Nurse Empowerment Blog by our National Workforce Lead for Nursing

How do we empower nurses today?

Nursing has long been seen as a challenging profession but viewed by many as a vocation for the dedicated and the selfless, which relies on nurses being professional, self-aware and motivated educators to lead change. Being caring and compassionate were integral to the role, as was the ability to follow instruction, which for some led to ritualistic practice for a number of years.

The development of nurse education led to evidence-based practice through nursing data and research, which has been key to empowering nurses to influence change, resulting in service improvements and better quality of care, and recognition of the need for nursing to be part of a life-long learning process.

Nursing empowerment is a structural process which supports shared team goals and ability. This is  supported by open communication and positive leadership which has the desired outcome of motivating staff to work to the best of their ability which will improve achieving outcomes and  creates the capacity to utilise resources and to provide support, opportunity, and information.

Research shows that empowering nurses allows for better decision making, job satisfaction, reduces stress and improved outcomes for patients. Subsequently when nurses are in a position to influence, they are less likely to suffer from ‘burnout’ as they feel listened to and are empowered to work to the top of their job descriptor.

Within the care sector nurses should not only be empowered but expected to work with a high degree of autonomy, and to act as an advocate for the residents, as they can’t always do this for themselves.

According to the RCN ‘One of the most important principles of safeguarding is that it is everyone’s responsibility ’.This requires strength of character to challenge other professionals, who may often hold more senior roles, to ensure the views of the residents are upheld, and more importantly no harm ensues. The quality of care is reliant on nurses measuring risk and harm and being educated and skilled to act appropriately to ensure safe practice.

This is particularly important within the independent care sector to ensure that despite some residents being frail and having cognitive deterioration, that they are still given the opportunities for improvement and achieve a level of stability through preventative programmes

Research would indicate that a move to an inclusive approach empowers residents through self- determination and autonomy although this does require the nursing staff to think differently and be more innovative.

The World Health Organisation (WHO) defines patient empowerment as “a process through which people gain greater control over decisions and actions affecting their health” and should be seen as both an individual and a community process.

This is evident within interventions such as the Care About Physical Activity (CAPA) programme and meaningful activities used with care home nursing, which show that empowerment initiatives provide both a process and an outcome. Research is limited in this field however if empowerment is present for staff then residents may benefit in a way that promotes an awareness of self-ability that can influence goal setting, with the potential to improve quality of life.

So how do we empower our nurse today?

Education, alongside a determination to provide quality care within a positive culture of change has brought nursing to where it is today, but it is through positive leadership that we will harness our nurses to be empowered today and into the future.

We know that disempowerment can be related to deficient leadership interventions. Some nurses may feel that managers are insensitive to their staffing needs, don’t support employee well-being, and don’t invest enough in training or career or professional advancement. This is fundamental to ensure successful recruitment and to retain staff in this field. Many nurses leave their positions because of negative experiences with heavy or unrealistic workloads, as well as a feeling of being unheard and undervalued.

On the other hand, several studies have indicated that when staff rate their managers then they feel that they’re listened to, and more likely to get, and be involved in the decision-making process. This is an indicator of positive leadership. Therefore if our managers’ behaviours support a team -based approach, then this will ultimately impact on empowering our nurses.

Creating supportive environments where staff have the psychological safety to speak out, to have an opinion and ultimately grow, is also a reflection of positive leadership. This should not be underestimated as highlighted within this recent article: https://t.co/9aHI8UPvsb?amp=1

Creating a positive culture that provides access to appropriate training and development will provide staff with the necessary knowledge and skills to carry out their role efficiently and effectively .This will boost self -awareness, give staff a voice, and the ability to be confident to act as a representative across a variety of arenas. It will continue to challenge staff to find solutions and promote nurse led initiatives.

This needs however to be done as a systemic organisational approach, as even when positive changes are adopted where staff are not consulted about these changes in advance then the changes can still be perceived negatively by staff.

Through this visionary intelligent leadership approach a supportive culture will exist that expects staff to question, to take risks and to have the permission to ensure transformational change.

Ultimately the message to our nurses is one that continues to push the boundaries for excellence, promotes our new nursing standards, ensures advocacy for our most vulnerable adults and doesn’t lose sight of our ability to care.

 

Jacqui Neil

National Workforce Lead for Nursing, Scottish Care

Workforce well-being blog by Jacqui Neil – Workforce Lead for Nursing

2020 is the ‘International Year of the Nurse and Midwife’ so it seems the right time for my first ever nursing blog. These will continue each month to celebrate the contribution and dedication of our nursing and care staff across Scotland.

This year offers the prime opportunity to hear about the spectacular work that is happening across our care homes in Scotland ,and to showcase this through our Nursing Blogs and to get our talented staff involved by being guest speakers, and take on the Nightingale Challenge.

Our aim at Scottish Care is to provide a topical platform for updates to keep staff informed and to support employers, and through our staff guest speakers to inform the wider care sector that this sector offers fantastic career opportunities for staff at all levels, and delivers quality care to our residents across Scotland.

January’s blog is looking at Workforce Wellbeing, as it’s the start of the year, and it’s important that all our staff take time to think about their own health and wellbeing, to ensure safe and quality care to their clients/residents.

The social care workforce in Scotland is predominantly female and organisations like Scottish Care have long argued that the way in which the workforce is treated in terms of fair work practices, equal pay and other related matters is often one rooted in a discriminatory approach and is evidence of gender segregation. Research indicates that gendered ageism seems to be the cause of many problems women experience whilst working. This will require a change in prevailing values, beliefs and norms within organisations. Viewing the treatment of female staff through a human rights lens would have a significant impact on the retention of staff.

