You Do Not Get Excellence On The Cheap

At a recent press conference Lord Coe said, "You can never spend too much on elite sport. It will always be the greatest driver of sporting participation and we should be unashamed about that.” He went on to say “Of course, you have to have the right structures in place to deal with that demand. Be under no illusion, you do not get excellence on the cheap”

While we are still in the grip of celebrating sporting achievement those words of Lord Coe could resonate throughout any aspect of society not just sport and particularly in social care.

Excellence is always a driver for success, the concept of being a role model is hardly a new one and while the concept may have become something of cliché it remains a fact that we will always try to emulate our heroes or businesses will endeavour to emulate the success of rivals. Unfortunately, in social care, we do not see the success achieved in supporting people to live active and fruitful lives with the support of family or care workers, we do not outwardly demonstrate the excellence of so many care workers dedicated to enhancing the lives of those who can no longer fully participate in society on their own.

Obviously within the sector we do celebrate excellence, primarily through various awards schemes such as the Skills for Care Accolades, yet those celebrations do not extend outwards to the general population and the only view of social care that achieves mainstream coverage is when things go wrong such as the Winterbourne View case. Yet it is only through showing excellence on a wider scale that we can improve recruitment and retention in the sector and inspire people to work in social care.

The Daily Mirror has stated they have found 61,309 jobs in social care (Care for a Change) and, in the current economic climate it seems incredible that so many jobs are available and, let’s be honest, if that many vacancies exist there are some companies struggling to provide a full level of care and support.

To provide the best possible care services we need the best possible care workers and entice the best we need to demonstrate to the wider public the excellence that already exists to inspire people to see social care as a vocation that is rewarding and intensely satisfying. To achieve that we need investment in the social care workforce, we need to move it from the perception of an underpaid, poorly regulated job to a career that promises recognition and gives a sense of pride in working in a sector that is recognised for its contribution to society and the lives of individuals.

The fragmented nature of social care means that the only way this can be achieved on a national level is by the Government coordinating efforts across all of the Local Authorities and the myriad of care providers. The Government needs to invest in social care to ensure a high level of excellence in care provision that will inspire the public and restore faith in the social care system.

Naturally not everything can always be perfect and rogue careers will always enter the system (not unlike drugs cheats who enter sport) but we need to ensure that excellence is highlighted above all else. To achieve this the Government needs to invest in social care – you do not get excellence on the cheap.

Not Long-Term Care But Services for Life

When people think about long term care they often think of the time older people spend in care homes or receive care services at home. They may also consider learning disability care homes but it is unlikely they will consider the true nature of long term care for people with learning disabilities.

People are born with or acquire learning disabilities early in life and, dependent of the nature of the disability need care and support services from that time. With a learning disability other conditions are more prevalent than in the general population, for example autism and epilepsy, which, in turn defines the type of support needed for an individual. In childhood support is needed for education, health etc which is dependent on individual needs and social circumstances and this is followed by transition services which support the individual in the move from child to adult services.

Although ‘adult services’ is the last stop in terms of the catch-all bureaucratic terminology the reality is individuals need support on their journey through life, and their journey is not really any different from the rest of us.

In our twenties and early thirties we are in our physical prime and we reach the pinnacle of physical achievement, obviously that achievement is dependent on lifestyle etc. but it still, for every one of us, it is where we reach the peak and where we are at our fittest. As a general rule we are more ‘immortal’, life’s goals lay ahead of us and achieving our dreams seems easy, old age and death seem so far away as to be almost non-existent. Many people with learning disabilities are not so different and they need support in achieving the goals and dreams and in maintaining their physical well-being.

As we tip over our mid-thirties and head towards the big 50 we start to deteriorate! Obviously we are all individuals and the rate of change varies greatly between people but generally we are not quite as physically fit as our minds think we are! Some people start having mid-life crises while others simply accept that life is moving on and they must move on with it. We become more settled in our lives and readjust our long term aims and ambitions to a more realistic level.

