Skills, Social Care & Society

Very soon the whole social care consultation merry-go-round will start once again with the emergence of the White Paper. When the Government  publish this  undoubtedly the focus, once more, will be on who pays for care services and how they do so, leaving out HOW MUCH such services really cost.

Part of the debate on social care is about providing quality services but there is little discussion how this is achieved and how the front line care workforce is trained to deliver that quality and why training is so important to achieving the best possible outcomes for those who rely on care services.

Everyone sitting in an office right now knows about Health & Safety at Work, to most it is something that is fairly abstract but rigorously enforced by the ‘Health & Safety Police’ in a manner that appears somewhat obsessive. Yet in social care health and safety is a lot more immediate and is not only about the workers but also about the people they support and care for. Slips, trips and falls, for example, become a much greater hazard for those who are frail and have problems with mobility, it is not just a case of worrying where computer terminal wires trail but all small lumps and bumps in the flooring become potentially hazardous.

Care workers, therefore, have to have a  greater awareness  of health and safety than the average worker and, of course that level of training costs.

One of the favourite things in social care is to compare the workforce (in terms of pay conditions etc) with the retail sector. I have often questioned this comparison but the issue of training helps illustrate why the comparison is a false one, particularly moving and handling. Obviously both jobs involve manual handling, lifting etc but in a supermarket the only handling involves inanimate objects. How much more complex the need to be able to handle people, to help them in and out of bed or the bath, how to use the more complex equipment, such as hoists, which need to be tailored to the individual.

Care workers, therefore, have to have a  greater awareness  of moving and handling than the average worker and, of course that level of training costs.

The same applies to many of the basic training elements in many workplaces where care workers have the additional element of having to take into account how that knowledge applies to those they work with.

Beyond that the care workforce is expected to have additional knowledge that is, generally, only otherwise found in the health sector. This includes infection control and ensuring that the risk of infection is minimised, they need to understand the concepts of cross contamination, the hazards of handling bodily waste and how to deal with contamination if it occurs. Care workers need awareness of medication, how to store it, deliver it and record its use and care workers need to understand the signs and symptoms of adult abuse and what to do if they suspect abuse has taken place.

Society also expects care workers to deliver dignity and respect to those they provide services for. While the words dignity and respect are often bandied about very little is said about what this involves and the principle skill is communication and care workers need to be trained in the complexities of communication in order to listen to and understand the needs of the individual to deliver the best possible service.

Social care is often portrayed as a generic service where care workers are transferable. But, in fact, care services are far from generic, older peoples services are vastly different from learning disability services or mental health service or physical disability services and aside from the general skills listed above there are also specialist skills needed by the care worker dependent on the service they are working in. Knowledge of dementia is an essential skill for working with older people but not in many other services, (although in learning disability services dementia is an issue that is probably needs more consideration as the population ages), knowledge of autism and epilepsy is needed in learning disability services where these conditions are prevalent and, of course, knowledge about specific learning disabilities need to be known in order to provide the best possible service.

Overall then the care workforce  needs  extensive skills and knowledge to deliver the best quality care. This sometimes fails, as demonstrated by Winterbourne View and Ash Court but this cannot be surprising in a society that undervalues care workers and fails to see the importance in ensuring care services are funded sufficiently to allow the full spectrum of  specialist  training to match the  specialist  service that care workers are expected to deliver.

When the White Paper is  published  and the consultation process around the proposed draft social care bill starts they needs to be a greater examination of what we expect the social care workforce to deliver, the skills and knowledge that are needed to deliver quality care and how much investment is needed to ensure these skills are in place.

Hard or Soft! Actually we need both

I recently heard a debate about the “soft skills” and “hard skills” needed to lead and manage social care and the importance of focusing on each but perhaps the principal argument is the need to understand these labels, consider what is the most  desirable  and question whether they are somewhat misleading.

The ‘soft skills’ in question are the ones usually associated with leadership, particularly communication. The soft skills are usually associated with ‘Emotional Intelligence’ (I would certainly recommend to work of Daniel Goleman if you have not already  read  it) which focus on personality traits, the use of language etc. and in terms of leadership it is about the way in which the leader acts, interacts and inspires those around them.