In light of this I have decided to look at Menopause in the Workplace due to the fact that 86% of the workforce are women and to promote awareness of how managing this can improve retention of staff and reduce the days lost to sickness absence.

The average age of the workforce employed and applying for posts in the care sector is 46 years and above. Many are likely to be mothers, grandmothers or informal carers, alongside choosing to work in an extremely physically and emotionally demanding workplace.

Being aware of this and also that staff may also be experiencing issues as a result of bereavement (personally and or/at work), financial pressures, or other health conditions, is important and knowing that all of this could escalate their menopausal symptoms. Beyond the menopause, the lack of certain hormones in women can lead to increased risk of brittle bones and heart disease.

According to the National Statistics Department (NSD) the average age of women experiencing the menopause is 51 years, although this can happen much earlier for some women, with 1 in every 100 being under 40 years. Nationally there are 3.5 million women over 50 in the workplace and this is set to increase due to the increased retirement age.

The Care Inspectorate’s recent report found women workers over 50 years account for 45% of care workers. This therefore means that a significant amount of women working in care are experiencing symptoms in relation to the menopause, and for some these are very significant and impact on their work and personal lives. It is therefore paramount that this issue is recognised and understood so we can ensure that the working environment is supportive, and that staff feel secure and valued.

The true impact of this is under-reported as many women do not seek help, despite experiencing severe physical and psychological symptoms such as anxiety, depression, loss of confidence as well as severe fatigue and difficulty sleeping. At a time when the care sector is in crisis in relation to recruitment and retention of staff, it is key that the staff who are employed take responsibility, and feel empowered to raise this if they are experiencing menopause symptoms that are impacting on their job.

Findings from a new national report revealed that over 370,000 working women in the UK aged between 50 and 64 admitted they have left, or considered leaving their career, because dealing with the symptoms of the menopause in the workplace was too difficult. As in the NHS, staff absence in the independent care sector for short and long-term absences is increasing in this age group, with data suggesting 1 in 4 experiencing menopausal symptoms consider leaving their jobs. Moreover, in a recent study involving a 1000 women, nearly a third of women surveyed (30%) said they had taken sick leave because of their symptoms, but only a quarter of them felt able to tell their manager the real reason for their absence.

Presenteeism is highlighted as a bigger issue than absenteeism in some areas, as staff are fearful of being reprimanded for being off sick. Especially when many are being managed through inappropriate HR policies, with a lack of occupational health support, which not only prevent staff caring for their own health, but also can negatively impact on the quality of care provided to residents/clients.

This can be achieved by developing more support and by introducing mandatory equality and diversity training around age and gender. This may include the implementation of policies around menopause related absence and flexible working arrangements, as well as encouraging informal women’s support networks across the workforce.

The Equality Act (2010) protects women against workplace discrimination on the basis of sex or age, whilst other pieces of legislation place a general duty on employers around Health and Safety and the welfare of workers.

Recent figures have shown that women aged 50 to 64 are the fastest growing economically active group, and therefore have the potential to support the social care recruitment crisis if they are encouraged to join the workforce and managed and supported to be at work.

The employee should adopt a self -management approach and consider ways to ensure that they are looking after their own health and well-being:

  • Keeping hydrated in line with the RCN’s ‘Rest Rehydrate Refuel’, which campaigned to ensure staff get nutritional breaks. Ensure breaks are taken, it’s in no one’s benefit to work on.
  • Uptake of the flu vaccine remains considerably low, even in the NHS where staff can access free. This needs to be available to all care staff working with vulnerable adults as this prevents unnecessary short-term absences. It’s not too late ……
  • You don’t need to join the gym, go for a walk.
  • Eat healthier / Drink responsibly
  • Seek help with smoking cessation.
  • Mental health and wellbeing information guidance.

The following is a list of organisations/websites that offer valuable help and support to women suffering the symptoms of the menopause:

  • British Menopause Society: http://thebms.org.uk
  • Menopause Matters: www.menopausematters.co.uk
  • NHS: www.nhs.uk/conditions/menopause
  • Menopause.org.uk: www.menopause.org.uk

Employers should consider positive changes within the working culture and environment to alleviate the difficulties for women to enable attendance at work, and when absent are able to be supported back to work at the earliest opportunity:

  • Encourage all managers to undertake a course to deal with this, and to take account of the menopause transition. This would be a positive step to improving retention and days lost through sickness absence. The 2013 TUC report, Supporting working women through the menopause, found that 45% of managers did not recognise the problems associated with the menopause.
  • More recently according to the Wellbeing of Women Survey (2016) despite employers requiring an inclusive workforce, around two thirds offered no specific support to women experiencing difficulties related to the menopause.
  • Ensure supervision meetings. The Strathclyde’s Scottish Centre for Employment (SCER) research findings and interviews found that care workers valued supervision as a source of support and an opportunity to reflect on practice.
  • Managers and colleagues should be more understanding, including education for ALL members of the workforce.
  • Option of flexible working hours and time off for appointments.
  • Provision of a quiet, cool room with fan to allow staff time out.

Finally in 2019 the Laura Hyde Foundation  launched a well-being badge for nurses to wear  that states ‘Ask me how I am’,  in a bid to allow the public  to consider the staff wellness.

