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Home Care Day 18: The Future of Home Care – from an integration perspective

The Future of Home Care

As I write this thousands of people across Scotland are receiving care and support in the comfort of their homes. For many this is a life line and the reason they can remain at home, in their communities, surrounded by a life time of memories.

On hearing the knock at the door in the morning and seeing the smiling face of the Home Carer when entering their home, the person receiving the support will not be aware of the challenges facing all those involved in service delivery.

The economic situation, procurement and commissioning processes, the crippling recruitment and retention issues, the complexities of regulation and registration and the ever increasing demand for services are a daily feature in the lives of every care at home provider in Scotland. Yet, despite this they continue to operate and endeavour to develop, improve, adapt, innovate and influence. It is this spirit that gives me hope that one day, the most frail and vulnerable of our population will receive the care and support they deserve by an empowered, valued and recognised workforce.

Is it unreasonable to expect people to receive care and support at a time and in a manner they choose? I doubt there is anyone who would argue against outcomes focused care delivery and instead support the current time and task approach to service delivery. So why is it that we, one of the most progressive countries with regard social care, see care being purchased in blocks of time and delivered by support workers under intense pressure to quickly complete a task before moving onto their next client?

Admittedly transforming current procurement and commissioning services is far from an easy task, and is by no means the only of element involved in shaping care at home service so it is fit for the future. However there is increasing evidence that current models inhibit innovation.

In “Messages on the Future of Domiciliary Care” Dr Jane Townson noted that her experience showed that there is little thought from commissioners as to how they might contribute to creating the conditions in which providers are encouraged to research and innovate for new and best practice. If, for example, contracts are only 3 years long and, at the end of it, you the provider might be “booted out”, why would a provider invest thousands of pounds in innovation.

I have regular contact with care at home providers, as do all my colleagues in the Partners for Integration and Improvement team. We are always impressed with their passion and commitment to improving the lives of those they support. Despite the challenges of working in a sector often described as being in “crisis”, their innovative approach and entrepreneurial spirit shines through.

By harnessing this spirit and energy, by exploring and utilising the opportunities technology brings, by changing systems and processes, by the true cost of care being allocated to social care and rewarding and recognising our workforce, then only then will we see a care at home service fit for the future.

This is when we will see person led, human rights based care and a care at home system we can truly be proud of.

Margaret McKeith

National Lead, Partners for Integration and Improvement, Scottish Care

#homecareday18

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Home Care Day 18: 12 minutes to midnight, 5 months on

12 minutes to Midnight 5 months on

On 17th June 2018 Scottish Care published its short report, ‘Twelve Minutes to Midnight: 12 challenges, 12 solutions, 12 months to save the homecare sector.’

The report received, as might have been anticipated, significant media reaction though not all of it got beyond the headlines into the actions and suggestions that we were making.

We are now 5 months on and given today is Home Care Day, it might be appropriate to revisit progress.

So firstly what were the issues and suggestions?

 

1. The Scottish Living Wage

The last few months have seen the reality on the ground look even worse than it had been in May. It took several months after the commencement of the Scottish Government 2018 commitment for the monies which should have been allocated to finally reach the pockets of the providers. In some instances it was as late as September before several Scottish Local Authorities sorted themselves out and decided to pay external providers. This is unacceptable meaning either that frontline workers were not paid their increase because providers had no assets or reserves thus making retention very challenging. Or providers used the little additional reserves they had in order to pay workers until they received their payments. This again risk the sustainability of many organisations and meant in practice that resource that could have been used for innovation and development  was lost.

It is a great pity that the flawed implementation of a well-intended measure has resulted in even less sustainability within the homecare sector.

We are very concerned of what the future might hold. One thing that Scottish Care is clear upon and that is that if this initiative is to continue it must be appropriately resourced, clearly ringfenced, properly implemented and externally reviewed. We simply cannot leave it to a wing and a prayer.

We must also seriously address the fact that the failure to pay differentials has now resulted in many organisations struggling to attract senior staff and managers.

With renewed pressures from Brexit and from the hospitality and retail sectors we must do more than a badly implemented and poorly resourced Scottish Living Wage initiative to secure the future of the valued homecare workforce.

 

2. Time and task commissioning

There is now no shortage of initiatives, including those of the Adult Support and Care Reform process from Scottish Government and work on a potential National Framework facilitated by Scotland Excel within the commissioning landscape. There are also emerging models in practice of collaborative models including alliance models. There does indeed seem to be a willingness to move away from the obscenities of time and task commissioning which has served to drive quality down and to develop outcomes based approaches. This cannot be done on the cheap and must be resourced to enable the step change which citizens require. Care in fragments, deserves to become a thing of the past.  We must re-imagine the potential of as preventative, time-flexible, outcomes focussed approach to commissioning.

