Twelve Christmas words and wishes

The Christmas and New Year period mean different things to different folk. For me it’s an annual opportunity to engage in an ever failing effort to try to beat the quizzes in our newspapers. My competitive instinct comes to the fore when I convince myself (wrongly) that I really do know the name of Cruz Beckham’s first solo or the winning baker in the Great British Bake Off.

But it’s also a time of reflection, recollection and reconsideration.

2016 has been a busy and ‘interesting’ year. For me personally it’s seen the start of my role as CEO of Scottish Care and the start of these blogs on our new website. Looking back on them they have covered a wide range of topics. That is itself descriptive of the amazing scope of the independent care sector. But in the spirit of the season here are my Twelve Christmas words and wishes:

Nursing

Scottish Care has produced two nursing reports in the last two months. https://www.scottishcare.org/nursing/ . I am grateful they have been so well received and that we are seeing progress on their recommendations. I was privileged to conduct one of the interviews in the Voices report and that conversation has left a deep impression on me. It was with a dedicated nurse who was growing tired of workload pressures and the lack of value accorded to her role in caring for older people. She felt that others viewed her as ‘just a care home nurse’. So my Christmas wish would be for a society that values nurses who care for our older citizens wherever they work whether care home or an acute hospital ward.

Palliative Care.

I’ve personally spent a lot of time with people at the end of their life. There is a transparent truthfulness and honesty at such times and in such conversations. But the discussions I have had this year with frontline care staff show me that we aren’t giving enough time to paid carers to be with those who need simply to talk, to sit and be still, to have someone bandage up their fears as much as to attend to their physical pain. So my Christmas wish would be for a society that values those who sit and hold the hands of the dying by adequately resourcing their work.

Dementia

For me dementia has been a personal and professional concern. My mothers’ own journey with the disease came to an end this past year. Dementia takes over your living when it comes into your family; its rhythm is one which echoes emptiness where once there had been shared memory and story. But I also want to celebrate the capacity and contribution of those who live with dementia rather than, as some do, seeing people with dementia as a problem to be addressed. So my Christmas wish is that people will stop talking about dementia ‘sufferers’ and start celebrating dementia lives.

Human Rights

The beating heart of any society is the degree to which it speaks for the voiceless and recognises those on the margins. Human rights provide the language for such an articulation; they are the vocabulary that enables people to be treated and dealt with not out of sympathy or charity but as equal citizens of a community. So my wish for Christmas is that in Scotland we continue to challenge instances where the rights of our older citizens are minimised, ignored or suppressed. There is no use-by-date on one’s rights.

Living Wage

My first public words in my new role as Scottish Care CEO were a positive recognition of the decision to pay frontline care staff the Scottish Living Wage. Yes, it has been hard and at times a challenge to implement – but the positivity of giving people a wage by which their work of care is valued cannot be downplayed. So my Christmas wish is not only that we are able to build on what we have started and to improve the terms and conditions of carers, but that we work to create a society where those who care are accorded the greatest possible societal value and are awarded appropriate financial reward.

Care Home Reform

33,000 people live in our care homes and this year has reminded me of the astonishing brilliance of the care which is received by so many. But that care comes at a cost. The reform process which has occupied Scottish Care and our partners in the last few months, is seeking to build on existing best practice so that we create a care home sector fit for the future. So my Christmas wish is that Scotland has the courage to adequately fund the care of some of our most vulnerable citizens.

Fullness

The negative, limiting image of people living in residential care or in their own homes and receiving support is often wholly wrong. I have met countless individuals who aren’t simply waiting for their end to visit them but are striding out to own their futures, living with enthusiasm and energy in the face of illness and long-term conditions. Too often society constructs isolation and fosters loneliness by doing things that fail to include, engage and involve our older citizens. The lives of those in care homes and in their own homes are rich to overflowing with dreams still to be realised and contribution lying untapped. So my Christmas wish is that as a society we stay silent for just a second to ask and listen to what older people want from the Scotland that is their home and their future, and to learn what older people can give to the rest of us both now and tomorrow.