 

Jacqui Neil

National Workforce Lead for Nursing, Scottish Care

An introductory blog from our National Workforce Lead for Nursing – Jacqui Neil

It’s now 3 months since I took up my new post with Scottish Care as National Workforce Lead for Nursing , I feel revitalised and reconnected to Nursing,  and so proud to be a nurse in the ‘International Year of the Nurse’. As you will be aware 2020 marks 100 years of nurse registration, and 200 years since Florence Nightingale and a team of nurses improved the unsanitary conditions at a British base hospital, reducing the death count by two-thirds, which led to worldwide health care reform.

Subsequently Care Home nursing has evolved to meet the increasing demands and changing demographics of older people and will require to continue to evolve in light of the numbers of older people predicted to continue to rise up until 2035. Demographic change is complex, with links between the different drivers of demographic change, and a range of social and economic factors which can impact on trends, leaving projections open to uncertainty . Transformational change and leadership is therefore paramount for sustainability of the workforce.

Networking with front line staff who are delivering first class care and compassion within extremely challenging times, alongside working with strategic stakeholders has confirmed the importance of having a shared goal of improving the profile of care home nursing.

Prior to taking up this post I had a 32 year NHS career managing staff groups across acute and predominately community nursing, taking up my first staff nurse post in 1990 , then working as District Sister, Clinical Team Leader and finally as Service (Locality) Manager within  a HSPC.

Despite not having worked within the independent sector I have had strong partnership alliance with the third and independent sector throughout my career.

Working on improving the recruitment and retention of staff within the care sector at a strategic level allows the opportunity to make a difference at service level. Be reassured that I am fully committed to raising and transforming the profile of nursing, and the quality of care provided within the sector through strong leadership.

In September the pre reg nurse training will ensure all students will have a placement within a care home and it’s up to the staff to make it a memorable rewarding experience, that hopefully will see a trend in more newly qualified nurses seeking to work in care home nursing, and see it a positive long-term career opportunity.

Do not hesitate to contact me if there are any workforce or nursing issues concerning you. It’s important that I am focused on areas of concern that are an issue to service delivery, quality and client safety.

My nursing blogs will start this month starting with Workforce Wellbeing and will continue throughout the ‘Year of the Nurse’  to encourage staff to get involved and undertake the Nightingale Challenge. If you have any topics that you would like highlighted please get in touch by email [email protected] or Twitter @TransformNurse.

 

Jacqui Neil

National Workforce Lead for Nursing, Scottish Care


On a separate but related note, Tom McEwan from UWS will be hosting a webinar on Friday 17 January at 11:30 am to discuss the new pre reg nursing programme, as well as their proposed pilot of care home placements around their 4 campus areas – Ayr, Lanarkshire, Paisley and Dumfries. They are currently looking for care home providers to nominate themselves to take part in this pilot. Please click here to find out more.

Imagine a Decade of Care: a new year blog from our CEO

As doors of all sizes, shapes, and colours open up across Scotland to welcome in the first foots of the year; as peat, log and paper kindle an open hearth, as hand and hug, food and drink foster hospitality and welcome, so we find ourselves standing at the brink of a new decade. What to say at such a point in a blog for the New Year?

It would be the folly of futility to try to prophesise what this decade will bring. Indeed, at its edge we are witnessing almost unapparelled times of political uncertainty and societal challenge and no little fear and discomfort. But in the spirit of the optimism and hope with which we traditionally greet the new year as Scots, I for one would want to be positive and optimistic for to be any other is to bring into life the darkness that risks our tomorrows. So, what of social care? I would like to imagine and hope that this will be a Decade of Care.

I imagine a decade where women and men who do the astonishing job of caring for others, whether as a family member or as a paid professional, will be recognised as the vibrant heart of our country not as is so often the case as a drain and drudge. Where they will be properly remunerated and resourced either by appropriate respite and support or by being paid a wage, which is not just about ‘living’ but about being valued and affirmed, being able to dream their own dreams and live out their own future.

I imagine a country which turns the tables on what is considered to be of fiscal value and sees that those who care for others, those in our people sectors as the true entrepreneurs and navigators of our nation’s future; where the economic value of social care is not just talked about but that we consciously choose as a society to invest in, to finance and support the innovation and growth of our care sector.

I imagine a decade where we will be able to shape the way in which technology can enable us to be better at caring, to be more present when we need to be, which frees people up to care and which reduces the drudge of the practical. The 2010s have seen enormous progress. It was that decade which brought us technology as diverse as the iPad, driverless cars, smart devices by the score and 3D printing. Who knows what the 2020s will offer. But I want to hope that all innovation will be rooted in an ethical and human rights framed understanding that commits to the human and the personal, to citizen autonomy and control over data; and for each of us, but especially those who require care and support, to be the directors and leaders of their lives and not actors to someone else’s script.

I imagine a society which finally takes seriously the environmental and natural challenges we are all going to have to address. A Scotland where we do not just leave it to our children to be the campaigners for our planet. Admittedly the care sector has much to do in this regard, but this decade will have to be one which reduces waste, replaces unnecessary use of plastics, transforms our use of energy  and which makes being green a core part of what it means to care.

I imagine a society which does not just talk about human rights in pious platitudes and political catchphrases, but which acts to enshrine the rights of others at the heart of all we do and who we are. Where dignity, fairness, respect and choice are ethical values which are also underpinned by the robustness of legal recourse. Where we do not just talk the talk by passing great legislation in our Scottish Parliament but robustly enable change to happen through progressive work on issues like self-directed support, mental health legislative reform, palliative and end of life care and bereavement support, and every other piece of work that enables citizens to lead, removes power from vested social and political interest and truly democratises the way we do things.