 

3. The model of care is not appropriate – not holistic not person led …

 Scottish Care’s report, ‘Bringing Home Care’  was a call to develop prevention focussed, time flexible and relationship-based care. More than ever individuals accept the validity of these options but we are still struggling within a system that is failing to join up the dots. Despite the mantra of integrating health and social care and creating one system approaches, we still witness a fragmentation of resource and leadership. More than ever before we need to re-envision the sort of care we need to deliver. Investing upstream by re-shaping homecare will in the medium to long-term make significant fiscal savings and lessen an unhealthy dependence upon the acute NHS. But this requires courage and an active disinvestment from buildings and roles which are weighing down innovation. It is hard to prove a future which is calculated on not doing something  without at least testing new approaches. We know what they are we need political will to start implementing them. Scottish Care is committed to continue to demonstrate the clear personal and societal benefits of a reformation of homecare and the development of housing with care models.

 

 4. Recruitment of staff

As the Scottish Care Autumn Care Tour goes around the country  there is one singular issue which is concerning providers of housing support and acre at home service s- that is recruitment and retention. All the evidence is that things are getting worse rather than improving. Providers tell us they are massively struggling to recruit staff.  IN previous years people came through the door and were then sifted , now there are not even individuals who are showing an interest in social care. This isn’t too much of a surprise when we have a highly regulated sector, with qualification demand,. And low level remuneration. Go along the road and there are plenty of equally well paid jobs in retail and hospitality without the level of demand and external oversight, and societal stigma. We have a massive recruitment crisis. Inevitably this is already being made worse by the cloud of uncertainty which is Brexit. Providers are reporting that loss of staff is a reality now rather than an anticipation for next year. It is very difficult to encourage and recruit in such a negative atmosphere. We are pleased that there will be a Scottish Government funded campaign to attract workers and are happy to collaborate in its development. However, on its own, and without addressing the elephants in the room, it will be insufficient.

 

5. Holding on to existing staff

‘The Four R’s’  and the ‘Experience of the Experienced’ reports from Scottish Care’s Workforce Matters team have been published since the spring of this year. They paint a picture of real challenge around retaining the staff that we have in homecare. We know that 63% of staff leave within the first six months of joining an organisation. Retention is critical. We have to get better at holding on to the workforce we have because we know that for every 10 people who leave 3 never come back into social care. We have to explore with partners what are the reasons that people are leaving. We know that some leave because they and the work is not a fit; we also know some leave because of the stress and strain of the work and the way it is structured. But we also know that people say that they are not happy with the lack of autonomy, too much emphasis on regulation and compliance, and insufficient time to be with people.

 

6. Qualifications and especially older workforce fitness to practise…

Registration opened for frontline care staff a year ago and with it came a requirement to be appropriately qualified within a set timescale. Scottish Care shares the desire to have a well-trained, valued and recognised care workforce. But there are real fears out there, and these have been compounded over the last few months, that despite the supports, we will lose some of our most experienced and talented older staff because they will not want to go through the rigours of our current qualification system. Added to that Scottish Care believes that we need to radically reform the qualification system. We hear from providers that there are real problems in accessing local training providers, inflexibility in forms of assessment, an over-dependence on text and academic models amongst other concerns. We dare not lose the gifted resource of trained and skilled individuals who have worked in the sector for years but whose life-skills and prior learning is not being appropriately valued and acknowledged.

 

7. Emotional fatigue… mental health stress and distress

 After terms and conditions, we know from our research at Scottish Care that the second main reason that people choose to leave social care is because it is such an emotionally draining and demanding area of work. ‘Fragile Foundations’ was published nearly a year ago and describes the often draining and exhausting reality of care and its impact on the mental health and well-being of the workforce. There have, over the last few months, been a considerable degree of political focus on mental health and wellbeing, not least of children and young people. We need the same level of commitment to older person’s mental health in general and a particular emphasis on the mental fatigue being faced by the care workforce.  As we have said we must all get better at caring for the carers.

 

8. Integration

The establishment of a Review of Health and social Care Integration is to be much welcomed. Scottish Care is grateful to be included in that review which is an important acknowledgement of the fundamentally important role that the independent care sector plays in delivering services across Scotland. We all want the aims and vision of integration to work in reality. The next few months will involve the need for courageous thinking and creative work to ensure that the benefits of a one system approach are truly achieved. We look forward to building upon this early work both at national and local level. In the midst of this we continue to encourage local Integrated Joint Boards to give formal recognition to our contribution by having a representative from the sector on the Boards. Since we last reported the Scottish Care Partners for Integration staff have produced a report and held a conference which highlights the work of the independent sector across integration authorities. It is clear from that when we work together we achieve the joined up and positive outcomes which our citizens desire.

 

9. Technology used to limit rather than to liberate

 There is tremendous potential in technology to transform and deliver a more person-led, preventative approach to home care and housing support. Scottish Care has long argued that this technological contribution has to be undertaken for the right motives – to enhance person-led care and support, and in the right way – embodying human rights at the heart of care. To that end we published a report called ‘TechRights’ in August.  It is a call for a human rights based approach in the developing use of AI, Big Data and the Internet of Things within social care. It is our hoped that the partial engagement of the independent sector by other stakeholders will increase over the next few months. The future of care necessitates all of us working together.

