Don’t walk away – a mental health challenge

Don’t walk away – a mental health challenge

 

One of the most interesting and yet challenging studies I have read recently was one published in the British Journal of Psychology last week. In an extensive European wide study researchers found many more elderly people than expected have or have experienced a mental disorder when evaluating them with a new, simpler screening technique. Indeed they discovered that nearly one-quarter of older people had a mental disorder in the previous year, and one-third had been treated for one in the previous year.

 

Traditionally it had been thought that the risk of mental disorders declined with age, but this new study suggests that is not true, raising concerns because of the greater effect depression, anxiety or substance dependence can have on health conditions for older people.

 

According to the researchers, older people struggle to remain attentive during traditional diagnostic tests and the questions may be too long or complicated, which makes their performance even worse. For the new study, researchers developed a new diagnostic method using a computer-based interview system with simplified questions and statements.

 

This research seems to underpin what I have been hearing and witnessing when I talk to staff who work in care homes, care at home and housing support services. The challenges facing services in Scotland are significant. It was therefore a positive measure to see proposals in the consultation on Scotland’s Ten Year Mental Health Strategy which have the potential to address the mental health challenges of our older citizens.

 

Scottish Care has made a response to the consultation. In it we highlight that many older people develop mental health challenges later in life, often when they are receiving care at home or care in residential settings.

 

We have come a long way in the last ten years with our work on dementia. However, there has always been a risk that the focus on dementia has taken our eye off other mental health and life enduring challenges faced by older Scots. I spoke recently to someone who had lived with chronic depression most of their adult life and had received good supports until that is they got to 65 years of age. Then almost overnight, he told me, it felt like the system was abandoning him and the supports he had been used to changed and disappeared.

 

“It was like standing at a window and seeing everything and everyone who had helped you live your life, especially in the down times, walk down the street and wave goodbye. I felt really alone.”

 

 

We have I believe to get much better at supporting people who have life enduring mental health challenges transition from adult to older people services. This will include properly resourcing the older people care sector to train and equip staff to deal with mental health issues and challenges and also to give greater priority to enable the development of new models of support which can cater for individual and particular mental health needs.

 

In addition, old age itself brings about a whole range of changes, many of which are positive and welcomed, but some are challenging and difficult. I do not believe, and the study quoted above highlights this, that we have sufficiently robust mechanisms in place for diagnosing and then supporting individuals who develop a whole range of conditions after the age of 65.

 

There is a real opportunity for Scottish Government, older people and providers to work together to improve the quality of mental health support. At times of vulnerability we need to give people the feeling and sense that people are there to support and guide, not that they are walking away from them.

 

Dr Donald Macaskill

18th September, 2016

 

Greetings from Argyll and Bute

Greetings from Argyll and Bute.  We wanted to let you know about an exciting project that took place in Oban this summer.

One of the care at home providers, Carer’s Direct, took part in a pilot for a placement for physiotherapy students from Glasgow Caledonia University.  The placement was referred to as a split placement – the students time was split between the physiotherapy department in Oban, Lorne and the Isles District General Hospital, the Community Healthcare Team and Carers Direct.  This was an ideal project for us to work on together, as it built on improved partner relationships which had developed in Argyll and Bute over the last few years.  These relationships were forged against the backdrop of RCOP (Reshaping Care for Older People) and a workforce development project facilitated by IRISS (Institute of Research and Innovation in Social Services) and supported through the role of the Local Integration Leads.

The aim of the placement was to promote awareness of the move to more people being cared for at home and the implications for healthcare professionals (specifically physiotherapists) of supporting people in their own home.

The project was supported by a steering group with representatives from each of the agencies involved – Carer’s Direct, NHS Highland, NES, Care Inspectorate, Scottish Care, Glasgow Caledonian University so that learning from the pilot could be written up and disseminated.