Age

Perhaps more than anything in the work I do I have become increasingly aware that we treat people differently based on an artificial number – usually 65, sometimes 70,

sometimes 80. I have written this year that the time is right to stop using language such as demographic ‘time bomb’, to stop subconsciously regretting longevity, and instead to seize the opportunities given by longer and healthier living. But I know that real discrimination happens daily for many of our older citizens, so my Christmas wish is that in 2017 civic society in Scotland will come together and work towards creating a legal framework that adequately protects the rights of older Scots.

Struggle

2016 has been a year of struggle for many of the providers who offer care services across Scotland. I have had too many conversations with individuals who have felt that the pressures of viability and unsustainability have become overwhelming. I have personally despaired of the system of competitive tendering of social care, especially in care at home services, which makes a mockery of dignity and is as far away from person centred care as the heavens are from the sea. So my Christmas wish is that collectively we find a way in which social care can be arranged which will banish forever the obscenity of 15 minute visits and enable small, often family run businesses not only survive but thrive in the giving of care.

Partnership

Partnership working, co-production and collaboration have almost become the buzzwords of the age. They speak to the potential of finding common cause, working together for the benefit of the person needing support and focusing on outcomes rather than systems. Where I have seen partnership work it has fostered remarkable innovation, enabled shared risk-taking and created mutual respect. But independent social care providers have struggled with being heard and represented not least in our Integrated Joint Boards where only 7 out of 31 have representation. So my Christmas wish is that in the reshaping of social care in Scotland we don’t just talk the talk but walk the walk of partnership and realise that partnership without presence is meaningless.

Celebrate

And my last word and wish is that over the next few months and year we all of us, whether we commission care, work in direct support, receive care, or simply talk about care – that we all of us work together to daily celebrate the good rather than talk up the negative; that we give space to hear stories of compassion and care beyond cost; that we influence our media to tell our nation of the thousands of individual acts which every day go unnoticed, unmentioned and unheralded – because that is in essence what happens across Scotland today and everyday.

This Christmas I for one want to thank the 98,000 workers who are the life-blood not only of the independent care sector but also of our communities.

Merry Christmas

Donald Macaskill

‘Cinderella Syndrome……..’

‘Remember Cinderella, when the clock strikes midnight, everything will change.’  Sage advice from the kind and generous Fairy Godmother in the much loved children’s story ‘Cinderella.’

With the festive period now in full swing we find ourselves rushing around full throttle, busy with work, parties to attend, presents to wrap, trees to trim and in my case a very demanding ‘elf on the shelf’ who needs to be moved around the house on a nightly basis!  Then suddenly the clock strikes and everything changes………

Prior to joining Scottish Care I worked for 17 years as Project Manager with East Ayrshire Carers Centre, a voluntary organisation providing information, advice, support, training, leisure, respite and social activities to unpaid, family carers of all ages in East Ayrshire.  On a daily basis I developed services and provided support to a number of individuals, all suffering from ‘Cinderella Syndrome.’  Bong, the clock strikes and a mother gives birth to a child with complex needs, bong, a husband keeps watch by the bedside of his wife who has suffered a life changing stroke, bong, a long expected dementia diagnosis is finally given.  All major events which will change life as they know it and nothing will ever be the same again.

Carers Centres of which there are more than 25 all over Scotland, have a very particular unique selling point in that they are there totally for the carer, the family member or friend devoting their lives to those most dear to them who have become disabled, frail or suffer at the hands of a drug or alcohol addiction.  They are the number one priority.  Typically, when a carer first presents they are at the end of their tether, unable to cope and on the verge of becoming unwell themselves.  Sometimes, the listening ear of someone who is non-judgemental and who they know they can talk to in confidence is all they need to get them back on track.  More often than not however, much more complex support is required.  Carers Centres can assist with the completion of benefit forms, referrals to social work to access assessments and additional services and in the case of East Ayrshire Carers Centre, in conjunction with the local authority, carry out a ‘Carers Assessment’, taking into account their needs for additional support and respite. Centres can also provide the carer with a much needed social outlet.  Many carers suffer from loneliness and isolation and meeting people in a similar situation at training events or social events such as coffee mornings can have miraculous effects and supportive friendships can be developed which go far beyond the scope of the work carried out by the Carers Centre. 