As part of that future for homecare we have been delighted to have been working with the Glasgow School of Art School of Innovation in  a project which has technology at the heart of a vision of homecare for the future. We hope, after our Autumn Care Roadshow, to write up our findings and specific recommendations.

 

10. SDS needs to work better for older people

Self-directed support (SDS) is the only way that citizens should be accessing social care – but for many older Scots the principles of choice, control, participation and dignity are still being daily ignored or only partially offered. We are still hearing stories from across Scotland, often on the grounds of fiscal austerity, that older people are not getting the same access to choice. This is not the fault of SDS , this is the fault of a social care system not enacting the legislation properly and a lack of resource to implement the change we all want to see.

Scottish Care is absolutely committed to ensuring our citizens are able to exercise choice and control, have a clearly identified personal budget and that there is a diversity of the market to enable real choice to happen. We will resist any attempts, including political ones, to water down or neutralise this potentially life-changing legislation and delivery model. We will continue to be strong advocates of self-directed support and its potential to put the citizen in control of their own care.

 

11. Social care is underfunded

 We are a few weeks away from the Scottish Budget Statement and over the next few weeks Scottish Care will be publishing our own Budget for A Caring Scotland. Every year we are faced with the uncertainty of lack of finance in the social care system in Scotland. Every year at budget time we at Scottish Care make a call for substantial funding to bridge the care gap which is getting wider and wider as our population ages, as dependencies increase and as services cost more and more.

We remain deeply concerned that there is a lack of political energy beyond political party interest and ambition to gather around the table and properly explore how we will fund social  care in the short and medium term. As others elsewhere, for instance in Wales, are holding robust conversations with citizens on funding care we hear a deafening silence in Scotland. We need to start having a debate which will be central to the social fabric of our communities and to the maintenance of effective care at home and housing support.

 

  1. Discriminated and devalued

 Our last statement was that we believed that one of the most significant issues facing the social care of older people is the pervasive discrimination which many older Scots and those organisations who support them continually experience and talk about. We have not seen this alter over the last five months, indeed if anything, because of a simplistic analysis of Brexit voting we have seen it increased. Such stigma and stereotyping needs to be called out for what it is – discrimination based on age. The creation of an inclusive Scotland cannot be created on a foundation which is inherently ageist.

 

 

Starters at midway point 

Our previous report listed 12 specific starters – let us see how we are progressing…

 

1.Emphasis on prevention

 We called for investment in tests of change, in developing new models rooted in prevention and self-management for the old and frail, which is non-condition specific  but designed to enable independence and is person-led. We asked any Integrated Joint Board willing to work with us to get in touch. We are still waiting.

 

2.

We called for a change in commissioning to make it collaborative and relational. We are thankfully beginning to see a growing collective and governmental desire to make this happen.

 

3. Learning needs to grow up

We called on partners to work with us to radically alter the way we validate and recognise care worker learning and experience. We invited the SQA and SSSC to work with us so that together we can create a  qualifications framework which is built around the needs of the person rather than the system. We have started the process of discussions and debate but we believe there is still a resistance to making the radical change we need to see.

 

4. Utilise technology by equipping workforce

We called for the creation of a five-year Technology for Social Care Project Fund – to fund creative technology designers to work with frontline care workers for a month and then out of that experience to design innovative solutions for practical problems in collaborative partnership. We still believe this is a good idea – we are still waiting on our colleagues in the Scottish Government’s Digital Health and Care Team to get in touch.

 

5. Let us all try and make the Scottish Living Wage initiative work

Scottish Care is committed to the maintenance of this initiative from the Scottish Government. We have to get better at its implementation and adequate resourcing. We are continuing to work with our partners in seeking to achieve this positive outcome. The next Budget has to clearly delineate priority for social care staff. We would encourage our politicians to note that the Welsh Government has made social care its fourth area of economic priority.

We called for the creation of a Pay Commission to be established to decide what is an adequate rate of pay for those engaged in the increasingly skilled and challenging tasks of care in our community. We are still waiting for buy in.

 

6. Prioritise learning and development

In order to recognise the critical role of training and learning in homecare , and in response to the growing reduction in funding through contracts for staff training, we called on commissioners to ensure that at least 10% of the whole sum of a tender should be committed to the training, learning and development of the workforce. We have not seen anyone do this.

 

7. Respecting the workforce 

In recognising that it is time to trust our workers by giving them power to make decisions, to act autonomously, to feel that they are trusted and valued, professional and capable, we called upon SSSC and others to work with us to change the workforce regulatory culture from one of compliance to partnership, one of fitness to practise to freedom to perform. Discussions continue but we believe we have not got the balance right and that regulation is still disproportionately heavy.

 

8. Care for the Carer Fund

Faced with all the evidence we have published on worker stress and distress, on burnout and fatigue and the critical importance of retaining the workforce, we called on the Scottish Government to establish a Care for the Carer Fund dedicated to ensuring the mental health and well-being of frontline social care staff. They are our greatest asset to hold on to and our easiest treasure to lose. We have not seen this come to fruition.

