The Challenges of Social Care Inspection

The appointment of Andrea Sutcliffe as Chief Inspector for Social Care at the Care Quality Commission is a highly commendable one. Not only is she knowledgeable about the care sector (see for example http://www.guardian.co.uk/social-care-network/2013/jul/15/what-good-homecare-looks-like) but she also has her own personal experiences to draw upon (http://www.whentheygetolder.co.uk/finding-care-for-older-relatives/) and that combination, along with her naturally open approach, bode well for the future inspection of social care.

Yet that future is strewn with challenges that Andrea first needs to tackle. The general perception of social care is not great and trust in the Regulators has been severely dented over recent weeks. The first challenge will be defining a model of inspection that will ensure poor provision is identified and stamped out yet this model must also reflect the nature of the care sector and the huge variations within it.

Yesterday, for example, the new Chief Inspector for Hospitals, Prof Sir Mike Richards, outlined a model which he frequently referred to as ‘an army’, 20 or more inspectors marching into a hospital to inspect all aspects of care provision and ensure the meeting of standards. Unfortunately, in social care that will not work as, in many instances that many inspectors would outnumber both residents and staff!

The variation in social care is completely different from that of hospitals. Social care covers care homes and home care, it covers care and support for the elderly and care and support for those with learning disabilities, it covers large care providers with 100’s of homes as well as micro providers with just a few beds. Finding a model of social care inspection that fully encompasses the variation while ensuring consistency is, in itself, a challenge.

The Care Quality Commission has recently stated that it intends to have more specialist inspectors and social care could really benefit from this approach. For example recent reports have highlighted training and development issues with Health and Social Care staff and having learning and development specialists as part of the inspection process can help raise awareness of the importance of staff development, encourage providers to focus on training and development and help identify failings where providers fail to implement staff training and development. Similarly specialists in infection control or nutrition could have a significant impact.

One thing that would be good to see, and may well happen given Andrea’s former job, is a focus on best practice information and its application both by providers and inspectors. Resources, for example, from the three main national bodies, Skills for Care, National Skills Academy for Social Care and, of course, the Social Care Institute of Excellence should be routinely be embedded in care practice and those who inspect should also be fully familiar with this in order to ensure inspections are informed. One challenge has always been getting best practice information through to all providers, it is easy for providers to say they don’t have time to look at these things or, in the worst cases, believe they know what they are doing and don’t need any advice. If providers know their inspectors will look at this then they are far more likely to make to time to look at and use this information.

The regulatory framework has increasingly moved toward an outcome based approach, if providers and inspectors do not access the knowledge of what excellent outcomes look like then that system fails.

Undoubtedly, Andrea Sutcliffe has a challenge ahead, one that I am sure she will meet head on, and, ultimately, social care can only benefit by having such an effective leader at the helm.

Health and Social Care Training: The Real Issues

“There is no minimum standard of training for healthcare assistants before they can work unsupervised, an independent report has found” http://www.bbc.co.uk/news/health-23246066

Actually that’s not true!

Back in March Skills for Health and Skills for Care launched the National Minimum Standards for Healthcare and Social Care workers – see http://www.skillsforhealth.org.uk/about-us/news/code-of-conduct-and-national-minimum-training-standards-for-healthcare-support-workers/ . In addition the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 state quite clearly the Health and Social Care providers must ensure employees are “appropriately supported in relation to their responsibilities, to enable them to deliver care and treatment to service users safely and to an appropriate standard, including by receiving appropriate training, professional development, supervision and appraisal” (Regulation 23)

So, the issue is not whether those standards are in place but how those standards are applied, implemented and inspected.

The first area that needs real scrutiny is the induction process.

Imagine that time when you first started in a new job, there is always an element of nervousness as you enter a new environment, have to learn new routines and adapt to working with new people. Now imagine how much information you are likely to retain when you are bombarded with DVD’s or reading material which is supposed to make you competent in the role you are about to undertake!

While we have, in social care, the Common Induction Standards, it has to be remembered these only form a part of the induction process. Induction must be as much about ensuring that new employees learn about the workplace, its routines etc. and how the induction standards apply to the workplace and the individuals receiving care and support there. A tick box approach to the induction standards will not work and there needs to be a greater understanding by managers and leaders in the home of the importance of mentoring new employees to ensure the induction standards are embedded in work practice.

Learning and development must not stop after a successful induction. Professional development is a regulatory requirement and continuous training is important. Even if you have been on endless health and safety courses the chances are going on another will spark something in your mind that you had forgotten or prompt you to think about a bad habit you have got into and encouraged you to change it. Training, aside for giving us new information, can also make us think about how we do things right now, it brings us into ‘conscious competence’, always a good thing to do on occasion.