Being a family carer is difficult for adults but it can be even more traumatic for young carers and young adult carers who commonly are caring for a parent, grandparent or sibling on a daily basis providing personal care and support far beyond the expected capabilities of their tender years.  The youngest carer I ever supported was a 7 year old girl who was looking after her mum, a single parent, who was receiving treatment for cancer.  This vibrant young girl, with bouncy red curly hair, not unlike Annie, the character in another much loved movie, was brutally honest yet pragmatic as I chatted to her and summed up how many carers feel when she said, ‘I do lots of things for my mummy, like carry buckets of sick when she’s not so well, but if you really, really love someone, you don’t mind.’ 

In general carers don’t mind, they carry out their role willingly but additional external support is often assessed as being necessary and many rely on the support provided by Care at Home services on a day to day basis and Care Homes for much needed respite.  They open their homes and their hearts to carers and entrust the well-being of someone very precious to them.  As one carer said to me, ‘the carers that come into my house four times a day are amazing, so kind but I told them right at the start, she might just be one person to you but she’s the world to me.’  So if you’re reading this and you’re perhaps a carer, a nurse, a provider, a social work professional and you’ve just had a difficult conversation with a family carer whose being demanding, critical or emotional, please remember, the person they care for may be just one person to you but they’re the world to them.  So, as the big day approaches, take 5 minutes out of your hectic schedule and find the number of your local carers centre and when your next talking to a family carer, ask them if they are aware of the services a carers centre can provide to them, it just might be the best gift you give this year.

As it is Christmas, my gift to you is the ‘happy ever after’ part of the Cinderella story.  I recently met the 7 year old Annie lookalike who is now 27 and I can happily report that she proudly achieved a second class honours degree, has met her Prince charming and is an amazing mother to a beautiful baby boy, and her mum, who made a full recovery, is a very proud Grandma.  Merry Christmas.

Laura Bennie   

Dance me to the end of love …

 

As we grow older the sounds and voices of our life and its conversations change; they continually ebb and flow, re-energise and diminish. Some voices grow quieter and less significant, others lose their fire and passion, their strength and depth; and with the passing of the years many more, grow silent altogether. 2016 has been a year when some of the most familiar voices of my youth and adult life have grown silent. And perhaps more than anyone I have been moved by the death of the singer, poet and philosopher Leonard Cohen.

 

Leonard Cohen divided people between those who loved his music and those who reached for the mute button. Certainly this was true of my friends, some saw his lyrics as laden with deep insight and profundity about the human condition whilst others thought that he was the depressing master of despair and angst.

 

I am unashamedly in the former camp and I’ve always admired not just his expressive voice but also perhaps more than anything his creativity with words, rhythm and language. Just before his death he had released an album which according to his son he considered to be one of his best – ‘You Want it Darker’

 

In an extensive interview in The New Yorker in part promoting the album but also reflecting on what an increasing awareness of mortality gave him, Cohen said:

 

 

“At a certain point, if you still have your marbles and are not faced with serious financial challenges, you have a chance to put your house in order. It’s a cliché, but it’s underestimated as an analgesic on all levels. Putting your house in order, if you can do it, is one of the most comforting activities, and the benefits of it are incalculable.”

 

Indeed though his death was sudden, Cohen had already spoken at length this year of his thoughts about life, death, memory and attachment. One of my favourite Cohen songs was ‘So Long Marianne.’ Just a few months ago Cohen sent a moving final letter to the dying Marianne Ihlen, the subject of his song, who died in Norway on July 29 at the age of 81. They had been lovers and partners for a decade in the 1960s when they had met first in Hydra, Greece.

 

Marianne’s friend Jan Christian Mollestad told Canada’s CBC radio that he had contacted Cohen, 81, to tell him Ihlen was dying of leukemia and had only a few days to live. He recalled: “It took only two hours and in came this beautiful letter from Leonard to Marianne.

 

“We brought this letter in to her the next day and she was fully conscious and she was so happy that he had already written something for her.”

 

Mollestad, a documentary filmmaker, read the letter to Ihlen before she died.

