The Summer edition of the Scottish Care Bulletin has now been distributed to members.
Summer Bulletin 71st edition June 2018Support at the heart of protection – Latest Blog from our CEO
It is now over ten years since the Adult Support and Protection Act (ASPA) became law in 2007. As someone involved in its early stage development and roll out it is amazing to think that ten years has passed. Scottish Care was funded at the time to develop a programme of training and support, called ‘Tell Someone’ , which brought the Act alive for those working in frontline care in care homes and homecare services. It is still a resource which is much used today. Last week the Care Inspectorate, Her Majesty’s Inspectorate of Constabulary in Scotland (HMICS), and Healthcare Improvement Scotland (HIS) published a ‘Joint Inspection of Adult Support and Protection’, the first inspection looking specifically at how well the agencies responsible for keeping adults safe are working together to protect those at risk of harm. The Inspectors looked at a representative sample of six local areas: North Ayrshire, Highland, Dundee, Aberdeenshire, East Dunbartonshire and Midlothian. In each area, they looked at the experiences of individual people, the extent to which key protection processes are in place, and how well local leaders were performing. By and large the Inspectors found that there was evidence in most areas that adults at risk are safer and better supported because of the Act and the supports which underpin it. This is positive news but conversations with those who work in the world of adult protection and safeguarding would caution against over assurance that we have got everything completely right. My concerns are as follows:
- Quite rightly the Adult Support and Protection Act has been lauded as a very solid piece of legislation and it is much envied elsewhere in the United Kingdom. Part of that admiration is that it has a set of overarching and underpinning principles which are firmly rooted in the Human Rights Act. The concepts of ‘least intervention’, of ‘proportionate response’, of ensuring any action ‘benefits the individual’; all of these are squarely human rights principles in practice. However, there is a legitimate growing concern that at times the actual practice of the Act is paying only a passing lip service to the principles which lie at its heart. At best I think we need to do more to assess whether or not we are intervening and utilising the Act in all necessary circumstances and instances. For instance, are we using ASPA within health settings as much as we should?
- When the Act was being implemented a lot of good work was undertaken in the care home sector and that resulted in the development of confidence and skill amongst the care home workforce. My concern is that some of that earlier inclusivity has been lost. Are care home managers and staff as fully included in the implementation of the Act , e.g., in case conferences, in multi-disciplinary reviews, as they might be?
- I am less convinced that there has been sufficient and appropriate attention given to issues of adult protection and safeguarding for our care at home sector. There are real challenges of lone working and being able to identify and act upon concerns of harm. Associated with this is the inevitable issue of resources. As training and learning budgets are being slashed by contractual practice across the country, are we properly equipping our social care workforce in the community to properly understand issues of adult protection, to be able to recognise the signs of harm and to have confidence in knowing what to do if they come across concerns? I am not convinced in all instances that this is the case. It is time for us to do some serious capacity building within specific sectors.
- On a wider front the Act did a lot to try to change the cultural and popular understanding of adult protection. If you look at the legislation and its associated Guidance you will not find the word ‘abuse’. At the time of its development there was a considerable debate on this matter, but the idea won out that ‘harm’ needed to be used as a term to identify a wider range of behaviours than the word abuse described, including actions which were pre-meditated, conscious and deliberate, but also unintentional and unplanned behaviours, such as potentially neglect. I am not convinced that at a popular and societal level this broader understanding of what constitutes harm has gained much ground. That might be because we have failed as a country to properly invest resource in public awareness around adult protection and what constitutes harmful behaviour.
- A related issue is the extent to which despite the Act’s existence for over a decade we have seen a rise in behaviours which have been discriminatory and thus ‘harm-full’. This is especially a concern when we consider the sharp rise in discrimination and hate on the grounds of age. How, one might ask, does the reality of increased discrimination and harm on the basis of age relate to the implementation of the Act when it impacts on someone who is defined as being an ‘adult at risk’?
- At a national level I have expressed a personal concern that we now no longer have an Adult Support and Protection Forum. Up until three years ago this was a body which brought together individuals from diverse sectors with a common purpose for improving practice, disseminating knowledge and advancing the issues around adult protection. Its loss has been a matter of significant concern especially at a time when the lessons of the benefits of national multi-agency co-operation around child protection have become so obvious.
