Social Care Culture Wars

One of the changes promised by the Care Quality Commission in their “Fresh Start” document published yesterday (http://www.cqc.org.uk/public/news/new-approach-inspecting-social-care-services) was that they will be “checking providers who apply to be registered have the right values and motives, as well as ability and experience.”

This could be challenging!

Whether we like it or not the bulk of social care provision, at present, is delivered by companies, large and small (and every size in between!) who are out to make a profit, because without profitability the business will fail. Therefore private company that applies to register a care service has, naturally, to have the right business values and motives to be profitable in order to be able to deliver the care service.

This fact highlights one of the issues with social care in England and why integration seems such a difficult thing to achieve.

The word ‘silos’ is often used to describe the way in which different parts of the care system are isolated but, in reality, we should see them as different cultures and, as often happens with cultures, the existence of that particular culture is built on difference rather than commonality and those within a culture will defend the values and motives that underpin that culture.

So at the front line of social care provision we have providers who have to make money, even charities and not for profit companies have to ensure their income in order to carry on their business, so they have to exist in a ‘market’ culture where income must exceed (or at least match) expenditure, their actual provision of care is limited by the monies they receive, however good their values and motives are in terms of wanting to care they are constrained by economics. There are over 12,000 registered care providers and each one will have a different organisational culture based on the values and motives of the company owners.

Another culture within the system are the Local Authorities, 152 with social services responsibilities. Each on will have their own ‘corporate’ identity, influenced by working practices, senior leadership and, importantly, politics. All local authorities are over seen by elected councillors and this, obviously, impacts on the organisational culture. Somewhat like the EU, the heads of social services departments gather together to discuss overarching policy but, again like the EU, these can be implemented slightly differently in each council because of the values and motives of those who lead the council.

Within the local authority system are other elements that those who need care services also need to access, e.g. housing. In many areas these are located within a different authority than the one responsible for social care which, again, has its own particular organisational culture.

Then there is the NHS, another completely different organisational culture, founded on a basis totally different from care providers and local authorities. Health services (either NHS or private) have grown from medical science with a fairly rigid hierarchy of who is allowed to do what and developed a clinical culture that is different from other fields of work. The NHS itself is more fragmented now, which is why individual hospitals or trusts have failed because of inadequate leadership, but the overall structure is the same. In this realm we have the Royal Colleges which underpin the professional expertise of those who work in health, and which elevate the roles they undertake, all of this creates the values and motives of the NHS and other health services.

The problem for those who need care services is that all of these different cultures have different languages and practices, all have different values and motives that underpin their roles.

Because different cultures defend their identity through maintaining difference with other cultures, the integration needed by those who need care services is hampered and will continuously be so unless we develop a culture which recognises that the individual is more important than any of the organisational cultures involved.

To achieve connected services for people who need care services all involved need to recognise the commonalities in their services and who they benefit the individual.

Before care providers can be judged on their values and motives we need to establish what those values and motives are and how they benefit the individual rather than imposing values and motives that cannot be achieved at the ‘market’ end of the system and which, ultimately, impact negatively on the care service provided.

Do the Media Really Care So Little about the Vulnerable in Society?

Last week (12^th Sept) the Health & Social Care Information Centre published their provisional report on the Abuse of Vulnerable Adults in England 2012/2013. (https://catalogue.ic.nhs.uk/publications/social-care/vulnerable-adults/abus-vunr-adul-eng-12-13-prov/abus-vuln-adul-eng-12-13-prov-rep.pdf)

The report reveals that of the 86,000 completed referrals to social services 43% were substantiated or partially substantiated.

That means around 37,000 cases of adult abuse occurred.

Yet the news reporting on this staggering statistic has been woefully small, there has been no obvious political indignation that such a large number of vulnerable people have suffered abuse and there has been no official comment from Westminster on the matter.

The statistics are similar to the previous year but that should not mean a lack of interest in protecting those who are vulnerable in society nor should it mean that the abuse of so many should become less news worthy. In fact there should be a national outcry that nothing has been done to reduce the number over the last year.