 

9. Distinct bereavement support for every worker

In accepting that most social care for older people is at the interface of palliative and end of life care, that the social care workforce offers solace in distressing times, we argued the need to support that workforce better. In so doi9ng we asked Scottish Government to prioritise bereavement support for the workforce through a joint national project with Cruse Bereavement Scotland to establish a network of bereavement support for care professionals. We have not seen this suggestion taken up.

 

  1.  

We argued that in order to make integration work it should be a requirement to include representatives of the independent sector social care providers and frontline workforce on IJBs to have their voices heard.  We still believe that you cannot have partnership without presence and yet still most IJBs do not have a sector representative.

 

11. 

In recognising the substantial contribution of social care to the wider Scottish economy we called for the creation of a special division or unit within Scottish Enterprise dedicated to enabling the greater promotion and development of social care and to fostering and co-ordinating innovation and entrepreneurship for the benefit of the wider economy. None such has been developed.

Alongside this we are called for Skills Development Scotland to strategically work with organisations like Scottish Care to focus more of its priorities and resource on the social care sector. We have had constructive dialogue and progress in parts of this over the last five months.

 

  1.  

Our last suggestion was that we create a cross-party and independent Commission on the Future Funding of Social Care in Scotland. We acknowledge the reform work that is ongoing but our call for an urgent exploration of the financing of social care and health in Scotland has gone unheard

 

So overall…

Scottish Care as the representative body for the majority of older people homecare organisations is disappointed that five months after we identified 12 critical areas to be addressed and offered 12 solutions to meet the challenges facing social care that the vast majority have not been accepted or acted upon.

On our calculation we are seven months closer to a point of real breakdown. Every day across Scotland we are faced with a homecare sector struggling for survival and sustainability.

The thousands of women and men who work in the services , and the thousands who receive support, deserve better than a countdown to even more chaos and disintegration in the care and support they received. We need to all of us work together to make the change that is needed, and to nurture the care that changes us all from bystanders to active citizens in creating an inclusive Scotland.

We hope next May to say something very different.

 

 

 

 

 

 

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Home Care Day 18: The future of home care resources created with the GSA

The challenges facing the home care sector are well known and increasing. There is a need for improved sustainability, greater recognition for care staff and for a shift towards a preventative, relationship-based and person-led model of care that will support people to live independently for longer and lead to better outcomes for those being supported. Sadly this story is supported by statistics such as a staff turnover of around a quarter, and quotations from frontline staff such as in our report ‘Fragile Foundations’ on staff mental wellbeing “a lot of the time I drive out, pull into the next stop and cry”.

This subjectivity can make it harder for us to re-imagine a better future and so we commissioned work with the Glasgow School of Art (GSA) Innovation school to challenge our thinking and turn it into areas of opportunity based upon current trends, and to make tangible the way in which home care could change in the future.
The Project Aim was to creatively explore and prototype a future of care at home that is underpinned by the National Health and Social Care Standards and engages a dynamically different sector.

Methodology

The methodology was in two parts.

Firstly on the ‘Here and Now’, with the purpose of identifying challenges, aspirations and opportunities they carried out desk research, observation and shadowing and a ‘pop-up’ engagement at the “Design, Technology and Dementia” conference, finalised by a ‘sense-check’ with Scottish Care. Out of this, the following 4 current themes were identified:

 

 

 

 

 

 

The second part to the methodology was on ‘There and Then’ and using a ‘future-orientated design approach’ in which creative and visual methods were used during participatory design workshops. The GSA used the ‘fortune telling’ theme to make the project less formalised and inspire people to get involved. The decision was made to base thinking in twenty-five years time firstly, to free our thinking from existing challenges. In twenty-five years, our ways of living will be different, we will have different views and life experiences and will have grown up in quite different technological, social and economic climates. We will have different family structures, friends and relationships, and people will hold different opinions on what it means to ‘live well’.

This time focus groups were held with care providers and frontline staff, specialist experts and members of the public, to creatively explore a future vision for care at home.

The following emerging and underpinning themes were identified:

 

 

 

Designing the Care at Home workforce of the future

The themes were translated into a set of principles which were used as a basis to develop a speculative collection of personas to depict three future care at home roles not designed to be concrete examples, but instead as a way to support further engagement and stimulate debate and conversation with the wider care at home sector around the purpose, key activities and skills, and training specific to each future role:

Care Navigator

Specialising in coordinating the multidisciplinary care team through gathering, making sense of and organising different flows of data in order to provide responsive, personalised and relationship-based care at home.

Care Connector

Specialising in facilitating meaningful relationships – both physical and digital – for people receiving care at home and supports clients to work towards their aspirations and goals.

Care Technologist

Specialising in facilitating the interactions between assistive technology, people receiving care, and the wider care team in order to provide meaningful and personalised support.

 

What next?

Out of this, the GSA developed a set of tools with the purpose if supporting people to actively be involved in imagining and shaping the future of care at home by exploring some radical possibilities of tomorrow.