- My final observation about the Act is that, in part because of financial constraint, we have as a society in our practice focussed on only one part of the legislation, namely the ‘protection’ of individuals who might be at risk. This is a real disappointment. The originators of this legislation envisaged the importance that as adults individuals who might require protection would of necessity benefit from ‘support’ to enable them to be free from harm. We have failed to adequately focus on a permissive, enabling approach to safeguarding and perhaps unsurprisingly have concentrated on the ‘protection’ element. This is to miss the primary energy of this ground-breaking legislation. It is to fail to recognise that in our vulnerability we all need support to prevent us from being the object of another’s wish to harm. It is to fail to give equal weight to Adult Support as much as Adult Protection.
We have come a long way in ten years. Practice is on the whole sound. But it is time for us to re-discover some of original intent and energy within the Act and its Guidance and to re-invigorate a system of right’s-based support which fosters true adult protection. Dr Donald Macaskill @DrDMacaskill
Media statement: Ipsos Mori research highlights social care Brexit challenge
New research undertaken by Ipsos Mori on behalf of the Scottish Government has painted a worrying picture for the future of social care.
The research highlights that 1 in 10 workers in adult social care and child care are non-UK EU nationals, with the figure even higher in nursing. Whilst the research found the current impact to be limited, it emphasises the negative consequences for the future if these workers choose to leave Scotland after Brexit.
Responding to the research, Scottish Care CEO Dr Donald Macaskill said:
“We welcome the Ipsos Mori findings but we believe they provide a conservative estimate of the current situation. We have been calling for a commitment to clarity but political events of the last few days are further indication that we aren’t getting that.
“We agree that there is a particular challenge facing nurses with a 31 per cent vacancy rate for nurses in care homes. The lack of commitment to put in place a flexible migration system which prioritises the real gaps in social care is causing us profound concern.
“The impact is not just on EU nationals, but the general negative political climate around migration is putting off non-EU workers too. The consequences of this political gamesmanship over Brexit are going to leave some of the most vulnerable people in Scotland stuck in hospitals because there will not be enough people in the community to care for them.
“When all the politicians fall silent, we will have a social care system in tatters.”
For more information, see: www.heraldscotland.com/news/16343645.warning-that-care-workers-could-quit-scotland-after-brexit-leaving-system-in-tatters/
‘Sharing good practice in Krakow’, Blog from Margaret McKeith
Going the extra mile – CWC event
Each year Scottish Care has a nominated charity we support in various ways – as some of you may be aware, in 2018 that charity is the Care Workers Charity.
CWC are launching a national ‘Care Workers Charity Day’ on the 30th of July. As part of this they are asking the care sector to put on some kind of event, ideally a mile walk, to raise awareness, publicity for the care sector and essential funds for the charity. If you’d like to get involved or are looking for more details please see the event pack below.
Event pack - going the extra mileGuest Post from Local Integration Lead, Rene Rigby
Test of Change
We are living and working in an inter-connected environment. The use of email for sending messages, exchanging information and assisting with workflow is common place across the public sector. There are many links between the health and care system, but it’s often difficult for health and care professionals to share information. Access to the right information about patients and users of services at the right time is essential to ensure continuity of care.
When patients are discharged from hospital, care homes are still receiving information about that individual by fax, in person or post. Often, key pieces of information are not received at all. This makes it difficult for care homes to prepare for a new patient’s/resident’s arrival or the return of a resident who has been in hospital. As well as being inefficient and slow, paper-based communication is not a secure delivery method.
Lothian Unscheduled Care Board have agreed to fund costs for a one year test of change –Secure emails access for all care independent care homes (circa 103) in Lothian. Each care home will be provided with up to three nhs.net accounts for a period of one year. Care homes coming on stream during the next few months have also been included in this test of change.