Another aspect of the released figures should also be raising eyebrows. Of the 86,000 completed referrals more than a quarter (27%) were inconclusive – neither substantiated nor unsubstantiated after investigation. And, while adult protection issues can be notoriously complex, this seems a high number yet there has been no call for an explanation of why this may be the case and what action is taken to protect those who may be at risk following an inconclusive investigation.

Do we really care so little about the plight of the most vulnerable in our society?

Obviously the Health & Social Care Information Centre can only publish the official statistics and given the high amount of abuse in them there must also be concern about the level of unreported abuse of vulnerable people. If there is so little news and Government interest in the numbers of those we know have been abused what is the likelihood of action being taken to help those who are vulnerable and abused yet unknown to the system.

There has always been a lack of interest in social care by the mainstream media and, for that matter, by central Government, yet it is people at their most vulnerable who are suffering from various levels of abuse who are left unprotected by Government and, importantly, by social pressure through the media.

This has to change.

How can we call ourselves a society when we ignore the needs of those who need our help the most and by allowing these levels of abuse to continue? How can the public know of the staggering numbers of people being abused if the media is not interested in them?

We need change but that change can only come if there is enough social pressure on politicians and that can only come from the media.

Do the media really care so little about the plight of the most vulnerable in our society?

Zero Hour Contracts, A Cautionary Approach

This week the Trade Union Congress will call for the outlawing of zero hours contacts (http://www.tuc.org.uk/the_tuc/tuc-22485-f0.pdf pg12) and while, personally, I dislike the practice there has to be caution in either outlawing the practice or, indeed, modifying it.

It is estimated that around 300,000 social care workers are on zero hours contracts (http://www.socialcareworker.co/2013/08/02/300000-social-care-workers-on-zero-hours-contracts/), around a third of the total workforce.

Before we puts jobs at jeopardy or social care services at risk by outlawing zero hours contracts there first needs to be a comprehensive look at why the use of zero hours contracts has risen in social care and, obviously, an understanding of the impact to services if those contracts are outlawed.

Is there, for example, a link between the increased use of zero hour contracts and the increased use of ’15 minute’ social care services being commissioned?

A survey last year by the UKHCA found that

·         Short homecare visits being commissioned by councils to undertake intimate personal care, with risks to the dignity and safety of people who use services;

·         Continued downward-pressure on the prices paid for care, where lowest price has overtaken quality of service in commissioning decisions;

·         Contracting arrangements which have resulted in visit times and the hourly rates paid for care as the decisive factors in the viability of the sector.

(http://www.ukhca.co.uk/pdfs/UKHCACommissioningSurvey2012.pdf)

If providers are fighting to compete on price then, from a business point of view, it means having staff on zero hours contracts makes sense if it helps reduce overall staffing costs. So the issue is not only about zero hour contracts but also about commissioning and funding in social care.

There also needs to be thought about the impact on services if zero hours contracts are outlawed or modified without any real thought of the implications.

Social care is, by its very nature, difficult to plan for. We cannot tell how many people will suddenly need social care services in the near future or, sadly, how many will no longer need care services. So there needs to be a degree of flexibility in social care staffing, particularly in home care where the greater use of zero hours contracts are found.

If zero hour contracts are removed without arrangements for dealing with this need for flexibility then care services could be affected. For example not enough staff would lead to people receiving care services only when people are available rather than when they need them or providers could have a surfeit of staff who would still need to be paid even when there was no work for them, putting pressure on the provider’s economic viability.

Within social care zero hour contracts are as much a symptom of the financial constraints as they are about employer exploitation. Yes let’s get rid of them but in a manner that ensures social care services are improved rather than put in jeopardy and a manner that improves the lives of social care workers rather than puts jobs at risk.

Go On – Ask a Question Today.

It is very easy to forget that many of the things we take for granted nowadays did not exist 50/60 years ago, or if they did they were in the realms of the elite who could afford such luxuries.

Fridges and freezers, for example, did not become common place until the 1960’s, which, naturally, means frozen foods did not become popular until that time and that food storage was a different kettle of fish (an expression from when fish was boiled rather than sealed with sauce in a soft plastic container!).

