives can be worlds apart as can be their memories and how life has impacted on them over time.

Our experiences through our life make us unique individuals. Each of us is touched by different experiences which then impact on how we move forward in life. We are influenced by different people and we are influenced by the events of the world around us, and how we see those events depends on our past influences and our age.
We are, individually, a complex make up of different memories and experiences and to deliver the best possible services we have to take time to understand both the individual and the wider world which influenced them. Delivering quality is not just about clinical execution of care duties but of taking time to help people to live the life they want, which is, inevitably, based on their age and life experiences.

Tuesday, 9 April 2013

How do you feel about memories?

Remember the time you first fell madly head over heels in love with someone? No matter how it all ended (if it did) you can probably recall those feelings that swept through you at the time and carried you away though that first burst of youthful infatuation with associated physical feelings of heart racing, skin tingling and shortness of anticipatory breath.

Now recall a time of great sadness in your life. How did you feel then, how did you feel physically, in all probability your posture slumped making you breathing shallow. You may also have been tearful and short-tempered as you feel the universe is against you as the hurt digs deeper into your soul.

Now success, remember that time when you were truly and utterly thrilled with yourself for achieving something you did not think was possible. Recall that elation and the feeling of confidence running through, a confidence that made you feel invincible and that there is nothing you can’t achieve in the future. Remember how you felt physically, probably the feeling of strength coursing through you, holding your body straight and held, literally, held high.

Now what about right now?

Did you notice, as you read through those paragraphs, that you experienced some of those feelings here and now.

As human beings our memories are associated with our emotions and feelings. We are not, generally, like computers were recall is just a copy of a saved file. Recalling the past evokes associated emotions right now, think about your favourite slushy song and how it makes you feel as you remember why it holds such special memories for you.

The stronger the emotion of the original event, the greater likelihood of it creating a strong emotional feeling within you right now.

If we want to truly improve the lives of those who need social care services, particularly for those with dementia, then we need to understand the power of memory and the effect of recalling feelings. We need to understand each individual’s history in order to ensure we communicate with them in a way that will produce positive feelings now and, more complexly, in care homes there is a need to understand that individuals will have differing emotional memories about the same historical events.

For example, one person’s memories of World War Two could be one of success and achievement through victory and survival, a successful battle against the odds where camaraderie was an essential key to that success and resulted in life-long friendships that shaped the individual’s life. For another, perhaps sitting in an adjacent chair, the memories could those of loss and sadness perhaps tinged with guilt for surviving when so many others around them lost their lives. For both people a care home playing “We’ll Meet Again” will evoke memories and emotions but completely different ones.

Or, to be more topical, look at the reaction to the passing of Margaret Thatcher, the mixture of adoration and animosity dependent on the individual’s experiences 30 years ago. Those with really strong emotions of her are likely to retain those memories and emotions and, in another 30 or 40 years when they need care services and images of Mrs Thatcher will evoke that adoration or animosity and the care staff will probably be oblivious to the reason why.

Social care is not just about physical care tasks, it is about helping people emotionally as well as physically. This cannot be achieved without understanding feelings, emotions, memories and communication. Social care needs to understand the people who need care, their families and the social background that frames their shared experiences and memories and the how these affect individuals.

With the increasing emphasis on health and social care integration there is a danger we lose the social model of care and the social impact of ageing as well as the social importance of memories. Let’s hope that in the future we do not look back with sadness as we failed to understand the importance of emotions in social care.

Wednesday, 3 April 2013

Reflections on Power

When you get up in the morning, generally, you exercise control over what time that is. Obviously there are factors that influence that decision, the time you start work, the time you need to get the kids up and ready for school or perhaps you might find yourself changing your routine for a special event. Whatever the constraints you still make the decision because you know how much time you need in the morning to get ready etc. Some people like plenty of time, others seem to be able to get up and get out within minutes.

Think about your lunch today, again there are probably constraints on time depending on your personal schedule but the choice of what to if, if anything, is yours.

Now fast forward to this evening and what you will be eating, you may have already planned your evening meal, perhaps you will make up your mind at the last minute or perhaps you will abandon your plans to have that takeaway you’ve really developed a craving for. The power to choose is yours, as is the power to make the decision about what time you go to bed.

What would it feel like to have that power removed?