Scottish Care has been taking the tools out as part of their Roadshow around Scotland and hopes to take them to partners such as the Scottish Social Services Council, Care Inspectorate and Scottish Government as well as others. Collaboration really is key to the success of this project – by bringing together experts in homecare with experts in thinking, the tools provide a platform for shaping the future that we want rather than a continuation of the reactionary response that the sector often makes in a crisis.

But this activity cannot happen in isolation, the GSA also made recommendations which need to happen alongside the use of the tools, and these include, sharing good stories of care and celebrating the sector, matchmaking technology with current needs and exploring new collaborations.

The results of the workshops will be collated into a report with the purpose of shaping the future of care at home. There is also a second project now considering similar questions for the future of care homes and this will be led once again by the GSA Innovation school, but also in partnership with the University of the West of Scotland.

If you want to get involved, please get in touch [email protected],  or consider running a workshop yourself and sending on the information and ideas that you create.

I invite you to imagine what might be possible, given what we know today.

 

 

 

 

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Home Care Day 18: Overnight Care at Home Service, Highland

Overnight Care at Home Service: Highland

In 2014, NHS Highland was providing older people with a traditional in-house care at home service and a small amount of independent sector contracting. We embarked on a transformational change programme within the care at home service. Our new model seeks to deliver increased care at home hours through a transfer of budget from the NHS service to the independent sector, that will improve outcomes for service users and increase the volume of delivered hours within the existing budget. The NHS care at home service focuses on the provision of short-term reablement only.

Work with the independent sector, facilitated through the Partners for Integration Team identified that the creation of discrete small geographical zones best supported providers to effectively and efficiently deliver the service requirements.

Prior to the introduction of the Overnight Service, there was no care at home provision of either scheduled or unscheduled care for older people between the hours of 10pm -7am. In general, older people requiring overnight care at home would have been admitted to hospital as an emergency, remained in hospital awaiting a care home placement, admitted directly to a care home or remained at home at significant risk. The Operational Unit clearly identified that this was a gap in service.

Development of the Service

In order to pilot this approach to overnight care at home all support and care at home providers who met the NHS Highland commissioning criteria were invited to participate in a consultation event to discuss the commissioning of an overnight service. Following this initial consultation this was narrowed down to care at home providers as other support providers do not provide personal care. This created the opportunity to use existing care at home providers with the caveat that any provider subject to placement restrictions or support with service delivery was unable to participate.

Building on the firm foundations the care at home transformational change programme presented, the opportunity to work further in a collaborative manner to design and develop an overnight service was embraced by three independent sector providers, namely Gateway, Eildon and Castle Care.

They elected to work as a co-operative, which, supported by Scottish Care, offered a creative response to the challenges of both capacity and sustainability in delivering such a service. Central to the service model is a reablement approach.

Governance

Advice was sought from the Care Inspectorate regarding the proposed operational model for the three providers working in partnership. Each partner operates under their individual care at home registration and is inspected under its own auspices. Each partner also employs a proportion of the workforce. However, to more closely align working practices, policies and procedures specific to the Specialised Overnight Service were produced. All workers, regardless of their employer, were recruited, trained and work together as a single team. There is a Heads of Agreement in place, which includes a dispute resolution process. A part time Co-ordinator is employed by one of the partners, with financial contributions made towards the post from the other two partners.

Recruitment, Training and Workforce Support

Experienced and qualified care at home staff at SVQ level 3, (or working towards), were recruited utilising a Values Based Approach underpinned by the SSSC’s programme, “A question of care, a career for you?”

There was service user participation in the selection process from the Highland Senior Citizens Network (HSCN). HSCN consists of a Highland-wide network of local voices to represent the interests of the 77,000 people of the Highlands who are over 55 years.

Training was structured to ensure an authentic learning experience. It was both competence and confidence building. It offered a range of skills delivered by a spectrum of professionals. Within this range of proffered skills, was the inclusion of decision making and was delivered by a host of local independent sector and NHS professionals from a range of disciplines including OT, Physiotherapy, District Nursing, Care at Home, Psychology and Pharmacy. This was further enhanced by a session from a Service User on personalisation and individual outcomes.

This total partnership approach to staff development and training between the NHS, the 3rd Sector and the three providers is a good example of the close working and the ready access to skilled support this change has brought about.

A thorough evaluation of training showed the usefulness of each session and staff identified there were no gaps in their training.

Part of the training examined decision making and managing risk. This has empowered the workers to work more flexibly within a broad structure to ensure individual need is met.

Staff satisfaction is high. This is reflected in individual support and supervisions, practice audits, team meetings as well as in the sickness record for the service. In the 7 months of operation of the service, the total staff sickness within the service has been only one shift.

Service Delivery

A team of two workers provide a service from 10pm to 7am each night with an optimum of 17 interventions per night. This has gone as high as 22 per night where there was difficulty in discharging some people from the service due to individual or family member’s expressed lack of confidence which has now been addressed.