Similarly supermarkets did not exist as we know them today, Sainsburys opened their first ‘self-service’ store in 1950 and Tesco’s opened their first supermarket in 1958, and even then it took a while for the supermarket to spread across the country to become the default means of buying the weekly shop.

Obviously before these momentous changes eating habits were completely different, no ready meals, no frozen dinners, food bought according to season and location rather than according to what you fancy. Culturally things were different too. In the 1950’s more women stayed at home and were expected to provide meals for the family which had to be freshly prepared from scratch.

Naturally most people who need older peoples social care services now spent their early, formative years eating in a completely different way to the way we do now.

Now think back to your own childhood, what was your favourite food? What memories does the thought of that food evoke? What other memories do you associate with that? There will, of course, be a whole range of memories because of the different favourites you had at different times in your life and it is the unique tapestry of memories that makes us all unique individuals.

The only way we can find out about the memories of others and what makes them unique is by listening to them and asking them and this, to my mind, is one of the most important things in social care provision.

It does not matter what our position in life or what age we are right now, if someone takes a genuine interest in us and talks to us, listens to us and asks us about ourselves, it makes us feel good. Now if you are a person who needs care services, either at home or in a care home, the knowledge that the person providing that care takes an interest in who we are rather than looking at us just as a ‘task’ to be completed it will boost personal esteem and do considerably more good to an individual.

Obviously cognitive decline may impact on memory recall yet even if the memories have faded the mere act of sitting and talking to someone is, in itself, a worthwhile act.

The more we can engage on a personal level the more we learn about a person and the more we can tailor our service to them but, more importantly, the more we engage with people the more we build their sense of worth.

Go on – ask a question today.

Social Value and Social Care

What did you want to be when you grew up?

Perhaps you wanted to be a train driver or a nurse, maybe you wanted to be a famous sports star or singer, or even, possibly, you wanted to be a princess or a pirate.

The chances are that the idea of being a social care worker did not enter your head.

Then as you got older and you discovered your talents and abilities your dreams will have changed, more professional ambitions may have come to mind, accountancy, medicine, architect, law etc. Perhaps, you were more vocationally minded, and liked the idea of a more hands on job, beauty therapist, mechanic, hairdresser, electrician etc.

The chances are that the idea of being a social care worker did not enter your head.

The fact that social care is well down the list of career choices is also backed up by the facts. The Skills for Care National Minimum Data Set (NMDS) shows that 60% of social care workers are aged 35 or over with just 10% under the age of 24. Social care is a job that people enter into later in life.

The issue with social care is how we value it in society and even though they provide essential front line services for vulnerable people, social care workers are low on social value.

Part of the issue is invisibility in society. Yes we have seemingly endless negative reporting, but generally speaking adult social care only becomes important to individuals when they, or a loved one, needs care services. In popular media social care is often portrayed negatively and infrequently, when fictional programmes portray social care as either inefficient or outright failing. Even where we have had mainstream fiction about care (i.e. Waiting for God) the care staff were not portrayed particularly well.

High social value needs positive role models through mainstream media and fiction often carries more weight than factual programmes. Fiction carries archetypes that embed themselves in social awareness (you’d be surprised how many people think the ‘medieval’ stories of King Arthur are true!) and in order to raise the social value of social care we need more positive archetypes of social care work portrayed through fiction.

That does not mean that non-fiction media doesn’t have a role to play. We increasingly need positive social care stories to underpin the social value of social care. Unfortunately the mainstream media seems adverse to the positive side of social care, which is strange as more and more of their viewers/readers will need social care services or know someone who needs social care services and the relaying of the negative horror stories and experiences, that are not suffered by the majority of care users, undermine the whole system. Yes it is important that these are exposed yet the overall impact has a detrimental effect and probably puts a lot of people off the idea of working in social care.

Social care is important in today’s (and tomorrow’s) society. Increasing longevity combined with a larger population means that social care services are needed more than ever before and more and more people are needed to provide that care. We need to raise the social value of social care, raise awareness in society of social cares importance in society and we need positive role models to encourage people to consider a career in social care.