He recalled: “It said:

 

‘Well Marianne, it’s come to this time when we are really so old and our bodies are falling apart and I think I will follow you very soon. Know that I am so close behind you that if you stretch out your hand, I think you can reach mine.

 

“And you know that I’ve always loved you for your beauty and for your wisdom, but I don’t need to say anything more about that because you know all about that. But now, I just want to wish you a very good journey.

“Goodbye old friend. Endless love, see you down the road.”

 

Mollestad told host Rosemary Barton that when he read the line “stretch out your hand”, Ihlen had stretched out her hand.

 

“Only two days after, she lost consciousness and slipped into death. And when she died, I wrote a letter back to him saying in her final moments I hummed A Bird on the Wire because that was the song she felt closest to.

 

This story when recounted went viral on the Internet and especially Twitter. Simple words with real depth and meaning between two old friends written by someone with a realisation that his own journey was coming to its close; that the last few beats of his dance were being played.

 

At Scottish Care we have recently launched project work on palliative care in care homes and care at home services. There are four main strands to this work. The first has been the holding of focus groups with staff who work on the frontline, daily working with, supporting and being with those who are approaching the end of their life. I have been privileged to be present at a couple of these events and have heard rich, challenging, beautiful and harrowing stories. The majority of individuals who die in Scotland today and who are receiving social care supports will, in all likelihood, be supported by someone who works for an organisation which is a member of Scottish Care. We are eager to tell the story of these workers and organisations as they deliver this exceptional care despite challenging contexts. A report on these focus groups and their insights will be available at a workshop on February 8^th. Please keep an eye out for an invitation.

 

The second strand of the work is an online survey which can be completed at

https://www.scottishcare.org/scottish-care-news/sector-news/palliative-care-survey/ ;  the third an identification of best practice around Scotland, and the fourth strand is called ‘This speaks to me…’

 

For many of us it is through the words of poetry and story, through music and art that we are helped to gain insight into the nature of good care and support at the end of life. ‘This speaks to me…‘  is an opportunity for workers, carers and family members to share words, images or music which tell them something about what good palliative and end of life care can or should be.

 

Leonard Cohen provided a space to talk, music to ponder and images to paint insights which go beyond the ordinary and the tangible; he illustrated that some of the most important lessons in life cannot simply be limited to text, however creative, and I hope we can all take the opportunity of sharing the things, and the voices, that help ourselves and others to ‘dance to the end of … love… down the road.’

 

 

Dr Donald Macaskill

Loneliness and Social Isolation

Most of us are lucky to have good friends, family and colleagues in our lives that provide us with the emotional support we need and we often take for granted the range of social opportunities that we can access. We know that not everyone is as fortunate.

Research shows an increased threat to Scotland’s health from loneliness and social isolation. Triggers for loneliness include significant life changing events such as bereavement, and disability / illness. Research shows that social isolation and loneliness can lead to, for example, people eating, drinking and smoking more that can then result in poor physical health and that feelings of loneliness are also linked to poor mental health.  300,000 people contact the Samaritans each year with loneliness as the main reason. The Samaritans advise that loneliness can lead to depression and to other mental health problems accounting for 90% of suicides. They report that the risk of suicide is higher among men and is rising among older men, particularly those in areas of social isolation and ask ‘how can we address the health needs of older men who may be becoming increasingly isolated?’

 

Loneliness of course affects people of all ages and backgrounds and the broader impacts of loneliness include increased use of health and social care services e.g. GP / NHS24 / A&E / unscheduled admissions. If people have no one to turn to in a crisis to give them the reassurance and emotional support they need, it is more likely that they will contact emergency services. We are part of a multi-agency ‘Experienced Based Co-Design’ project in North Lanarkshire that is examining why some people frequently attend A&E in distress but who do not need clinical intervention and who are not admitted. This includes people: in poverty; with poor mental health; with addictions; who are homeless; and elderly people living on their own. Findings from staff interviews conducted so far confirm that loneliness and social isolation are relevant factors. The aim of the project is that service users and staff will work together to develop services that better meet the needs of these people by providing the right care at the right time in the right place and avoid presentation at A&E.