Thanks to a lot of goodwill and hard work from all of the agencies involved in supporting the students during the placement it was a real success. We also have to mention here that the sun shone on Oban for the duration of the placement!  We are hoping that having worked and seen Argyll in it’s best light this might help with recruitment and retention!  Some of the students evaluation has been filmed and will be widely available soon – look out for the link on the Scottish Care website.  There will also be a link to the written evaluation and this includes lessons learned as well as the notable successes.

Of particular interest to care at home providers, development officers and local integration leads will be the students comments about how little time care at home staff are allocated to complete complex care tasks.  For the students this was at odds with promoting independence.  Care staff reported back that it was very helpful to have access to the physiotherapy students and to learn from how they worked with people to promote well-being and independence.  The care at home manager observed that care staff have gained transferrable skills and insight from working with the students.  We also recognised that the project helped cement relationships across the sectors within the partnership, promoted a better rapport and understanding of each other’s perspective and fostered a stronger team approach to delivering care.

Glasgow Caledonian University are keen to extend split placements for students to other providers and other areas of Scotland as a result of the outcomes from the pilot.  So if you know of any providers who might be interested in hosting a placement please spread the word.

 

Anne Austin & Susan M. Spicer,

Argyll and Bute Local Integration Lead, Scottish Care (job-share)

Anne’s email:  [email protected]   or, mobile: 07460898897

Susan’s email: [email protected] or, mobile:07771610728

Let’s start talking…

Let’s start talking…

 

For both personal and professional reasons my mind these last few weeks has been much occupied by thoughts of death and dying.

Now before you scroll away stay with me for a while …

It’s always struck me as a strange indictment of our modern living how uncomfortable we are as a society with talk about death. If sex, politics and taxes were the Victorian taboo then death has surely been added to the modern dining table no go areas of conversation. Why is that I wonder? Is it because death has to some extent become a stranger, an occasional visitor we keep standing at the doorstep of our experience?

A hundred years ago, certainly in a Scottish context, the immediacy of death was intimate. Most people died at home, in their own bed, own street and own community. Scottish traditions such as the ‘kisting’ where the remains of the deceased remained in the family home until the funeral and where ordinary living continued around about, made death feel a more natural stage. The average Scot at that time experienced the death of a close family member at an early age but today for many folks their first encounter with bereavement is often in their late twenties.

In December 2015 the Strategic Framework for Action on Palliative and End of Life Care 2016-2021 was published by the Scottish Government. It has a set of ten commitments of which the sixth states:

‘Support greater public and personal discussion of bereavement, death, dying and care at the end of life.’

Later the Strategy describes the danger of the over medicalisation of death –

‘Social and cultural change has resulted in a ‘death-denying culture’ and the medicalisation of death. An entire generation has come to expect that all aspects of dying will be taken care of by professionals and institutions, potentially undermining personal and community resilience in coping with death, dying and loss as part of the ‘cycle of life’.

The Strategy is a real opportunity for us to change the way in which people are supported at the end of life and also to change and challenge popular attitudes to dying and bereavement. In my work I speak to many frontline staff in care at home, housing support services and care homes who day in and day out are engaged in support for individuals who are at the end of their life. Their work is irreplaceable and their contribution to ensuring that people spend their last few days in dignity, with appropriate support and the management of pain and distress is critical.

At times, however, the role of social care staff whether in a nursing home or in the community, is not always appreciated or valued. Yet this is perhaps the most important work any of us can undertake on behalf of another. It is work which has a value beyond calculation but it is also hard, emotionally draining and challenging.

 

Over the next few weeks and months Scottish Care staff and members will be involved with other health and social care colleagues in working to try to make sure that all staff, whatever their role, feel a sense of support and training to enable them to do this work as best as they can.

One of the first challenges in that is for us all to start talking about death, being open to discussions about mortality, and to help one another to become communities where grieving and bereavement are at the heart of who we are and what we do. There is a terrible conspiracy of silence around death and that silence has to end for the sake of us all.