Supervision and appraisal also serves the same purpose. It helps us question why we do things in certain ways and can make us consider better ways of doing our work. Too often supervision and appraisal are seen as a means to be critical of an employees work but they should be seen as a means of encouraging employees to think about their own role and how they perform it.  

The key issue is to ensure that those responsible to managing and leading staff are sufficiently trained themselves in staff development.

One of the vital areas of training, often overlooked, is the quality of training itself. Certainly I have stopped using training providers because of the negative feedback I had from staff (the usual complaint is ‘they were just reading from a script’ – how can a trainer engage learners when they a focused on reading their lines?) yet how many providers actually get feedback from staff about the quality of training. It is important that providers do this, not only to ensure the quality of training but also to ensure they are not wasting their money!

There are schemes in place which accredit training in social care the principle one being the National Skills Academy for Social Care, and whilst their list is somewhat small at the moment, it would benefit all those who provide social care training to apply for accreditation (here’s the link https://www.nsasocialcare.co.uk/training-providers ).

Given that standards and regulation already exists the obvious question is how are these actually regulated and inspected. If there are issues over training and development why are these not picked up in the inspection process? It can only be speculated that the inspectors themselves are receiving insufficient training into what to look for and what questions to ask about training and development. One of the proposals from the Care Quality Commission’s consultation on inspection is the introduction of ‘specialist’ inspection teams – personally I hope that includes specialist in training and development to ensure standards and regulations are adhered to.

The training and development regulations and standards are there, the issue is how these are applied and inspected, if we can improve this we can improve the general quality of care across the board.

Take Care Before Wielding the Knife

An interesting piece of news from the National Skills Academy for Social Care (https://www.nsasocialcare.co.uk/news/whitehall-to-consider-protecting-social-care?utm_source=twitterfeed&utm_medium=twitter) 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.

Back to Basics after Winterbourne View: Social Care Training

The Governments final report on Winterbourne View says a lot about the need for staff training but within all of that there is an important phrase that applies right across the social care spectrum and that phrase is “properly trained”.

While there could be some debate about what ‘properly trained’ means it is essential that all care providers reflect on the standard of training that they are providing for their staff. Under the current economic climate it is quite possible that providers are focusing on the cost rather than the quality of training.

Skills for Care and Skills for Health are charged with producing minimum training standards by January but it is unclear as yet whether these will be tick boxes for providers or fundamental changes in the way training must be monitored or delivered yet in either instance care providers should take responsibility for the quality of the training they provide for their staff and this can be done in a number of ways.

Firstly talk to staff. How did they feel about the training, were they engaged with the training or was it just a chore that just had to be done? I know, from personal experience, have conversations like that are useful, once I was informed that a training session was pointless because the trainer just read everything from a book and obviously did not know much about the actual subject. Needless to say that training provider was not used again but without seeking that feedback in the first place the company would probably have continued using the same trainer.

Naturally it would be obviously more useful if care providers could have some assurance about the quality of training providers before they booked them. This is easy for certain courses such as First Aid and Food Hygiene where trainers are accredited by the Chartered Institute of Environmental Health but for other training the route to quality is much less clear.

Yet there is some help, the National Skills Academy for Social Care has started a list of endorsed trainers (available here) and of course word of mouth through local trade associations is a good way to identify recommended trainers. Hopefully the endorsement/registration of trainers in social care will expand to help providers in identifying trainers who can provide appropriately qualified trainers to meet the needs of their particular service.

It is also, perhaps, important that care training providers look at how they can improve their own service by , perhaps, ensuring that the model of care set out in the Winterbourne View report is embedded in any training they deliver and by seeking recognition from the National Skills Academy for Social Care so that providers can trust that they will receive quality training.

Care providers have further responsibility though. Ensuring staff are ‘properly trained’ is not just about what happens in the classroom setting, that training has to be turned into practice and that aspect is the responsibility of the management of the care provider. How aspects such as infection control, medication, mental capacity, adult protection etc. are applied to those the provider cares for can only be done at the point of care delivery and it is essentially vital the staff development activities work hand in hand with formal training.

Unfortunately, when the sector changed from the National Minimum Standards to the Essential Standards of Quality and Safety many of the training standards were lost as the new standards were required to cover hospitals, dentists, ambulance services etc. as well as social care but hopefully the new standards being worked will fill some of this gap.

There can be little doubt that training and the quality of training will be high in the Care Quality Commission inspection agenda and ultimately training provision is the responsibility of the care provider and it is essential that training provided for staff is high quality training that engages and leads to better outcomes for those they provide services for.

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

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.