So, I have no shortage of imagination as I stand on the edge of the decade – but that is not enough. Imagination has to be rooted in a determination to do different and be better. Imagining tomorrow starts with struggling with the issues of today.

For me in the work I do those struggles are against the discrimination of the old who are too often treated as if they are ‘has beens’ with nothing to say, contribute or change. It means challenging the cult of youth by recognising the mutuality of community, the inter-generational nature of belonging and the inter-dependency of all. It means challenging the easy complacency which inadequately resources and funds the costly task of care. It means the end to a naivety which thinks that quality care and compassion can be bought on the cheap and delivered on a shoestring. It means giving real power to citizens and real choice, not the creating of one-size fits all solutions or the drawing back of choice on the questionable presumption that Mother State knows what is best for you. It means shouting down the casual excuses of ‘It’s Aye been done like that’It’ll no work here’ or ‘We’ve tried it afore.’ – these three sisters of Scottish passivity – which are holding back so much across Scotland that is innovative, progressive, challenging and new.

To imagine a decade of care is to imagine a time where all those with something to say are heard and listened to; where those who struggle to be heard because of disability or self are able to find voice and recognition; where the scars of mental health are recognised and reshaped regardless of age; where the emptiness of a lonely life is populated with the presence of others; where personal purpose and meaning unleash the shackles of addiction and dependency; where the stranger is seen not as an outsider but as the one whose presence shapes our communities; where the contribution of those who are migrant and new citizens is celebrated and valued; where we no longer debate difference as the means of creating identity but where inclusion and openness foster belonging and citizenship.

I hope with others to reach a 2030 having contributed my own small share to creating a Decade of Care.

Bliadhna mhath ùr agus deichead ùr sona

Happy New Year and Happy New Decade.

Dr Donald Macaskill

CEO, Scottish Care

 

 

Home Care Day 19: Changing times for home care – a blog by our National Director, Karen Hedge

 

How is home care changing…

The pace of change is fast, yet the principles of care and compassion are age old. Whilst practical methodologies have changed in how we might support someone, the way we want to feel when we are cared for has not. Care, which is grounded in dignity and compassion, which supports us to be independent and to have choice and control, to be part of and contribute to our communities for as long as we might wish, and which makes us feel safe and connected.

We are now in a place where idea to execution can take only a matter of weeks, making it all the more important to ground progress in human rights. There is much conversation about the role of technology in social care – increasingly more of us use wearables, tech is becoming much less intrusive, but the development of products has often been in isolation from the sector, or solution- focussed rather than innovative. Earlier this year, Scottish Care launched A Human Rights Charter for Digital and Technology (https://scottishcare.org/wp-content/uploads/2019/10/Tech-charter.pdf), developed in collaboration with people who access care and support, care providers, academics, software and hardware producers and others. By signing up to the charter, organisations commit to founding their developments in human rights, and with this in mind technology is developed which can help to create the conditions or that positive care experience. The development of the charter came from Dr Donald Macaskill’s report ‘Tech Rights’ which can be found here.

For the last 2 years, Scottish Care has been working with the European School of Innovation and Design at GSA on what the future of care should look like. You see it is important as Megatrends drive change, that to ensure these principles remain as key drivers, we are not only ready, but are part of leading change to come (https://futurehealthandwellbeing.org/future-of-care-at-home).

What was initially seen as a 20-year vision is already coming to being (I said the pace of change is fast). Out of the research came 3 new roles for home care. They have a particular focus on connectivity and feeling connected, which chimes with the human rights approach outlined in the aforementioned ‘Tech Rights’ report. Much of this is about freeing up care staff to simply ‘be human’, and with that the potential to optimise their wide-ranging skills in care and support.

We have since ran workshops with providers and regulators and many others to test out the applicability of the roles and as a result, some organisations have made changes to practice. The roles were designed to stimulate conversation and inspire the sector towards meeting requirements of the future, yet we are now seeing components of the roles in action.

Some care organisations have begun to monitor vital signs which is leading to a reduction in unplanned hospital admissions or GP visits. Some have invested in digital software and staff who will analyse the data contained within to inform care plans for the future. The opportunity to introduce e-MAR in care at home has reduced mistakes as well as medicines wastage.

The regulators are getting behind the trends with the SSSC developing open badges in the use of technology, and the Care Inspectorate looking to upskill their own staff to be able to inspect in a technological age of care.

Technology is being used to support people to live more independently, where an alert system or other can offer security that care, and support will be there when needed. This is not just about in emergency situations, although this is obviously important and can form part of the home care support offer, but this is about longer term data analysis which in identifying trends sooner allows us to intervene sooner.

The challenge with this is the multiple systems which we all use – I am frustrated when my laptop and phone don’t speak because one is Apple and one is Android, but imagine if you have several systems, all collecting data. The solution is not to make them interoperable, nor to have one tech provider owning the market, but instead to have a cloud-based system where citizens hold their own data, and which they get to choose who has access to it. Better still, imagine if this data was held across a person’s care journey and could be accessed across health and social care. Scottish Care is working with organisations to pilot this technology in 2020 and of course will be developed with the Tech Charter at its foundation, because there are many ethical questions to be answered in this context.

