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.

Communicating Leadership

Whenever you attend any seminars or courses about communication you will usually be told that communication is made up of three elements, words, tone and body language and while these are important elements in immediate face to face communication successfully communication over a period of time depends on one other very important element – behaviour.

How we act sends messages equally, if not more powerfully, than the words, tone and body language we use.

Imagine, for example, the office manager who eloquently extols the virtues of hard work, putting our noses to the grindstone and pulling out all the stops to ensure everyone in the team benefits from the rewards of hard work, who, then, returns to their office to put their feet up while everyone works their fingers to the bone.

Or, perhaps, visualise the Care Home owner who promises prospective clients and their families the best possible care package with person centred approaches and high quality care services but then delivers run of the mill services which are of no real benefit to any individual.

In such instances the message eventually being sent is one of incongruence and leads to distrust of the words, tone and body language being used.

While distrust is the first element of such incongruence in the workplace situation things will inevitably deteriorate further.

As human beings we are more likely to emulate the behaviour of others rather than their professed principles and if someone in a senior role is being incongruent then it is their behaviour that will be unconsciously copied as how they behave is an indication of how they achieved their senior role.

Successful leadership is therefore as much about communicating behaviour as it is about using words, tone and body language.

Naturally the successful leader ‘practices what they preach’ rather than take the ‘do as I say not do as I do’ attitude. The successful leader is a part of the team and encourages the rest by example as much as by other methods of communication.

Honesty is also an integral part in successful leadership. A leader should be prepared to admit they don’t know something but, at the same time, make a commitment to find out. This encourages other members of the team to take the same attitude rather than create a situation where people are afraid to ask for help when they need it.

Successful leadership is about attitude, behaviour and actions as it is about words, tone and body language and all of these elements constitute communication. Communicating leadership is a vitally important element of success and those who consider themselves leaders should be wary of incongruence and creating distrust and poor behaviour in their team.

Personalisation and Being Human

You would probably agree that there is a part of you that enjoys time alone to relax and reflect yet at times you enjoy the company of others and, if you were being honest with yourself you do, perhaps, enjoy the attention others give you.

Perhaps, at times, you feel that you are not using your full potential in some aspect of your life and that those you are with fail to understand how much more you can offer and improve yourself.

Maybe there is a hidden part of you, one that you can’t reveal to anyone that holds a regret in life, a choice made wrong which, on one hand, is seemingly trivial yet on the other is one that has lived with you for a long time.

We are all the same, and the above holds true for most of us but the degree to which it applies may vary, yet they are fundamental part of our make-up.

Yet do we pay enough attention to these aspects of being human when delivering social care?

Personalisation is the key to delivering good quality social care yet the key to personalisation is understanding what it is to be human and understanding how we tick. Unfortunately the basic training of care work does not include this aspect of understanding which is so vital if quality care is to be universally delivered.

Core training consists of health & safety, infection control, food hygiene, etc. The Skills for Care Common Induction Standards go further but beyond induction training how much training do the majority of care workers get in understanding the individuals they are working with.

There is, of course, a tendency to stereotype people who need social care services (as in all aspects of life) using generic labels such as ‘learning disability’ ‘dementia’ ‘old’ and so on. Such labels have their uses and stereotyping is a human trait which allows us to form our own identity but in delivering care services and treating people with dignity and respect such labels represent just one aspect of who the person is. Although this one aspect may have significant impact on other areas of their life the person who needs social care services is still a person with the many individual quirks, nuances and subtleties that make us all slightly different but with the same underlying aspects of what it is to be human.

Obviously the immediate tool for learning about a person in order to provide personalised care and support is communication. Effective communication is essential, especially about listening to the person about their likes and dislikes but it needs to go further to understand a person’s desires  dreams and hopes. For example if we want to promote a person’s self-esteem we have to understand what that means to the individual, self-esteem involves personal beliefs and emotions not merely the likes and dislikes which are the standard part of any care plan.

Being a person is a complex thing and delivering quality, personalised care and support relies on understanding the individual not merely their personal preferences but also their values and beliefs which form their individuality. Those responsible for delivering care and support services are those on the front line of care and it is essential that their training includes more than the safety and physiological aspects of life.