The number of interventions varies depending on:

  1. The amount of referrals
  2. Complexity of calls
  3. Throughput in the service

The service delivers both scheduled and unscheduled care, with the bulk of the visits being scheduled. Common interventions of the service include:

  • Helping people to return to bed
  • Help with continence
  • Repositioning to prevent pressure sores
  • Uninjured falls response
  • Telecare response to 3 sheltered housing complexes

We are seeing patterns emerge with some service users who need an unscheduled response overnight. An example of this is around acute periods of discomfort during the night for people that have palliative conditions. As a result of this type of request the inhours integrated health and social care neighbourhood teams are alerted to ensure appropriate follow up including review and support.

Service users and family carers who received scheduled interventions rated the service highly. This was confirmed by practice audits. Whilst an initial questionnaire was issued with good response, it was recognized that a continuous measure of satisfaction using postcards would help towards more effectively measuring satisfaction with unscheduled interventions.

The care outcomes for the service gives us some baseline data to standardise the length of time the service is provided to an individual for before other alternatives are considered.

There are multiple sources of referral which include:

  • Integrated health and social care teams
  • OOH Social Work
  • NHS 24
  • Discharge Support Team
  • Care at Home

The service has demonstrated an ability to provide a more flexible and responsive approach to meeting the needs of individual service users and has been able, because of this, to fit unscheduled visits around a scheduled programme of support at night.

Carolanne Mainland

Former Regional Lead, Scottish Care

The above is taken from the recent Focus on Partners for Integration and Improvement report.

#homecareday18

#commissioning

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Home Care Day 18: Commissioning blog from National Director, Karen Hedge

On Homecare Day 2018, I was asked to write about commissioning.

How peculiar I thought, given that the ethos of the day is about celebration yet, commissioning of homecare is continually raised in quite the opposite context.

For many years it seems that there has been little change in the way that homecare is commissioned. At its very worst, it could be described as some updating of statistics based upon a limited dataset pulled together to inform a competitive tender perhaps with the involvement of those who access care and support in the final selection of providers.
Providers, who find themselves torn between continuing to provide a service at a rate which is significantly lower than they require (9 out of 10 home care providers say they do not know if their business will be sustainable beyond the year end), or to leave the market carrying with them the knowledge and emotion of; disrupting the care and support of some of our most vulnerable citizens and, the impact on their workforce.

Of course, this does not apply everywhere, but it is certainly leaning towards the norm rather than the exception.

Indeed, in some areas, the commissioning part has been by-passed completely in the hope of a new national solution, going straight to an extension of existing contracts which may on the face of it seem like a positive outcome in terms of continuity, does not take into account the increased challenges that providers face with a rising cost of living, increased qualification requirements, significant staff vacancies and turnover rate of around a quarter.

I also find that I am writing this in the same week as the strikes in Glasgow highlight the risk of having a majority provider, in addition to the limits placed on a right to choice as intentioned by the Self Directed Support Act.

So what needs to change? How can commission in a way that is worth celebrating?

Remember first of all that commissioning is a whole cycle and not simply procurement.

We need to know who is likely to access home care now and in the future, and what homecare actually means to them. If we are planning for the future now, perhaps you may also wish to ask yourself what it means to you?

Partly this means better data, and better use of data, but it also highlights a need for systems and processes to facilitate future thinking, just as Scottish Care is currently undertaking with the Glasgow School of Art Innovation School on the future of care.

This work is enabling us to couch future thinking in the context of economical, technological and sociological changes amongst others, to develop tangible recommendations for the sector.
Above all, commission in partnership, with planners, providers and people. There needs to be cradle to grave thinking and a person-led approach which supports grassroots involvement in development. There needs to be the establishment and support of a collaborative rather than competitive market, where outcomes focussed and relationship based care takes the place of the inflexible and inhumane time and task model.

And please, don’t unintentionally patronise those involved by shielding them from the economics and the cost. We all know about rising demand in a tightened economy, but knowing exactly what that means locally lends quite a different understanding, which can led to quite different solutions. I have previously spoken at length on how by involving those who access care and support in commissioning amidst the context of careful market stimulation with providers, resource was freed up which led to the local authority that I was a commissioner in at the time lowering the eligibility criteria, thus increasing the numbers of people accessing care and support by 110% at no additional cost.

Incidentally, last week I heard of a pilot on outcomes based commissioning in Wales that led to a reduction in cost because people were able to access what they needed when they needed it, and often this meant better use of and access to existing facilities in the community. It was described to me in terms of an all inclusive holiday. The first two or three days are often about over-indulging on heaped plate loads accompanied by rivers of the local tipple, but by the end of the week we’re reaching for the salad and water.

We find a pattern of knowing what we need and when.

Which brings me to the most important aspects of commissioning – trust. On all levels, if we can trust, then we can foster the transparency and respect required to think innovatively about what the future of care means for the future of commissioning care.

Despite the gloomy start to this blog, I will finish with something worth celebrating. A focus on and a nod to the areas in Scotland where this conversation is beginning to happen and I hope to be able to share some of this in the next few months. As we progress we need to work together to evidence and measure the impact that such changes to commissioning can have, both locally and nationally. We need to share both learning and success when a test of change becomes the norm, let’s make my blog on commissioning for Homecare Day 2019 a celebration from start to finish.