But megatrends do not point solely to technological advances. There is much talk of collaboration and whilst laudable, it is merely being promoted as a systemic diversion rather than a real solution. The change required in social care remains as it always has done, by focussing on the individual and how they can lead in their care and support. The future is about creating the conditions to achieve that, and collaboration may be one aspect, but what is truly required is the realisation of integration in the widest sense. Every week I read the Economist, there is a call for a change to capitalism – what is needed in home care is a route to address the power imbalances tied up in tender process and contracting, shifting the importance to achieving person-led care and support with systems which support all who are involved in making it happen. Another example of such a shift is the increasing number of employee-owned organisations in social care – widening the offer which people who access care and support have available to them.

It is clear that the independent care sector is at the forefront of developments for the future. Of course it is, it is a sector of innovators and entrepreneurs and it has the capacity to adapt quickly, with the support of skilled and dedicated staff who come to work because they care. Home care also bucks the business trend by having proportionally more women in leadership roles and as business owners. Scottish Care is working with Women’s Enterprise to promote the sector as such and to explore further why that may be and how other organisations can learn from this, culminating in a Cross-Party Group at Scottish Parliament.

It might be Home Care Celebration Day, but it is not the only day that we should be celebrating home care. It is not only a part of our future but leading the way. As one of very few job roles which sees no threat by automation, it is integral to our future. To deliver care is to care and we should be proud of that.

Thank you

Karen Hedge

National Director, Scottish Care

 

#homecareday19

Home Care Day 19: Working in Home Care, a blog from our Workforce Lead

“It is a privilege to be welcomed into someone’s home and to work with them in their daily lives”

Working in home care is not for the faint hearted, however, for the amazing individuals that do work in home care it is, even with the challenges, a particularly rewarding career.  It is a privilege to be welcomed into someone’s home and to work with them in their daily lives experiencing all their different highs and lows.  The relationship between care and support workers and those they provide services to can be something extremely emotional to behold.

I personally have many stories and great memories from working in home care both as a care and support worker and as a manager.  I started working as a care worker at the age of 24 and it made me into the person I am today.  I learnt so much from the people I supported from practical skills to seeing different perspectives and learning some good old-fashioned wisdom.

When I started as a new care worker, even with comprehensive training, it can be an overwhelming experience going into people’s homes and assisting them with their complex needs.  Learning how to assist an individual to move in a training session is quite different from assisting an actual person with various health concerns and mobility issues.  I was very fortunate to receive great support from wonderful supervisors who were able to demonstrate the job and mentor new staff members with little or no previous care experience.  Care and support workers who had worked in care for many years and had that innate and natural ability to build relationships with people in challenging situations and to make a difference to their lives.  These experienced workers provide reassurance and comfort at distressing times in a person’s life and are invaluable when showing new workers that important aspect of the role.  Many practical skills are transferable and can be taught but having compassion and empathy for others in distress and understanding their needs is at the heart of the job the social care workforce does.

I will never forget the supervisor who received a round of applause upon completing roughly five minutes of the Great Scottish Run in order to get from one side of the road to the other.  The crowd watching the run responded with joy and laughter when the supervisor set off at a jog in pace of the runners to weave her way through the crowd.

This is a lighthearted example but there are so many more of staff going above and beyond to help and care for the service users they support.  This often means taking time out of their own lives and personal time to stay with someone who is unwell or has fallen.  Home care workers rearrange their own commitments and responsibilities to ensure that the individual has a familiar face and someone there to provide comfort while they are waiting on an ambulance and are in pain or unwell.

I had the absolute privilege to accompany staff during the extreme adverse weather we experienced when the “Beast from the East” came to Glasgow.  Staff were walking though knee-deep snow and found the solution of wearing poly bags over their socks and inside their boots to try to keep their feet warm and dry.  On an occasion where people were being advised to stay at home and protect themselves, care and support staff, among others, were out walking through the snow and blizzards to get to people in their homes and give them the care and support they needed.

Within all types of social care valuable relationships are made but it is so inspiring especially as a manager of a home care service when you find that match between care and support worker and service user that is life changing for that individual.  I have seen first-hand the difference that special person can make especially when people have experienced mental health problems and periods of stress and aguish caused by a change in life circumstances.  To see someone flourish under the right support after a time that they thought they would never get back to the person they had been is so rewarding for all involved.

I loved my job as a home care manager going out and meeting some fantastic individuals and hearing stories of their lives and personal experiences.  I met an elderly lady who had worked at the age of 16 during the war on a forty-foot crane and had walked along the gantry whistling with her hands in her pockets.  People are full of surprises from all walks of life and have so much to offer to the younger generations.  This is an important aspect of social care and we must realise that these relationships can go both ways and benefit both the care worker and service user.  Staff often express their pleasure in some of the things that they learn from the people they support, and you can see this empowers the service user too when sharing their life skills with others.

Amongst the current challenges it is important to remember the positive aspects of this sector and the good times that happen too.  I will leave you with a story that I feel encompasses home care: I was talking with a provider who told me that during the torrential rain we had back in September they had been calling their staff working out and about in the community to see how they were getting on.  When the manager of the service had spoken with one staff member they had responded that they were absolutely fine: they had been soaked to the skin while getting to their first call, however, they were now getting dry and were nice and warm in the service users home having a cup of tea together and planning the day ahead.  That to me gives a true example of the sharing of lives and experiences and the wonderful benefits that home care can bring to both the workforce and those they care and support.

