Purple Badgers and Social Care

Really try hard not to think about a purple badger

Now having mentioned the purple badger it is probably highly likely that, in an attempt not to think about a purple badger that you have naturally conjured up an image of one so that you can try to not think about it! If I were more conventionally minded I probably would have said try not to think about a pink elephant, but now that I have said it has the pink elephant replaced the purple badger in your mind? Or are the pink elephant and purple badger co-exiting in multi-coloured animal harmony?

Naturally I do have a point about this.

To move to a less abstract level, have you ever witnessed someone saying to someone else, “mind the plate it is hot” and the instant reaction of the other person is to unconsciously actually touch the plate to verify that? Children are usually the best example to see this phenomenon in action – saying “don’t step in that puddle” invariable ends up in wet shoes and muddy clothes!

Language can be a powerful thing and what we say can have an impact on the behaviour of others.

Of course there is nothing new about this. Advertisers, marketers and politicians have been using various language techniques to tempt us, draw us in or deflect us for years. And, obviously, it is not an exact science. How we react to what someone says to us varies according to our own perceptions, views and upbringing. So if I were advertising bacon sandwiches you would have to actually like them before any advertising had any impact, and no amount of suggestion of sweet smelling, succulently crisp bacon being taken from the sizzling pan and being placed on deliciously soft freshly cooked bread would work.

So what does this have to do with social care I hear you ask (with a mouth full of bacon sandwich!)

Social care is intensely people orientated. Care workers work face to face with those who need care services, social care leaders supervise and manage those social care workers and the social care leaders interact with other agencies and in order to achieve the best possible care and support down the line we have to be aware of the power of language and the effect in can have on those we speak to.

Imagine a supervision where the manager tells a staff member that that must stop acting so defensively, the usual reaction is to say “I’m not being defensive” in a very defensive manner. If the manager were to say, “it would be good if you allowed yourself to relax more at work” then the reaction would be different and while the person may not actually relax now they would not have the image of being defensive.

Similarly, if a person with challenging behaviours were told to stop being aggressive they have to think about being aggressive before being able to stop it! This is particularly problematic when the individual does not perceive themselves as being aggressive in the first place. In such instances it is far better to focus on positive words such as relax, calm etc, (although calm down can be an issue – calm down from what?) as these words are better suited to the state you wish the person to achieve.

Even on a minor level we have to be careful what words we use. If I were to say – don’t forget to share this blog with others – the possibility is that you would forget! Yet if I said  REMEMBER to share this blog with others I am far more likely to get a positive result.

If you have read this far the purple badgers have probably slipped from your mind, oops they are back again! But in the future any time pink elephants are mentioned you’ll naturally have an image of purple badgers too!

Language is intensely powerful and it is important that, in social care, we are aware of this power. It is by no means easy to consciously and continuously control what you say to others but we have to be aware that the behaviours of others can be a direct result of what we have said rather than being something totally disconnected from us. Effective communication is the cornerstone of quality care and support and must be one of the key skills that is taught at all levels of social care, if we do not understand the importance of communication and language how can we effectively communicate with those who need care services and those we work with.

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.

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.

Residential Care Providers Outperform the NHS.

Residential Care providers outperform the NHS.

That is, of course, a blanket statement but backed up by the State of Care report published by the Care Quality Commission last week. The headline figure when the report was published was the fact that 15% of hospitals failed to meet the standards on making sure patients had the right food and drink and the help they needed, yet for residential care – i.e. non-nursing care - the figure was 11% of homes failing to meet these standards.

It was not just this standard that saw a difference. On meeting standards on respect and involvement 9% of NHS hospitals failed to meet this standard compared to 7% of residential care homes and on meeting standards of effective care, treatment and support 19% of NHS hospitals failed to meet the standards compared to 18% of residential care homes.

Obviously this is a very simplistic and selective view, in general, nursing homes were worse than hospitals and the complexity of health service provision is different from that of a residential care home.

Yet these figures should not be totally ignored and lessons must be learnt.

The health service must, for a start, consider what it can do to improve performance and what it can do too learn from the residential care providers which outperformed it in a number of areas. Why are residential care providers better at providing food and drink, what lessons can be learned in improving respect and involvement. There has to be a system in place where the NHS can draw on the best practice of social care to improve its performance with its patients.