Karen Hedge

National Director, Scottish Care

#careaboutcare #careaboutcommissioning

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Home Care Day 18: A Day in the Life of Home Care

Earlier this year Scottish Care commissioned a Day in the Life of Home Care. This is a film created in collaboration with Michael Rea, an experienced documentary film maker with a long standing relationship with Scottish Care and a proven ability to capture the diverse voices of those working in and receiving social care.

What better time to revisit this than during Workforce hour this Home Care Day 18?

#homecareday18

#workforce

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Home Care Day 18: Workforce blog from our National Workforce Lead

The 4 R’s: the open door of recruitment and retention in social care

‘A career in care is not the same for everybody but it needs to be available to everybody’

Independent sector home care services support 47% of nearly 50,000 people who receive this form of support, over half of whom are frail older people.  It also employs nearly 54,000 people in Scotland.  The sector is absolutely crucial in supporting people to stay at home for as long as possible and, alongside care home services, in preventing admissions and supporting discharge from acute settings.

However on-going, recruitment and retention challenges have continued to intensify for home care providers throughout Scotland; fewer people are choosing to enter the home care sector and more people are leaving.

Mindful of the impact this is having on Scottish Care members, Workforce Matters supported a piece of research that sought to capture the employment journey of so many committed, dedicated and skilled individuals of different ages, backgrounds and experiences working in care homes and care at home organisations across Scotland.  The 4 R’s - recruitment, regulation, representation and retention – provides us with a framework designed to explore the experiences of the workforce and in doing so, encourage us all to think differently about transforming the way we enable care provision and the people who deliver it to grow and flourish.

To make this a reality however, we have to consider the 5th R – reality.

  • The reality of trying to develop, train, qualify and lead a workforce against a backdrop of task and time commissioning, fifteen minute visits and the persistent denial of policy and decision makers of the true cost of delivering dignified, person led, preventative care and support to older citizens across the country
  • The reality that the potential of health and social care integration is yet to be realised in Scotland and we continue to see the confliction of a health or social care workforce.
  • The reality that a largely unappreciated and undervalued social care workforce, delivering compassionate care to individuals with multiple complex mental and physical illness in their own homes, is at breaking point.
  • The reality that if we choose to do nothing, we will simply cease to have a social care sector.

Only by acknowledging these realities and working together to develop solutions in a meaningful way will we have any chance of developing a rights-based, dignified social care system for the tens of thousands of older people receiving care in their own home.

The 4R’s provides a structure and a foundation to work in partnership with employers, front line workers and stakeholders across the health and social care landscape to do something different, ambitious and brave – operationally and strategically; tinkering around the edges simply won’t suffice.

Let’s all of shut that door through which dedicated and skilled individuals are flooding out from, and create conditions where people stay, develop and thrive in the home care sector.

Please take time to read our report and watch our animation and do get in touch if you would like to find out more about our Workforce Matters project.

 

Katharine Ross

National Workforce Lead

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Home Care Day 18: Convention on the Rights of Adults and Older People Receiving Care at Home or Housing Support

It is over 2 years since Scottish Care published the Convention on the Rights of Adults and Older People Receiving Care at Home or Housing Support. 

With our focus on Human Rights in the first hour of Home Care Day 2018, it is an opportune time to revisit the Convention and the simple yet crucial ways in which individuals told us their human rights can be protected and promoted through the delivery of care and support at home.

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Home Care Day 18: Health & Social Care Standards

Scotland’s new Health and Social Care Standards were published by the Scottish Government in June 2017 and started to be used from April 2018.

The Health and Social Care Standards set out what we should expect when using health, social care or social work services in Scotland. They seek to provide better outcomes for everyone and to ensure that individuals are treated with respect and dignity and that the basic human rights we are all entitled to are upheld.

They mark a shift in how services are regulated, commissioned and delivered in that they are grounded in human rights.

We’re delighted, as part of Home Care Day, to be able to share a short film - created in partnership with the Care Inspectorate, Scottish Care, CCPS, home care providers and individuals who access support – about how the new Standards and their rights-based approach can make a difference in home care services.

#homecareday18

#humanrights

 

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Home Care Day 18: Human Rights blog from our CEO

The Dignity of Rights: Homecare and Human Rights.

Dignity is one of those words which risks falling into overuse and thus into misunderstanding. This is a great pity because it has a real importance within the care and support of people and has a real power when we consider the role of human rights.

When the leaders of the world gathered to sign off the UN Universal Declaration of Human Rights the concept of dignity was at the forefront of their concern and appears many times in that document. Indeed Article 1 of the Declaration states that:

‘All human beings are born free and equal in dignity and rights.’

In some sense then ‘dignity’ is in with the bricks, a foundation marker, embedded at the heart of what we mean by human rights. In the new Health and Care Standards which are relevant for all care services including care at home and housing support we also find ‘dignity’ as one of the core over-arching principles. It states that as someone who uses services:

‘My human rights are respected and promoted. I am respected and treated with dignity as an individual. I am treated fairly and do not experience discrimination.’

