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.

Inspiring Leaders

The concept of leadership in the workplace is not new and the importance of leadership behaviours in successful organisational culture is well established.

But what actually is leadership? For a start the word is a vague word, it is not something you can pick up and look at and it will mean many things to many people dependent where the word is being applied. For example would you expect the same application of leadership from the Prime Minister as you would from a supervisor in social care? On one level the answer would be no yet the same qualities of leadership still apply.

The Institute of Leadership & Management (ILM) have an excellent guide to what is leadership (click here for link) and these can be applied to whatever level of leadership you are engaged in.

The manner in which social care has rapidly changed over the past 25 years or so means that the ideals of leadership may have passed unnoticed, in a bureaucratic system that has focused on standards of quality that tick boxes rather than truly reflect the end result.  Similarly there has been little focus on the ideals of leadership in commissioning services. Even in the drive towards personalisation has focused on the need to provide individualised services without the recognition that  implementing personalisation needs leadership skills to be successful!

In other words the whole culture in social care has ignored leadership values.

Even though nowadays the majority of social care is delivered by private providers I doubt (although would be happy to be proved wrong) that leadership qualities are high on the agenda of many of these providers and that there is a lack of understanding of what leadership entails and how it will ultimately help their business. How many leaders are there in social care with membership of the ILM? Or who have undertaken training in leadership that goes beyond the Registered Managers Award?

Yet training in leadership is only a part of the issue and raises another issue on leadership that is, perhaps, at times missed in social care. A part of the tick box culture has been focused on training, ensuring care workers have ‘done the right courses’ yet, and  I have said this  many times before, training fails without development activities to embed the knowledge gained through training into skills in practice and that is where leadership is important.

Not only should the manager be talking to people who attend courses and asking how they would apply their new learning to their work practices but we should also embed a culture of self-leadership where staff members automatically reflect on this and actively speak to their seniors about ways their learning can be applied in improving care provision.

We need a culture change because the qualities of leadership can have a much more important impact than in general commerce. In most business sectors the aim is to make profit by providing goods or services that people want. The aim is to attract customers and hope that your qualities inspire them to part with their money.

In social care, however, we have the added responsibility of ensuring the quality of life of the people who need social care services and that responsibility deserves good leadership at all levels, from the Department of Health right down to front line carers.

After yesterday’s event I am confident that leadership is coming to social care and will begin to embed itself in business behaviours and care practices which can only help to bring better services to the most vulnerable in society.

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!

Social Care Businesses: Welcome to the Real World

There is a general rule of thumb in customer service training that says if a customer receives bad service they will tell, on average, ten people. Yet if they receive exceptionally they are likely to only tell two or three people.

The advent of the internet has made the audience for peoples thoughts on a service much wider than just relatives, friends and acquaintances. Sites such as Trip Advisor offer people the chance to vent their frustrations publically and have become a first port of call for many planning a holiday. Would you choose to stay in a hotel that had consistently bad reviews?

With the creation of The Good Care Guide (http://www.goodcareguide.co.uk/) social care providers will need to be much more aware of customer service skills and the potential impact of giving bad service to care users and their relatives. It is not now just a matter of providing efficient care and support but the manner in which it is delivered also becomes important.

In one sense this new website means that social care providers are catching up with most other business sectors in the UK. Businesses will now have to ensure their ‘public facing’ image is as good as their image to the local authorities and care regulators who currently hold the balance of power over what is and what is not a good service. Care providing businesses are entering a phase of new opportunities to promote their company yet it is a phase that could be fraught with danger for those who choose to ignore the importance of this change.

Comment has been made that one malicious comment could ruin a business, that is certainly true however the issue has to be that providers will need to monitor the comments they are receiving and act accordingly. Business owners will need to be much more active in the image of their company and be prepared to make instant adjustments to their service delivery.

At some point it will be inevitable that Local Authority commissioning will also be influenced by the guide. It would be hard for any authority to justify using any care provider who constantly received critical reviews which will naturally mean a reduction in the number of referrals, by the same token anyone self-funding care will be unlikely to even consider visiting a poorly rated care provider.

The one question mark over the new web service is how the Care Quality Commission will use it and what happens if a provider is constantly criticised for its service yet it meets all the requirements of the essential standards of quality and safety.

That aside there will be an increasing need for social care businesses to look to increasing their focus on customer service and marketing skills in order to compete in this new environment.

Social Care businesses are entering into the real world of customer choice, customer service and marketing and those who will survive are those who adjust sooner rather than later.

Social Care Leadership: Visions, Targets & Goals

"Where there is no vision the people perish." — Proverbs 29:18

One of the hallmarks of leadership is vision. Vision encompasses everything that the leader wants to accomplish in the long term in order to achieve success in whichever field they are in. So in film, for example, the director has a vision of the completed film, in sport the athlete has the vision of winning major accolades, in business the CEO has the vision of successful business with high profitability etc. The leader’s vision becomes the focus of the whole team and marks the way forward to success.

One of the problems facing social care leaders may be defining that essential vision. The present system is a fragmented and diverse one which can lead to vision being eclipsed by the demands made on the service.

There is much ambiguity facing social care providers, those who receive frontline care services are not necessarily those who pay for it, therefore Local Authorities and the NHS are also customers (service users) as are families who pay for care services. In addition many of the terms of the service provided are dictated by Government policy and regulation, with all the bureaucratic involvement in social care it is easily forgotten that front line services are provided, in most cases, by the private and voluntary sector.

It is essential that, as businesses, social care providers have leadership and vision. Where do you want to be in five years time? What do you want your business to achieve? In the present climate of financial cuts and uncertainty about the future having a vision for the future is vitally important.

Vision inspires and motivates people. Vision allows businesses, teams and individuals to move forward. Vision brings success.

But a vision without action is little more than a dream or wishful thinking.

So how do you set out to achieve your vision, by setting targets and goals.

While a vision is the ultimate aim, targets and goals are the pathway that needs to be trodden to get there. Take your vision and ask yourself, what are the smaller things that need to be done in order to achieve this? This is, perhaps, the more difficult process but it is the essential part of good leadership skills. So, for example, if your vision was to be the best care provider in your district you would need to identify the elements that are preventing this from being true now, what actions you need to take improve those elements, how this can be done within budgets and limits on time etc.

From this you can begin to build a plan with targets and goals at key points in your timescale. You should always try to follow the S.M.A.R.T. principles when planning to ensure your plan is Specific, Measurable, Achievable, Relevant and Timely.

Once the leader has their plan in place they can roll it out to the team, yet one of the important aspects of leadership that is often overlooked is presenting the plan of targets and goals without also presenting the vision behind it. We all have a natural reluctance to have targets imposed on us but if those targets and goals are part of the wider vision then people are much more likely to feel a part of that vision and be motivated to achieve the steps needed to achieve it.

The other important thing about setting targets and goals is that it allows the leader to regularly assess the road to success. By reviewing the achievement of targets and goals it is possible to make any necessary adjustments sooner rather than later, after all it would be devastating to learn that you had failed in one area when you were close to the time you had set to achieve your vision. It would be much better to be able to tweak and adjust your plan on a regular basis to ensure success.

Vision is the key to success but only if that vision is backed up with action and marked along the way with targets and goals.

Social care is no different from other businesses in needing vision to achieve long term success and it is something that every leader in social care should take the time to think about.