For people with learning disabilities this can be a crucial time of life, many age related conditions that we would normally expect to have in the latter years of our lives can begin to impact on the lives of those with learning disabilities. There are also many social changes for them too. Those who live with parents face issues of their parents becoming older and the possibility of becoming a carer for those who care for them creating a complex co-dependent relationship.

After this point we do come to a split, older peoples services generally start when people reach the age of 65 but way back in the days of Valuing People the government recommend that for people with learning disabilities older peoples services may need to include those aged 50+. Conditions such as dementia can strike much earlier, particularly for those with Down’s Syndrome and issues of continence can also occur earlier than in the general population. As the population is getting older and people with learning disabilities are living longer there are also social issues that need to be supported, people are more likely to lose parents and siblings will take over as primary carers or significant people in providing care and support.

For most of us, as we get older we make adjustments in our lives, we adapt our lifestyles when our health needs change, we find ways of coping when we lose special people in our lives and we adjust our circumstances to what is best for us. We do our best to cope with the extra stresses that ageing can bring.

In other word we LEARN to live with it.

But was happens when the ability to learn is impaired? How easy is it to cope when you don’t fully understand the changes to your body or to your life? That is why it is so important that older people with learning disabilities have the right support as they age, support that will be different from earlier in life.

There is a tendency to focus on older peoples care because of the numbers involved and what is neglected is the fact that many of those with learning disabilities need care and support services for their entire lives and there is a need to recognise the importance of those services alongside those for older people.

Learning disabilities is not about long term care, it is about services for life.

Lets Work to Support Success in Social Care

“Success breeds success” is one of those quotes that we all know but rarely think about what it means yet ‘success’ is big business – just type ‘business success’ into Amazon and see how many thousands of books are available on the subject.

There is some science behind the idea of “success breeds success” for example, Euro 2012: England v Ukraine - The science of home advantage, and while this deals primarily with football the science can apply to many other areas, including social care, especially in learning disability services.

Where the main focus of success is on achieving wealth, power and status the reality is success is any achievement that you make, no matter what level of status it is and success brings about its own rewards. For example, remember back to when you first did something you thought would be impossible, whether it was riding a bike, passing your first exam or baking your first edible cake! Then remember how you felt as you achieved that success, the pride that swelled inside you and the confidence it gave you to undertake that activity again and spur you on to be a little more ambitious next time.

Equally important is what it did to your previous failed attempts at that activity, the pride and feeling of success pushed those failures away from your mind, consigning them to distant memory or erasing them from your mind completely.

In social care services we have many different buzzwords for providing support services and what we want to achieve, we talk about personalisation, independence, outcomes, etc. but, in reality, what we need to talk about is success. We need to support people in becoming successful in independence, personalisation is about achieving success in individual goals and outcomes are only of use if they are successful ones.

I’ve written before about visions, targets and goals in relation to leadership in social care  (http://socialcareinsight.blogspot.co.uk/2012/02/social-care-leadership-visions-targets.html) but the principles also apply to working with individuals to achieve the highest possible level of independence  and these principles are, perhaps, more important in terms of personal support for individuals than anywhere else.

The big vision must always for the individual to lives as independently as possible but to get there people need targets and goals to act as milestones to mark the way to the ultimate goal.  The small ‘wins’ are so important in bolstering confidence and achieving further success, it does not matter how small that success is it helps people understand that success is achievable at any level and spurs them on to achieve the next goal.

The achievement of individual success is also important for people working in learning disability services, if they can support an individual to be successful then they too have achieved success and the same feelings of pride and confidence are imbued in their work.

Success does breed success and we should start talking about achieving success in care services to ensure that helping individuals become successful in their lives is one of the main goals for care providers.

Ministers Need to be Aware of Learning Disability Services

It is Learning Disability week and a great opportunity to raise awareness of the needs of those who have learning disabilities especially as we await the forthcoming White Paper and draft social care bill.