If we do not as a society and community start considering death and what it means for us all then we are left with a lot of people struggling to cope and all the negative health impacts that result. One of my favourite poems around grief is Nobody ever told me. It highlights just how hard it is for people to talk and be open in this area but equally how the work of the new Strategy is essential in getting us all to share, talk, reflect and be comfortable with mortality.

 

Nobody ever told me.

 

Nobody ever told me

it would be this hard;

that I’d wake up in the morning

and think that you were there

lying beside me in our bed;

that I’d walk down the street

and recognise your shadow

following me in the sun;

that I’d listen to the radio

and hear your voice

inviting me to sing;

that I’d sit in the park

and watch you go by

in a group of strangers.

 

Nobody ever told me

it would be this hard;

that I’d wonder why I should

get up in the morning;

that I’d think making plans

was a children’s playground game;

that I’d rage with anger, red and raw,

at your leaving;

that I’d wonder was it me

who did something

that made you go away.

 

Nobody ever told me

it would be this hard.

 

Why can’t someone tell me instead

how I can stop crying

and dam the tears from soaking my pillow?

How I can start again when all I want to do

is rest in our lost togetherness?

How I can ‘move on’ when I only want to settle

in the place of our memories?

 

And please someone tell me

when will this time come,

the time they all talk of

in easy careless cliche,

the time which they say

will heal all things

and help me to live again?
Donald Macaskill

Blog from Loretto Care’s Eddie Coleman : “No Two days the same”

Eddie Coleman : No Two days the same

‘A fantastic blog by Eddie Coleman – a front line support worker at Loretto Care and an active member of the Scottish Care Front Line Strategy Forum– highlighting the skills and attributes needed at the front line of social care.

Thanks Eddie!

 

I rang the bell. The door was opened by a perplexed looking Mrs Jones (not real name) clutching a letter in her hand.

‘Come in’, she said. So I did. ‘You look worried this morning’ I offered.  ‘Aye, I am son. I got this letter this morning and I haven’t stopped worrying since. I haven’t been able to eat breakfast for worrying’.

No breakfast, now that’s not good.

‘Can I look at your letter?’ I asked. ‘Of course you can, you were getting it anyway. They’re stopping my benefits’.

I looked at the letter and sure enough it was from the benefits office. The letter stated that there had been overpayments to Mrs Jones’s housing benefit going back three months and that they would be taking £3 off her benefits every two weeks until the overpayment is paid back. I explained all this to Mrs Jones who was visibly relieved. ‘Aw is that all? I just saw overpayment and pay back £30 and thought the worse’. She sighed.

‘Three pounds, not thirty’ I advised. ‘Should’ve gone to Specsavers’. That gave us a laugh anyway.

The Sherlock Holmes in me decided to double check the claims in the letter. I explained to Mrs Jones that I would like to phone housing to verify that there was in fact overpayments made to her housing benefit and asked her if that would be ok. It was.

In short, I spoke with a very nice person who informed me that this wrong and that it was a mistake on the part of the benefits office.

Right, I thought, put the rest of the morning on hold while I phone the benefits office. To be fair, I know they have a very, very busy schedule.

I phoned my office and spoke with the shift co-ordinator who was able to arrange for a colleague to do my next projected visit for me.

Deep breath.

Pachelbel’s Canon was very soothing to my ear. Not so the ‘you are number 48 in the queue’. Ok, so that was a bit of an exaggeration but you get the picture.

To cut a long story short, and quote Spandau ballet, I got it all sorted out after an hour and a half and was very happy to tell Mrs Jones that there had been a mistake and that her benefits will remain as they are.

Now, about that breakfast……

And the moral of the story is that patience, persistence, inquisitiveness, a nice manner and team work will get you through most days as a frontline care worker.

 

Back to the Future ; staying where we are is not an option.

“BACK TO THE FUTURE”

 

Any night of the week, there are 33000 older people in Care Homes in Scotland, and  approximately 22000 of these are publicly funded. For the past 10 years these placements have been made under the National Care Home Contract.

I joined Scottish Care as CEO when the first annual settlement was being negotiated, and now as an Associate I’m working on the Reform of the Contract, to put in place the framework by which Care Home provision will be commissioned, funding levels determined and placements made for the next 10 years or longer.