There must also be a look at the significant difference in performance between nursing and non-nursing residential care where the contrast is quite startling. In nursing homes 20% failed to meet the nutrition standards, 15% failed on respect and involvement and 28% failed on effective care, treatment and support. In just about every standard nursing care fell behind residential care the most surprising of which was management of medicines where 33% of nursing homes failed to meet the standard compared to 26% of residential homes – surprising because nursing care should have trained nurses on their staff whereas this is not necessary in purely residential care.

The Care Quality Commission report gives us a snapshot of the state of care but we need now to act upon its findings and this is where we need national leadership to make improvements.

The fragmented nature of social care provision, around 25,000 different nursing and residential care homes providing services across 152 councils with social services responsibilities, means that there is little coordination over the country to draw together what lessons can be learnt from the report, how to implement the changes needed and how to engage with the vast myriad of providers to ensure ‘best practice’ becomes the social care standard.

The fragmentation of social care means that those at the top can frequently pass the buck and abrogate responsibility but with the increasing need for social care as the population ages and the increase in the complex needs of social care users we, as a nation, need those in Westminster to take full responsibility for the services provided to the vulnerable in the country.

The route to improvement is learning, learning where the failures are and learning the best way to decrease those failures. The system is never going to be perfect but we need national leadership to reassure the public that all possible action is being taken to ensure health and social care provision the best it can be and the lives of ALL those who need care services are paramount in that.

Being Gay is Wicked: Language, Leadership & Social Care

"Being Gay is Wicked”

What does that phrase mean? Fifty or sixty years ago it would mean “being happy is sinful” today it would mean “being in a same sex relationship is a really good thing”.

What this illustrates is that the language we use can change meaning quite drastically is a relatively short period of time and while the example above is quite extreme in nature more subtle changes exist that impact on our understanding of everyday things and social care is not immune to this.

Take, for example, the discourse of institutions. The current social care system was created out of a  desire  to get people out of institutions, at that point institutes were the large, impersonal, usually Victorian, buildings that held people with learning disabilities or age related conditions that impacted capacity. These places were notorious for their lack of privacy, dignity and respect where people were treated as objects of pity rather than as individuals with their own personalities, preferences and rights. The people incarcerated in these institutions had no control over their lives, no chances to participate in how their lives were being run and little opportunity for any decision making.

It is no wonder then that the term ‘institution’ developed an extremely negative meaning.

The answer was, of course, to close these institutions and develop smaller care homes for the elderly and frail and those more severely disabled whilst promoting care in the community for the more able.

Yet, just a few decades on, the term ‘institution’ is used to describe those care homes which grew up out of the  desire  to rid the country of those old institutions!

Because of that, and the negative connotations of the word, care homes are seen by the public at large as bad places where the practices of old institutions still take place. Obviously there are bad care homes where institutional practices still take place but, in general, care homes have considerably improved the level of care from the dark days of the institutions.

The principle reasons for painting care homes as bad places is to promote the agenda of more community care and this is a perfectly normal way we operate in language. If we want to show that something is better we contrast it with something that is not as good but there are implications in doing this with social care.

For many there is no alternative to living in a care home. Those with advanced dementia, for example, may need the 24 hour care and support that their families (if they have one) are no longer able to provide. Some, with severe and profound learning disabilities, may benefit from the community setting of a care home rather than the potential isolation of living alone and for other elderly people a care home setting may free them from loneliness.

The negative image of care homes also impacts on the hundreds of thousands of care workers in the country, the majority of who deliver the best possible care they can. Being associated with the impersonal, autocratic staff of the old institutions is hardly a basis for improving moral in the sector!

This is where effective leadership across social care is so important.

To promote social care and to raise the standards those who lead must  present a positive image  of the sector. Being positive does not mean ignoring the deficits and problems of care homes nor does it mean painting a false picture.

Truth and honesty are important traits in leadership as they generate trust as does a recognition that things are not as good as they could be. But the important things is that those deficits are accompanied by visions and goals to show a way to correct those deficits in an achievable way.

Leadership is also about working with what you have got. So there has to be a recognition in social care that care homes are a part of the system, there also has to be a recognition that care homes have changed dramatically over the last few years. The average age of entering a care home has risen and, more often than not, care homes are the final stage of the care process when home care is no longer appropriate for the safety of the individual.

Leadership is about using language that is positive but honest and realising that using stereotypical labels may do more harm than good.

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. 

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!