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.

Routes, Routines and Dementia

To anyone with knowledge of Neuro Linguistic Programming (NLP) the phrase “the map is not the territory” will be familiar, although the phrase pre-dates NLP and was actually coined by Alfred Korzybski in his work on General Semantics.

To those not familiar with the idea, simplistically, the concept is that none of us sees the true reality of the world. What we see is our perception of it through our own personal filters that are embedded within us as a part of our experiences in life, in other words, our own internal map. An example would be witnesses to an accident or crime who come up with different versions of events. The events are reality but how they are viewed depends on those individual’s experiences and filters.

Our internal maps guide us and guide our responses to the situations we find ourselves in. If there is nothing on our map to help us in certain situations we become unsure or maybe even panicky, in other words the map is our comfort zone. Yet after we have delved into the unknown our map rewrites itself to encompass this new experience and, in the same situation in the future, we are likely to repeat the actions that successfully saw us through it the first time.

Occasionally what we do may not actually be the best way to deal with that situation by we will continue to do it that way because that is how our internal map guides us and we may not bother to think of possible alternatives.

In general terms this is why change is so often difficult. We are moving into the unknown and our minds are guiding us to stick with the tried and trusted even if that is not the best route for us in the long run. That is why certain addictions can be difficult to break because the addiction has become so familiar it means moving off the chart and into the unfamiliar to break the habit.

There are, naturally, conflicting views on this theory but it does give us a useful tool for thinking about social care.

Imagine you have a map and you are using it to find your way to a specific destination, you just follow the shortest possible route from A to B and off you go, with occasional reference to the map to make sure you are on the right road. Now imagine that halfway along your journey your map changes and suddenly there is a huge blank space between your starting point and where you want to get to? How would that make you feel? Panicky? Frustrated? Angry?

How must it feel to those who have dementia when their memories, and therefore their internal map, begins to fail?

Our built in Sat-Navs help us move from task to task without having to think. Our morning routines, for example, are often done on auto pilot, yet if we suddenly did not know what we need  do we could find ourselves unintentionally missing breakfast or completely forgetting to wash. But everyone of us has a different morning routine and those different ‘maps’ could actually cause distress even when we desire to be helpful.

If I tried to impose my ‘route’ on to your morning routine you’d probably speak to me very unkindly!

Even where someone’s own map has developed a blank space trying to impose a new routine may well feel ‘wrong’ even if the person cannot articulate why that feels wrong (that can even happen to us in everyday life sometimes something doesn’t feel quite right does it? So we will question whether or not we should do it even if we can’t quite put our finger on it).

Understanding and supporting someone with dementia is not just about being able to do routine personal tasks for them. It is about understanding the complexities of the disease and how your actions might impact on people’s lives. We need to learn to be able to read other peoples maps so we can provide them with support along their own routes to achieve the goals they want

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.

Issues in Integration

Twelve weeks ago I went over on my ankle, it hurt. The swelling and bruising was pretty nasty but I just put it down to a twisted ankle that would clear itself up. Unfortunately, after a couple of weeks it was still intensely painful so I went to the nearest A & E where they x-rayed it and told me I had a fracture, they gave me a pair of crutches (no other treatment) and told me they would get me an emergency fracture clinic appointment and I could expect a call on the next working day.

Two days later I finally got through to the clinic who mentioned they had seen something with my name on and could I come in later in the week.

At the fracture clinic I was told I didn’t have a fracture (they used the same x-rays) and it was severe wear and tear, even though I protested that my ankle was fine before going over on it, I was summarily dismissed with a piece of paper to give to my G.P. to arrange for physiotherapy.

When I got to the G.P. I was asked what the piece of paper was because hospitals do not normal send that bit of paper to G.P.s! However I had a telephone consultation arranged and was referred to the Physiotherapy Dept.  I then had to visit the G.P. because the pain was still intense and I was simply given a co-codamol prescription, again with little other advice.

It then took six weeks to get a physiotherapy appointment. While, of all the different elements of the NHS involved, the physiotherapy team have, undoubtedly, been the most helpful, once at my first appointment I had to relay all the details of my injury as they had no notes on my fracture clinic appointment or the history so far.

Because of the time lapse between referral and getting a physiotherapy appointment I had a follow up fracture clinic appointment after my second physio session. Again this was another frustrating experience, quick chat with consultant who I told I was still in pain, hour wait for x-ray, then back to consultant who told me there was definitely no fracture just evidence of an old injury. What old injury, I exclaimed, only to be dismissively told, “oh it might have been something minor” and then told to come back in six weeks.