Get it right and hopefully it will deliver improvement in both service quality and business viability. Get it wrong, and an already stetched and fragile sector, could be severely impaired. Whatsmore, the reform of the Care Home contract is likely to have a knock on impact on the reform of Care at Home.

But staying where we are is not an option: change has to happen. The local planning and commissioning environment has altered significantly with the advent of the new Integrated Health and Social Care Partnerships. The needs and dependency levels of residents have shifted over time.

The role of Care Homes, the services on offer, and the expectations of service users and their families have grown and developed, together with the demands of Regulation and Inspection. Partly as a response, the business models underpinning the sector have also adapted, with much tighter margins and pressure on investment. And, as if this wasn’t enough, we are going through the most challenging period in terms of the public finances for a generation.

Any new set of arrangements has to respond to all these factors, and find a way of combining the protection and efficiency of national benchmarking and negotiation with a new emphasis on local planning and flexibility. Moreover, we have to have at least the bones of this teased out and agreed by the end of the autumn. A tall order, yes, but potentially achievable, providing we have the continued support and commitment of all parties.

Watch out for updates and make sure you are fully connected to Scottish Care: The Bulletin, the Website, Branch Meetings, and of course, Yammer.

For me, retirement can wait, it’s time to power up the De Lorean and get back in there!

 

Ranald Mair

Associate, Scottish Care

Attending to care: a summer reflection

Earlier in the year Scottish Care published Voices from the Front Line which was the gathering together of personal stories of nearly 40 front line care staff working in the care home, care at home and housing support sector across Scotland. They were the stories of individuals who spoke of their hopes, aspirations, frustrations and exasperations with that most challenging of roles – caring for and supporting others. I was privileged to be one of those who conducted the interviews and many sentences and phrases have remained with me. One in particular continues to resonate in my mind as I tour the country talking to front line staff and providers alike. One participant said to me:

“The problem is, I don’t think we are paid to give time to people. We give care, we do the task, we have conversations as we are working … but we no longer have time, just to be with someone, just to be social. We’ve lost the time to really see what’s happening in someone’s life.”

 

Maybe that’s something you can recognise. The pressure of activity pushing out quiet space; time running away from us like sand in an hourglass, disappearing into the lostness of memory. Even at this time of year when we are supposed to be ‘re-charging the batteries’, resting and refreshing ourselves in the summer sun, there is still a pressure on time. Our traditional two weeks off never seem quite enough and so many folks talk about coming back as tired as they were when they finished up and within minutes of opening the laptop or starting the shift, being in need of the next holiday. Care can become a busy occupation rather than being an activity which allows reflection, validates the art of chat, and accentuates a space for being.

 

The scientist Alexandra Horowitz has written a brilliant study on how so preoccupied by busyness we can sometimes miss what’s in front of our eyes, how seeing isn’t an action but an art. A couple of years ago she published On Looking: Eleven Walks with Expert Eyes – the tale of a walk around a city block with eleven different “experts,” from an artist to a geologist, a toddler to a dog, and how she emerged with fresh eyes on what she witnessed.

 

Horowitz begins by pointing out the incompleteness of our experience of what we conveniently call “reality”:

Right now, you are missing the vast majority of what is happening around you. You are missing the events unfolding in your body, in the distance, and right in front of you.

 

By marshaling your attention to these words, helpfully framed in a distinct border of white, you are ignoring an unthinkably large amount of information that continues to bombard all of your senses: the hum of the fluorescent lights, the ambient noise in a large room, the places your chair presses against your legs or back, your tongue touching the roof of your mouth, the tension you are holding in your shoulders or jaw, the map of the cool and warm places on your body, the constant hum of traffic or a distant lawn-mower, the blurred view of your own shoulders and torso in your peripheral vision, a chirp of a bug or whine of a kitchen appliance.