CEO’s or equivalent of each individual independent care home must sign the Data Sharing Contract, as must the staff identified as secure email recipients. Following on from this each identified recipient must sign a NHS Lothian User ID Request Form
The provision of secure emails to all care homes in Lothian will markedly improve communications between care homes general practice and social work. Specifically, it will enable faster discharge of patients through the electronic communication of patient assessments and subsequent discussions rather than this being by post.
Secure email will transform how healthcare organizations in Lothian share and work collectively to provide coherent joined up services for the people concerned the public. Good timeous information underpins good care and on-going support.
Care homes will benefit greatly from having a consistent electronic transfer of medical discharge summaries (typically sent to a GP within 24 hours). This will enable the care home to fully prepare their service for supporting people discharged from hospital by preparing for the persons needs well in advance of their arrival.
Pre admission assessments will be carried out and shared timeously thus supporting early discharge to the care home and help improve the efficiency of the discharge process generally.
Secure emails offers the potential to share Anticipatory Care Plans from statutory services. E.g Person moving into a care home. Referrals, assessments, multidisciplinary review summaries, flu vaccine consent forms will be immediately accessible to care homes. Opportunities for Tissue Viability, Health Protection, Care Home Liaison, CPN’s and pharmacy specialists instant ability to network and support and safely communicate sensitive information with care home staff.
Other benefits are the ability to send and receive patient/resident information quickly and securely. No confusion from messages taken over the phone or illegible writing on faxes. Improved awareness of care home staff in relation to information governance rules on handling patient information. Secure paper trail in place for example, time emails were sent, removal of fax machines which are costly and require maintenance. Costs of postage for partnership reduced. Reciprocal communication time by health and social care professionals markedly reduced and this initiative supports positive change in service.
This test of change Secure e-mail access for care homes in Lothian should seek to demonstrate measurable improvement in outcomes either directly to individuals or indirectly through improved service design and delivery. There will be on going monitoring to make sure the project is achieving the desired results and to demonstrate the impact of the project to others; as well as to identify issues or problems as they arise within the project so that actions can be taken to change or redesign the project while it is in progress.
Rene Rigby
Local Integration Lead, Edinburgh City
Technology Event: Tech Care, Care Tech
SSSC Expo event – 26 September
Details on the Scottish Social Services Expo event below and via: https://book.shsc.scot/shsc/frontend/reg/thome.csp?pageID=72095&ef_sel_menu=1684&eventID=211
Expo 2018 - Expo Programme
‘The Experience of the Experienced’ – Scottish Care launches new workforce report
Recently (Thursday 28 June), Scottish Care launched a new report on the independent social care workforce at our Workforce Matters event in Glasgow.
‘The Experience of the Experienced’ explores the employment journeys of experienced and older individuals working in nursing home, care home, care at home and housing support organisations.
It is based on interviews with 9 social care workers, aged 41-71, who have either entered the care sector later in life or have worked in the sector for a long time.
Following the report launch, CEO Dr Donald Macaskill said:
“Our experienced social care staff are our experts. As we seek to address the challenges of re-designing roles, of recruiting a new generation of carers, of reshaping how we support and care for people we forget the voice of experience at our peril.
“We need to mould our systems of regulation, registration, learning and qualification to enable those entering later into social care to know that their skills and experience is valued and validated.”
Katharine Ross, National Workforce Lead, added:
“We welcome the opportunity to work in partnership with providers, front line staff and partners across the health and social care sector to not only attempt to answer some of the challenging questions that the report raises but to ensure that the experience of the experienced is respected, appreciated and celebrated.”
The report can be accessed here: https://www.scottishcare.org/wp-content/uploads/2018/06/SC-The-Experience-of-the-Experienced.pdf
You can follow discussions from the event on Twitter using the hashtag #exPEERience
If you would like to discuss the report and its findings in more detail, please contact Katharine Ross, Paul O’Reilly or Becca Gatherum.
Big Community: the return of the Big Society – Latest Blog from our CEO
Big Community: the return of the Big Society
In recent months there has been a developing discourse which goes somewhat like this:
‘In the face of the growing demographic challenge and pressure on health and social care services coupled with acute financial austerity, we need individuals in their communities to take more responsibility for the care and support of their family members and neighbours. This is after all not the responsibility of the State but rather the individual. If you are ill, we will treat you as a last resort after you have self-managed your condition and used whatever technology that is available which will avoid expensive direct human intervention. We are no longer able to pay for you to be fully independent and achieve what you may want because we simply cannot afford it.’