Dear Jeremy Hunt, Focus on People with Dementia not just the Cost

Today the Government announced a G8 Summit on Dementia.

https://www.gov.uk/government/news/uk-to-host-g8-dementia-summit

While every effort to raise awareness of dementia has to be welcome, the tone of the press release announcing the event shows that the Government is more interested in cutting the cost of dementia rather than helping those who suffer from the condition.

The press release quotes Health Secretary Jeremy Hunt saying,

“Dementia requires long-term health and social care support that can be hugely expensive. Currently 70 per cent of the global cost is incurred in medically advanced nations like Western Europe and North America. But nearly 60 per cent of people with the condition live in developing countries. As their populations grow and age, the pressure on their services and budgets will inevitably increase.” &

“The G8 today have a unique chance to come together to help people manage dementia better, lead healthier lives and deliver real improvements in care and substantial economic savings.”

Yes the increase of the numbers of people with dementia will put pressure on budgets but, surely, the primary focus has to be how to give people with the condition the best possible quality of life as the disease takes hold.

Yes we need to find ways to eradicate dementia but we also need to help people NOW rather than solely focus on cures that could be many decades down the line.

Yes there are still economic troubles yet to focus on the cost of dementia rather than improving care and support for those who need it now is a shameful way for a Government to act. Social care funding has decreased year on year for at least the last five years and the costs of providing social care have spiked – food and energy inflation have a huge impact on care provision – and the Government has done little to redress this issue.

The press release today effectively labels those with dementia as a cost burden to the State and I hope action will be taken immediately to apologise and redress this.

Life and Change

Do you ever feel you could do more in life? Do you feel you could achieve more, earn more, succeed more?

Obviously we all feel like that at some point in our lives, how we deal with those feelings is, however, a completely different matter. Some will do nothing and become increasingly frustrated with life usually blaming the failure to progress on ‘circumstances’ or the people around them, others will be like whirlwinds in a constant flux of change and new projects as soon as the previous one bores them.

Thankfully most of us are somewhere in the middle. As human beings change is inevitable and how we tackle that change impacts on our lives just as much, if not more, than the change itself. How often have you gotten nervous and worried about something new only to think afterwards “Well that wasn’t so bad was it”?

The best way to manage personal change is to plan for it. Decide what it is you want to achieve and then work out what you need to do to get there. Small, incremental steps are usually the best way, if we can succeed in making one step, it makes it easier to move on to the next, if we take a huge jump we could end up flat on our faces, feeling embarrassed and distinctly unwilling to try that again.

We cope with achieving our goals better when we are supported. Top sports people have high aims but they have a support system in place to help them get there, yes they have the raw talent but it is shaped and moulded by coaches, physiotherapists, psychologists etc. in order to maximise the individuals potential.

But what about real life?

Ageing is a change, ageing means changes to our physical and mental make-up, ageing is a challenge that needs to be faced particularly if the ageing process means coping with age related conditions that undermine our own sense of well-being.

Ageing is an inevitability yet it does not mean that the change cannot be supported and goals set to minimise the impact of the ageing process. Obviously there are the standard routes we can take in terms of pension and retirement planning and we can always find support for this.

But the crucial need for support, effective planning and achieving effective goals come when there is a need for social care services as we age.

Naturally most people want to live as long as possible in their own home, this becomes the goal. To achieve the goal we need support, we need a plan of how that support is to be achieve, a plan that needs to be broken down in terms of smaller achievements, what we might need to have now in order to make further changes in the future.

If we go back to the athlete analogy, we need our coaches, physios and psychologists to be working together to support us and work with our plan. In other words we need social care, health care and housing working together to support us and work with our plan!

We need effective integration!

Integration is about services working together to support the individual, not about services working together for the benefit of the services.

The support needed by individuals will vary according to the needs, goals and desires of the individual and the various ‘support’ systems available, social care, health, housing, benefits, employment etc. need to coalesce around the individual, to focus on the individual and provide support for the individuals wishes.

Moving forward in life always presents challenges, as we age those challenges may become increasingly difficult to face without professional support. That support needs to be integrated around the person needing it and that has to be the starting point for any discussion on integration.