 

She says that this ‘adaptive ignorance’ is there for a reason — we call it ‘concentration’ and it stops us from sensory overload and helps us focus on what is important for our sense experience at that particular time.

 

So we need such attention’ to survive but when it comes to relationships, to the art of caring, do we filter out things that we need and which are necessary?

 

Horowitz has said that her book is not, “about how to bring more focus to your reading of Tolstoy or how to listen more carefully to your spouse.” Rather, it is an invitation to the art of observation – we are invited to become:

Investigators of the ordinary, Sherlock characters in the midst of busyness.

 

The book is richly layered with hidden depths but what I want to focus on is a consideration of what is at the heart of the art of caring. I think there is a danger that when we commission and contract care we are oriented around the delivery of tasks thatcan be calculated, monitored, budgeted and thus remunerated. But what about that which falls beyond calculation and observation? I sometimes feel we have stripped the ‘social’ out of care on the basis of cost but in doing so, have  we stripped out the ability of carers to effectively care and support?

 

Caring and support is at a fundamental level about relationship. The effective carer sees beyond the observable; spots the subtle changes in behaviour which speak a tale no words can express; they read a story unfolding in the person before them; they can become the detector of life change which enables intervention and support. This becomes especially important where front line staff are increasingly having to have conversations about anticipatory care and end of life issues.

 

As we seek to re-consider and reform the way we structure care and support in Scotland will we leave room for such attention? Will we give space to our workers to have ‘time’ to be with rather than simply to do?

 

They want to – if we (and that’s a society ‘we’!) allow them. Systems which record visits from staff and time them to the minute might fit in a world of contracts but what place have they in arrangements which should be premised on the priority of building effective relationships, ones that make a difference to the lives of people?

 

One of the ‘experts’ who allows Horowitz to see differently, to develop her ability to ‘attend’ to the moment is a toddler. She says that part of toddlers’ extraordinary capacity for noticing has to do with their hard-wired neophilia – ‘the allure of the new and unfamiliar, which for them includes just about everything that we, old and jaded, have deemed familiar and thus uninteresting.’ (except as Horowitz says when we go on holiday – when we give space and time to the new – what she calls the holiday paradox).

 

I can well attest to the inquisitiveness and excitement of new discovery which a toddler enthuses into life. Perhaps then we need in Horowitz’s terms to spend more time ‘on holiday’, to see the world through a toddler’s love of the new, to move beyond our concentration on the familiar?

 

Think of what a difference we could make – what preventative excellence could be achieved if we commission and pay care workers to simply be, to sit, to see, to ‘attend’ rather than always to do, to record and to thus be monitored. Or is all that summertime dream? 

 

 

Dr Donald Macaskill

 

@DrDMacaskill

Dr Donald Macaskill

Scottish Care

www.scottishcare.org

07545 847382

Be somebody who makes everybody feel like a somebody

Tracy Viljoen:

I came into this role hoping to help to make a difference to others.  My Twitter profile states that you should “be somebody who makes everybody feel like a somebody”; something I genuinely believe in.

I’m sure anyone who knows me would say that “Tracy loves anything to do with leadership, she loves all that fluffy stuff” and they would be absolutely right. But, I’m glad to say that more and more people out there quite like the taste, the need and the success of ‘fluffy’.

North Lanarkshire is saturated with many wonderful stories of success, the problem is that staff however are not always great at blowing their own trumpet; they typically say “But that’s just what we do” or “it’s my job”. One care home had a resident with mental health issues and challenging behavior, he was quite unstable and sadly unhappy. He had always talked about owning a pet and so the care home manager and staff decided to take a SAFE RISK and arrange for ‘Gordy’; a bearded dragon to come and live with the resident.  Self-harming incidents have significantly reduced for this man and the staff can work with him in a far more manageable way.

A local frontline worker who was on nightshift when a resident took ill managed to stop a hospital admission being arranged by the GP – the lady had an anticipatory care plan (ACP) in place which stated very clearly she wished to remain at home, to die around loved ones and staff who knew her and how she liked to live. The worker used her AUTONOMY and SELF LEADERSHIP to achieve the desired outcome. I could go on and on, there are literally no shortage of examples of amazing things and great practice happening here in North Lanarkshire.