Most of us can probably recall times in our youth when we rebelled, to a greater or lesser degree, against the constraints put upon us by our parents about what time we had to come home or go to bed but imagine having the power to make decisions about your own life be taken away from you as you age, imagine the frustration you would feel.

Yet this is the situation we put many elderly people in as their own personal circumstances dictate the need for social care services. The personal power that we all take for granted is swept away and taken up by the bureaucratic process that then takes over the life of the individual.

Whether we like it or not we take away personal power the moment someone enters the care system.

Even where we use the terms empowerment and co-production the reality is personal power has been taken away.

To empower someone simply means to allow them a certain degree of power, in order to empower someone you must hold power over them in the first place in order to release that power to them, and, ultimately you still hold that power and have the power to withdraw that empowerment at any time.

Similarly, co-production, by its very name, indicates that we are allowing someone to share power about their daily lives, as with empowerment the real power lies with those who allow co-production and who, if they wish, also have the power to withdraw that sharing.

Naturally things are not quite so black and white in the real world, exercising personal power may well be dependent on personal capacity and other factors but the bottom line is personal power is removed and only partially given back within the framework of the local authority or care provider. The time many get up or go to bed is dependent on the availability of staff to assist them, what many eat is not dictated by the own personal choice but only a choice of limited availability.

We often take our own personal power for granted, for example when you do your weekly shopping you are able to make spur of the moment choices depending on your own whims, imagine the limitations on your personal power when others have to shop for you or your meals are dictated by the care home you are in.

Power in our lives is important and we need to remember how the loss of power feels to those who are vulnerable and remember that the loss of power may impact on an individual’s mental well-being and general health. Those who need social care services should be empowering us to assist them in their lives rather than social care professionals dictating lives and the amount of power a person can retain.

It is a complex area but it is important that we reflect on individual power to ensure we can, at the very least, assist people in retaining their own power rather than creating a situation where we patronisingly hand a limited amount of power back to them.

Tuesday, 2 April 2013

Take Care Before Wielding the Knife

An interesting piece of news from the National Skills Academy for Social Care ( which suggests that the treasury are looking at further ways of cutting the social care budget, including curbing care provider fees.

Now the reality is that care providers have, in general, had lower than inflation increases in fees since at least 2008, well before the current financial crisis really kicked and, the bottom line is, the constant reduction in real terms of care fees impacts on the quality of care that providers can deliver.

Costs have spiralled, even if social care workers pay has be held back the costs of heating premises etc has risen sharply as have food prices and other costs.

While we have to accept the implementation of austerity measures handed to us the fact is further cutting back on care provider costs affects the lives of those who need care services.

While providers focus on meeting increasing costs and maintaining the level of care they provide there are inevitably areas that have to be cut back, invariably training of staff is one of those areas and because of this it means less well trained staff are providing direct care services and because they are less well trained it means the level of service will drop.

This is, of course, exacerbated by the fact that much of the funding for care training has almost completely disappeared. Where once NVQs for workers of all ages were funded, now only under 24s generally get free training yet many of those coming into care are older, usually returning to work rather than as a first job, which means the £1000 plus cost of a formal qualification is beyond the realms of realistic costs for many and, unfortunately, because it is no longer a requirement under the current standards it means many employers will not see the point of spending that amount out.

The real issue that needs to be tackled right now is not how we can save money but how we can ensure the safety and dignity of those who need social care services, yes we need to ensure people can stay in their own home as long as possible but this should not solely be based on saving money. Those who provide care in a person’s home still need to be adequately trained and given time to sufficiently care for the individuals rather than be forced into excruciatingly tight time slots which do little for helping the individual.

There are, undoubtedly, savings that can be made yet the Government must proceed with caution to ensure the well-being of those who need care services. Cutting care provider fees could drive some providers out of business, if that happens then the Government will find themselves actually increasing social care costs as they will have to fill the gap. The reason most care is provided by private companies is because it was felt this was a cheaper option than local authority provided care by driving providers out of the market it is probable that local authority provision will have to increase.

Social care in the U.K. is increasingly complicated, with control from Whitehall being disseminated through local authorities while actual provision is delivered by private companies who receive payment for services through many different channels, i.e. local authorities, the NHS, private funding or a combination of those.

If we want to save money let’s start by reducing some of this bureaucracy rather than targeting those who provide front line care in order to minimise the impact of cuts on those who actually need care services.