You would probably agree that if you needed social care services that you would want services that understood what you needed, delivered by people who know when you need company or when you need to be alone, people who knew how to motivate you yet understand when you may be pushed too far, people who understand what dignity and respect mean to you. Isn’t only right then that we should apply this principle to all social care users.

The Voice of the Vulnerable

The Guardian’s Social Care Network has recently asked the question “How do we give service users a voice?” yet the fact that the question needs to be asked does, perhaps, highlight what is wrong with the current social care system and why we need wholesale reform to achieve social care that meets the needs of those who need it.

The most obvious answer to the question is, simply, that we ask those who use the services and, more importantly listen to what they say. But, unfortunately we have such a fragmented and somewhat territorialised system that any messages have to pass, in the manner of Chinese Whispers, upwards towards those who make policy decisions via the agendas of the various parties involved.

If we start with the individual the person who will listen to them the most and who probably has the best rapport with them is the frontline care worker. There may be occasional contact with a social worker but my general experience this will only happen once or twice a year at reviews, obviously families will probably also be involved in listening to what the individual thinks about their care package.

The route for the care worker is obviously their own line management but that would require the care worker be given the time (and be paid for it!) to sit down with the manager to outline their discussions with the care user, how things could be done differently to meet their needs and how the care service an improve their overall care delivery.

From there the route upwards means the care provider talking to the local authority funding the care to pass on the individual’s views and what they want from their care package. Yet there are probably very few opportunities to do this except where reviews take place and there is almost certainly not enough time to discuss everything the user may have said over the intervening period and be more focused on the care plan in place. It is also at this point the Chinese Whispers can begin with the agenda of the provider being set.

For example a care user might have said they would prefer to have their care at a particular time and the care worker would have passed this on, but if the care provider was unable to facilitate this because of staffing levels etc then would they necessarily pass this on to the local authority, especially if they feared the contract could be passed to another company who could accommodate that.

Once the care provider has passed on the views of the care user to the social worker then it will get passed along the upward line of the local authority where, to be brutally frank, it is likely to get lost or transform from the voice of an individual into a statistic aimed at proving why the authority should get more money from central Government. Of course the message may have to go through the NHS route and that is equally convoluted.

So by the time that the voice of the care service user gets to the Department of Health it has changed beyond recognition ceasing to be a voice and just one of many numbers that are processed by the bureaucracy of Westminster.

How do we stop this? Well the simply way is to ensure that all user comments about their care service are written down. This may seem a little old fashioned but it achieves one thing – the original message retains its value, unadulterated, on the way to the top. Yes it would generate a lot of paperwork (or e-paperwork!) but at least in Westminster they would have access to the qualitative data in addition to just the quantitative stuff!

In reality the problem is a fundamental one, the distance between the person using a service and the policy makers deciding what is best for individuals is an immense chasm with a rickety bridge connecting the two. The change in social care needs to address this, it needs to ensure there is a smoother, undistorted route for the users of care service to move up the line towards those who make the policy and hold the cash.

Not easy by any means but worthwhile it we are to achieve the best social care for those who need it.

Building Social Care

Social care is full of concepts and the problem with concepts is that there are difficult to get across to the wider population as it is difficult to grasp what something actually means, especially when those espousing the concepts of put different interpretations on what they mean.

Take for instance the Social Care Institute of  Excellence   definition: "Personalisation means thinking about public services and social care in a different way – starting with the person and their individual circumstances rather than the service" 

Compared with the Department of Health version: "every person who receives support, whether provided by statutory services or funded by themselves, will have choice and control over the shape of that support in all care settings" 

Broadly similar but the first takes personalisation as being outside the care service where the latter stresses that personalisation occurs within the care settings.

That is, of course, pure semantics but it serves to illustrate how talking about social care is open to interpretation both by the organisations delivering the message and those listening to it and why listeners may simply switch off if they cannot fully understand the message being delivered.