Last year I went to a workshop run by the amazing IRISS which was called ‘THE BIG IDEA’ and oh my word that’s exactly what it has turned into. They wanted a local partnership to work with, on any chosen project, in the new integrated world. Obviously I wanted this to be North Lanarkshire and 10 months later we are slap bang in the middle of an experience based co-design programme or as we call it EBCD. Developed by Bate and Robert it’s a methodology for working with groups of people who access support or care and the staff who provide this to improve services.

We have partners from all sectors, NHS Local Authority and social work involved in a project that is looking at the experience of going to Monklands A&E Department if you are a frequent attender who arrives in DISTRESS but not needing clinical attention. Such a worthwhile project and even today I met another provider who wants to be involved at the co-design stage.

There are so many examples of great projects locally which show innovation and great passion.

North Lanarkshire frontline staff in the independent care sector are creative and innovative and I have no doubt will continue to go from strength to strength if this work continues at both local and national level. These are exciting times for the sector!

 

Tracy Viljoen, Development Officer for North Lanarkshire

 [email protected]

Mob: 07446843547

Shining the light on SDS

The worst secrets are truths not shared.

It’s amazing how sometimes folks who you think should know about things, which seem second nature to you, catch you inside out. I had two such conversations recently. The first was from a care home provider who acted with shock when I said that someone assessed as requiring residential care has the right to a personal budget and to exercise choice and control over their care and support. The second conversation was from a daughter who reacted with equal befuddlement when someone asked her had she thought about the various options for controlling her mother’s budget whilst she was in a care home.

Now maybe I am being a bit disingenuous but as someone who has campaigned for and worked to raise awareness of self-directed support for nearly 20 years I am still astonished that two and a bit years after its inception so many folks do not know about the Social Care (Self Directed Support) (Scotland) Act 2013. Okay, I am not expecting folks to be experts in the minutiae of legislation but I would have hoped and imagined that this distance down the road that the basic rights and entitlements of older citizens were being advanced and promoted across Scotland. They are clearly not in every place.

The Act – and therefore that in practice means it is now a legal requirement – states that any individual assessed as requiring care and support and meeting the eligibility criteria of a local authority has the right to be offered four options as to how the budget allocated to meet their assessed and agreed outcomes should be spent. The so–called four options exist for all our citizens and many individuals have already had and are having lives transformed by being more involved in designing the support they require around their outcomes rather than having to fit into a pre-designed service or system. So choice and control has and is making a real difference to the learning disabled, to those with physical and mental health challenges, but what of the tens of thousands of older citizens?

That picture is not so clear. Undoubtedly many hundreds who live in communities are being supported to exercise choice through self-directed support and projects like our own Getting it Right For Older People are embedding their human rights at the heart of their care and support.

For those in residential care the story is less positive. Legally many of those individuals have the right to be offered control over their budget through three options, although not direct payments (option one). We have two test sites exploring the way in which all four options can be exercised. In both of these there is really interesting work going on - in East Renfrewshire and Moray - involving the local integration partnerships, providers and citizens themselves.

But what about the rest of the country? On the one hand, I hear a lot of platitudinal statements around older people and self-directed support. Folks will say – older people do not want the hassle that controlling budgets and all that that might bring. What presumptive discrimination! Who are we to limit the exercising of rights because it conflicts with our status quo systems and existing ways of working?
On the other hand, one of the challenges is the way we commission and purchase residential and nursing care home provision. Our present system is not designed to focus around the particularities of the individual – it is a one size fits all model. The reform process now underway has a real opportunity to personalise residential care commissioning and assessment. It will not be easy but it is I think necessary.