Given the wider debate on social care, particularly around who pays for care it is easy to forget that social care does not solely focus on the elderly and that people with learning disabilities use and need social care services. These services are not exclusively care home services but a wide range of services that have a different focus from elderly care and are vital in helping people live as independently as possible.

The exact number of people with learning disabilities in the UK is not known but what is known is that the numbers of people accessing those services is increasing.

Over the last few years there has been a very small drop in the overall numbers of people accessing council funded services but in those with learning disabilities the number has increased, and quite dramatically with an increase of around 10%. At whilst, relatively speaking, those with learning disabilities are a small percentage of the number of overall numbers of people receiving care services, those services are required over many more years and have an impact on social care provision and funding. Research suggests that about 16% of the total social care budget goes toward learning disability services.

In addition people with learning disabilities are living longer and the rate of longevity is rising faster than that of the general population. Between 2005 and 2010 the numbers of people with learning disabilities over that age of 65 increased by just under 20%. With ageing comes increased need for social care and health services that have to be acknowledged by those on high.

There is, quite rightly, a high focus on dementia and the needs of the elderly but there also needs to be a recognition that learning disability services are different, requiring a care workforce with a different set of skills, knowledge and training that focuses on the different challenges faced by those with learning disabilities.

There needs to be a recognition that ‘Learning Disability’ is a wide ranging catch-all term that encompasses a number of different conditions (and a number of undiagnosed ones) and therefore the number of services needed to meet the needs of the individuals has to be greater than any other aspect of social care.

With the focus on funding elderly care there is a danger that the needs of those with learning disabilities will be passed over by the Government yet the needs of people with learning disabilities are as important as any other group requiring social care services.

Ministers need to be aware of the issues facing learning disability services and ensure that the White Paper and draft Bill reflect those needs.

Raise the Social Value of Social Care

“Why is it you need a degree to get a job in fashion, but when it comes to looking after our most vulnerable members of society any one with no qualifications can get a job as a support worker?” (Guest Blogger, Whose Shoes: http://wp.me/p1enjT-tu )

The above quote highlights one of the intrinsic issues facing social care in today’s society and that is the social value of care services. Whilst the Government will focus on than who actually pays for social care, rather than the actual cost of care services and others focus on the quality of care services provided, yet perhaps where we need to start is changing the view of the wider population to view social care as an essential service, as essential as health given the demographic trends, and a view that social care is there to enhance life rather than be the beginning of the end of life process.

Social Care is not a highly rated career choice. Be honest and ask yourself would you encourage your son or daughter to pursue a career in social care? While many people, when asked, will state that they admire care workers and the work that they do, I suspect that many parents would not be encouraging their children to undertake such a low-paid, low esteem job role. This is, perhaps, reflected in the demographics of social care workers with those aged between 18 & 24 making up around 14% of the workforce and even if we include those up to the age of 34 we still only get to 36% of the workforce. In other words, two-thirds of care workers are aged 35 or above.

This rather suggests, although I can find no research to back it up, that social care work is a career of opportunity, i.e. a matter of what is available when needing a job in later life, rather than a deliberate career choice.

Yet, surely, caring for those in most need in society should be a job that is celebrated and regarded as an important role in our society, one that is rewarded appropriately in accordance with the gravitas associated with the work role.

Another, yet highly connected, issue in terms of valuing social care is that the seeming denial of many people when it comes to their own future and the potential need for care services in the future. Naturally none of us like to think about the possibility of getting old or suffering from some form of dementia and that denial leads to people ignoring the idea of social care until such time that it touches their lives. People do not want to think about being reliant on others to help them through their daily lives and, subsequently, do not think about the type of person they would want to deliver that care.

The same type of denial applies to other types of social care. If it does not directly impact on the life of a person they tend to ignore the issues of those with learning disabilities or mental health issues.

The forthcoming White Paper needs to do more than make technical changes to the current system, it needs to reach out to those not yet affected by the need for social care services and highlight that social care is about everyone’s future not just about those who need services now.

Raising the social value of social care is vitally important and needs to be the priority of Government Policy

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

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.