So what exactly does this oft mentioned concept of dignity really mean? The Oxford English Dictionary states that dignity is:

“The state or quality of being worthy of honour or respect”

Every human being is worthy of respect for who and what they are. By virtue of their very existence a human person deserves to be treated with value and worth, concern and protection. We are not saying that it is only some who have dignity, we are proclaiming all humanity has dignity. There is something in our status as human beings that makes us worthy of respect and necessitates us to give respect to others. We do not require a person to change, to grow into their dignity, they are born with full dignity, as and who they are. Every person has within their being a sense of dignity which is, as it were, part of their DNA. It is inherent. It is a human right.

Closely linked to both respect and dignity is the view that we have of our own identity. Our understanding of who we are as a human being and as an individual is formed and nurtured by a whole series of influencers. It is the classic nature and nurture debate. We are influenced by our upbringing, by the development of our attitudes and values, by our emerging personality and character. We are shaped by the encounters we have, the relationships we form and the experiences we share.

We mould our self-understanding into something which either includes or excludes. We can become individuals who accept and recognise the inherent worth and value – the ‘dignity’ – of those we come across – or we can become someone who puts conditions and restrictions on the full humanity of another. We can go through life developing a robust sense of self which gives us esteem and self-love, or circumstances and encounters can serve to limit and demean us to the extent that we consider ourselves as having little worth or value.

There are so many people in today’s society whose identity, their self-understanding, is one which emphasises their own ‘self’ to such an extent that it causes arrogance and narcissism. Some psychologists have argued that we are in the midst of the ‘selfish generation’, a time where the necessary and healthy concern and attention for your own self is out of balance and replaced by an over-emphasis on your own ‘self’ and the arrogant advance of the ‘me.’ It’s all about my needs, my desires, my priorities. It is as if we have stopped growing up and are stuck with a toddler sense of the self.

Dignity is a human right. Dignity demands that the individual recognises worth in another. As a consequence dignity requires humanity to be mature in how it sees the individual, how it values the self, and how it celebrates difference.  These are fundamental requirements for those who would want to work in homecare – they are the essence of care.

But it goes even further than that. A human rights concept of dignity says to us that not only should we recognise the inherent value of other people, but that it is actually the degree to which we are able to relate to, engage with and include others that marks us out as being human. I recognise that recently some have criticised the concept of dignity being inherent within humanity and a given in terms of human rights but I think this is to miss the point that at a profound psycho-social level there is something in the marrow of humanity that requires respect and value.

If this is true, and I would argue it is, then the task of caring is one which is a paramount example of human rights in practice. To care for another is to give of your ‘self’; to care for another enables you to become a better version of who you are, it nurtures an openness to encounter and a willingness to be changed by interaction and relationship with someone you care for. The more we give of ourselves in the care we do, the stronger that ‘self’, that ‘humanity’ at the heart of me becomes.

To treat someone without dignity, with no regard to their needs and dignity, is what we describe as ‘inhuman treatment.’ To care for, to have regard to someone else by caring for them is a glorious illustration of what true humanity really is. It is not a truism to suggest that by caring for another we become more fully human. And it is not just in the actions or tasks we undertake but it is in the being with and the attending to someone who is not your own self.

The poet John Donne famously wrote:

 

No man is an island entire of itself; every man

is a piece of the continent, a part of the main;

if a clod be washed away by the sea, Europe

is the less, as well as if a promontory were, as

well as any manner of thy friends or of thine

own were; any man's death diminishes me,

because I am involved in mankind.

 

Now without getting into a debate about Brexit, what Donne articulates is a view of humanity which says that if someone is missing, if we do something that cuts off another from society, then we cannot describe our community as whole, our humanity as mature.

But there are now and always will be threats to the human right of dignity.

Dignity is so tied to our conceptions of humanity that we use terms like ‘inhuman treatment’ to describe acts that breach our human rights. There is a sense that treating someone humanely means behaving towards them in a way that is consistent with their humanity and dignity.

So in homecare today are there threats to dignity, a dignity inherent within our humanity?

Is our dignity threatened when at the point of vulnerability society decides because of fiscal budget and austerity that the supports I used to get to enable me to be independent, to be part of the community I live in, are to be withdrawn? Where is dignity in eligibility criteria in homecare provision which makes it harder and harder for the majority to access free care and support?

Is our dignity threatened when the increased use of technology leads to a situation where human presence is being replaced by technological interventions? Or do we need to re-define dignity for a technological age?

Is dignity threatened when we make decisions to give greater value to some because of their youth compared to others who are old?

It is easy to recognise the assaults on human dignity that come by means of ‘inhuman’ treatment, by torture, by punishment, by violence and force. But what are the potential ‘inhuman’ assaults of dignity that come by means of less subtle interventions?

The delivery of care in whatever context is a superb example of dignity in action. The fulfilment of human rights within any society demands the nurturing and support of the care for others. For unless we adequately resource and seek to develop a workforce able to deliver cradle to grave quality care, then we risk being ‘inhuman’ in our treatment of the most vulnerable and to diminishing the ‘dignity’ of all.

Dr Donald Macaskill

CEO, Scottish Care

@DrDMacaskill