Personalisation is not just about ensuring that the services and supports that an individual care home resident receives are built around that person’s outcomes and needs. Personalisation, in the Scottish context, is about the principles of informed choice, collaboration, involvement and control. That practically means that individuals need to be individually assessed, their outcomes (unique to them) identified and then they need to be allocated a personal budget. Clearly this suggests a systemic change in the way we offer and deliver residential care. It is a task and a challenge for commissioners and for providers together. It is a process, a change, a journey that we need to work at together and with those who use services now and who will require supports. It is a journey we have delayed for too long.

The worst secrets are indeed those truths we do not speak of and tell. It is time for all of us to start talking about the rights of residents having access to the full extent and breadth of the law around self-directed support and by extension to their full human rights. It’s too important to keep it a secret.

Dr Donald Macaskill

Innovation at the heart

Legislation to implement Health and Social Care Integration came into force on 1 April this year. This brought NHS and local council care services together under one partnership arrangement for each area. In total, 31 Health and Social Care partnerships (HSCP’s) have been set up across Scotland.

At its heart, Integration aims to ensure that those who use services get the right care and support whatever their needs, at any point in their care journey. This brings a greater emphasis on enabling people to stay in their homes, or another homely setting, where possible, sharing their lives with their family and friends, doing the things that give life meaning and value.

The independent sector, being the biggest provider of social care in Scotland has a significant role to play in this programme. Though the largest provider of health and social care, our sector is not always associated with service excellence or seen as a true and valuable partner.

In order to change this I have recently set up The Learning and Innovation Group within Scottish Care. This will take the lead on sharing good practice, promoting the range of services provided by our sector and to support learning, improvement and innovation. I am joined by seven Local Integration Leads, all of whom are directly involved in innovative tests of change in their areas, by Becca Gatherum and by Jamie McGeechan. Jamie is our newly appointed Communications and Events Officer.

Those of us close to the sector see, on a daily basis, the commitment of our workforce, the high levels of skills and expertise within our teams, innovative practice, strong leadership and an absolute commitment to service excellence. This is a sector I am very proud to be part of.

The Learning and Innovation Group met for the second time yesterday and as anticipated, there was a really positive energy in the room. Given the significant challenges facing our sector just now, it was heartening to focus on the success stories and to remind ourselves why we do what we do.

Over the coming months we will share the learning from tests of change and innovative approaches to the delivery of health and social care. A variety of platforms and approaches will be used in order to reach as wide an audience as possible. These will include digital stories, publications and reports, presenting at conferences and events, videos, formal research, the development of a resource library and social media.  Jamie’s skills in communication will be evident to all! We plan to develop a section dedicated to innovation on the Scottish care website which will hopefully become a first stop for those interested in developing services. Whether looking at small tests of change, a major development or have an experience to share, we are interested in hearing from you.

I have many hopes in life, one being that the independent sector will get the respect and response that we deserve from our partners, the media and the public. We all have a role to play in this, I hope that my part in sharing the good news will help towards this.

 

Margaret McKeith

13 July 2016

Bringing human rights home

Over the last nine months Scottish Care has published two human rights documents, the Convention on the Rights of Residents in Care Homes for Adults and Older People and two weeks ago at the annual Care at Home and Housing Support Conference, the Convention on the Rights of People receiving Care at Home and Housing Support Services. Both were products of collaborative work where individuals who used support services articulated their sense of what constituted for them basic rights and quality in service provision.

Nearly two decades ago the Human Rights Act incorporated the European Convention of Human Rights into domestic legislation enabling individuals if they felt that there had been a breach in their human rights to take their case to a local court without having to have recourse to a court distanced from them in Europe. The whole process was badged as ‘Bringing Rights Home.’

In some sense that is what both of the Scottish Care Conventions have sought to do. They have sought to bring ‘human rights’ into the homes of individuals who use social care support whether they live in residential care or in the wider community. They have sought to make human rights something which spoke to their needs and aspirations, something which was real rather than a set of abstract concepts used by the media and politicians to score cheap points in a debate. As one of the participants said:

‘Human rights are ours.’