Caroline Deane

Workforce Policy & Practice Lead, Scottish Care

#homecareday19

Home Care Day 19: Defining home care, a blog by our CEO, Dr Donald Macaskill

 

‘You can change a life in a few minutes…’

In my role I inevitably spend a lot of time with policy makers, commissioners and politicians talking about and not infrequently arguing over the nature and state of the homecare sector in Scotland.  In some of these discussions I get a sense that folks do not really understand the nature of the care and support the sector offers and delivers. For too many there is still an outdated image of homecare as ‘mopping and shopping,’ as a set of practical activities designed to make people feel better but not much more than that. As almost like an added luxury!  This lack of real understanding of what homecare is has become especially evident during this General Election – albeit that these issues are technically reserved matters in Scotland – when it is clear that there is a lack of public and societal awareness about the nature of what homecare is and how critical and vital it is for tens of thousands of people.

But when you strip all the debates – which are critical – around commissioning, funding, workforce and the future away – what you are left with is a consideration of what the essence of care at home and housing support is.

That is why Scottish Care has been articulating our own definition of social care – in part because far too many people (and some of these should know better) keep conflating social care with health care – which it clearly is not! We have stated that:

‘The enabling of those who require support or care to achieve their full citizenship as independent and autonomous individuals. It involves the fostering of contribution, the achievement of potential, the nurturing of belonging to enable the individual person to flourish.’

Homecare is that care and support which enables and empowers an individual to be free, autonomous and independent in their own home. It is the energy which gives purpose to someone wanting to remain in their own space and place, it is the structure of support and care which enables citizens to remain connected to their families and friends, their neighbours, streets and villages. It is not an added extra but the essential care that enables life to be lived to its fullest.

The best of homecare is a care that changes life and gives life.

Some of my readers may know that I am a bit of a Bruce Springsteen obsessive. In an interview which he gave around the time he launched his autobiography in 2016, Springsteen said that:

‘You can change a life in three minutes with the right song.’

He expanded on this by talking about the power of song to change a life and give voice to a story which is not heard or told; the importance of his own challenging upbringing in giving him continuity and boundary, freedom and permission. He spoke insightfully about the way in which words and music can create a possible future for those who feel alone, empty and directionless.

At the time the sense of words and music changing and transforming a life struck me as being a powerful description of the musicality of one of the greats of his genre. But I also think that it is a description of the essential life changing and enabling power which lies at the heart of care. It is this ability to change a life through care and support which we are celebrating in this second Homecare Day.

The women and men who work in homecare are life-changers. The reason that statement is true is that by their acts of personal care, by supporting someone to take their medicines, to get up in the morning; by making sure their space and place is tidy and safe, that hazards are controlled or removed; by taking someone to a club or to their family, to an activity or simply to belong somewhere, these women and men who are the workers of care are the gifters of purpose and meaning to so many. This is not incidental it is essential. It is this work that binds a community together, that truly creates neighbourhood, and moulds togetherness in the midst of our cities, towns and villages.

Most of us are able to be independent – to get around on our own, to have the control that we need not be dependent upon another. As life changes through age or illness the loss of that independence and the forming of bonds which make us reliant upon another can be both challenging and difficult for our sense of identity and self-worth. It is in this territory that the marvellous work of support and care locates itself and comes to the fore.

Good care is not about taking over another person’s autonomy, good support is not about creating dependency – they are both the total reverse. They are the actions and deeds, the words and encouragement that enable others to either re-discover or find for the first time, the abilities to make decisions, to exercise choice, to be in control and to be independent even if support is needed to achieve that goal.

This is why homecare is important – it is because for so many of us being in our own space and place surrounded by familiar furnishings of our memory and the story of who we are,  are critically important to enabling us to be ourselves or to be the person we dream of becoming. The autonomy that homecare gives  a supported person enables them to flourish to their best and continue to grow into the person they want to be.

So, if a good song can change a life in three minutes then good care and support changes a future forever.

So today let us celebrate homecare as the lifeblood of a society which cares.