Maybe I am being a little generalist and overly simplistic in that description, but I suspect not that much. Is this not broadly the message which the Edinburgh Integrated Joint Board has been communicating to the good folk of the capital? Is this not the underlying message from the Westminster administration? Is this not the message which landed Glasgow’s HSCP on the front page of the newspapers with their threat to remove (after minimum consultation of) sleepovers in the lives of some of that city’s most disabled citizens?
So somewhere out there at the bottom of the garden is an empathic, time-rich, resource-endowed group of individuals just waiting to step in because the State (also known as that group of individuals created and employed through the taxation of the populace) chooses no longer to afford the cost of care. Oh and as in the past, it is the role of the female members of the community to do all this work. After all care is a woman’s work.
And as I hear and read this developing and subtle narrative where some of our most vulnerable are expected to be supported for less resource by utilising the untapped potential of the community, accessing community ‘assets’ then part of me philosophically says “Yes, it’s good that people have more control and choice, autonomy and power; that people do need take responsibility and collaborate with professionals, to self-manage and exercise responsibility. But ….”
Are we in danger here of unintentionally slipping into a new mode of social responsibility and a new model of social care without having thought through the full consequences of such a move? Is there a danger that decisions essentially made on financial grounds and dressed up in the rags of a social philosophy, are taken without a robust and appropriate moral, ethical or human rights underpinning? Is this idea of the Big Community not somewhat resonant with the failed and flawed concept of the Big Society? Remember the Big Society?
Every political era and every politician looks for a catchy phrase, slogan or idea which will capture the public mood and define them as distinctive and visionary. For Tony Blair in the halcyon days of New Labour it was the Third Way, though we weren’t that sure what the other two were. For Bill Clinton it was ‘community’ – a word which appeared more in his pre-presidential speeches than any other idea. For Gordon Brown it was a brief flirtation with the idea of Britishness. For Obama every change was possible. For Trump it’s the myth of ‘false news.’ But for David Cameron it was at least before the Brexit Fall– the Big Society.
‘The Government indicated that the Big Society is communities feeling empowered to solve problems in their neighbourhood, having the freedom to influence and discuss topics that matter to them, and a more local approach to social action and responsibility.’
The term “Big Society’ aimed to create a climate that empowered local people and communities, building a “big society” that would take power away from politicians and give it to people. It aimed at “integrating the free market with a theory of social solidarity based on hierarchy and voluntarism”.
Doesn’t that all sound remarkably similar to some of the political rhetoric that we are hearing today about the need for social care to be devolved to the individual; for communities to use their assets rather than the State to support and provide anything other than life and limb supports?
I think we are in the midst of an unarticulated political paradigm which I will term as the ‘Big Community.’ Its failings are not insignificantly the failings of the Big Society. Primarily it is a concept based on a naïve and utopian understanding of community or society. Its foundations are therefore weak and insubstantial. We are not in a bucolic age where people are living in families in geographically proximate communities. We are not living in an era where individuals have so much time that they can spend it in activities to help communities become more cohesive. Most are doing two or three jobs to pay for the mortgage. We are not living in a time when we can be assured that skilled clinical health and social care is being delivered by the State and what we do is an added extra in an individual’s life. Indeed it is an insult to the professionalisation of social care work to suggest that ‘care’ can be undertaken by anyone – that it doesn’t require training, ability and developed skill.
I am more and more convinced that just as the Big Society was called out as a naïve political mantra divorced from the reality of fractured and failing communities, that we now need to challenge the rhetoric of the Big Community and insist that we adequately fund social care beyond our already high levels of eligibility; that we adequately remunerate and resource social care staff and organisations so that we attract the best and deliver real quality; and that we help to use community assets to really advance our togetherness and not to paper over the cracks caused by austerity and fill in the gaps of a failing national health and care system. If not then neither community nor society are big but detached, distant and absent.
Dr Donald Macaskill
@DrDMacaskill