 

Some of the loneliest of all are those that are housebound through physical disability and who need help and support to access social events but that support, sadly, is not always available or comes at a cost that many can’t afford. Appropriate transport is currently a massive barrier. North Lanarkshire has an enviable third sector subsidised transport service but it is stretched to capacity and often wheelchair accessible taxis are the only option. Some people will need accompanied by their carer if they are to participate in social events but who meets this cost assuming SDS is not in place? What more can we do to enable people who are lonely and socially isolated get the support they need to access local community services?

 

We have started a joint pilot project in one of the localities with an Independent Care at Home provider, the Third Sector community consortia and Locality Link Officers to identify people receiving care at home services that might benefit from becoming involved in social activities in their local area or from a befriending service. This is exciting work that will provide us with an evidence base to help inform future planning and delivery.

 

Research has shown that unpaid carers and family members are also at risk of depression, social isolation and loneliness as they give up their own social activities as their caring responsibilities increase, and as they struggle to cope with the decline and death of a loved one. Loneliness and social isolation after the unpaid caring role no longer exists can be extreme. It is important to make sure that people register as carers but this can be difficult as they often don’t see themselves as such. There are excellent support services available for unpaid carers in North Lanarkshire. I have been working with staff at North Lanarkshire Carers Together to help facilitate awareness-raising about this within the Independent sector.

 

The good news is that people do care. In Scotland, the problem is recognised and many partners, agencies and community groups are working together to do something about it. This year the Scottish Government’s Equal Opportunities Committee instructed an Enquiry about Social isolation and loneliness – the first of its kind in the world, and subsequently released funding to help tackle loneliness and social isolation. It has also pledged to create a National Social Isolation Strategy to ‘ensure a holistic approach across government to problems of loneliness and isolation”. It anticipates that the integrated Joint Health & Social Care Boards will play a key role in taking action. Consultation is planned for February 2017.

 

At a local level it is apparent to me that those delivering health and social care across North Lanarkshire in the statutory, third and independent sectors are acutely aware of this growing situation and of the potential for it to worsen as more people are living longer at home. There are already many huge hearted people working every day doing everything they can to support people and help improve their quality of life in line with the National Health and Wellbeing outcomes. My hope is that we can do it better together and I am looking forward to being part of that with independent providers and our partners across North Lanarkshire.

 

Local Integration Lead for North Lanarkshire – Linda Scott       [email protected]

Inclusive technology

 

Every so often a report comes across my desk – admittedly not often – that is worthy of more than a single read – one of these was published last week – it is the report from the team behind the Technology Enabled Care work in Scottish Government. See http://www.gov.scot/Publications/2016/10/3839

 

We live increasingly in an age where technology assist and enables our daily living and can be a positive contributor to our health and well-being. At a very basic level it is clear from what the report indicates that many of us use technology to self-diagnose, so for instance:

 

• 1 in 4 UK adults currently self-diagnose;
• Internet is first port of call for health information for adults under 65;
• 75% of the UK population goes online for health information;
• UK second in the world behind the US for use of online self-diagnosis.

The report highlights the valuable project work underway including the use of video conferencing in care homes to support GP and Allied Health intervention. It underpins its focus by identifying five principles which should lie at the centre of all activity. These are:

 

• Citizen-centred: work with citizens, users and patients to co-design and develop solutions which support the management and delivery of their own health and wellbeing, with a particular focus on addressing health inequalities;
• Flexible: facilitate flexible solutions which expand choice, control, coverage and accessibility;
• Familiar: build on existing and increasingly familiar technologies and favour the adoption of simple, low cost approaches which can be tailored to the individual, utilising users own technologies where and when practical to do so;
• Facilitative: Support service redesign to integrate new ways of working into mainstream service provision and pathways;
• Innovative: secure continued investment in innovation to ensure a pipeline of ‘next generation’ solutions for the benefit of our citizens and our economy,

 

It is fundamentally important but this work has to recognise the issue of age related use and comfort with technology. The sad reality is that for every one ‘silver surfer’ there are another 9 left on the beach!

 

This has been highlighted in the Scottish Household Survey, published last month which shows that older people face continuing barriers in their ability to participate in the technological world.