Dr Donald Macaskill

CEO, Scottish Care

#homecareday19

Latest blog from our CEO: Time to raise awareness of Self-directed Support

Reform of our health and social care services cannot only be an ambition but is an urgent requirement. The recent annual report from the Auditor General on NHS Scotland made this extremely clear. If we are to meet the current and future health and care needs of our country, we have to change how we deliver care and treatment, with more services based in our communities, meeting individual care needs. Audit Scotland’s annual report said the NHS was “seriously struggling to become financially sustainable” and the Auditor General Caroline Gardner said the integration of health and social care was too slow and staff were under intense pressure. The conclusion was that Scotland could face a £1.8bn shortfall in less than five years if it is not reformed. Change is urgently needed but the pace of change is too slow. We have achieved a consensus on the need to integrate health and social care services and reform social care. Health and Social Care Partnerships have been established to bring about more effective collaboration, but progress is patchy. Yet by embracing rather than resisting reform of health and social care, we have the opportunity for transformational change which will benefit the thousands of people in our country who are supported by care services. For me social care has always been profoundly about human rights. It is about giving the citizen control and choice, voice and agency, decision and empowerment. These principles underpin the Scottish Government’s flagship social policy of Self-directed Support, which seeks to give people more control over the care services they receive.  The policy means local authorities now have a legal duty to offer people eligible for social care four options on how to use their personal budget. The four options are direct payments; an Individual Service Fund held by the local authority and allocated to a provider of your choice; the local authority arranging support on your behalf; or a mix of these options. Human rights and social care practice come together in our Self-directed Support legislation in Scotland which unapologetically grew out of the independent living movement of the learning and physical disabled communities in the 1970s. With the closure of large-scale institutions there was an emphasis on enabling individuals to live more independent lives. Policies and practice at the time and since emphasised the importance of building social care supports around the life of the individual rather than expecting the individual to fit into what services were available. A one size fits all approach was replaced by the urge to develop and offer bespoke individual services and supports. A personalised approach has the potential to benefit and empower people with a range of conditions and care needs. This is why we have been keen to assess levels of awareness of Self-directed support among those groups of people who could potentially benefit most. We have been working with Royal Blind to research awareness of Self-directed Support among people with visual impairment. People living with sight loss require care which meets their specific needs to enable them to flourish and foster their full contribution. Self-directed Support offers them the potential to ensure they are provided with specialist support, equipment and accessible information to help them live well with visual impairment. There are around 188,000 people in Scotland living with significant sight loss, around three quarters of whom are over 65, and this number is projected to increase to over 200,000 by 2030. This means Scotland requires a social care system which can support an increasing number of people with sight loss. Self-directed Support has the potential to benefit thousands of people with sight loss, enabling many to maintain their independence and live at home for longer. So it is disappointing to learn that there is low awareness of Self-directed Support among many people with sight loss. Over 100 people with sight loss were surveyed by Royal Blind and Scottish War Blinded to learn their views and experiences of Self-directed Support. When asked the question “have you heard of Self-directed Support,” two thirds of respondents said they had not. Only five respondents said they had a support plan funded through Self-directed Support.  Over 60 percent of respondents had never been informed of the budget available to them for their care and support. If I am living with a lifelong condition or need support in any way because of life circumstances or age then I most certainly do want to have more choice and control both over who is in my life as a carer and what the nature of that support and care might be. The critical importance of legislation like Self-directed Support is all about embedding that control and choice, building those rights with the citizen including fiscal and budgetary control. This is why it so frustrating that for too many people, including people with sight loss, the promise of Self-directed Support is not being realised. The legislation is now in its fifth year – bedding down should have long since passed. The excuses are running out and we are left with the conclusion that this human rights-based policy is being consciously ignored, blocked and underfunded, or that only those who shout the loudest are being given choice and control. We are still defaulting to models and a provision of assessment and care which too often do not meet individual need and are economically unsustainable.  This situation needs to change urgently if we are to secure sustainable models of care and the rights of people accessing care services to be fully included in our communities. There is little point in having fantastic legislation if there are is a collective failure to put it into practice. There is little point in having rights under the law if the obstacles to exercising those rights are growing every day. Dr Donald Macaskill  CEO @DrDMacaskill

A new blog from our CEO – Scottish Labour consultation on Health and Care

Human Rights and Social Care Reality.

There is a lot of election talk in the air at the moment. Along with this there is a great deal of media debate and discussion south of the border over the state of social care, it’s under-funding and need of reform. Social care along with health are devolved matters in Scotland and discussions and plans around reform and funding are well under way.

However what happens in England influences the delivery of social care in Scotland regardless of the fact that I would suggest since the commencement of the Scottish Parliament some twenty years ago we have been trying to do things differently and with more collaboration.

Political parties in Scotland are at the stage of both preparing for Westminster elections but also beginning the process of defining positions and policies for the Scottish Parliamentary elections in 2021. As part of this Scottish Labour has put out a consultation on health and social care. Scottish Care has responded to this and we are pleased to publish this response for a wider audience.

Scottish Labour are considering the effective nationalisation of social care and talk of a desire to ‘bring back in house’ social care provision is contained in the paper. Personally I believe such rhetoric and policy articulation needs to be challenged from the perspective of a diminution of citizen choice and a loss of rights.

Indeed I have been led to believe that a number of commissioning officers in Scottish local authorities are investigating whether it would be desirable or possible to bring social care provision in house. I would suggest that this needs to be strongly resisted not least because currently it would be illegal.

So on what basis am I making these assertions?

What is social care?

Within the Labour Party document and elsewhere within the current political debate there is a conflation, sometimes accidental, sometimes deliberate, of what health and social care services are and what they seek to deliver. The equating of the two is damaging and unhelpful. In order to understand how social care (or long-term care) can be viewed we need to understand what it is and what it is not.

The Adult Social Care Reform process which is currently underway acknowledges this lack of robust understanding and as part of its articulation has suggested the importance of talking not just about social care but about ‘social care and support.’

There are many definitions, both legal and philosophical, as to what social care is. Importantly, for instance, social care whilst it may contain services and behaviours which are clinical or medical in nature is not primarily about one’s physiological health.

The Scottish Care working definition of social care is:

‘The enabling of those who require support or care to achieve their full citizenship as independent and autonomous individuals. It involves the fostering of contribution, the achievement of potential and the nurturing of belonging to enable the individual person to flourish.’

In essence social care is about enabling the fullness of life for every citizen who needs support whether on the grounds of age, disability, infirmity or health. Social care and support are holistic in that it seeks to support the whole person and it is about attending to the individual’s well being. It is about removing the barriers that limit and hold back and the fostering of conditions so that individuality can grow, and the independent individual can flourish.

Social care is not about performing certain functions and tasks alone for it is primarily about relationship; the being with another that fosters individual growth, restoration and personal discovery. It is about enabling independence and reducing control, encouraging self-assurance and removing restriction, maximising choice and building community.

Therefore, as many of us have sought to illustrate over the last few years, social care is not equivalent to health but a critical component to the realisation of health.