The ‘hard skills’ focus on the tasks usually associated with management, the practical skills of how we achieve a task, the steps needed to achieve a goal or target and the day to day housekeeping associated with any work role.

In recent years the  focus  in social care has been on the hard skills, training in the core skills such as infection control, health & safety etc. and while there are excellent courses on such things as communication skills these have been less important to the regulatory framework and, therefore, of less importance to the care providers.

But in the real world what are really the harder skills?

For example, what is harder, working out the level of cover you need to provide the right level of care or persuading staff members to work the shifts needed to implement that level of cover?

Imagine  the care worker who has told support an individual in dealing with incontinence. The practical skills of assisting them to clean themselves and applying appropriate infection control procedures are surely a lot easier than the task of reassuring a person who may feel shame and embarrassment and developing an empathy with the individual told help them understand that such things are not their fault.

The above also illustrates that while I have talked about leadership and management skill sets these actually apply at all levels of care provision. Front line care workers need the ‘soft skills’ to be able to provide effective personalised care to individuals. The skills of empathy and effective communication are essential in discovering what really matters to the person and what they want from their care package and life in general.

I have blogged before on the need for both leadership and management skills (Thoughts on Leadership & Management) and the  importance  of both but there is also a need to recognise  that these skills apply across the spectrum of care delivery.

Commissioning, for example, needs to be more than the management process of ‘tick box’ contracts with care providers and commissioners need the soft skills to work with providers in an effective way that benefits the individual receiving care, equally providers need to work with commissioners in the way that most business sector would deal with customers (after all it is the commissioners who are paying your wages!).

Effective social care needs both the soft skills and hard skills in balance in order to provide effective social care to the ever growing numbers who need it and we need to ensure that the regulatory framework recognises that both sets of skills are equally important.  

Thoughts on Leadership & Management

There has, of late, been a strong emphasis on leadership in social care but at yesterday’s SCA Conference (which I  followed avidly  on Twitter thanks to the tweets of @cpeanose) the issue of the importance of management was raised. So I thought it would be a  good opportunity to reflect  on Leadership and Management.

Leadership is about people skills. The good leader is one who sets out a vision and inspires and motivates their team to achieve that vision. The leader is the role model who sets the example for others to follow and leadership is about effective communication using the skills of listening and giving effective feedback.

Management, on the other hand, is about the tasks. The good manager organises workloads, ensures targets are set and outcomes are met. Effective management is about assessing, evaluating and planning.

Having laid that out it must be said the truly effective leader is one who is a good leader AND a good manager. In a previous blog (Social Care Leadership: Visions, Targets and Goals) I stated the importance of setting out a vision as one aspect of being a good leader. Yet equally important is achieving that vision through targets and goals and that is where effective management skills are required. The manger needs to take the vision and break it down into achievable steps, to set the goals that will achieve the final vision and assess what is needed to reach each step. The leader then needs to come back to the fore and  communicate those objectives to the team in a way that  motivates and inspires them to achievement. The manager returns to assess progress and evaluate what further action the ‘leadership’ side needs to take.

The important issue is the balance of leadership and management skills. By way of illustration I, back in the dim distant past when I left school, worked for a national menswear retailer where I had the opportunity to work with a number of branch managers. One I recall was a brilliant people person, he could sell snow to eskimos and he could inspire the staff to up their game. The problem was he was hopeless at managing, you needed to discreetly stay close to him to ensure that what he promised was actually delivered because he would be immediately forget that promise when the customer was out of sight. Another manager I worked with would, literally, hide from people. He would stay in his small office doing paperwork or live in the stockroom checking deliveries and his level of communication with the staff was minimal leaving it others to discuss how we stood in terms of targets etc.

A truly effective leader is a person who can completely balance those leadership and management skills, of course, in the real world such perfection is unlikely and this is where the real skill of leadership comes in.

The true skill of leadership is recognising the qualities and short comings in your own ability and organising your team to counter any deficiencies. Someone whose people oriented skills out balance the task oriented skills needs to acknowledge this and be prepared to delegate some of the management tasks to the team member most capable in that area. Similarly where the balance lies the other way it is important to identify the best communicator in the team and allow them to help motivate and inspire the team towards goals.

Leadership and management are not separate entities but are two sides of the same coin and to  achieve real success  those ‘in power’ must endeavour to achieve a balance between the two.