 

For example, the survey reveals that older people are more likely to be sidelined by the digital revolution.

 

• Although 82% of adults regularly use the internet, this rate substantially reduces with age (only 69% of those aged 60–74 do, and this drops to 30% among the 75+ age group).
• Older people who do use the internet use it less often, are less likely to use sites which request personal or financial information (such as for online banking and shopping), and are less likely to take recommended security measures such as using unpredictable passwords and changing them frequently.
• They are also less likely to use digitally-enabled devices such as tablets and smartphones (88% of 16–34-year-olds use their smartphones to access the internet, but only 36% of those aged 65–74 and 19% of those aged 75+ do).

 

These statistics become even more challenging as public services are moved online.  This will be something the new Social Security system will hopefully take on board and appreciate. In addition as we continue to develop exciting new technology that enables information about individuals to be passed from one professional to another issues of confidentiality and privacy will come more sharply into focus. Equally the importance of a workforce being skilled and equipped to use smart technology in the workplace to assist and promote greater control and choice by those who use services and supports will increasingly demand a recognition from commissioners and purchasers of these services that technological innovation requires investment and resource.

 

But we must be careful of making sweeping assumptions and generalisations. The use of technology in care demands person centred approaches to technology and I am not wholly convinced we are there quite yet. The work of academics like Prof Rebecca Eynon from Oxford who has highlighted the issue of digital poverty and the affects that has on a person’s sense of identity and wellness is an important contributor to this debate. Technology even technology in care is not neutral.

 

Technology is a massively positive potential innovator in care but we cannot ignore the reality of digital poverty, the psychological impacts of using technology and the effects on the human environment. If we do the irony will be that technology designed to enable inclusion will result in exclusion on the grounds of age.

 

Dr Donald Macaskill

CEO of Scottish Care

Swaran’s Blog October 16

 

This is a very challenging period for our sector within social care, with issues regarding funding and workforce shortages as major concerns. We have highlighted to our strategic partners the fact that we have a considerable vacancy rate for nurses employed within our sector and are looking with our partners at trying to address this issue in the short, medium and long term. There is no easy answer!

 

This made me think about my nursing career and the reasons why I commenced my nurse training many years ago in 1978. In those days I was young, fit, looked like Jesus with long hair, dressed in cheesecloth shirts and I pretended I was from the hippy generation whilst the punk scene and drain pipes were the “in thing”!!

 

In those days I wore my hair in a bun, with two Kirby grips on either side to pin my hair up! I think I got away with this as folk thought I was a Sikh (my background) although a practicing Christian, and in those days I was called Nurse Singh!  (Nursing!!!!) OK looking at me now I can imagine it’s hard to believe, as we all change as we get older, but I’ve got the photos as proof, honest!!

I felt drawn to a nursing career due to the compassion I felt for others and wished to ensure that I was someone that could make a difference. It is a privilege and honour to be able to look after someone who is unwell, who trusts me to do and say the right thing!

So often I heard folk saying “I could never do that”, however I believe that each one of us has the potential of showing compassion and care towards others in society, at various levels!

 

Most of my nursing career has been spent working with older persons in a variety of settings, and I truly believe that the area of “geriatrics” as it was in the old days, is an area of care which has been maligned, forgotten about and devalued by society. Poor funding, complex and challenging work undertaken within social care settings such as care homes and care at home services, needs to be recognised. It requires being valued, attracting proper funding, drawing nurses and carers as a career, and properly rewarded for the work they undertake!

 

I was recently encouraged to hear about my niece Jen who qualified as a nurse earlier on this year. After a period within academia she decided to take some time out and work within Erskine hospital as a care worker, and the NHS bank as an auxiliary nurse. There were several nurses within her family and with some encouragement she decided to commence her nurse training. She always said that she would return to Erskine, as she believed that that was where her heart lay, working with older clients!

When she completed her training it came as no surprise to me that she decided to work as a nurse within a busy surgical unit to gain further experience as part of her nursing career!

I was disappointed within myself, as I thought yet again another potential nurse was lost from our sector to the NHS, as this has happened on numerous occasions, hence the vacancies within our care homes!