Following week back to physiotherapy, who had no knowledge of fracture clinic appointment and I had to explain what had happened there.

That was last week and I still have bursts of intense pain

The point of this story? We have this long running debate on integration between health and social care yet it is evident within the health service alone there is no real integration and, while mine is a relatively minor injury, I have no doubt people with much more serious conditions suffer from the same frustrations of the lack of ‘joined-up’ care in the NHS.

Social care itself is not a ‘whole’; it is a combination of public sector and private sector services that because of those different sectors cannot fully be bought together efficiently. The bottom line is most of the private sector works for profit and the public sector works toward bureaucratic efficiency.

Integration: The act of combining parts to form a whole.

When we talk about integrated services for health and social care is this what we mean? For those who use services yes it is. Anyone who needs services wants an holistic approach, seamlessly receiving care and support from all aspects of the ‘system’, support with health, social care, housing etc. is, idealistically, delivered in a joined-up way that involves everyone responsible for delivering the services knowing exactly what everyone else is doing and working together toward a single purpose.

From a public sector point of view the issue is different. Technically speaking, integration would mean combining all the parts of the system into one and that is not likely to happen, so the key word here is collaboration rather than integration and this is where the difficulty often arises. Who is responsible for this collaboration, who takes the lead to ensure the individual needing services gets a seamless service?

Naturally people are territorial about their domains, and certainly ‘professionals’ can often give the impression of others not really knowing enough to give a valid opinion, so there is inevitably some tension between ‘professionals’ of different sectors. Yet this approach does not benefit the individuals who need the services which is why there must be clear, defined leadership.

Before there can be talk of, and delivery of, integrated services for those who need them there must be a clear demonstration that those services are themselves integrated as until that happens it means they will be unable to deliver on that which is truly desired.

The Challenges of Social Care Inspection

The appointment of Andrea Sutcliffe as Chief Inspector for Social Care at the Care Quality Commission is a highly commendable one. Not only is she knowledgeable about the care sector (see for example http://www.guardian.co.uk/social-care-network/2013/jul/15/what-good-homecare-looks-like) but she also has her own personal experiences to draw upon (http://www.whentheygetolder.co.uk/finding-care-for-older-relatives/) and that combination, along with her naturally open approach, bode well for the future inspection of social care.

Yet that future is strewn with challenges that Andrea first needs to tackle. The general perception of social care is not great and trust in the Regulators has been severely dented over recent weeks. The first challenge will be defining a model of inspection that will ensure poor provision is identified and stamped out yet this model must also reflect the nature of the care sector and the huge variations within it.

Yesterday, for example, the new Chief Inspector for Hospitals, Prof Sir Mike Richards, outlined a model which he frequently referred to as ‘an army’, 20 or more inspectors marching into a hospital to inspect all aspects of care provision and ensure the meeting of standards. Unfortunately, in social care that will not work as, in many instances that many inspectors would outnumber both residents and staff!

The variation in social care is completely different from that of hospitals. Social care covers care homes and home care, it covers care and support for the elderly and care and support for those with learning disabilities, it covers large care providers with 100’s of homes as well as micro providers with just a few beds. Finding a model of social care inspection that fully encompasses the variation while ensuring consistency is, in itself, a challenge.

The Care Quality Commission has recently stated that it intends to have more specialist inspectors and social care could really benefit from this approach. For example recent reports have highlighted training and development issues with Health and Social Care staff and having learning and development specialists as part of the inspection process can help raise awareness of the importance of staff development, encourage providers to focus on training and development and help identify failings where providers fail to implement staff training and development. Similarly specialists in infection control or nutrition could have a significant impact.

One thing that would be good to see, and may well happen given Andrea’s former job, is a focus on best practice information and its application both by providers and inspectors. Resources, for example, from the three main national bodies, Skills for Care, National Skills Academy for Social Care and, of course, the Social Care Institute of Excellence should be routinely be embedded in care practice and those who inspect should also be fully familiar with this in order to ensure inspections are informed. One challenge has always been getting best practice information through to all providers, it is easy for providers to say they don’t have time to look at these things or, in the worst cases, believe they know what they are doing and don’t need any advice. If providers know their inspectors will look at this then they are far more likely to make to time to look at and use this information.

The regulatory framework has increasingly moved toward an outcome based approach, if providers and inspectors do not access the knowledge of what excellent outcomes look like then that system fails.

Undoubtedly, Andrea Sutcliffe has a challenge ahead, one that I am sure she will meet head on, and, ultimately, social care can only benefit by having such an effective leader at the helm.