Human rights.

For me social care has always been profoundly about human rights. It is about giving the citizen control and choice, voice and agency, decision and empowerment. These sentiments are well reflected in the international literature both on the role and purpose of social care – especially independent living and its acceptance as a human right – and in what has been written about ‘long-term care’ , including a growing volume of human rights case law.

Included within the United Nations International Covenant on Economic, Social and Cultural Rights (CESCR) there is the right to health. The right to health is the right to a universal minimum standard of health to which all individuals are entitled without discrimination. What this means in practice has been long debated but there is now a mature conviction that the right to health is not solely the right to physical and clinical health but to psychological, emotional and societal well-being. There has been a considerable volume of debate, not least in the ten meetings of the UN Open-ended Working Group on Ageing (over the last decade and more) that part of what constitutes the right to health for older persons and people with disabilities is the full realisation of ‘rights’ in relation to what the UN terms as ‘long-term care.’

I would argue that such ‘long term care’ or what we would describe as ‘social care’ is inherent to the realisation of the human right to health, and that we need to seek to develop and articulate what are considered to be the key characteristics of exercising a right around ‘long-term care or ‘social care.’ I intend to argue both points more substantially in a future publication later this year (for Human Rights Day on December 10th).

Self-directed Support (SDS)

Human rights and social care practice come together in our SDS legislation. The Self-directed Support legislation in Scotland unapologetically grew out of the independent living movement of the learning and physical disabled communities in the 1970s. With the closure of large-scale institutions there was an emphasis on enabling individuals to live more independent lives. Policies and practice at the time and since emphasised the importance of building social care supports around the life of the individual rather than expecting the individual to fit into what services were available. A one size fits all approach was replaced by the urge to develop and offer bespoke individual services and supports. This has been eloquently re-articulated in the current reform process.

The Social Care (Self-directed Support) (Scotland) Act 2013, is a direct continuation of this earlier work on personalisation. The pursuit of citizen control, independent living, autonomy and choice is not a recent one. It is clearly a pursuit at the heart of the disability civil rights movement and a contributor towards the realisation of human rights.

The Self-directed Support legislation seeks to enshrine in law and social care practice the core values of inclusion, contribution and empowerment through real choice and respect.
The legislation is underpinned by a set of core values which at times mark the link between social care legislation and day to day practice.

The following words describe the values that have helped to inform the guidance:

• Respect
• Fairness
• Independence
• Freedom
• Safety’

It will be clear that such values are rooted in the earlier concepts of personalised services and greater independent living. The Act and Guidance then go on to indicate that there are certain core principles at the centre of self-directed support. Principles are described as ‘....... the means by which we put our values into practice. The 2013 Act (Sections 1 and 2) provides four legal principles

• Participation and dignity
• Involvement
• Informed Choice
• Collaboration.’

The Guidance then goes on to root these principles and values within a human rights-based framework. The Guidance reflects the conviction that the provision of social care and the facilitation of choice as part of this, is a way of protecting human rights.

‘Effective, person-centred social care, determined and led by the individual in partnership with the relevant professional increases the choice for the supported person and provided them with the opportunity to take more control and manage their life.’ (Guidance section 4.9).

The Act and its Guidance envisage various ways in which the values and principles are put into effect. In practice this means that there needs to be as much emphasis placed upon the universal needs of an individual as much as attending to their basic needs. There is a clear distinction between addressing needs which keep you alive and healthy and those which are more holistic and relate to well-being. To remain in relationship, to maintain friendships and be connected up to the community are as important requirements of support as being nourished, healthy and safe.

‘Participation and dignity are core aspects of independent living whereby all supported people should expect to have the same freedom, choice, dignity and control as other citizens at home, at work and in the community. In some respects, the concept of independent living provides a modern interpretation of the social welfare duties provided in the 1968 Act.’ (Guidance section 4.4).

Choice:

Informed choice is therefore critical to the implementation of a human rights-based approach to SDS. Choice is very different within the social care context compared to the health environment.

If I have a medical emergency then personally I want the best clinical care and don’t really want to have much say in who delivers that care as long as they are trained, suitably qualified and supervised. A short term stay in a hospital is very different from the place and people with whom I spend my life. If I am living with a lifelong condition or need support in any way because of life circumstances or age then I most certainly do want to have more choice and control both over who is in my life as a carer and what the nature of that support and care might be. The critical importance of legislation like Self-directed Support is all about embedding that control and choice, building those rights with the citizen including fiscal and budgetary control.

This has implications for the social care ‘market.’ At the moment within the legislation there is a requirement to ensure the diversity and reality of this ‘choice’ of provision for citizens. (section 19). Is it possible to fulfil this requirement and Statutory Duty if you only offer one provider (in-house provision)? Such proposals not only fail to understand that we never had a national social care system, but that historically social care was delivered in large part by charitable bodies such as the churches. But the suppositions also challenge the real potential creativity of self-directed support which was about enabling local individuals and communities to recognise and use their own assets to care for those in their midst. Where would such micro community provision stand in a nationalised system?

So, in our discussions and debates on the future of social care in Scotland I do not think we can avoid the reality that in practice and in law social care is a human rights issue and any changes to its delivery has to be rooted in human rights.

Donald Macaskill

CEO Scottish Care

@DrDMacaskill

You can view a copy of Scottish Care's response to the Scottish Labour Party consultation below.

Scottish Labour Party Health Care - Scottish Care Response Aug 19f (003)