The First Minister in a speech in the Pearce Institute in Govan in September 2015 in addressing attempts to repeal the Human Rights Act spoke of the need to see the Act as a floor rather than as a ceiling beyond which one could not go or aspire.

“When the Human Rights Act was passed in 1998, the intention was that the Convention would provide a floor for human rights across the UK. That’s because it would be incorporated within the domestic law of all nations of the UK – through the Human Rights Act, and the different devolution settlements.

But the Convention was always intended to be a floor, not a ceiling. Devolved governments have the flexibility to go further, if we choose. And so complying with the Convention should not be the limit of our ambitions.”

(First Minister Nicola Sturgeon, Pearce Institute, Govan, 23 September, 2015)

The First Minister challenged civic and public society in Scotland to attempt to work together to achieve a context where human rights were at the heart of all we do in Scotland. In a small way the Conventions seek to contribute to that process.

The analogy of bringing rights home is a helpful one. To a considerable degree we have indeed brought rights home but I also suspect that we have kept human rights at the doorstep. Human rights have not entered into every room and corner of our ‘house of care’. We have, and are increasingly articulating the role human rights can play in the delivery of quality services which respect and enhance the dignity, voice and choice of those who use services and supports. The new National Care Standards will go a long way to embedding a rights-based approach to care. But if that is all we do – and that’s not to diminish that process – we will still be keeping human rights in one small room, a room about individual relationships and rights.

For human rights to mean more than just platitudinal rhetoric they have to infiltrate the whole of our health and social care system. Put simply you cannot have a human rights based approach to care and support without a human rights based approach to budgeting, to finance allocation and to commissioning.

It is all very well to require providers and those who work in care services to embed human rights at the heart of their work and services, but unless you have a system whereby human rights can direct the decisions we make about spending limited resources, and unless we change procurement processes to properly operate on a human rights basis then we are just tinkering with rights, we are just keeping human rights at the doorstep.

So at the Care at Home Conference we called upon our partners in Scottish Government and local authorities to work with us in building and developing a human rights based approach to commissioning and budgeting. We are partly there with good rights based procurement guidance, but we have a long way to go.

So what might such a model look like? Well it could perhaps be based on the widely recognised PANEL principles, which is an approach to what a human rights based approach means in practice. PANEL stands for Participation, Accountability, Non-Discrimination, Empowerment and Legality.

What might this mean for budgeting, procurement and commissioning?

 

Participation – People should be involved in decisions that affect their rights. So providers and those who use services should be key partners in strategic and local decision making, not informed or engaged in consultation after decisions have been made.

Accountability – There should be monitoring of how people’s rights are being affected, as well as remedies when things go wrong. If insufficient resource is allocated to enable an individual to be adequately supported then something is done to address this.

Non-Discrimination – Nobody should be treated unfairly because of their age, gender, ethnicity, disability, religion or belief, sexual orientation or gender identity. Is the allocation of public resources discriminatory for older people? Do we enable the same degree of choice and personal budget allocation to those over 65 as to those under 65, to those who live in our care homes and those who live in their own homes?

Empowerment – Everyone should understand their rights, and be fully supported to take part in developing policy and practices, which affect their lives. Do those who use supports adequately understand their right to involvement in decisions around their support and care e.g., in terms of self-directed support?

Legality – An approach like this is about going beyond the minimum legal requirements and mainstreaming human rights in services, policies and practice to make them run better for everyone.

The challenge is to fully bring human rights home, so that whatever part of our system of care and support from assessment to delivery, from budget allocation to workforce support, we have human rights at the heart and core, not rhetoric but a person centred approach that values the individual and gives real choice, control, involvement and dignity.

Scottish Care is committed to embedding both our Conventions and building upon that work in the months and years to come. So feel free to keep visiting us and join us as we bring rights home.

Dr Donald Macaskill, 5th July 2016

@DrDMacaskill

This blog builds on a speech delivered to the 2016 Care at Home and Housing Support conference on 23rd June. This can be seen at https://www.youtube.com/watch?v=X7uUf0v6phY