To add to the general woolliness of social care speak many of the more recent concepts, such as personalisation, are being inserted into a system established 20 odd years ago and may not always be totally compatible without significant change to the system.

To illustrate in more, literally, concrete terms.

Most people agree that personalisation needs to underpin social care (and other public services), it needs to be the foundation on which such services are built. Yet if you can imagine social care as being a house exactly how easy is it to change the foundations without tearing the house down and rebuilding it? But, I hear some people cry, surely personalisation could be used to underpin the subsiding house of social care that is sinking rapidly yet is this a wise move using personalisation to simply prop up a house that is no longer fit for the ever growing family that is needs to accommodate.

We can extend the metaphor to the forthcoming white paper. Will it be an instrument that simply attempts to paper of the cracks in the social care house? One that replaces the odd rotten beam rather than tackle the endemic rot in the system, maybe it will knock through a few walls to allow for more space to accommodate prevention or even add an extension out the back to allow room for the ever growing number of people who will need social care over the next few years.

Or will it be a white paper that recognises that the house is no longer fit for purpose and tear the whole thing down in order to build a bigger   higher   social care house with firm foundations on personalisation and one that has personalisation insulating all the walls. A new,   desirable,   house that has more than enough capacity for social care to grow, has wide corridors making it easier for those who live in it to move from one room to another and, perhaps, even adjoin the Health Services house with a single door through which people can move with ease.

To  engage   the public in the importance of social care and   build   public awareness we need to ensure that the language we use is accessible to all and that the message being sent is consistent, whether we undertake extensive repairs to the social care house or rebuild a shining new ‘des res’ the important thing is to get the planning permission through with the support of the general population and the millions who will need to live in the house in the future.

Improve Dementia Care Sooner Rather Than Later

Dementia is a disease, or rather the generic term for a group of diseases that are classified as degenerative diseases of the nervous system. The World Health Organisation classifies these diseases, Alzhiemer’s Disease, for example, is listed as “a primary degenerative cerebral disease of unknown etiology with characteristic neuropathological and neurochemical features. The disorder is usually insidious in onset and develops slowly but steadily over a period of several years” in the WHO International Statistical Classification of Diseases and Related Health Problems 10th Revision, more commonly known as ICD-10.

Given that the various types of Dementia are a disease it seems surprising, yet deeply disturbing, that the NHS is failing to provide adequate care for those who have dementia http://www.bbc.co.uk/news/health-16206169

One of the reasons could be that care for those with dementia in the UK falls under the social care remit rather than the health care one. Therefore the expertise in supporting people with dementia is detached from front line health care.

The problem is, perhaps, exacerbated by the fact that few people access hospital services because of their dementia. The reason for being hospitalised is for other health reason, yet it has to be born in mind that these reasons can be related to the dementia, for example a cut or burn could be the result of failing to remember something, so true, holistic care needs to take into account all aspects of the persons health.

One of the answers being touted is training for NHS staff, while this can only help it may not be enough to solve the problem. Training imparts knowledge but that is all, how that knowledge is used in practice is a completely different matter. To ensure that the knowledge gained through training is used effectively their needs to be both good staff development and effective leadership at all levels of the NHS. And to achieve this, managers and supervisors, at all levels, need both effective leadership and communication skills along with a knowledge of dementia themselves.

An additional area highlighted was communication between hospital staff and relatives of the person with dementia. This is an important area to be addressed. Dementia is a disease that can have a great impact on a family, the worry about a loved one can be tremendous, along with the guilt of feeling inadequate in caring for them. If this is made worse by a) poor care & b) poor communication then it is not only the patient that the hospital is failing.

Again the solution is better knowledge, better practice and better communication skills.

Perhaps it is now time to take a fully integrated approach to health and social care. Why not have social care specialists on elderly wards? Why not recognise that social care is best placed to provide the support for people with dementia in hospital. This is particularly important in ensuring there is sufficient after care when the person leaves hospital, especially if they are returning to their own home.

The numbers of people with dementia are predicted to rise sharply and unless action is taken soon the situation will only get worse, so let’s hope we get action sooner rather than later.