I am conscious that Scottish Care are very concerned about this and are working with providers, strategic partners and the Scottish Government to look at the whole area of nursing, and ask questions about how to attract nurses to work within our sector. Working within a care home can be as challenging if not more so than working within a hospital setting. You still have to deal with the complexities of old age such as dementia and palliative care,  and the various infirmities that that brings; working within a pressured, highly regulated environment, perhaps being the only nurse on shift, and also having management responsibilities!! Supernurse comes to mind!!

 

Well, my story has not finished,. When I was offered the post within Scottish Care, I was excited, as I was coming back to my first love, a position related to nursing and care of the older person (by and large). I am still involved with care, utilising my experience and nursing, my focus being within the social care sector within Scotland. My role is to support the various members and their services, ensure they provide quality care and are fully informed about what is happening within our sector.

 

Jen’s story is also not finished either! She decided that after enjoying her surgical staffing experience, that she missed working with older folk, and is now working within Erskine as a Registered Nurse within one of their older persons units!  Well she was true to her calling of returning to her “auld folk” and I applaud her for bucking the trend and deciding that working within social care is where her heart lies!

The future for her, who knows!!  Manager, Matron…….Chief Nursing Officer for Scotland, who knows!!!

Swaran

New models; old principles.

 

One of the most common phrases heard in discussions on the future of older people’s care and support is ‘new models of care.’

 

Behind these discussions and the desire for change and reform, is the presumption that the present way of delivering services and supports needs to change. Increased levels of dependency, an emphasis on personal control and choice, a focus on maintaining independence and advancing self-treatment and rehabilitation – all combine to encourage change. In addition pressures of demography, workforce and austerity have come together to create an environment clamoring for doing things differently.

 

But what lies behind the language and conversations? What are these oft mentioned ‘new models of care and support’? What will older people’s services and supports look like in the future? What do people want now and tomorrow?

 

Scottish Care is hosting a workshop where providers and other stakeholders are invited not to come and hear from ‘experts’ but to share with one another what is happening currently in Scotland and also to explore together possible future developments and ‘new models of care.’

 

First and foremost, however, what will be important in our discussions is the identification of what are the key characteristics or principles, which should lie at the heart of any ‘new’ models. There is always a danger that the metaphorical baby is disposed alongside the bathwater in our search for the new and the innovative.

 

So what is it that should lie at the heart of all services and supports, whether already in existence or still to be imagined?

 

Part of my response to that question is influenced by the work of John and Connie Lyle O’Brien. In 1987 the O’Briens embarked on a piece of research in Seattle on what makes a good quality of life.

 

Their Framework for Accomplishment proposed five areas which, over thirty years later, have become widely agreed to be important in shaping everyone’s quality of life. The Framework argues that the task of human services and support systems is to support people to fulfill their needs in these five areas. Their model has deeply influenced the development of learning disability services including its use as a tool to assess and judge whether services are working towards or against these five ‘service accomplishments’.  The O’Briens argued that services should be judged by the extent to which, as a result of their input people are:

 

• Sharing ordinary places
• Making Choices
• Developing abilities
• Being treated with respect and having a valued social role
• Growing in relationships

 

 

So when we re-design older people services, I think – as a starter – we could do worse that ask ourselves the O’Briens’ questions.

 

Community presence – are the models of care home we are seeking to develop ones which will enable the inclusion and participation of individual residents at the heart of their communities or do they rather serve, by default or design, to cut off, withdraw, separate by location and thus exclude? How do they serve to increase the presence of a person in local community life?

 

Community participation – are the models of care at home which we hope to develop ones which foster and embed the ability of individuals to expand and deepen personal relationships? Do they act against loneliness, rejection and marginalisation or do they rather subtly confirm these?

 

Encouraging valued social roles – do our supports enhance the status and role of those who use them, recognising their continued and intrinsic membership of local community, family and society, affirming their contribution and individual capacity?

 

Promoting choice – is the ability of the individual to exercise informed and meaningful choice at the heart of what we are developing? Is control with the individual or the system, with the person or the professional?

 

Supporting contribution – are we fully developing the capacity and contribution of those who use supports or are they passive recipients of service with little ability to influence or change, to be valued as contributors and co-designers in their care?

 

I might wish to add some other ‘marks’ or characteristics of what today constitutes the heart of any new models – respect for capacity, emphasis on human dignity, the articulation of human rights, a stress on personalisation and individuality.
Whatever happens in the reform of social care in the next few months and years in Scotland, whatever new models of care and support are designed and developed, there must be a set of underpinning principles which guide that discovery and design, or we risk being reactive to passing fads and responsive to fiscal necessities. And that’s a conversation that involves us all.

 

We will be launching a new section of our website at Scottish Care to explore new models and supports, including the principles which should lie behind them. Join us in that conversation.
Dr Donald Macaskill

I have been in this role for over 3 years now and had taken up the post hoping to help make a difference.  If you would have asked me last year if I had achieved this I would have probably said No! However, ask me now and I know that I have made a difference to some services.  I have worked with providers in developing their services, provided them with tools and the experience for them to take forward and this has shown in past and now current Care Inspectorate grades.  I must say that it was not all my own work by any means, but it gives me a sense of satisfaction knowing that I had an input.

I am excited to be working with the My Home Life Team in Borders on a new cohort starting early next year. We already have a cohort running currently which has had some excellent feedback from care home managers. The new cohort will include working with NES and enhancing care homes as a placement location for students. In addition we will be including a Community Development Strand and the focus will be on Personal Outcomes, with a particular focus in this cohort on working with care homes as learning organisations thus strengthening services in the Borders. This is all currently in draft format but Watch this Space !

Falkirk sees a Creative Facilitation process coming through currently in conjunction with the My Day My Way SDS project which looks at SDS for Older People (including people with Dementia). The project is all about how we move forward with a new Model of Care and day supports using a creative approach for developing how we want services to look like in future. This could be very exciting and includes a wide range of partners from the Local Authority, the NHS, the Independent Sector, Third and Voluntary Sectors, service users and their carers, etc.

Exciting times for all going forward and I am so enthused to see so many examples of good practice and innovation around the country.

 

Margaret McGowan

Local Integration Lead for Borders / Falkirk

[email protected]

What price dignity?

 

The flagship policy of Health and Social Care Integration which was established, from April 1, created Integrated Joint Boards bringing health and social care together for many services.

 

Like many I saw the logic of closer working, pooling resources, placing the patient or citizen at the heart of clinical and social care. With others I heard the words ‘partnership’, ‘collaboration’ and that frequently used and rarely understood concept called ‘co-production’.

 

So how has it been on the ground?

It’s early days but the signs have not been positive in many areas if you are a care at home or housing support provider.

 

The first real test came in the form of dispersing £125m Government funds to frontline care staff to ensure they were paid the Scottish Living Wage.

This has the potential of creating real change in a sector which employs thousands of workers who daily deliver care and support to some of our most vulnerable citizens. But over the years public authorities have sought to buy quality care from providers, whether charitable or private, by paying lower and lower rates.

 

Such a process cannot continue if we are to attract and hold onto staff who are required to be increasingly skilled, whose work is demanding and emotionally draining.

 

But even if we move into calmer waters the recent experience of negotiation has highlighted a deeper issue. Namely, the relative priority given to older people’s care and support.

Successive governments have trumpeted Free Personal Care and this has been a laudable policy. But one cannot dine out on a single initiative forever.

 

Year on year as an ageing population increases and lives for longer we are spending per capita less on older people’s care and support. By 2022 the number of over 75s will increase to 530,000 in 2022, reaching 780,000 in 2037 – an increase of 86 per cent in just a quarter of a century –  360,000 more than today.

 

Hard decisions must be made sooner rather than later and these in large part will determine how much we truly value older people in modern day Scotland.

The cake is getting smaller and smaller – but have we had a proper debate about the equity of cutting that cake? I think not.

 

This goes beyond party politics to the heart of who we are as a society.

It necessitates the real hard collective work of determining the true cost of care now and for the next decades. It is more than negotiating a decent set of terms and conditions for workers. It is about negotiating the price of dignity and the value of old age.

 

Dr Donald Macaskill

This article first appeared in The Times on 27^th September 2016